Duality of roles and moral injury in defence force nurses

TL;DR

This study explores how the dual roles of military medics as soldiers and healers can lead to moral injury and psychological distress.

Contribution

The study investigates moral injury in Australian Army medics due to role duality, a relatively new and under-acknowledged risk factor for psychological harm.

Findings

Australian Army medics experience ethical conflicts due to their dual roles as soldiers and healers.

Moral injury is identified as a significant psychological risk for medics in warzones.

Interviews reveal the psychological impact of actions conflicting with personal moral codes.

Abstract

Military medics, who are both professional soldiers and qualified nurses, can face situations where their training and moral ethos conflict in the performance of duty. Their role has intrinsic duality. They are both a soldier, thus a member of a military organisation as well as well as a healer, a nurse with a corresponding duty of care. Both roles have ethical, legal and professional responsibilities, codes of conduct and moral codes. Both also are roles which have strong cultural images and distinct expectations from individuals and those around them. This can lead to moral dilemmas, moral injury and long-term psychological illness. In the 2024 Royal Commission into Defence and Veteran Suicide in Australia, moral injury was cited as a relatively new, but not widely acknowledged, risk factor that may lead to suicide. In the context of defence, moral injury can be described as being experienced by a person who participates in, or witnesses, actions that go against their moral code or moral beliefs.

The research presented is a component of a larger study into the role duality of the Australian Army medic in warzones. It focuses on interviews from twelve currently serving army medics who have deployed overseas in recent conflicts with the research question: How does the intrinsic duality of the role of the medic impact the individual performing this specialised role.

This research has ethics approval from both the Australian Defence Human Research Ethics Committee #778–15 and the Human Research Ethics Committee #2015/024. Participants have given formal consent for their reflections to be used in publications.

For this research the psychological impact of these ethical conflicts on Australian Army Medics who have served in this dual role has been investigated, with specific focus on moral injury.