“Part of a cog, of a system; a system that’s broken”: social workers’ experiences of moral injury in England

TL;DR

This study explores how social workers in England experience moral injury when their professional values clash with system limitations and poor care conditions.

Contribution

The paper introduces a novel qualitative exploration of moral injury in social work, highlighting system and service-related factors.

Findings

Moral injury arises from system constraints and interprofessional conflicts.

Witnessing poor care quality leads to feelings of guilt and helplessness.

Formal psychosocial support is crucial for moral repair in social workers.

Abstract

Moral injury is the long-term effect of the experience of events that violate deeply held moral beliefs. Social workers in adult care settings are tasked with managing morally complex situations and make decisions that impact the lives of service users. Simultaneously, they adhere to their professional ethical code and organisational standards, potentially giving rise to moral injury. Little is known about these experiences. This qualitative descriptive study aimed to explore social workers’ experiences of moral injury.

Remote interviews were conducted with ten social work professionals, in adult services in England. Data were inductively analysed using reflexive thematic analysis.

Three themes were identified: a) System-related impacts; b) Service-related impacts; c) Individual psychological impacts. Social worker moral injury can arise from efforts to uphold professional values whilst navigating limited resources, interprofessional conflicts, and working within a constrained system. Witnessing dehumanising, low-quality, and impersonal care is a major source of moral injury. This is marked by professional disempowerment, sadness, guilt, betrayal, and helplessness.

Recognising these experiences is important. Building psychosocial resilience through formal support is essential for moral repair. Application of the concept for social work, alongside further research, is paramount to adequately support staff.

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