{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,14]],"date-time":"2026-10-14T20:24:39Z","timestamp":1792009479559,"version":"4.4.0"},"reference-count":56,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2020,3,28]],"date-time":"2020-03-28T00:00:00Z","timestamp":1585353600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"name":"Beta Psi Sigma International for the Naomi Ballard Award","award":["1016180"],"award-info":[{"award-number":["1016180"]}]},{"name":"OHSU Dean\u2019s Dissertation Award"},{"name":"Delta-Alpha-at-Large Sigma International for a Dissertation Award"}],"content-domain":{"domain":["sigmapubs.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["J of Nursing Scholarship"],"published-print":{"date-parts":[[2020,5]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>To date, there has been no published work towards understanding or classifying patient safety incidents (PSIs) or their aftermath as potential morally injurious experiences (pMIEs). A morally injurious experience is one that violates deeply held moral values and beliefs, and can put an individual at risk for burnout, post\u2010traumatic stress disorder, and other trauma\u2010related problems. This can also set the stage for moral injury, which can occur when there has been a betrayal of what is right by someone in a position of legitimate authority, or by one\u2019s self, in a high\u2010stakes situation.<\/jats:p><\/jats:sec><jats:sec><jats:title>Objective<\/jats:title><jats:p>The objective of this review of nurse second victim literature is to describe symptoms of moral injury empirically observed in nurses in the aftermath of a PSI.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>A critical review using a SALSA (search, appraisal, synthesis, analysis) method commenced with a search of electronic data base\u2013indexed original evidence between 1980 and December 2018, focusing on registered nurses involved with a PSI.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The nurse empirical literature reviewed included qualitative (<jats:italic>n<\/jats:italic> = 10), quantitative (<jats:italic>n<\/jats:italic> = 7), and mixed\u2010methods (<jats:italic>n<\/jats:italic> = 4) studies (total <jats:italic>n<\/jats:italic> = 21). Core moral injury symptoms included guilt (67%), shame (71%), spiritual\u2010existential crisis (9%), and loss of trust (52%). Secondary symptoms of moral injury included depression (33%), anxiety (57%), anger (71%), self\u2010harm, (19%), and social problems (48%).<\/jats:p><\/jats:sec><jats:sec><jats:title>Implications<\/jats:title><jats:p>Moral injury better describes what historically has been called the nurse second victim phenomenon. Through identification of pMIEs and symptoms of moral injury, nurses and organizations can be empowered to advance training and intervention programs addressing pMIEs that affect nurses\u2019 safety and retention in the aftermath of a PSI.<\/jats:p><\/jats:sec><jats:sec><jats:title>Clinical Relevance<\/jats:title><jats:p>By describing the experiences associated with a PSI as potentially morally injurious, we set the stage to describe the potential consequences associated with the aftermath of the PSI. Furthermore, this language avoids victimizing those involved by more accurately reflecting the pMIEs of the aftermath.<\/jats:p><\/jats:sec>","DOI":"10.1111\/jnu.12551","type":"journal-article","created":{"date-parts":[[2020,3,28]],"date-time":"2020-03-28T08:22:03Z","timestamp":1585383723000},"page":"320-328","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":79,"title":["A Critical Review: Moral Injury in Nurses in the Aftermath of a Patient Safety Incident"],"prefix":"10.1111","volume":"52","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9466-9287","authenticated-orcid":false,"given":"Mady","family":"Stovall","sequence":"first","affiliation":[{"name":"<i>Delta Alpha at Large<\/i> PhD Student Oregon Health &amp; Science University School of Nursing Portland OR USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lissi","family":"Hansen","sequence":"additional","affiliation":[{"name":"<i>Beta Psi<\/i> Professor Oregon Health &amp; Science University School of Nursing Portland OR USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michelle","family":"van Ryn","sequence":"additional","affiliation":[{"name":"Professor Oregon Health &amp; Science University School of Nursing Portland OR USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2020,3,28]]},"reference":[{"key":"e_1_2_10_2_1","doi-asserted-by":"publisher","DOI":"10.1377\/hlthaff.2018.0711"},{"key":"e_1_2_10_3_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2648.1994.tb01116.x"},{"key":"e_1_2_10_4_1","doi-asserted-by":"publisher","DOI":"10.1353\/book.3367"},{"key":"e_1_2_10_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.aorn.2009.06.028"},{"issue":"1","key":"e_1_2_10_6_1","article-title":"Lateral violence in nursing and the theory of the Nurse as Wounded Healer","volume":"19","author":"Christie W.","year":"2013","journal-title":"Online Journal of Issues in Nursing"},{"key":"e_1_2_10_7_1","doi-asserted-by":"publisher","DOI":"10.1590\/S0104-11692010000300005"},{"key":"e_1_2_10_8_1","volume-title":"Respectful management of serious clinical adverse events","author":"Conway J.","year":"2011"},{"key":"e_1_2_10_9_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1466-769X.2004.00203.x"},{"key":"e_1_2_10_10_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1547-5069.2007.00164.x"},{"key":"e_1_2_10_11_1","doi-asserted-by":"publisher","DOI":"10.1037\/trm0000027"},{"key":"e_1_2_10_12_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2834.2011.01208.x"},{"key":"e_1_2_10_13_1","doi-asserted-by":"publisher","DOI":"10.1002\/2327-6924.12468"},{"key":"e_1_2_10_14_1","doi-asserted-by":"publisher","DOI":"10.3928\/00220124-20080601-03"},{"key":"e_1_2_10_15_1","doi-asserted-by":"publisher","DOI":"10.1086\/JCE200920406"},{"key":"e_1_2_10_16_1","doi-asserted-by":"publisher","DOI":"10.1080\/23294515.2019.1586008"},{"key":"e_1_2_10_17_1","first-page":"76","volume-title":"The encyclopedia of psychological trauma","author":"Freyd J. 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