{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,5]],"date-time":"2026-08-05T00:49:17Z","timestamp":1785890957645,"version":"3.56.0"},"reference-count":16,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"2","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,8,1]]},"abstract":"<jats:p>Traumatic brain injury (TBI) is among the most emotionally demanding conditions encountered in neurosurgical and acute neurotrauma practice. Sudden neurological deterioration, unexpected death in young and previously healthy individuals, persistent prognostic uncertainty, and systemic resource constraints together create a uniquely intense emotional environment for clinicians involved in TBI care. While the psychosocial consequences of TBI for patients and caregivers have been extensively studied, the emotional burden borne by treating clinicians\u2014particularly experiences of grief, moral distress, and moral injury\u2014remains comparatively underexplored.<\/jats:p>\n                  <jats:p>This integrative narrative review synthesizes established conceptual frameworks of clinician grief, second-victim phenomena, burnout, and moral injury with the clinical realities of TBI management. Key emotional stressors intrinsic to neurotrauma care are identified, including rapid neurological deterioration, prognostic ambiguity, ethically complex decision-making, prolonged intensive care trajectories, exposure to family distress, and episodes of hostility or violence directed toward healthcare workers. Evidence from low- and middle-income countries highlights how high patient volumes, resource limitations, financial constraints, and medicolegal pressures amplify clinician distress and vulnerability to emotional exhaustion and moral injury.<\/jats:p>\n                  <jats:p>The authors further examine the psychological mechanisms underlying clinician responses to TBI care, including intrusive recollections, anticipatory anxiety, value dissonance, and the cumulative emotional residue that accrues across repeated high-stakes encounters. Finally, institutional and system-level strategies to mitigate these effects, including structured debriefing, peer-support programs, resilience-oriented training, transparent communication frameworks, and protections against workplace violence, are outlined. Recognizing clinician grief as an inherent component of TBI practice is essential for sustaining neurosurgeons\u2019 well-being, ethical decision-making, and long-term workforce resilience in high acuity neurotrauma systems.<\/jats:p>","DOI":"10.3171\/2026.4.focus2619","type":"journal-article","created":{"date-parts":[[2026,7,29]],"date-time":"2026-07-29T00:01:35Z","timestamp":1785283295000},"page":"E3","source":"Crossref","is-referenced-by-count":0,"title":["Clinician grief, moral distress, and moral injury in traumatic brain injury care: an integrative narrative"],"prefix":"10.3171","volume":"61","author":[{"given":"Swaminathan","family":"Ganesh","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, Christian Medical College, Vellore, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeena","family":"Joseph","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Christian Medical College, Vellore, India"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"issue":"7408","key":"b1","series-title":"BMJ","first-page":"185","article-title":"Doctors\u2019 emotional reactions to recent death of a patient: cross sectional study of hospital doctors","volume":"327","author":"Redinbaugh EM","year":"2003","unstructured":"Redinbaugh EM, Sullivan AM, Block SD,  Doctors\u2019 emotional reactions to recent death of a patient: cross sectional study of hospital doctors. BMJ. 2003;327(7408):185\u2013180. doi:10.1136\/bmj.327.7408.185"},{"issue":"4","key":"b2","series-title":"Innov Clin Neurosci","first-page":"22","article-title":"Physician grief with patient death","volume":"9","author":"Sansone RA","year":"2012","unstructured":"Sansone RA, Sansone LA. Physician grief with patient death. Innov Clin Neurosci. 2012;9(4):22\u201326."},{"issue":"7237","key":"b3","series-title":"BMJ","first-page":"726","article-title":"Medical error: the second victim","volume":"320","author":"Wu AW","year":"2000","unstructured":"Wu AW. Medical error: the second victim. BMJ. 2000;320(7237):726\u2013727. doi:10.1136\/bmj.320.7237.726"},{"issue":"2","key":"b4","series-title":"Eval Health Prof","first-page":"135","article-title":"Health care professionals as second victims after adverse events: a systematic review","volume":"36","author":"Seys D","year":"2013","unstructured":"Seys D, Wu AW, Van Gerven E,  Health care professionals as second victims after adverse events: a systematic review. Eval Health Prof. 2013;36(2):135\u2013162. doi:10.1177\/0163278712458918"},{"issue":"7","key":"b5","series-title":"Am J Nurs","first-page":"40","article-title":"CE: moral distress: a catalyst in building moral resilience","volume":"116","author":"Rushton CH","year":"2016","unstructured":"Rushton CH, Caldwell M, Kurtz M. CE: moral distress: a catalyst in building moral resilience. Am J Nurs. 2016;116(7):40\u201349. doi:10.1097\/01.NAJ.0000484933.40476.5b"},{"issue":"8","key":"b6","series-title":"Clin Psychol Rev","first-page":"695","article-title":"Moral injury and moral repair in war veterans: a preliminary model and intervention strategy","volume":"29","author":"Litz BT","year":"2009","unstructured":"Litz BT, Stein N, Delaney E,  Moral injury and moral repair in war veterans: a preliminary model and intervention strategy. Clin Psychol Rev. 2009;29(8):695\u2013706. doi:10.1016\/j.cpr.2009.07.003"},{"issue":"2","key":"b7","series-title":"AJPM Focus","first-page":"100173","article-title":"Moral distress and moral injury in military healthcare clinicians: a scoping review","volume":"3","author":"Wilson MA","year":"2024","unstructured":"Wilson MA, Shay A, Harris JI, Faller N, Usset TJ, Simmons A. Moral distress and moral injury in military healthcare clinicians: a scoping review. AJPM Focus. 2024;3(2):100173. doi:10.1016\/j.focus.2023.100173"},{"issue":"4","key":"b8","series-title":"Arch Surg","first-page":"371","article-title":"Stress and burnout among surgeons: understanding and managing the syndrome and avoiding the adverse consequences","volume":"144","author":"Balch CM","year":"2009","unstructured":"Balch CM, Freischlag JA, Shanafelt TD. Stress and burnout among surgeons: understanding and managing the syndrome and avoiding the adverse consequences. Arch Surg. 2009;144(4):371\u2013376. doi:10.1001\/archsurg.2008.575"},{"issue":"18","key":"b9","series-title":"Arch Intern Med","first-page":"1377","article-title":"Burnout and satisfaction with work-life balance among US physicians relative to the general US population","volume":"172","author":"Shanafelt TD","year":"2012","unstructured":"Shanafelt TD, Boone S, Tan L,  Burnout and satisfaction with work-life balance among US physicians relative to the general US population. Arch Intern Med. 2012;172(18):1377\u20131385. doi:10.1001\/archinternmed.2012.3199"},{"key":"b10","series-title":"World Neurosurg","first-page":"351","article-title":"A well-being well-check for neurosurgery: evidence-based suggestions for our specialty based on a systematic review","volume":"185","author":"Abdelmageed S","year":"2024","unstructured":"Abdelmageed S, Horak VJ, Virtanen PS, Lam SK, Burchiel KJ, Raskin JS. A well-being well-check for neurosurgery: evidence-based suggestions for our specialty based on a systematic review. World Neurosurg. 2024;185:351\u2013358.e2. doi:10.1016\/j.wneu.2024.02.093"},{"issue":"9","key":"b11","series-title":"PLoS One","first-page":"e0239193","article-title":"Pattern of workplace violence against doctors practising modern medicine and the subsequent impact on patient care, in India","volume":"15","author":"Kaur A","year":"2020","unstructured":"Kaur A, Ahamed F, Sengupta P, Majhi J, Ghosh T. Pattern of workplace violence against doctors practising modern medicine and the subsequent impact on patient care, in India. PLoS One. 2020;15(9):e0239193. doi:10.1371\/journal.pone.0239193"},{"key":"b12","series-title":"Lancet Reg Health Southeast Asia","first-page":"100064","article-title":"Ending violence against healthcare workers in India: a bill for a billion","volume":"6","author":"Nair A","year":"2022","unstructured":"Nair A, Zadey S. Ending violence against healthcare workers in India: a bill for a billion. Lancet Reg Health Southeast Asia. 2022;6:100064. doi:10.1016\/j.lansea.2022.100064"},{"issue":"9","key":"b13","series-title":"Fed Pract","first-page":"400","article-title":"Reframing clinician distress: moral injury not burnout","volume":"36","author":"Dean W","year":"2019","unstructured":"Dean W, Talbot S, Dean A. Reframing clinician distress: moral injury not burnout. Fed Pract. 2019;36(9):400\u2013402."},{"issue":"3","key":"b14","series-title":"Method Innov","first-page":"2059799119889569","article-title":"Writing through grief: using autoethnography to help process grief after the death of a loved one","volume":"12","author":"Matthews A","year":"2019","unstructured":"Matthews A. Writing through grief: using autoethnography to help process grief after the death of a loved one. Method Innov. 2019;12(3):2059799119889569. doi:10.1177\/2059799119889569"},{"issue":"3","key":"b15","series-title":"Res Drama Educ","first-page":"628","article-title":"An autoethnographic exploration of the presence of death and grief within applied theatre with older adults","volume":"30","author":"Bowers GG","year":"2025","unstructured":"Bowers GG. An autoethnographic exploration of the presence of death and grief within applied theatre with older adults. Res Drama Educ. 2025;30(3):628\u2013642. doi:10.1080\/13569783.2024.2442709"},{"issue":"1","key":"b16","series-title":"Eur Psychiatry","first-page":"e132","article-title":"Prevalence of posttraumatic stress symptoms among physicians \u2013 a meta-analysis","volume":"68","author":"Reinhardt J","year":"2025","unstructured":"Reinhardt J, Linde K, Kersting A. Prevalence of posttraumatic stress symptoms among physicians \u2013 a meta-analysis. Eur Psychiatry. 2025;68(1):e132. doi:10.1192\/j.eurpsy.2025.10084"}],"container-title":["Neurosurgical Focus"],"original-title":[],"link":[{"URL":"https:\/\/thejns.org\/view\/journals\/neurosurg-focus\/61\/2\/article-pE3.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/neurosurg-focus\/61\/2\/article-pE3.xml","content-type":"text\/html","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/neurosurg-focus\/61\/2\/article-pE3.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,5]],"date-time":"2026-08-05T00:02:08Z","timestamp":1785888128000},"score":1,"resource":{"primary":{"URL":"https:\/\/thejns.org\/view\/journals\/neurosurg-focus\/61\/2\/article-pE3.xml"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8,1]]},"references-count":16,"journal-issue":{"issue":"2"},"URL":"https:\/\/doi.org\/10.3171\/2026.4.focus2619","relation":{},"ISSN":["1092-0684"],"issn-type":[{"value":"1092-0684","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8,1]]}}}