Reflective practice to reduce moral injury in healthcare workers.

Abstract

Background: Moral injury (MI) can arise when individuals experience events that violate their moral beliefs. During the COVID-19 pandemic, MI gained attention among healthcare workers (HCWs). Reflective practice (RP) may help prevent or mitigate MI but remains underexplored. This narrative review examines existing literature on RP interventions addressing MI in HCWs.

Aims: To synthesize existing literature on RP interventions to prevent or mitigate MI in HCWs.

Methods: A semi-structured literature search was conducted in July 2024 and updated in August 2025 across four databases. Twelve studies evaluating RP interventions, including three studies identifying barriers to RP, were included. Across the 12 studies, the sample size was n = 793, involving nurses and other HCWs.

Results: Most studies implemented structured workshops combining RP with psychoeducation and group discussion. Of the studies, 11 studies lacked control groups, three used pre-/post-test designs, while others relied on self-reported helpfulness. These studies provided preliminary evidence for the feasibility and perceived value of RP in addressing MI. The only study with a control group was limited by a small sample size, and the results were non-significant. Reported barriers to implementing RP included individual-level factors (e.g. lack of experience) and institutional obstacles (e.g. limited managerial support).

Conclusions: Findings suggest RP holds promise as an intervention for MI in HCWs. However, the evidence base is limited by small samples and weak study designs. Further research using robust methodologies, including randomized controlled trials (RCTs) and longitudinal studies, is needed to evaluate RP across diverse HCW roles, including administrative staff.