# A nurse who repeatedly cared for dying ICU patients reports feeling betrayed by the system, emotional exhaustion, and detachment. Which actions support recognition and management of moral injury? Select all that apply.

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=375097&lang=en  
> language: en  
> subject: Basic Care and Comfort  
> category: BCC

## Question

A nurse who repeatedly cared for dying ICU patients reports feeling betrayed by the system, emotional exhaustion, and detachment. Which actions support recognition and management of moral injury? Select all that apply.

1

Promote personal resilience practices alongside organizational change

2

Encourage participation in structured debriefings after critical events

3

Recognize that moral injury and burnout are systemic, not individual failure

4

Refer to Employee Assistance Program (EAP) and offer peer support resources

5

Suggest the nurse just toughen up and not bring emotions to work

## Explanation

Moral injury arises when health workers experience systemic violations of their moral beliefs (e.g., not being able to provide care they know patients need). It overlaps with but differs from burnout. Effective response combines INDIVIDUAL support (EAP, peer support, structured debriefings, resilience practices) with SYSTEMIC change (staffing, leadership, ethical climate). Telling someone to toughen up is invalidating, harmful, and ignores root causes. Recognizing it as systemic, not individual failure, is foundational.

## In-depth explanation

Schwartz Rounds, Code Lavender, peer-to-peer support programs, ethics consultation services have evidence in moral injury reduction.

## Clinical scenario

New nurse 18 months postgrad. Recently witnessed multiple unsuccessful resuscitations.

## Key concepts

- **moral injury** — Distress from perpetrating, witnessing, or failing to prevent acts that violate moral beliefs.
- **burnout** — Maslach syndrome of emotional exhaustion, depersonalization, reduced personal accomplishment.
- **Schwartz Rounds** — Structured forum for staff to discuss social/emotional aspects of patient care.

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