Process Experienced by Workers

Individual Moderating Factors

While burnout and moral injury are driven by societal and cultural, systems, organizational, and work and learning environment factors, individuals experience the effects of burnout and moral injury differently based on their personal/family demands and lived experiences of trauma, discrimination, and social vulnerability which they carry with them into the work and learning environment.

Moral Injury

Moral Injury Process

The moral injury process starts with betrayal, the sense of being harmed by the actions or omissions of a trusted individual or institution. Betrayal then leads to transgression, a breach of accepted social codes or laws, including moral standards. Sometimes, betrayal is not recognized until after the transgression occurs. The continuum of moral injury describes a range of experiences, from moral dilemma to moral distress to moral injury. This framework focuses on the experience of workers and learners who progress to moral injury. (See definition of moral dilemma, moral distress, and moral injury in our glossary).  

Moral injury can result in worker and learner feelings of anger, frustration, shame/guilt, and a sense futility.


Burnout Process

Burnout has been classified as an occupational phenomenon and defined in the International Classification of Diseases (ICD-11) as “a syndrome conceptualized as resulting from chronic workplace stress that has not been successfully managed.” Like moral injury, burnout operates on a continuum, meaning that varying degrees of symptoms and presentations exist as workers and learners move from engaged to burned out. Burnout has three hallmark features:

  • Emotional exhaustion
  • Depersonalization
  • Sense of ineffectiveness

The connection between burnout and moral injury is not entirely known. They appear to represent separate but related phenomena.

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