Moral Injury in French Healthcare Workers

Healthcare professionals are facing an escalating crisis, with burnout rates ranging between 40% and 60% and a growing intention to leave the profession, affecting one in five physicians and one in four nurses in the coming years. While current interventions focused on individual resilience, such as mindfulness, peer support, and workload management, have been promoted as solutions, they have failed to bring about systemic improvements. This raises the question of whether other factors, such as Moral Injury, play a key role in this crisis. Moral Injury is an emerging concept that highlights the profound misalignment between healthcare workers' professional values and the reality of their practice, often exacerbated by organizational and economic constraints. The primary objective of this study is to describe the manifestations of Moral Injury among healthcare professionals in France. Secondary objectives include the psychometric validation of a French-language Moral Injury scale, the analysis of organizational and individual determinants of Moral Injury, and the structural modeling of underlying mechanisms. This nationwide cross-sectional survey will be conducted electronically, reaching participants through healthcare institutions, professional societies, social networks, and a snowball dissemination strategy. Data collection will include standardized scales such as the Moral Injury Inventory for Healthcare Professionals, the Moral Injury Events Scale (MIES), the Maslach Burnout Inventory (MBI), and the EuroQol 5-Dimensions (EQ-5D) for quality of life, as well as ad hoc questions designed to explore additional systemic and professional challenges. A rigorous psychometric validation of the Moral Injury scale will be performed, followed by Structural Equation Modeling (SEM) to analyze the complex relationships between Moral Injury and other factors such as burnout, depression, and anxiety. By establishing the first large-scale assessment of Moral Injury among healthcare professionals in France, this study aims to identify key organizational and personal risk factors contributing to this phenomenon. The use of Structural Equation Modeling will help build a robust theoretical model that clarifies the underlying mechanisms of Moral Injury and its interactions with broader health issues. The findings will support the development of targeted interventions focused on systemic organizational changes to improve healthcare workers' well-being and guide public health policies.