Moral attentiveness and leadership in the lived experience of moral distress / injury and recovery : an interpretative phenomenological account of social work settings

Roche, Brigid Mary (2024) Moral attentiveness and leadership in the lived experience of moral distress / injury and recovery : an interpretative phenomenological account of social work settings. Doctoral thesis, Birkbeck, University of London.

Abstract

This thesis presents two studies exploring moral injury, the profound and persistent psychological distress that people may develop when their moral expectations and beliefs are violated by their own or other people’s actions (Litz et al., 2009; Shay, 2014). The first study is a systematic literature review (SLR) which addresses the opportunity to understand what is known about leadership in relation to moral injury and recovery in non-military, non-healthcare organisational settings. Three key factors are identified: 1) leadership awareness and accountability, 2) organisational context and conditions, and 3) individual factors such as moral attentiveness. The second study presents context-specific empirical research, using interpretative phenomenological analysis to understand the lived experience of moral distress/injury amongst frontline professionals and leaders in social work settings, and the role of moral attentiveness and leadership within this. Participants describe their experience of moral distress/injury in terms of holding knowledge of harm, experiencing tension in limited agency to correct wrongs, navigating boundaries of protocol, and experiencing power and decision strain. Moral attentiveness is active in the process of reconstructing the experience of moral distress/injury, through moral mentalisation, construction of moral logic, salience of moral identity, and socialised moral sensemaking. Participants share how leadership can protect against the impact of moral injury through proximity which builds understanding, balancing accountabilities to protect the workforce and the organisation, serving as a bridge in organisational communication, and facing moral complexity with integrity. Moral recovery is experienced through investing in wellbeing, maintaining proximal social connection with colleagues, accepting boundaries within the wider system of accountability, and through development of perspective. A provisional framework is presented depicting the components and relationships between moral distress/injury, moral recovery, moral attentiveness, and leadership. This thesis contributes uniquely to the literature, extends understanding of moral injury and outlines implications for research and practice.

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