Table 1

Terms and definitions

Moral distressThe psychological distress of being in a situation in which one is constrained from acting on what one knows to be right due to the presence of institutional or external constraint. 2 Although there are many definitions of moral distress, we have selected this definition because it was the first one reported in the literature and remains widely referenced.
Moral injuryPerpetrating, failing to prevent or bearing witness to acts that transgress deeply held moral beliefs and expectations.
A new concept in healthcare, consisting of a deep emotional wound and unique to those who bear witness to intense human suffering and cruelty
8 9 The term moral injury has been used mainly in military context. Recently, it is being applied into healthcare field, but still requires further investigation and clarity, particularly in its relationship with moral distress.
Moral residueThe result of moral distress when we have seriously compromised ourselves or allowed ourselves to be compromised, threatening or betraying deeply held and cherished beliefs and values. 6
Moral resilienceThe capacity of an individual to preserve or restore integrity in response to moral adversity, including situations that include moral complexity, confusion, distress or setbacks. 13 Moral resilience is still a concept under construction. We provide the revised definition by Rushton.
Collective moral resilienceShared capacity arising within a group with mutual trust and connectedness, through the process of sharing ethically challenging situations, thinking together about the challenges, and dialogue to sustain or restore moral integrity in response to moral suffering.This articleWe proposed this term in this article. It can be considered a term aligned with relational integrity (Holtz et al) as a characteristic of moral resilience to acknowledge the embeddedness of individuals in healthcare culture and social practices. However, collective moral resilience implies a process of dialogue to sustain moral integrity.