Date of Award


Document Type


Degree Name


Organizational Unit

Graduate School of Social Work

First Advisor

Jennifer C. Greenfield

Second Advisor

Michael Talamantes

Third Advisor

Heather Taussig

Fourth Advisor

Karen Albright

Fifth Advisor

Nicholas Cutforth


Health, Healthcare, Moral injury, Social work, Well-being, Workforce


The well-being of the healthcare workforce in the United States is important. Specifically, healthcare social workers (HSWs) are critical to the workflow of healthcare services. HSWs have a unique role in healthcare, addressing the psychosocial needs of patients. Despite their essential roles, HSWs receive minimal attention regarding their workplace-related well-being. This dissertation examined the experience of moral injury, an indicator of well-being, amongst HSW. Moral injury is “the moral transgression, or boundary breaking, by oneself or someone in a position of power, in high stakes situations, and the negative outcomes of those experiences” (Litz & Kerig, 2019; Shay, 2014).

This dissertation was a three-aim mixed methods scale development study. Aim one summarized relevant literature on moral injury and well-being in a registered systematic review. Aim two examined experiences of moral injury amongst HSWs in a Mountain West state using semi-structured interviews and hybrid qualitative analysis, using both thematic and rapid analyses. Aim three piloted the Moral Injury Symptom Scale- Healthcare Social Workers (MISS-HSW) in a national U.S. healthcare social worker well-being survey. Psychometric properties were examined on the MISS-HSW, including exploratory factor analysis.

The systematic review included 18 articles, illuminating the relationship between moral injury and well-being (e.g., burnout, trauma, mental health indicators). The interviews included 24 participants, and the thematic analysis developed three themes: 1) HSWs’ experiences of moral injury; 2) HSWs situated in the “in-between” of policy and practice; and 3) upholding social work values within the medical model. The rapid analysis created the MISS-HSW. The survey included 158 participants from 22 states in the United States. The MISS-HSW had strong reliability (a = 0.86) and produced two factors: 1) emotions and 2) values/purpose.

This dissertation contributes to the healthcare workforce well-being literature through the analysis of moral injury amongst HSWs. The new MISS-HSW is publicly available for HSW departments to use for self or staff screening of moral injury. This study provides data to support policy-level changes that can be implemented to better support HSWs. This dissertation provides foundational evidence and methodologies to support future study of moral injury and HSW well-being.

Publication Statement

Copyright is held by the author. User is responsible for all copyright compliance.

Rights Holder

Pari Shah Thibodeau


Received from ProQuest

File Format




File Size

224 pgs


Social work

Available for download on Thursday, August 01, 2024

Included in

Social Work Commons