2.4.C Moral Injury: Organisational Contributors to Moral Harm in Nurse Academia
Tracks
Concurrent Session D
| Thursday, May 21, 2026 |
| 5:35 PM - 6:00 PM |
| Room 4 |
Overview
Presenters:
Dr Geraldine Rebeiro
Dr. Mandy El Ali
Dr Geraldine Rebeiro
Dr. Mandy El Ali
Speaker
Dr. Mandy El Ali
Senior Lecturer
Australian Catholic Unversity
Biography
Mandy is a Senior Lecturer and Nurse Academic at the Australian Catholic University in Melbourne. With over two decades of experience in paediatric clinical practice, she brings deep practical knowledge to her teaching. Mandy has worked in the tertiary education sector for more than 20 years, supervising undergraduate nursing students across a broad range of clinical settings, including women’s and children’s health, residential care, medical-surgical wards, sub-acute units, and emergency departments.
In 2025, Mandy was awarded her PhD for research exploring the ethics of truth-telling in the care of seriously ill children. Her study revealed a troubling ethical tension: the expectation for clinicians to withhold the truth from children can directly conflict with their deeply held moral commitment to honesty. This conflict, her research found, is a significant contributor to moral injury—a psychological harm experienced when individuals are forced to act in ways that violate their core values.
Mandy’s work continues to explore the intersection of ethics, communication, and clinician well-being, with a focus on fostering morally sustainable practice in nursing and healthcare.
Dr Geraldine Rebeiro
Senior Lecturer
Australian Catholic University
From Moral Distress to Moral Injury: Organisational Contributors to Moral Harm in Nurse Academia
Abstract Document
Moral distress (MD), originally defined by Jameton (1984) as the psychological and emotional suffering that arises when external constraints prevent an individual from acting in accordance with their moral judgement, has been widely examined in clinical nursing contexts. However, comparatively little attention has been paid to MD within the academic environments where nursing students are prepared for professional practice. Emerging evidence suggests that the moral tensions experienced by nurse academics may not only constitute moral distress but, under chronic or unresolvable conditions, also meet criteria associated with moral injury—a deeper, more enduring form of moral harm characterised by violations of moral expectations, institutional betrayal, and threats to moral identity.
Drawing on the expanded DSM-5-TR Z Code category “Moral, Religious, or Spiritual Problem” (Mattson et al., 2025), this presentation explores how recurring ethical tensions in nurse education—including academic dishonesty, grade manipulation, pressure to pass underperforming students, incivility, misalignment between policy and practice, and cultural or organisational silencing—may exceed the threshold of distress and contribute to cumulative moral injury among academic staff (Ganske, 2010).
Issues such as reluctance to fail unsafe or unprepared students (Adkins & Aucoin, 2022), systemic tolerance of plagiarism, or subtle institutional expectations to “maintain pass rates” can create scenarios in which nurse academics feel complicit in actions that conflict with professional values and public protection mandates. Over time, such exposures may erode moral integrity, undermine professional identity, and contribute to burnout, withdrawal, or attrition—representing a significant concern for the sustainability of the nursing academic workforce.
This presentation aims to stimulate debate regarding whether moral distress within the nursing academy is sufficiently recognised, how it may progress to moral injury if left unaddressed, and what organisational responsibilities exist to prevent moral harm and protect the integrity of nursing education.
References
Adkins, D. A., & Aucoin, J. W. (2022). Failure to fail – Factors affecting faculty decisions to pass underperforming nursing students in the clinical setting: A quantitative study. Nurse Education in Practice, 58. https://doi.org/10.1016/j.nepr.2021.103259
Ganske, K. M. (2010). Moral Distress in Academia. Online Journal of Issues in Nursing, 15(3), Manuscript 6.
Jameton, A. (1984). Nursing Practice: The Ethical Issues. Englewood Cliffs, NJ: Prentice Hall.
Mattson, S., VanderWeele, T. J., Lu, F., Carey, L. B., Cowden, R. G., Fung, E. N., Koenig, H., Peteet, J. & Wortham, J. (2025). Moral, Religious, or Spiritual Problem: An Expanded Z Code Diagnostic Category in the: DSM-5-TR. The Journal of Nervous and Mental Disease, 213(11), 297-304. https://doi.org/10.1097/NMD.0000000000001856
Drawing on the expanded DSM-5-TR Z Code category “Moral, Religious, or Spiritual Problem” (Mattson et al., 2025), this presentation explores how recurring ethical tensions in nurse education—including academic dishonesty, grade manipulation, pressure to pass underperforming students, incivility, misalignment between policy and practice, and cultural or organisational silencing—may exceed the threshold of distress and contribute to cumulative moral injury among academic staff (Ganske, 2010).
Issues such as reluctance to fail unsafe or unprepared students (Adkins & Aucoin, 2022), systemic tolerance of plagiarism, or subtle institutional expectations to “maintain pass rates” can create scenarios in which nurse academics feel complicit in actions that conflict with professional values and public protection mandates. Over time, such exposures may erode moral integrity, undermine professional identity, and contribute to burnout, withdrawal, or attrition—representing a significant concern for the sustainability of the nursing academic workforce.
This presentation aims to stimulate debate regarding whether moral distress within the nursing academy is sufficiently recognised, how it may progress to moral injury if left unaddressed, and what organisational responsibilities exist to prevent moral harm and protect the integrity of nursing education.
References
Adkins, D. A., & Aucoin, J. W. (2022). Failure to fail – Factors affecting faculty decisions to pass underperforming nursing students in the clinical setting: A quantitative study. Nurse Education in Practice, 58. https://doi.org/10.1016/j.nepr.2021.103259
Ganske, K. M. (2010). Moral Distress in Academia. Online Journal of Issues in Nursing, 15(3), Manuscript 6.
Jameton, A. (1984). Nursing Practice: The Ethical Issues. Englewood Cliffs, NJ: Prentice Hall.
Mattson, S., VanderWeele, T. J., Lu, F., Carey, L. B., Cowden, R. G., Fung, E. N., Koenig, H., Peteet, J. & Wortham, J. (2025). Moral, Religious, or Spiritual Problem: An Expanded Z Code Diagnostic Category in the: DSM-5-TR. The Journal of Nervous and Mental Disease, 213(11), 297-304. https://doi.org/10.1097/NMD.0000000000001856
Biography
Dr Geraldine Rebeiro is an experienced senior nurse academic who has been employed at Victoria University and La Trobe University previously and is currently employed at ACU where she has been since 2012. She holds leadership roles in UG and PG nursing and professional experience coordination. Her research and SOTL interests include student learning in professional experience practice (PEP) and the relationships between RNs and students in PEP. Her professional practice has been in paediatric, med-surg, aged care and home & community nursing, as well as neonatal, high risk antenatal and postnatal midwifery care. Geraldine’s passion is nursing education, particularly PEP education. In addition to her PhD and RN and midwifery qualifications, she also holds a Bachelor of Applied Science in Advanced Nursing, Bachelor of Educational Studies and a Master of Education.
