The straw that breaks the camel’s back: Micro trauma and its moral injury implications
| Thursday, May 21, 2026 |
| 9:00 PM - 9:01 PM |
Speaker
Ms Megan Dale
Lecturer
James Cook University
The straw that breaks the camel’s back: Micro trauma and its moral injury implications
Abstract Document
The Straw That Breaks the Camel’s Back: Micro Trauma and Its Moral Injury Implications
Authors: Megan Dale¹*, Dr Maude Chapman¹, Professor Caryn West²
¹ Nursing and Midwifery, College of Healthcare Sciences, James Cook University, Australia
² School of Nursing, Paramedicine and Healthcare Sciences, Charles Sturt University, NSW, Australia
*Presenting/Corresponding author
Background: Nurses are frequently exposed to small, often unnoticed events that accumulate over time, impacting their wellbeing. While cumulative trauma is acknowledged in nursing literature, the concept of micro trauma remains undefined. This study addresses a critical gap by exploring nurses’ understanding of micro trauma.
Aim: This research aims to explore registered nurses' understanding of micro trauma and its impact on their health and wellbeing.
Methods: Utilising Schwartz-Barcott and Kim’s three-phase hybrid concept analysis model, the study combines a scoping review of existing literature with thematic analysis of qualitative data collected through an online survey of registered nurses. The final analysis integrates these findings to develop a comprehensive definition of micro trauma in the context of nursing.
Results: Micro trauma, though not widely recognised in nursing literature, resonates strongly with registered nurses. It is defined as small, often unnoticed events that accumulate over time, leading to significant psychological and emotional distress. Key categories include organisational neglect, workplace disempowerment, duty of care burden, and erosion of professional ethos. These experiences frequently involve ethical and moral dilemmas, constrained agency, and perceived betrayal, core antecedents of moral injury. Nurses described feelings of guilt, shame, and disillusionment when unable to act in accordance with their professional values or when witnessing harm, they could not prevent. This intersection suggests that micro trauma may function as a precursor or subtype of moral injury, where repeated minor violations of moral identity accumulate and manifest in similar cognitive and emotional sequelae. Altered cognitive schemas, including diminished self-worth and erosion of professional ethos, further align with moral injury constructs, reinforcing the need for recognition of micro trauma as a morally injurious phenomenon within healthcare contexts.
Conclusion: Micro trauma represents a critical, under-recognised contributor to moral injury in nursing. Its cumulative effect threatens moral identity and professional ethos, underscoring the need for organisational strategies that acknowledge and mitigate these harms. Recognising micro trauma as a morally laden stressor can inform targeted interventions, enhance nurse wellbeing, and strengthen healthcare system resilience.
Keywords: Micro trauma, moral injury, nursing, cumulative trauma, hybrid concept analysis.
Authors: Megan Dale¹*, Dr Maude Chapman¹, Professor Caryn West²
¹ Nursing and Midwifery, College of Healthcare Sciences, James Cook University, Australia
² School of Nursing, Paramedicine and Healthcare Sciences, Charles Sturt University, NSW, Australia
*Presenting/Corresponding author
Background: Nurses are frequently exposed to small, often unnoticed events that accumulate over time, impacting their wellbeing. While cumulative trauma is acknowledged in nursing literature, the concept of micro trauma remains undefined. This study addresses a critical gap by exploring nurses’ understanding of micro trauma.
Aim: This research aims to explore registered nurses' understanding of micro trauma and its impact on their health and wellbeing.
Methods: Utilising Schwartz-Barcott and Kim’s three-phase hybrid concept analysis model, the study combines a scoping review of existing literature with thematic analysis of qualitative data collected through an online survey of registered nurses. The final analysis integrates these findings to develop a comprehensive definition of micro trauma in the context of nursing.
Results: Micro trauma, though not widely recognised in nursing literature, resonates strongly with registered nurses. It is defined as small, often unnoticed events that accumulate over time, leading to significant psychological and emotional distress. Key categories include organisational neglect, workplace disempowerment, duty of care burden, and erosion of professional ethos. These experiences frequently involve ethical and moral dilemmas, constrained agency, and perceived betrayal, core antecedents of moral injury. Nurses described feelings of guilt, shame, and disillusionment when unable to act in accordance with their professional values or when witnessing harm, they could not prevent. This intersection suggests that micro trauma may function as a precursor or subtype of moral injury, where repeated minor violations of moral identity accumulate and manifest in similar cognitive and emotional sequelae. Altered cognitive schemas, including diminished self-worth and erosion of professional ethos, further align with moral injury constructs, reinforcing the need for recognition of micro trauma as a morally injurious phenomenon within healthcare contexts.
Conclusion: Micro trauma represents a critical, under-recognised contributor to moral injury in nursing. Its cumulative effect threatens moral identity and professional ethos, underscoring the need for organisational strategies that acknowledge and mitigate these harms. Recognising micro trauma as a morally laden stressor can inform targeted interventions, enhance nurse wellbeing, and strengthen healthcare system resilience.
Keywords: Micro trauma, moral injury, nursing, cumulative trauma, hybrid concept analysis.
Biography
Megan Dale is a nursing lecturer and PhD student at James Cook University, with expertise in critical care, workforce development, and nursing leadership. She holds a Master of Nursing in Leadership and Management, along with graduate certificates in critical care and research methods. Megan plays a key role in shaping undergraduate nursing education and mentoring students during clinical placements.
Her career spans diverse clinical and leadership roles, where she developed strengths in workforce planning, financial management, and clinical governance. Passionate about nurse wellbeing and education, Megan advocates for sustainable healthcare and the professional growth of nurses, recognising their vital role in delivering high-quality, evidence-based care.
Her doctoral research focuses on enhancing professional support and improving the long-term sustainability of the nursing workforce. Through collaborative networks and a commitment to education, patient care, and peer support, Megan continues to contribute meaningfully to the future of nursing in Australia.
