ObjectiveTo investigate the current situation and influencing factors of moral injury among physicians in China， and to analyze the relationship between moral injury and medical professionalism， providing a reference for preventing and treating moral injury and protecting physicians’ physical and mental well-being. MethodsFrom September to October 2023， the convenience sampling method was used to conduct a questionnaire survey on practicing physicians， interns， or resident physicians in hospitals at all levels in Heilongjiang Province， Guangdong Province， Xinjiang Uygur Autonomous Region， and Beijing. ResultsA total of 421 practicing physicians， interns， or resident physicians were included. The total score of the Moral Injury Symptom Scale for Healthcare Professionals was （42.07 ± 13.67）， of which 31.6% of the respondents had significant clinical distress and functional impairment related to moral injury， with the highest mean score for the dimension “unforgiveness.” Correlation analysis revealed that the total score of medical professionalism， as well as the scores of each dimension， were significantly negatively correlated with the total score of the Moral Injury Symptom Scale. Linear regression analysis showed that job satisfaction， medical professionalism， whether they felt a low level of organizational support in the handling of doctor-patient disputes， whether they had witnessed patients’ suffering or dying， gender， whether they had worked overtime， and whether they had needed professional help in relieving psychological stress were influencing factors of physicians’ moral injury. ConclusionThe physicians’ moral injury in China is at a medium level overall. Physicians’ moral injury is affected by numerous factors， with a significant negative correlation between moral injury and medical professionalism. It is recommended to improve the level of organizational support in medical institutions and medical professionalism， establish specialized psychological and moral aid institutions， and create a caring organizational atmosphere， to prevent and repair physicians’ moral injury and better protect their physical and mental well-being.

Objective:Papers related to moral injury on platforms such as CNKI,Wanfang,and VIP were retrieved and analyzed to understand the current status of moral injury research in China,provide a reference for future related content research,as well as lay the foundation for subsequent in-depth research on moral injury.Methods:Quantitative and qualitative analyses were conducted on literature related to moral injury from 2012 to 2023.Using the NVivo12 analysis tool,based on the content analysis method,the current status of research on moral injury in China was reviewed from the three dimensions of moral trauma,including research topics,research objects,and research perspectives.Results:The research themes of moral injury in China were mainly summarized in five aspects:concept,mechanism,measurement and assessment,symptoms and manifestations,as well as prevention and treatment.The research subjects were mainly high-risk occupational groups such as war-related personnel,medical staff,and teachers.The research was mainly conducted from the perspectives of ethics,medicine,cultural studies,and psychology.Conclusion:In the future,research on moral injury in China needs to deepen its theoretical system and promote empirical research.Expand research horizons,as well as enrich the research in the field of interdisciplinary and cross-disciplinary.Raise the level of attention,and pay attention to the physical and mental well-being of special employment groups.

Moral distress in clinical practice is an important factor contributing to the moral injury of medical staff.The core idea of caring ethics emphasizes that caring and being cared for are fundamental human needs,which holds important guiding significance for preventing and treating moral injury of medical staff.By sorting out the basic ideas of caring ethics theory,this paper explained and analyzed the moral injury of medical staff,identifying the main causes of moral injury including individual medical staff exhibiting vulnerability and a low level of self-care;disharmonious doctor-patient relationship and asymmetry in the caring relationship between doctors and patients;and low level of organizational support and the lack of a caring ethical atmosphere.Therefore,with caring as the goal,the moral distress can be alleviated by improving the care literacy and moral resilience of medical staff,building a harmonious caring relationship between doctors and patients,creating a caring environment,forming a caring organizational ethical atmosphere,and other pathways.These are also beneficial attempts to prevent and treat the moral injury of medical staff and to build a doctor-patient destiny community.

The purpose of medicine is to preserve and develop the treatment in the process of saving lives and helping injuries. Medical professionalism is a comprehensive expression of physician’s clinical abilities, relationships and values between different subjects. In practice, white robed doctors utilize high standards of professionalism to practice the medical purpose and goals of "always centering on the interests of the patient" in specific diagnosis and treatment behaviors. At the same time, fulfilling the promises and expectations of medicine to the public. For these reasons, selfless dedication, self-sacrifice, and one-way pure altruism are all internalized into the basic requirements of medical professionalism: doctors should not only have the skill to revive the dead, but also have the benevolence of evangelists; they not only need to achieve maximum efficiency in technology, but also achieve the highest truth, goodness, and beauty in virtue. When these qualities are exaggerated or unattainable due to uncontrollable reasons, there will be a rift between the entrenched value systems and practical needs. In recent years, the global epidemic has had a huge impact on the medical system and medical staff, and the moral beliefs, role expectations, and value systems of doctors have also been impacted unprecedentedly, resulting in moral injury. The international research on moral injury in medical field has also received attention. China is currently in the adjustment period of epidemic related policies, with medical personnel bearing the brunt. Therefore, referring to relevant international research on moral injury to re-examine the relationship between the medical professionalism, which emphasizes one-way pure altruism, dedication and weakening or even neglecting personal well-being, and current medical practices. And constructing a moral injury early warning-repair system that focuses on doctors, patients, medical teams, medical institutions, medical environments, health systems, and other stakeholders, and ensuring its healthy operation. Not only in extreme periods, but also in ordinary daily diagnosis and treatment, it can support doctors to actively, safely, and healthily fulfill their mission of saving lives and helping injuries.