Moral InjuryMDMIPTSNCT07455370
A Study of Moral Distress, Moral Injury and Post-Traumatic Stress for Nurses
An observational study of Moral Injury and Moral Distress, run by Mayo Clinic at 3 sites in United States.
Trial summary
The goal of this descriptive study is to examine levels of moral distress (MD), moral injury (MI), \& post-traumatic stress (PTS) levels among nursing staff at Mayo Clinic. The main questions this study aims to answer are: 1. Read more about this study
- Who is it for?
- Any age
- Conditions the study is for
- Moral Injury, Moral Distress, Post-Traumatic Stress
- What is being tested?
- Surveys
- How many people
- 21,300 participants
- Where
- 3 sitesUnited States
- Study dates
- 3 Mar 2026to Nov 2026
- Phase
- Observational
Key requirements
Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.
- Ages Any age
- All sexes
- No healthy volunteers
- Child, Adult, Older adult
Study population: Mayo Clinic Department of Nursing Staff across all Mayo Clinic sites, including: Mayo Clinic in Rochester, Minnesota; Mayo Clinic in Arizona; Mayo Clinic in Florida; and Mayo Clinic Health System sites in the midwest.
Who may be able to join
- Mayo Clinic Department of Nursing Staff including:
- Registered nurses
- Licensed practical nurses
- Nursing support staff (including roles such as patient care assistants, patient care specialists, medical assistants, and nurse technicians)
Who cannot join
- Social workers
- Chaplains
- Unit coordinators
- Other staff who do not support direct patient care but are within the nursing department
- Other employees outside the Department of Nursing
Trial locations and contacts
3 sites in 1 country. Contact the study team or a site near you to ask about taking part.
United States3 sites
Mayo Clinic
Jacksonville, Florida, 32250
Mayo Clinic
Phoenix, Arizona, 85054
Mayo Clinic
Rochester, Minnesota, 55905
About this study
Official title: Moral Distress, Moral Injury and Post-Traumatic Stress Among Mayo Clinic Nurses
The goal of this descriptive study is to examine levels of moral distress (MD), moral injury (MI), \& post-traumatic stress (PTS) levels among nursing staff at Mayo Clinic. The main questions this study aims to answer are:
- Determine the levels of MD, MI, and PTS symptoms experienced by nurses who participate in the study.
- Evaluate differences in MD, MI, and PTS symptoms by setting, specialties, and geographic locations.
- Examine demographic and professional characteristics that are associated with high levels of MD, MI and PTS.
- Conditions
- Moral Injury, Moral Distress, Post-Traumatic Stress, Nurse Well-being, Wellbeing, Wellness, Psychological
- Being tested
- Surveys
- Keywords
- Moral Injury, Moral Distress, Post-Traumatic Stress, Nurse Wellbeing, Nurse burnout
- Medical subject headings
- Stress Disorders, Post-Traumatic, Psychological Well-Being
What participants receive
What participants receive. In a randomised study each person is assigned to one group by chance.
SurveysOther
Participants will complete an electronic survey containing the Measure of Moral Distress- Healthcare Professionals (MMD-HP), Moral Injury Outcome Scale (MIOS) including functional outcome measures adapted from the Brief Inventory of Psychosocial Functioning, The PCL-5 Checklist for DSM-5 (Post-Traumatic Stress Disorder (PSTD) Checklist for the Diagnostic and Statistical Manual of Mental Disorders-5 (DSM-5)) (PCL-5), and the Well-Being Index (WBI), additionally including a demographic questionnaire with wellbeing questions.
| Study group | Role | What they receive |
|---|---|---|
| Mayo Clinic Nurses | Mayo Clinic Department of Nursing staff across the enterprise including advanced practice nurses, registered nurses, licensed practical nurses, and nursing support/unlicensed staff. Receives: Other: Surveys |
What is being measured
The primary outcome is the main question the study is designed to answer.
Measure of Moral Distress-Healthcare Professionals (MMD-HP) Score
The MMD-HP (Measure of Moral Distress-Healthcare Professionals) is a 27-item moral distress scale. A composite score is computed for items 1 - 25 and is obtained by multiplying the frequency scores (0 = Never to 4 = Very Frequently scale) and the distress scores (0 = None to 4 = Very Distressing scale) for each item; the products of these can range from 0 - 16. Higher scores indicate a greater deal of moral distress.
Measured: Baseline
Moral Injury Outcome Scale (MIOS) score
The Moral Injury Outcome Scale (MIOS) is a 14-item self-reported survey divided into two subscales-shame-related and trust-violation related. Both the shame and trust-violated subscales are seven items per subscale. Respondents are asked to indicate how strongly they agree with each statement in the past month using a 5 point Likert scale where 0 = Strongly Disagree and 4 = Strongly Agree. The total score range for each subscale is 0 - 28, and the overall score range is 0 - 56. Symptom severity is categorized as follows: 14 - 28 indicates mild moral injury, 29 - 42 indicates moderate moral injury, and 35 - 56 indicates severe moral injury.
Measured: Baseline
Post-Traumatic Stress Disorder (PCL-5) score
The PCL - 5 (Post-Traumatic Stress Disorder (PSTD) Checklist) is a 20-item self-reported survey that assesses the 20 DSM-5 symptoms of PTSD. Respondents are asked to indicate the frequency that each item occurs on a 5 point Likert scale where 0 = Not at All and 4 = Extremely. The total score is the sum of all 20 questions, with higher scores indicating a greater likelihood of PTSD.
Measured: Baseline
Timeline
From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.
- First posted6 Mar 2026
- Study start3 Mar 2026
- Primary completion5 Jun 2026
- Study completionNov 2026 (estimated)
Resources
- Official record on ClinicalTrials.govThe registry entry this page is built from, with its full change history.
- Publications (25)Papers the sponsor has linked to this study.
- Other trials for Moral InjuryStudies of the same condition, open and under way.
- More trials run by Mayo ClinicThe sponsor's other registered studies.
- What the trial phases meanHow a treatment moves from first tests in people to approval.
More details
For doctors and researchers: how the study is designed, who runs it, and its registry IDs.
Study design
- Study type
- Observational
- Observational model
- Case only
- Time perspective
- Cross-sectional
- Enrolment
- 21,300 participants (estimated)
Sponsor and investigators
- Lead sponsor
- Mayo Clinic
- Sponsor type
- University, hospital or other
- Collaborators
- Mayo Clinic Center for Clinical and Translational Science (CCaTS)
- Responsible party
- Principal investigator, Melissa A. Wilson, Mayo Clinic
- Investigators
- Melissa A Wilson, PhD, Principal investigator, Mayo ClinicCindy Tofthagen, PhD, Principal investigator, Mayo Clinic
IDs, dates and publications
- ClinicalTrials.gov ID
- NCT07455370
- Sponsor's protocol ID
- 25-008396
- Other IDs
- Mayo Clinic CTSA
- Acronym
- MDMIPTS
- Status last verified
- Sep 2026
- First submitted
- 23 Feb 2026
- Last updated
- 17 Sep 2026
- Results posted
- No
- Data monitoring committee
- No
- FDA-regulated drug
- No
- FDA-regulated device
- No
- Individual data sharing
- No
Publications
Dyrbye LN, Johnson PO, Johnson LM, Satele DV, Shanafelt TD. Efficacy of the Well-Being Index to Identify Distress and Well-Being in U.S. Nurses. Nurs Res. 2018 Nov/Dec;67(6):447-455. doi: 10.1097/NNR.0000000000000313.
PubMed 30138124Wortmann JH, Jordan AH, Weathers FW, Resick PA, Dondanville KA, Hall-Clark B, Foa EB, Young-McCaughan S, Yarvis JS, Hembree EA, Mintz J, Peterson AL, Litz BT. Psychometric analysis of the PTSD Checklist-5 (PCL-5) among treatment-seeking military service members. Psychol Assess. 2016 Nov;28(11):1392-1403. doi: 10.1037/pas0000260. Epub 2016 Jan 11.
PubMed 26751087Houle SA, Ein N, Gervasio J, Plouffe RA, Litz BT, Carleton RN, Hansen KT, Liu JJW, Ashbaugh AR, Callaghan W, Thompson MM, Easterbrook B, Smith-MacDonald L, Rodrigues S, Belanger SAH, Bright K, Lanius RA, Baker C, Younger W, Bremault-Phillips S, Hosseiny F, Richardson JD, Nazarov A; Atlas Institute Moral Injury Research Community of Practice. Measuring moral distress and moral injury: A systematic review and content analysis of existing scales. Clin Psychol Rev. 2024 Mar;108:102377. doi: 10.1016/j.cpr.2023.102377. Epub 2023 Dec 27.
PubMed 38218124Booth AT, Robinson KL. System-wide assessment using the Measure of Moral Distress - Healthcare professionals. Nurs Ethics. 2025 Aug;32(5):1629-1643. doi: 10.1177/09697330251324296. Epub 2025 Mar 3.
PubMed 40033517D'Alessandro-Lowe AM, Patel H, Easterbrook B, Ritchie K, Brown A, Xue Y, Karram M, Millman H, Sullo E, Pichtikova M, Nicholson A, Heber A, Malain A, O'Connor C, Schielke H, Rodrigues S, Hosseiny F, McCabe RE, Lanius RA, McKinnon MC. The independent and combined impact of moral injury and moral distress on post-traumatic stress disorder symptoms among healthcare workers during the COVID-19 pandemic. Eur J Psychotraumatol. 2024;15(1):2299661. doi: 10.1080/20008066.2023.2299661. Epub 2024 Feb 9.
PubMed 38334706Austin CL, Saylor R, Finley PJ. Moral distress in physicians and nurses: Impact on professional quality of life and turnover. Psychol Trauma. 2017 Jul;9(4):399-406. doi: 10.1037/tra0000201. Epub 2016 Oct 31.
PubMed 27797570Blevins CA, Weathers FW, Davis MT, Witte TK, Domino JL. The Posttraumatic Stress Disorder Checklist for DSM-5 (PCL-5): Development and Initial Psychometric Evaluation. J Trauma Stress. 2015 Dec;28(6):489-98. doi: 10.1002/jts.22059. Epub 2015 Nov 25.
PubMed 26606250Schuster M, Dwyer PA. Post-traumatic stress disorder in nurses: An integrative review. J Clin Nurs. 2020 Aug;29(15-16):2769-2787. doi: 10.1111/jocn.15288. Epub 2020 May 5.
PubMed 32372541Brennan CJ, Roberts C, Cole JC. Prevalence of occupational moral injury and post-traumatic embitterment disorder: a systematic review and meta-analysis. BMJ Open. 2024 Feb 20;14(2):e071776. doi: 10.1136/bmjopen-2023-071776.
PubMed 38382965Weber MC, Smith AJ, Jones RT, Holmes GA, Johnson AL, Patrick RNC, Alexander MD, Miyazaki Y, Wright H, Ehman AC, Langenecker SA, Benight CC, Pyne JM, Harris JI, Usset TJ, Maguen S, Griffin BJ. Moral injury and psychosocial functioning in health care workers during the COVID-19 pandemic. Psychol Serv. 2023 Feb;20(1):19-29. doi: 10.1037/ser0000718. Epub 2022 Nov 10.
PubMed 36355661Ehman AC, Smith AJ, Wright H, Langenecker SA, Benight CC, Maguen S, Pyne JM, Harris JI, Cooney N, Griffin BJ. Exposure to potentially morally injurious events and mental health outcomes among frontline workers affected by the coronavirus pandemic. Psychol Trauma. 2023 Mar;15(3):524-535. doi: 10.1037/tra0001345. Epub 2022 Aug 4.
PubMed 35925697Hines SE, Chin KH, Glick DR, Wickwire EM. Trends in Moral Injury, Distress, and Resilience Factors among Healthcare Workers at the Beginning of the COVID-19 Pandemic. Int J Environ Res Public Health. 2021 Jan 9;18(2):488. doi: 10.3390/ijerph18020488.
PubMed 33435300Papazoglou K, Chopko B. The Role of Moral Suffering (Moral Distress and Moral Injury) in Police Compassion Fatigue and PTSD: An Unexplored Topic. Front Psychol. 2017 Nov 15;8:1999. doi: 10.3389/fpsyg.2017.01999. eCollection 2017. No abstract available.
PubMed 29187830Maguen S, Litz BT. Moral Injury in Veterans of War. PTSD Research Quarterly (RQ). 2012;23(1):1-3.
Gibbons SW, Shafer M, Hickling EJ, Ramsey G. How do deployed health care providers experience moral injury? Narrat Inq Bioeth. 2013 Winter;3(3):247-59. doi: 10.1353/nib.2013.0055.
PubMed 24407133