'I don't really know where I stand because I don't know if I took something away from her': Moral injury in South African speech-language therapists and audiologists due to patient death and dying.
Nabeelah Nagdee, Victor Manuel de Andrade
PMID 35925001WHAT IT FOUND
South African speech therapists and audiologists reported helplessness, guilt and anger when patients died, often blaming themselves for ethical choices.
They managed these feelings through religious practice, self-reflection and team support, but requested better training and guidelines for end-of-life care.
Key findings
01Participants experienced moral injury characterized by helplessness, guilt and anger when patients died, often questioning if they had met professional standards or acted ethically.
02Coping mechanisms included religious practices, self-reflection and support from allied health teams, but participants specifically requested more professional education and clear ethical guidelines for end-of-life care.
03Anger was directed at other healthcare professionals and religious leaders whose approaches to terminally ill patients conflicted with the participants' values, as well as at a Higher Power.
STILL TO COME
How it was doneWhat they foundWhat it means for SLPs
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What it does not show
The study is qualitative and descriptive; it does not measure the effectiveness of the coping strategies reported. All participants were female, which limits generalizability to male clinicians. The study was conducted only in South Africa, so cultural and professional contexts may differ significantly elsewhere. Participants were self-selected via professional associations and snowball sampling, which may bias the sample towards those more willing to discuss death.
Declared interests
The authors declare no conflicts of interest.
The easy way to misread this
Do not interpret the reported coping mechanisms as evidence-based interventions that will reduce moral injury. The study describes what clinicians did, not what worked best. Additionally, the findings are specific to South African SLTs and audiologists; do not assume these emotional responses or coping needs apply directly to other disciplines or countries without further research.