Moral Injury Among Professionals in K-12 Education: A ...

Moral Injury Among Professionals in K-12 Education:

A Mixed Methods Inquiry

A Dissertation

SUBMITTED TO THE FACULTY OF THE

UNIVERSITY OF MINNESOTA

BY

Erin P. Sugrue

IN PARTIAL FULFILLMENT OF THE REQUIREMENTS

FOR THE DEGREE OF

DOCTOR OF PHILOSOPHY

Adviser: Lynette Renner, PhD

June 2018

i

Acknowledgements

I would like to thank my adviser, Dr. Lynette Renner, for her thoughtful guidance

and patient feedback throughout my dissertation process. I would like to thank the other

members of my committee from the School of Social Work, Drs. Liz Lightfoot and Amy

Krentzman, for their generosity with their time, interest, and support. I want to thank my

committee member, Dr. Mark Vagle, from the Department of Curriculum and Instruction,

for introducing me to, and coaching me through, a post-intentional phenomenological

approach to research. I am also grateful for Dr. Vagle’s help in teaching me to “think

with theory,” and expand my writing beyond the descriptive. I am grateful for Dr.

Wendy Haight for introducing me to the construct of moral injury and giving me the

opportunity to study this construct in the context of child protection. My work with Dr.

Haight provided me a strong foundation from which to launch my own research in this

area.

I want to thank the education professionals who gave generously of their time and

their emotional energy to share their most challenging and morally troubling professional

experiences. I am grateful for their desire for social justice, their passion for their work,

and their dedication to their students and communities.

Finally, I want to thank my family and friends for their unending love,

encouragement, and support during this process, especially my children, Kathlyn and

Patrick, and my husband Tom.

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Abstract

This dissertation presents an explanatory sequential mixed methods study of moral injury

among professionals in K-12 public education. Moral injury refers to the lasting

psychological and existential harm that occurs when an individual engages in or

witnesses acts that violate deeply held moral beliefs and expectations. Two hundred

eighteen licensed K-12 professionals in one urban school district in the Midwest

completed an on-line survey that included measures of moral injury and emotional and

behavioral correlates. The K-12 professionals exhibited levels of moral injury similar to

those experienced by military veterans, and those working in high-poverty, racially

segregated schools were significantly more likely to endorse experiences of moral injury.

Based on these findings, 21 professionals who had demonstrated high levels of moral

injury during the quantitative portion of the study were invited to participate in individual

interviews about their experiences. Using a post-intentional phenomenological approach,

and informed by Critical Race Theory and Intersectionality Theory, the analysis

demonstrates how structures and processes of race and class oppression produce an

education context that is rife with moral wrongs and accompanying distress.

Recommendations are made for how the construct of moral injury can be employed to

work towards eliminating educational injustice.

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Table of Contents

List of Tables vi

List of Figures vii

Chapter 1: Introduction 1

Literature Review 3

Morals 3

Morality in the Context of Education 5

Moral Injury 9

Theoretical Foundations of the Dissertation 10

Theoretical Framework – Quantitative Inquiry 10

Theoretical Perspectives – Qualitative Inquiry 13

Research Questions 15

Methods 17

Population & Sample 17

Measures & Data Collection 19

Analysis 20

Overview of Three Papers 21

Chapter 2: Paper 1 24

Synopsis 25

Introduction 26

The Constructs 28

Moral Injury 28

Moral Distress 32

Demoralization 37

Discussion 40

Conceptual Similarities 40

Conceptual Differences 42

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Emerging Conceptual Convergence 43

Conclusion & Implications 46


Synopsis 52

Introduction 53

Background 55

Morals 55

Morality in the Context of Education 56

Working Conceptual Model of Moral Injury 57

The Current Study 58


Methods 59

Data Source & Sample 59

Measures 60

Data Analysis 65

Results 67

Extent of Moral Injury 67

Characteristics Associated with Moral Injury 68

Symptoms Associated with Moral Injury 69

Discussion 70

Tables 79


Synopsis 87

Introduction 88

Background 89

Morality in the K-12 Education Context 89

Moral Injury 91

The Current Study 92

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Guiding Theoretical Perspectives 92

Critical Race Theory 93

Intersectionality Theory 95

Methodology 96

Participants 96

Phenomenological Material 98

Post-Reflexivity 100

Analysis 102

Results & Discussion 103

The Trauma of Racism & Poverty 103

Morally Injurious Practices at the Intersection of Race & Class 107

“Colonizing the Natives” 107

Restorative Justice as a Buzzword 110

Don’t Look Under the Hood 115

The Fine Line Between Empathy & Pity 120

Conclusion 125

Tables 127

Chapter 5: Conclusion 129

Major Findings 129

Limitations 130

Implications 134

Bibliography 144

Methodological Appendix 164

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List of Tables

Table 1 – Paper 1: Comparison of Constructs 48

Table 1 – Paper 2: Demographics 78

Table 2 – Paper 2: Regression Analyses – Transgressions-Other 80

Table 3 – Paper 2: Regression Analyses – Transgressions-Self 81

Table 4 – Paper 2: Regression Analyses – Betrayal 82

Table 5 – Paper 2: Descriptive Statistics – Guilt, Troubled 83

Conscience, Burnout, & Intention to Leave a Job

Table 6 – Paper 2: Correlations 84

Table 1 – Paper 3: Demographics 126

Table 1 – Appendix: Mixed Level vs. Single Level – Methodological Appendix

Transgressions-Other


Transgressions-Self


Betrayal

Table 4 – Appendix: Variance Estimates Attributed Methodological Appendix

To School-Level Clustering Effect

vii

List of Figures

Figure 1 – Working Conceptual Model of Moral Injury - 12

Litz et al., 2012

Figure 2 – Conceptual Model of Moral Injury Among Professionals 13

In K-12 Education

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Chapter 1: Introduction

Over the past decade, a topic that has gained increasing interest across the fields

of psychology, social work, religious studies, and philosophy is “moral injury.”

Originally coined by clinicians working with American military veterans (Litz et al.,

2009; Shay, 1994), moral injury refers to the a lasting emotional, psychological, and

existential harm that occurs when an individual “perpetrates, fails to prevent, bears

witness to, or learns about acts that transgress deeply held moral beliefs and

expectations” (Litz et al., 2009, p. 700). Symptoms of moral injury include guilt, shame,

anxiety, depression, and anger (Dombo, Gray, & Early, 2013; Jinkerson, 2016; Litz et al.,

2009) and can lead to a loss of trust in oneself or others, existential dread, and deep

demoralization (Jinkerson, 2016).

Although its conceptual roots are in the military context, moral injury has been

explored among other populations, including refugees (Nickerson et al., 2015), teachers

in violent areas of El Salvador (Currier, Holland, Rojas-Flores, Herrera, & Foy, 2015b),

women with substance abuse histories (Hartman, 2015), women who are homeless (Otte,

2015), parents and professionals involved in the Child Protection System (Haight,

Sugrue, Calhoun, & Black, 2017a; Haight, Sugrue, & Calhoun, 2017b; Haight, Sugrue,

Calhoun, & Black, 2017c) and social workers in the criminal justice system (Fenton &

Kelly, 2017).

One morally significant context in which moral injury has yet to be empirically

explored is the American K-12 public education. Keefe-Perry (2016) and Levinson

(2015) have proposed the relevance of moral injury to the American public education

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context, due to the morally complex and high-stakes natures of the settings in which

educators work and the ethically challenging actions they are often required to take.

Specifically, Levinson (2015) has argued that educators are frequently faced with

situations in which they “have the obligation to enact justice, but . . . have to take action

under conditions in which no just action is possible” (p. 206). This inability to act justly

is a type of moral transgression, which results in moral injury (Levinson, 2015; Litz et al.,

2009). Keefe-Perry (2016) has hypothesized that moral injury may be widespread among

public school teachers in the U.S. in the age of high-stakes testing, widening racial and

economic achievement gaps, and zero-tolerance discipline policies, in which teachers are

faced with “a daily struggle between a desire to feel like you are part of a system that

produces good in the world and piercing evidence to the contrary” (p. 7).

The purpose of this dissertation is to explore moral injury among professionals1 in

K-12 education. In addition to psychological distress, moral injury may result in a

decrease in compassion (Haight et al., 2017c; Keefe-Perry, 2016), normalizing of

problematic behavior and unethical decisions (Dudzinski, 2016; Webster & Baylis,

2000), burnout (Currier et al., 2015b), and eventual exit from the profession (Keefe-

Perry, 2016; Levinson, 2015). These outcomes could lead to significant negative

consequences not only for individual educators, but particularly for students and families.

More importantly, the presence of moral injury among educators could signal that aspects

1The term “professionals” is used to refer to all professionally licensed non-administrative staff who have

direct contact with students, including teachers, school social workers, school psychologists, speech

pathologists, occupational therapists, and school nurses.

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of the education system are unjust and immoral. Boudreau (2011) and Levinson (2015)

have argued that moral injury is not an individual psychological issue, but rather a social

problem, reflecting a betrayal of society’s morals and values. If educators experience

moral injury due to their moral transgressions, not only are they culpable in violating

their moral beliefs, but so are we as a society by creating situations in which those

transgressions occur (Levinson, 2015). Thus, if we believe in the need for a just and

moral education system, we have a responsibility to identify and understand potential

sources of moral injury in order to enact the systemic changes needed to prevent them.

Literature Review

The review of the literature begins with a discussion of the constructs of morals,

ethics, and values, followed by an overview of the literature on morality within the field

of education, and finishes with a discussion of current conceptualizations of moral injury.

Morals

The terms morals and ethics are often used interchangeably, colloquially and in

philosophical literature (Crisp, 1998; Sheraton, 2012), to refer to systems of values and

beliefs about “rightness and wrongness, guilt and shame, and so on” (Crisp, 1998, no

page). However, some modern academic philosophers have attempted to draw a subtle

distinction between ethics, which is considered the broad subject area concerning “the

systems of value and custom instantiated in the lives of particular groups” of individuals,

and morality, which is a “distinct sphere” (Skorupski, 1998, no page) within the domain

of ethics concerning “normative thinking about action and feeling” (Skorupski, 1998, no

page). Sheraton (2012) has described ethics as representing “innate knowledge of right

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and wrong” (no page) that transcends “culture, religion, and time” (no page) and morals

as “culturally and/or religiously based distinctions of right and wrong” (no page).

Philosophers have been discussing and debating morals and ethics since ancient Greece,

but modern moral philosophy has generally been focused on the question of “what kind

of actions ought we to perform?”—the answer to which is “those which will cause more

good to exist in the universe than any possible kind of alternative” (McIntyre, 1998, p.

249).

Within philosophy, morality tends to be discussed descriptively, when referring to

“codes of conduct put forward by a society or a group (such as a religion), or accepted by

an individual for her own behavior” (Gert & Gert, 2016, no page), and normatively, when

discussing “a code of conduct that, given specified conditions, would be put forward by

all rational persons” (Gert & Gert, 2016). Skorupski (1998) has argued that morality can

be defined in terms of either its function, supremacy, or sentiment. For example,

morality can be defined as a set of beliefs and values whose function is to promote human

well-being, cooperation, and mutual advancement (Skorupski, 1998). Morality can also

be defined as a set of values, beliefs, and guidelines that are considered to have

supremacy over all other influences when making decisions. It is this claim to supremacy

that makes morality distinct “in relation to other deliberative conclusions” (Skorupski,

1998, no page). Additionally, morality can also be characterized in terms of the

sentiments, specifically guilt and shame, that are experienced by and towards those who

do not follow its guidelines (Skorupski, 1998). That is to say, an action can be

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considered moral if guilt and shame are appropriate sentiments directed at or experienced

by those who do not take the action.

The French sociologist, Emile Durkheim, argued that moral concepts and rules

are socially and historically constructed, and thus can vary significantly over time and

from one society to the next (Carls, n.d.). Echoing Durkheim, philosopher Alasdair

McIntyre (1998), in his seminal book, A Short History of Ethics, asserted that morality is

not a static, ahistorical concept. Rather, moral concepts “are embodied in and are

partially constitutive of forms of social life,” (McIntyre, 1998, p. 1) that change not

because social life changes but “as social life changes” (p. 1). According to Durkheim,

morality is a wholly social phenomenon and thus it exists only when individuals identify

as members of a social group (Carls, n.d.). The social nature of morality means that each

individual “has to choose both with whom we wish to be morally bound and by what

ends, rules, and virtues we wish to be guided” (McIntyre, 1998, p. 268).

Although he stressed the social construction of morality, Durkheim also noted the

important role of the individual in representing and interpreting the morality of the group

(Carls, n.d.). According to Durkheim, there is a morality of the group that exists outside

of the individual, but there is also the individual’s way of expressing this morality (Carls,

n.d.). Although society creates pressure on individuals to follow established moral rules,

individuals still retain their own unique moral consciences and add aspects of their own

personalities to the moral codes of society (Carls, n.d.).

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Morality in the Context of Education

Although discussions of morals and morality have been traditionally absent from

modern American teacher preparation programs, perhaps due to concerns about their

affiliation with religious or spiritual beliefs (Buzzelli & Johnston, 2002; Hansen, 2001),

several scholars have written on the inherent moral dimensions of teaching and education

over the past 30 years (e.g. Buzzelli & Johnston, 2002; Campbell, 2008; Clark, 1990;

Goodlad, 1990; Hansen, 2001; Huebner, 1996; Pring, 2001). Buzzelli & Johnston (2002)

have asserted that two core aspects of teaching render it moral in nature. First, all

teaching involves human relationships and interactions, which are inherently moral. As

echoed by Fenstermacher (1990), “what makes teaching a moral endeavor is that it is,

quite centrally, human action undertaken in regard to other human beings. Thus, matters

of what is fair, right, just, and virtuous are always present” (p. 133). Second, teaching

consists of influencing or changing the behavior of others to meet a prescribed, normative

goal (Buzzelli & Johnston, 2002).). As Buzzelli & Johnston (2002) argued, “making

decisions about what others should know and should become – these are based on

questions of value and worth, making them moral judgements” (p. 9). The mere

existence of a public education system is a reflection of morals, as it suggests a cultural

belief that individuals’ lives and society as a whole will be better off if its citizens are

educated (Fenstermacher, 1990; Hansen, 2001).

Education as both a practice and a context is morally complex (Buzzelli &

Johnston, 2002; Campbell, 2008; Levinson, 2015). Educators are constantly faced with

moral interactions and dilemmas. Fenstermarcher (1990) has argued, “Nearly everything

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a teacher does while in contact with students carries moral weight. Every response to a

question, every assignment handed out, every discussion on issues, every resolution of a

dispute, every grade given to a student carries with it the moral character of the teacher”

(p. 134). Buzzelli & Johnston (2002) expressed a similar belief when they stated that in

teaching, even the smallest of actions, “the fleeting moments of a look, a facial

expression, a response to a question, or an offhand comment” (p. 14) may carry moral

meaning.

Moral dilemmas facing educators range from specific issues involving individual

students, such as whether or not to keep a child in from recess for failing to do his

homework even though the teacher believes that recess is important for the well-being of

students, or whether or not to send a student to the principal’s office for their

disrespectful behavior, when doing so will further damage the relationship between the

student and teacher and result in the student’s falling farther behind in the class; to

deeper, global conflicts regarding their position of power and moral responsibility (Clark,

1990; Goodlad, 1990). Clark (1990) pointed out that “teaching is a fundamentally moral

enterprise, in which adults ask and require children to change in directions chosen by the

adults” (p. 264). Awareness of this reality can cause teachers to ask, “By what authority

do I push for changes in the lives of these children? At what costs to freedom and

autonomy?” (Clark, 1990, p. 264). Other elements that are central to the education

context, such as evaluation, assessment, and the physical control of student bodies in

school, are laden with moral meaning and can be sources of difficult moral dilemmas for

educators (Buzzelli& Johnston, 2002).

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In recent decades, a hyper focus on the technical aspects of teaching have resulted

in less discussion of the moral implications of individual acts and of the moral

underpinnings of the education system itself (Hansen, 2001; Huebner, 1996). The lack of

language around morality in education can lead to teachers becoming blind to the moral

implications of their actions; while at the same time, the increasingly high value and high

stakes associated with the technical aspects of teaching can contribute to “the temptation

to employ morally unjustifiable means (for example, humiliation, segregation, violence)

to achieve desired ends (for example, order, obedience, compliance)” (Clark, 1990, p.

264). The ubiquity of moral dilemmas in education requires that educators be attentive to

the moral nature of their work in order to find solutions that are meaningful and just.

(Buzzelli & Johnston, 2002). Buzzelli & Johnston (2002) have referred to this awareness

of the moral significance of one’s work as “moral sensibility” and have stressed the

importance of educators cultivating this awareness in order to lead to moral action.

Levinson (2015) has argued that moral sensibility will not lead to just and

appropriate solutions to educational dilemmas because the nature of the political,

economic, and social constraints in which the education system exists (and which it also

reproduces), place educators in situations in which they are obligated to enact moral

justice but in which no just action is possible. Levinson (2015) has asserted that despite

their obligations, their awareness, and in many cases their best intentions, educators are

perpetrating moral wrongs. She has rejected a philosophical argument that “unavoidable

action which infringes on others’ rights is regrettable” (p. 207) and results in “moral

residue” (p. 207) and instead characterized these actions as resulting in moral injury “in

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order to emphasize that moral wrongs are being committed in an ongoing fashion” (p.

207, emphasis original). In the next section, I present a more detailed discussion of moral

injury and its related constructs.

Moral Injury

The most commonly cited conceptual model of moral injury is that proposed by

Litz and colleagues (2009), in which moral injury is conceived of as a psychological

injury that results from deeply troubling cognitive dissonance between an individual’s

internal moral code and the actions that he or she engaged in or witnessed. When

attempting to resolve this cognitive dissonance, someone prone to moral injury makes

attributions that are global (i.e. not dependent on the specific context), internal (i.e. a

personality flaw), and stable (i.e. enduring), which results in lasting feelings of guilt and

shame (Litz et al., 2009). As time goes on, morally injured individuals begin to view not

only their actions but themselves as unforgiveable (Litz et al., 2009). These feelings of

self-condemnation lead them to engage in self-harming, isolating, numbing, or avoidance

behaviors, which serve to reinforce their beliefs about themselves as immoral and

unforgiveable (Litz et al., 2009).

Whereas Litz and colleagues’ (2009) conceptual model focused on the cognitive

appraisals that morally injured individuals make about their own moral worth and

identity, other researchers and scholars have proposed that the most significant impact of

moral injury is the impact it has on an individual’s belief in a just and moral world

(Dombo et al., 2013; Drescher et al., 2011; McDonald, 2017). In her article, Haunted by

a Different Ghost: Re-thinking Moral Injury, the philosopher MaryCatherine McDonald

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argued that when individuals are morally injured, they are not only troubled by what they

have done or have failed to do, “but also by the specter of a world without morals” (p. 3).

It is this “global loss,” (McDonald, 2017, p. 3), or what Currier and colleagues (2015b)

have referred to as a “breakdown in global meaning” (p. 26), that must be at the core of

conceptualizations and interventions for moral injury.

Theoretical Foundations of the Dissertation

This dissertation, a mixed methods study comprised of an analysis of conceptual

understandings of the impacts of moral transgressions, a cross-sectional quantitative

exploration of moral injury among K-12 education professionals, and a

phenomenological inquiry into how moral injury takes shape in the context of racial and

economically segregated schools, is guided by multiple theoretical frameworks. The

theoretical models guiding the quantitative and qualitative portions of the study are

explained below.

Theoretical Framework – Quantitative Inquiry

The quantitative portion of the study is primarily guided by Litz and colleagues’

(2009) working conceptual model of moral injury. This model, as described in the

previous section, is a social cognitive model, influenced by social cognitive models of

trauma and posttraumatic recovery (e.g. Benight & Bandura, 2004) and social cognitive

theories of moral thought and action (Bandura, 1991). As illustrated in Figure 1, in this

social cognitive model of moral injury, an individual perpetrates or witnesses a moral

transgression, this results in cognitive dissonance between their beliefs and the act. If, in

an attempt to resolve this cognitive dissonance, the individual makes stable, internal, and

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global attributions, they will feel shame, guilt, and anxiety. These feelings lead the

individual to socially withdraw, limiting their ability to engage in reparative experiences,

and instead resulting in them engaging in self-condemnation. This self-condemnation

leads to numbing, avoidance, and/or self-harming behaviors, which feed back into the

sense of self-condemnation and their global, internal, and stable attributions.

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Figure 1. Litz and colleagues’ (2009) working conceptual model of moral injury.

Transgression Cognitive

Dissonance Global, Internal,

Stable Attributions

Shame, guilt,

anxiety Withdrawal

Failure to

forgive, self-

condemnation

Avoidance;

Numbness

Self-harming;

demoralization

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This study is guided by a more simplified version of Litz and colleagues’ (2009)

model of moral injury. The model used in this study (see Figure 2) is focused less on the

cognitive processes involved in constructing and maintaining moral injury and more on

the contextual factors that produce moral injury and its accompanying emotional, social,

and behavioral symptoms. This model proposes that there are certain characteristics of

individual educators as well as characteristics of the schools in which they work that

influence the likelihood of experiencing moral injury. Additionally, those who

experience moral injury will report certain emotional, social, and behavioral symptoms

that they view as stemming from their morally injurious experiences.

Figure 2. Conceptual model of moral injury among professionals in K-12 education.

Theoretical Perspectives – Qualitative Inquiry

Post-intentional phenomenology. Post-intentional phenomenology is both a

theoretical framework and a methodology (Vagle, 2018). Thus, as my qualitative study

uses a post-intentional phenomenological approach, it is naturally guided by its

philosophical and theoretical underpinnings. Post-intentional phenomenology views all

knowledge as “partial, situated, endlessly deferred, and circulating through relations”

(Vagle, 2018, p. 126). Studying phenomena through a post-intentional lens does not

Individual &

School Level

Factors

Moral Injury

Moral Injury Emotional, Social,

& Behavioral

Symptoms

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involve an attempt to understand one “true essence” of a phenomenon, but rather to

capture the various productions and provocations (Vagle, 2018) of a phenomenon as it is

constantly being constructed, deconstructed, and moving through time and contexts. By

approaching the qualitative portion of this study from a post-intentional

phenomenological perspective, I am freed from trying to name a constant, static

conceptualization of moral injury in the U.S. K-12 education context, and instead am able

to explore multiple manifestations of the phenomenon as they interact and intersect with

the participants and with the larger social context.

Phenomenological perspective on moral injury (McDonald, 2017).

Approaching the qualitative portion of the study from a post-intentional

phenomenological framework, I was drawn to move beyond Litz and colleagues’ (2009)

social cognitive model of moral injury and consider McDonald’s (2017)

phenomenologically informed conceptual model. McDonald (2017) has argued that

social-cognitive theoretical models of moral injury (i.e. Litz et al., 2009; Shay, 2014)

assume that the core of moral injury can be understood as the persistent guilt, shame, and

accompanying dysfunctional behaviors that occur in response to specific acts that one has

done (or failed to do). In contrast, McDonald (2017) has proposed that moral injury has

less to do with the feelings related to specific moral transgressions and more to do with

how these experiences have “thrown the meaning of morality into question” (p. 6).

Instead of being haunted by their individual actions, morally injured individuals “may be

haunted by the idea that morals are arbitrary social constructs and not metaphysical

truths” (McDonald, 2017, p. 6). Citing the phenomenologist Maurice Merleau-Ponty’s

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work on the entanglement of perception and meaning, McDonald (2017) has called for an

approach to studying moral injury that moves beyond the internal cognitive processes of

the individual and to the “perceptual world at large” (p. 8). The experience of moral

injury may result in deep feelings of guilt, but it is how the experience alters an

individual’s way of perceiving, interacting, and drawing meaning from the world that is

of greatest significance.

Critical Race Theory & Intersectionality Theory. Post-intentional

phenomenology (Vagle, 2018) and McDonald’s (2017) phenomenological model of

moral injury are the overriding theoretical frameworks that have shaped my approach to

both the methods and analysis in the qualitative portion of this study. Additionally,

because the qualitative portion of this study was partially developed from the analysis of

the quantitative data, additional theories emerged from the quantitative analysis that I

used to guide my qualitative analysis. As will be discussed later in the quantitative paper

portion of this dissertation, the quantitative results suggest a significant role for the racial

and economic make-up of schools in professionals’ experiences of moral injury. Thus, in

the qualitative study I utilize Critical Race Theory (CRT) and intersectionality theory to

guide my interpretations of the qualitative data and help further explain the quantitative

findings. An overview of CRT and intersectionality theory and how they are used to

inform the phenomenological analysis is presented in Paper 3.

Research Questions

The following three questions are addressed in the quantitative portion of this

study:

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1) To what extent do professionals in K-12 public education experience moral injury

in their workplace?

2) What individual (e.g., race, age, gender, years of experience teaching) or school-

level characteristics (e.g., racial and economic make-up of the student body, type

of school) are associated with professionals in K-12 education experiencing moral

injury?

3)  What emotional, social, and behavioral factors are associated with experiences of

moral injury among professionals in K-12 public education?

The qualitative portion of this study was initially designed to answer the following

question:

4) How does moral injury take shape within the context of segregated public schools

with high percentages of low-income students of color?

However, since this study uses an explanatory mixed methods design (Creswell, 2014),

the focus of the qualitative portion of the study was refined in part by the results of the

quantitative analysis. In addition to the question stated above, which is broad in nature

and captures the phenomenological approach that is used in the qualitative portion of the

study, an additional, more specific question arose from the quantitative analysis:

5) How does the context of racially and economically segregated and marginalized

public schools produce moral injury among K-12 professionals?

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Methods

In this study, I employed an explanatory sequential mixed methods design

(Creswell, 2014), in which the quantitative data were collected and analyzed first,

followed by the qualitative data. I then used the results of the qualitative analysis to

explain the quantitative findings. Additionally, the results of the quantitative data were

used to determine the sample for the qualitative portion (this will be further explained in

the discussion of sampling below). The quantitative portion of the study used a cross-

sectional survey design. The qualitative portion employed a post-intentional

phenomenological approach (Vagle, 2018).

I chose a mixed methods design for the purpose of complementarity (Greene,

2007). As moral injury is an emerging construct that has never been empirically studied

in the context of the U.S. K-12 education system, a mixed methods design can produce a

deeper and more comprehensive understanding. The quantitative portion of the study

provides information on the applicability and extent of moral injury within the K-12

context, while the qualitative portion allows for an understanding of the meaning of

moral injury in this setting.

Population and Sampling

Samples for this study were drawn from the population of licensed non-

administrative professionals2 in one urban school district in the Midwest (N = 3,169). I

2 Licensed non-administrative K-12 education professionals included the following: general education

teachers, special education teachers, English Language Learner teachers, teachers on special assignment,

school psychologists, school social workers, school counselors, speech-language pathologists, occupational

therapists, physical therapists, and licensed school nurses.

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chose this district because of its size and its diversity of schools in terms of number of

students, grade levels, and racial and economic make-up. Email addresses for all

professionals in the district were available publicly through the district’s website,

allowing for the creation of a distribution list without having to coordinate with or gain

permission from the school district’s research department. I received approval from the

University of Minnesota’s Institutional Review Board under exempt status.

I developed a web-based survey for distribution using Qualtrics (Qualtrics, 2017).

Prior to beginning the study, I piloted the survey with six former educators who are

currently doctoral students in the University of Minnesota’s Department of Curriculum

and Instruction. Feedback from the pilot regarding comprehension and ease of survey

was positive and resulted in no changes being made.

Quantitative sample. A link to the survey was sent via email to the 3,169

licensed non-administrative professionals on May 17, 2017. The survey remained open

for six weeks, and weekly reminder emails were sent out. The survey was estimated to

take approximately 15-20 minutes to complete, and a consent form was included at the

beginning of the survey. At the end of the survey, participants had the option of entering

their name for inclusion in a drawing for one of two $50 gift cards. At the close of the

survey, 553 participants had initiated responses. Upon review, 318 respondents were

eliminated from the sample due to substantial missing data. Seventeen respondents

provided complete data but failed to sign the consent form and could not be included in

the study. The final sample consisted of 218 respondents (see Table 1 in Paper 2 for

detailed information on the sample). Although the response rate was low (7%), the

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resulting sample closely resembled the demographics of the population of licensed non-

administrative professionals in the district.

Qualitative sample. The purpose of the qualitative portion of the study was to

gain a deeper understanding of the meaning of moral injury in the K-12 education

context. Thus, a sample was drawn from the highest scoring participants on the measure

of moral injury, the Moral Injury Events Scale (MIES) (Nash et al., 2013), in the

quantitative survey. The sampling frame included all participants who scored a 5 or

higher (on a 6-point Likert scale) on at least two of the three factors of the MIES and who

had consented in the on-line survey to be contacted by the researcher at a future date (N =

36). Initial email invitations were sent to all 36 professionals on July 25, 2017, inviting

them to participate in a 60-90 minute individual interview to discuss their responses to

the survey. Of the 36 participants contacted, interviews were scheduled and completed

with 21 participants between July and October 2017 (see Table 1 in Paper 3 for detailed

demographics of the sample).

Measures and Data Collection

The measures used in this study included five standardized quantitative measures,

a demographic form, and a phenomenological interview. The standardized measures

were the Moral Injury Events Scale (MIES; Nash et al., 2013), the Trauma-Related Guilt

Inventory (TRGI; Kubany et al., 1996), the Stress of Conscience Questionnaire (SCQ;

Glasberg, Eriksson, & Norberg, 2006), the Copenhagen Burnout Inventory (CBI;

Kristensen, Borritz, Villadsen, & Christensen, 2005), and the Intention to Leave Scale

(ILS; Rosin &Korabik, 1991). Each of the standardized measures is fully explained in

20

Paper 2. Copies of each scale, a description of the demographic information collected,

and a discussion of the phenomenological interview process can be found in the

Methodological Appendix.

Analysis

As this study used an explanatory sequential mixed methods design (Creswell,

2014), the quantitative data were collected and analyzed first. The results of the

quantitative analysis shaped the selection of the qualitative sample and informed the

focus of the qualitative analysis. Quantitative data were analyzed using SPSS v24

software (IBM Corp., 2016) to perform descriptive, correlational, and regression

analyses. Qualitative analysis was guided by Vagle’s (2018) approach to post-intentional

phenomenological analysis and Jackson and Mazzei’s (2012) approach to thinking with

theory. Expanded discussions of the quantitative and qualitative analysis processes are

located in Paper 2, Paper 3, and in the Methodological Appendix.

Following Creswell’s (2014) procedures for explanatory sequential mixed

methods analysis and interpretation, in addition to independently and sequentially

analyzing the quantitative data, followed by the qualitative data, I “mixed” my analyses

by using conclusions drawn from the qualitative data to aid in explaining and expanding

on the quantitative findings. Specifically, the qualitative findings were used to provide a

greater understanding of the role that the race and class characteristics of a school’s

student body influenced K-12 education professionals’ experiences of moral injury.

21

The Three Papers

Paper 1 – Understanding the Impact of Moral Transgressions in the Helping

Professions: In Search of Conceptual Clarity

The first paper in this dissertation is an exploration of the extent that constructs

related to moral transgressions and their associated psychological, emotional, and social

impacts overlap and diverge to describe similar and/or distinct phenomena. Although the

central construct in this dissertation is moral injury, it is not the only construct that has

been proposed to represent the impact of moral transgressions on individuals’

psychological, emotional, and spiritual well-being. Other constructs, such as moral

distress (Jameton, 1984, 1993) and demoralization (Gabel 2011, 2012, 2013; Santoro,

2011), have been conceptualized and empirically studied in a variety of health care and

social science disciplines. Prior to beginning a mixed methods study using moral injury

as the guiding central construct, it was important to gain some clarity as to how moral

injury relates to similar constructs. This first paper begins with a literature review of

moral injury, moral distress, and demoralization, including a discussion of psychometric

measures associated with each construct, and then follows with an analysis of areas of

similarity, divergence, and emerging conceptual convergence. The paper ends with

recommendations for future research and conceptual refinement.

Paper 2 –Moral Injury Among Professionals in K-12 Education: An Exploratory

Quantitative Assessment

After the conceptual exploration of moral injury and related constructs in the first

paper, the second paper in this dissertation presents the quantitative portion of the mixed

22

methods study. This study examines the extent to which professionals in K-12 public

education experience moral injury, the individual- and school-level characteristics that

are associated with their experiences of moral injury, and the accompanying emotional,

social, and behavioral symptoms. An on-line survey that included measures of moral

injury and emotional and behavioral correlates was sent to all licensed non-administrative

K-12 education professionals in one urban public school district in the Midwest (N =

3,169). After six weeks, at the time of the survey’s closure, 218 surveys were deemed

complete enough for inclusion in the analysis. The K-12 professionals in the sample

exhibited levels of moral injury similar to those experienced by military veterans and

child protection professionals in previous studies.

Experiences of moral injury were associated with feelings of guilt, troubled

conscience, burnout, and the intention to leave one’s job. Some results demonstrated a

relationship between gender and moral injury, with women being more likely to endorse

experiences of moral injury and the professional’s role in school and moral injury, and

with mental health professionals being most likely to report being troubled by others’

immoral actions. However, the most significant and notable finding was in regard to the

relationship between the racial and economic make-up of a school’s student body and

professionals’ experiences of moral injury. Regression analyses demonstrated that

professionals working in schools with high numbers of students of color and students

receiving free or reduced lunch were significantly more likely to endorse experiences of

moral injury. These findings reinforce the significance of the intersectionality of race and

class in reproducing oppressive and immoral educational practices and outcomes.

23

Although this study provides insight into the extent of moral injury and correlated factors,

more information is needed to understand the nature of the sources of moral injury for K-

12 professionals, particularly as it relates to the racial and economic make-up of schools.

Paper 3 – Moral Injury in Racially & Economically Marginalized Public Schools: A

Phenomenological Inquiry

The third paper picks up where the second paper left off by more deeply exploring

how moral injury takes shape within the context of racially and economically isolated and

marginalized urban schools. Using a post-intentional phenomenological design, this

study identifies how racism and classism, and the intersection of these oppressive forces,

permeate schools with high percentages of low-income students of color and produce an

education context that is rife with moral wrongs and accompanying distress. Within this

context of injustice, specific racialized and classed educational practices including harsh

discipline practices that sanction and control the bodies of students, low expectations and

attitudes of pity that masquerade as attempts at equity, dishonest data reporting that

disguises student struggles, and the denial of educational rights for students without

claims or access to Whiteness, produced moral injury among professionals.

The paper concludes with a discussion on the utility of moral injury in the

education context as a tool for identifying and understanding injustice.

Recommendations are made for future research to examine how the identified practices

and structures that produce moral injury can be mitigated or eliminated.

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Chapter 2

Paper 1

Understanding the Impact of Moral Transgressions in the Helping Professions:

In Search of Conceptual Clarity

25

Synopsis

A vast academic literature exists on the moral dimensions and ethical dilemmas of

what are commonly referred to as the “helping professions,” (e.g. nursing, medicine,

social work, counseling, teaching, etc.). Over the past several decades, increasing

attention has been paid to the issue of moral transgressions perpetrated, witnessed, or

experienced by these professionals and their accompanying psychological and social

outcomes. As scholars have sought to understand moral transgressions and their impacts,

a variety of constructs have been proposed and examined, including moral distress

(Jameton, 1984, 1993), demoralization (Gabel 2011, 2012, 2013; Santoro, 2011), and

moral injury (Litz et al., 2009; Shay, 1994, 2014). The purpose of this paper is to

determine to what extent constructs related to moral transgressions and their associated

psychological, emotional, and social impacts overlap and diverge to describe similar

and/or distinct phenomena. Understanding the moral dimensions of the helping

professions is critical for effective research and just and ethical practice. Sources of

moral violations, their sequelae, and their impact on practice contexts are especially

important.

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Introduction

Professions that are geared towards caring for and aiding the physical, mental,

emotional, or spiritual well-being of others, including teaching, social work, counseling,

nursing, medicine, and ministry, are commonly referred to as the “helping professions”

(Esterson, 1982; Hawkins, Shohet, Ryde, & Wilmot, 2012). The term “helping” suggests

a core value of altruism shared across the different specialized professions. Skorupski

(1998) has defined morality as “that set of convictions whose function is to promote

human flourishing, to enable us to live together on terms of mutually beneficial

cooperation” (sec. 2, para. 1). Therefore, the helping professions are to some degree

shaped in moral terms. In addition to an identity rooted in morality, many of the helping

professions, including social work (National Association of Social Work, 2008),

psychology (American Psychological Association, 2017), nursing (American Nurses

Association, 2015), and medicine (AMA Council of Ethical & Judicial Affairs, 2016), are

guided by formal codes of ethics, which provide standards for professional behavior and

outline the core beliefs, values, and moral principles to which all professionals are

expected to adhere. Even for helping professions that lack a formal, nationally adopted

code of ethics, like teaching, ethical codes have been established by national unions

(National Association of Educators, 1975) and state-level licensing boards (e.g.

Minnesota Administrative Rules, 2015).

The academic literature on the moral dimensions and ethical dilemmas of the

helping professions is vast (e.g. Campbell, 2003; Carr, 2000; Goodlad et al., 1990;

Jameton, 1984; Reamer, 2013; Strike & Soltis, 2009). One area of the literature on

27

morality in the helping professions that has garnered increasing attention in the 21st

century concerns moral transgressions that are perpetrated, witnessed, or experienced by

professionals, along with the accompanying psychological and social outcomes. As

scholars have sought to understand moral transgressions and their impacts, a variety of

constructs have been proposed and examined, including moral injury (Litz et al., 2009;

Shay, 1994, 2014), moral distress (Jameton, 1984, 1993), and demoralization (Gabel,

2011, 2012, 2013; Santoro, 2011). Because these constructs appear to address the impact

of potentially morally transgressive events on a helping professional’s psychological,

emotional, and social well-being, questions arise as to what distinguishes them from each

other. Such questions include: Are these constructs describing the same phenomena but

employing different terms, depending on the academic and professional discipline? Are

they describing related but distinct phenomena with clear conceptual boundaries? If the

constructs relate to each other, how are they related?

Understanding the moral dimensions of the helping professions and their practice

contexts, particularly in terms of the sources and impacts of moral violations, is critical

for promoting just and ethical care and positive outcomes for recipients. To increase this

understanding, it is necessary to have some amount of conceptual clarity in order to

develop applicable theoretical models that can be used to guide research and practice.

The purpose of this paper is to answer the following question: To what extent do

constructs related to moral transgressions and their associated psychological, emotional,

and social impacts overlap and diverge to describe similar and/or distinct phenomena? A

broader conceptual understanding of these constructs and how they relate will allow for

28

more effective research into the moral actions, transgressions, and impacts across the

helping professions. In the next section, I summarize the existing literature, including

psychometric measures, on each of the following constructs: moral injury, moral distress,

and demoralization. Following the summaries, I present an analysis of the areas of

similarity and divergence among the constructs and make recommendations for future

research and conceptual refinement.

The Constructs

Moral Injury

Moral injury refers to the lasting emotional, psychological, and existential harm

that occurs when an individual “perpetrates, fails to prevent, bears witness to, or learns

about acts that transgress deeply held moral beliefs and expectations” (Litz et al., 2009, p.

700). Moral injury occurs when an individual experiences deeply troubling cognitive

dissonance between their internal moral code and the actions that he or she engages in or

witnesses (Litz et al., 2009). Symptoms of moral injury include guilt, shame, anxiety,

depression, and anger (Dombo, Gray, & Early, 2013; Jinkerson, 2016; Litz et al., 2009)

and can lead to a loss of trust in oneself or others, existential dread, and deep

demoralization (Jinkerson, 2016). The symptoms of moral injury can be long-lasting,

don’t resolve easily on their own, and are often resistant to typical psychological

treatments for trauma (Litz et al., 2009). The damage to one’s internal moral schema or

moral belief system is a particularly significant outcome of moral injury that can lead to

irreparable change in an individual’s self-identity (Dombo et al., 2013). Moral injury

causes a “disruption in an individual’s confidence and expectations about one’s own or

29

others’ motivation or capacity to behave in a just and ethical manner” (Drescher et al.,

2011, p. 9), and a “breakdown in global meaning” (Currier, Holland, Rojas-Flores,

Herrera, & Foy, 2015b, p. 26).

The term “moral injury” was first used by Jonathan Shay, a military psychiatrist

(1994, 2009, 2011, 2014), and the vast majority of research on moral injury has occurred

within the military context (Haight, Sugrue, Calhoun, & Black, 2016). Although the

military is not traditionally considered a helping profession, it operates from a strong

moral code and has a focus on self-sacrifice and helping others gain freedom, liberty, and

safety that can be viewed as a type of “caring” and altruism; and thus, for the purposes of

this paper, will be considered a “helping profession.” In many studies, participants who

have reported experiencing moral injury also have had a diagnosis of Post-Traumatic

Stress Disorder (PTSD) (Haight et al., 2016); however, scholars have insisted that moral

injury, though it may occur concurrently with PTSD, is a distinct condition (Dombo et

al., 2013; Litz et al., 2009; Shay, 2014). In PTSD, traumatic events threaten one’s safety

and mortality; in moral injury, the troubling act threatens the validity of one’s internal

moral framework (Dombo et al., 2013).

Measuring moral injury. Four scales have been developed to measure moral

injury. The Morally Injurious Events Scale (MIES) (Nash et al., 2013) and the Moral

Injury Questionnaire (MIQ; Currier, Holland, Drescher, & Foy, 2015a) primarily measure

exposure to morally injurious events, while the Moral Injury Symptom Scale–Military

Version (MISS-M; Koenig et al., 2017) and the Expressions of Moral Injury Scale–

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Military Version (EMIS-M; Currier et al., 2017a) focus on psychological and behavioral

symptoms associated with moral injury.

Developed using military samples, the MIES and MIQ were the first scales to

attempt to operationalize and psychometrically measure moral injury. Factor analysis of

the MIES revealed three factors: transgressions-self, transgressions-others, and betrayal

(Nash et al., 2013), while the MIQ is a one-factor scale (Currier et al., 2015a). One

limitation of both scales is that they do not distinguish between the exposure to a

potentially morally injurious event and the emotional and psychological symptoms

related to the exposure. For example, the nine-item MIES contains items such as, “I

acted in ways that violated my own moral code and values,” and “I am troubled by

having acted in ways that violated my own morals and values” (Nash et al., 2013). Both

items, one which assesses exposure to a morally injurious event and the other which

assesses the emotional reaction to a morally injurious event are scored on the same 1-6

scale from strongly disagree to strongly agree and are combined when determining a full-

scale score and scores for each identified factor. Thus, the act of violating one’s moral

code is summed in a scale along with how one thought or felt about violating their moral

code, which appears to conflate two unique aspects of experiences with moral injury.

Jinkerson (2016) has argued that, similar to assessment of PTSD, moral injury assessment

must involve two components: 1) evaluation of prior exposure to morally injurious events

and 2) assessment of core and secondary symptomology. Jinkerson (2016) has suggested

using either the MIQ or the MIES to assess exposure to events (preferring the MIQ to the

MIES, as he has argued the items on the MIQ inquire less about moral injury symptoms

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than those on the MIES) and then using a variety of established psychometric scales to

evaluate symptomology (e.g. the Trauma-Related Guilt Inventory, the Meaning of Life

Questionnaire, the PHQ-9, and the GAD-7, etc.).

The MISS-M (Koenig et al., 2017) and the EMIS-M (Currier et al., 2017a) were

developed specifically to assess moral injury symptomology. The MISS-M is a 45-item

scale comprised of 10 subscales or dimensions: guilt, shame, feelings of betrayal, moral

concerns, religious struggles, loss of religious faith/hope, loss of trust, loss of

meaning/purpose, difficulty forgiving, and self-condemnation. Koenig and colleagues

(2017) have suggested that the MISS-M’s strengths lie in its assessment of the multiple

dimensions of moral injury and suggest that it will be useful for measuring responses to

moral injury treatment. The EMIS-M is a 17-item scale that consists of two factors:

“self-directed moral injury” (e.g. “I am an unforgivable person because of things that I

did/saw in the military”) and “other-directed moral injury” (e.g. “I feel anger over being

betrayed by someone who I had trusted while I was in the military”). The EMIS-M

demonstrated high internal consistency and temporal stability, as well as strong

convergent, divergent, and incremental validity (Currier et al., 2017a). The authors have

argued that the EMIS-M is a stand-alone alternative to the two-step assessment process

advocated for by Jinkerson (2016). The MISS-M and the EMIS-M were only recently

published on-line in December 2017, and their utility to moral injury research and clinical

treatment has yet to be tested among other samples and in other settings.

Although research on moral injury has occurred predominantly in military

contexts, an increasing number of researchers have empirically explored the applicability

32

of moral injury to other populations, such as refugees (Nickerson et al., 2015), teachers in

El Salvador (Currier et al., 2015b), women with substance abuse histories (Hartman,

2015), women who have experienced intimate partner violence (Otte, 2015), police

officers (Papazoglou, 2017), and parents and professionals involved in the child

protection system (Haight, Sugrue, & Calhoun, 2017b; Haight, Sugrue, Calhoun, &

Black, 2017a, 2017c). Additionally, a few scholars have written conceptual papers

suggesting the potential applicability of moral injury to public school teachers in the U.S

(Keefe-Perry, 2016; Levinson, 2015; Porosoff, 2015) due to the morally complex and

high-stakes nature of the settings in which they work and the ethically challenging

actions they are often required to take.

Moral Distress

Moral distress was first coined by nursing ethicist Andrew Jameton (1984) and

refers to the “painful feelings and/or the psychological disequilibrium that occurs when

nurses are conscious of the morally appropriate action a situation requires, but cannot

carry out that action” (Corley, 2002, pp. 636-637) due either to internal constraints (e.g.

fear) or external constraints (e.g. lack of time, lack of resources, legal limits, hierarchical

decision-making) (Corley, 2002; McCarthy &Deady, 2008). Individuals experience

moral distress when “they know the right thing to do, but they are unable to do it; or they

do what they believe is the wrong thing to do” (McCarthy &Deady, 2008, p. 254). In

1993, Jameton refined his theory to distinguish between “initial moral distress” and

“reactive moral distress.” “Initial moral distress” refers to the emotional reaction (e.g.

frustration, anger, and anxiety) experienced when confronted with a conflict between

33

one’s moral values and available actions, while “reactive moral distress” refers to the

lasting distress individuals experience after not acting in a way that is consistent with

their moral values (Jameton, 1993). Symptoms of moral distress include anger,

frustration, guilt, shame, anxiety, loss of self-worth, depression, and powerlessness

(Corley, 2002). Nurses have been found to cope with moral distress by avoiding patient

interaction (Corley, 2002; McCarthy &Deady, 2008; Raines, 2000), abandoning their

moral principles all together (Hamric, 2012; Webster & Baylis, 2000), or leaving the

profession (Corley, 2002; Hamric, 2012; McCarthy &Deady, 2008).

Jameton (1984) distinguished between moral uncertainty, in which individuals are

unsure about the right action to take, and moral distress, in which individuals know what

to do but are unable to do it. McCarthy and Deady (2008) clarified that moral distress

goes beyond emotional or psychological distress. For example, a nurse could be

emotionally distressed when performing a work task, such as restraining a patient, but not

morally distressed if the nurse believed the restraint was the right thing to do (McCarthy

&Deady, 2008). Additionally, Weinberg (2009) argued that moral distress is distinct

from an ethical dilemma. While ethical dilemmas are conceptualized as problems at the

individual level, the conceptualization of moral distress acknowledges the role of larger

systems including “political dimensions of practices, thereby enabling structural issues to

be recast as ethical problems” (Lynch & Forde, 2016, p. 96).

Moral distress has received significant attention in the academic literature, both

conceptually and empirically, but the research has been primarily confined to the field of

nursing. A Scopus search, conducted on January 14, 2018, found 784 articles on moral

34

distress published between 1987 and 2018. All but four of the articles were published in

nursing or other medical-related journals. Despite the substantial body of literature on

moral distress, there has been some uncertainty over the specifics of its definition

(Dudzinski, 2016; McCarthy &Deady, 2008). Dudzinski (2016) has stated that the exact

definition and meaning of moral distress “is famously nebulous" (p. 321). Some scholars

have chosen to focus on the role of external social and institutional constraints in eliciting

moral distress (e.g. Jameton, 1984, 1993; Corley, 2002), while others have included the

role of internal constraints (Webster & Baylis, 2000). Hanna (2004) argued that some

scholars (e.g. Jameton, 1984, 1993; Wilkinson, 1988) focus too much on the

psychological aspects of moral distress – to the point that they are conflating

psychological distress with moral distress and ignoring the more salient ethical

components of the phenomena. In response to this conceptual muddiness, McCarthy and

Deady (2008) proposed that moral distress should be considered “a cluster concept or

umbrella concept” (p. 259) capturing a range of symptoms and experiences of individuals

who are morally constrained.

As previously stated, the majority of research on moral distress has occurred in

nursing contexts, and specifically North American nursing contexts (Pauly, Varcoe, &

Storch, 2012). Interestingly, in Scandinavia, a body of work exists within nursing

literature that uses different terms, such as “moral stress” (Lutzen, Cronqvist,

Magnusson, & Andersson, 2003) and “troubled conscience” (Glasberg et al., 2006) for

what appears to be moral distress. In this literature, “moral stress” refers to the emotional

experience that occurs “when nurses are aware of what ethical principles are at stake in a

35

specific situation and external factors prevent them from making a decision that would

reduce the conflict between the contradicting principles” (Lutzen et al., 2003, p. 314).

“Troubled conscience,” as explained by Glasberg and colleagues (2006), stems from the

discrepancy that arises among one’s internal conscience or “voice,” internal desires or

inclinations, and external demands when an individual “does not follow the voice of

conscience” (p. 635). Some of the differences between moral distress and its

counterparts in the Scandinavian literature could be due to translation alone, but an

integration of the North American and European constructs could help to clarify moral

distress’s conceptual ambiguity (Pauly et al., 2012).

Recently some scholars have pushed back against Jameton’s (1984, 1993)

assertion that moral distress must involve a situation of moral constraint (Campbell,

Ulrich, & Grady, 2016; Fourie, 2017, Johnstone & Hutchinson, 2015). Johnstone &

Hutchinson (2015) have argued that the dominant conceptualization of moral distress is

based on the flawed assumption that nurses always know the right thing to do, and the

only reason they are not doing the right thing is because they are unable to, due to

internal or external constraints. The authors have asserted that to assume “the

unequivocal correctness and justification of nurses’ moral judgments” (p. 8) is a fallacy,

and this conceptualization of moral distress “understates the moral responsibility of

nurses to take remedial action, even in difficult environments, and thus risks being an

apologist for their incapacities” (p. 8). Similarly, Campbell and colleagues (2016) have

pointed out that “life as a moral agent is complex,” (p. 3) and that frequently it is

difficult, if not impossible, for nurses to know the correct moral action to take. In

36

contrast to Jameton (1984), who distinguished between moral dilemmas (which are a

source of moral distress) and moral uncertainty (which is not), Campbell and colleagues

(2016) have asserted that both moral dilemmas and moral uncertainty can lead to moral

distress. Fourie (2017) has proposed that moral distress is comprised of multiple

categories, including the constraint-based moral distress, as defined by Jameton (1984,

1993) and the uncertainty-based moral distress as identified by Campbell and colleagues

(2016).

Measuring moral distress. Despite the complexity and conceptual haziness of

moral distress, Corley, Elswick, Gorman, and Clor (2001) developed a Moral Distress

Scale (MDS), to measure moral distress among nurses. The scale is made up of 32 items

with a 5-response format ranging from “little/almost never (1) to great (5)” (Corley et al.,

2001, p. 252). The scale is composed of three factors: individual responsibility, not in

patient’s best interest, and deception (Corley et al., 2001). A limitation of the MDS is

that it is designed to apply specifically to hospital-based nursing, and more specifically to

critical care nurses3, with items such as, “I have followed a family’s wishes I don’t agree

with,” “I have not told patients the truth when they ask for it,” “I have given a patient

medication intravenously when they have refused it orally.” The specificity of the MDS

makes it inapplicable to other helping professionals, both within and outside of the

medical field. Attempts have been made to adapt the MDS for application to other

professionals, but none outside of the healthcare field. Examples include the Moral

3Corley et al. (2001) found that the MDS did not apply to occupational health nurses who worked

outside of a hospital setting.

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Distress Scale-Revised (Hamric, Borchers, & Epstein, 2012), which can be used across

health care professionals, the Moral Distress Scale Revised for Occupational Therapists

(Penny, Bires, Bonn, Docker, & Pettit, 2016), the Moral Distress Questionnaire for Long-

Term Care Social Workers (Lev & Ayalon, 2016), and the Moral Distress Risk Scale

(Schaefer, Zoboli, & Viera, 2017), which is designed to be used across a wide variety of

nursing contexts. In the European literature, Glasberg et al. (2006) created the Stress of

Conscience Questionnaire to measure troubled conscience among healthcare workers.

Demoralization

Demoralization is a construct that has been used to describe “feelings of

impotence, isolation, and despair” (Clarke & Kissane, 2002, p. 734) in response to a

perceived inability to deal effectively with a stressful experience (Clarke & Kissane,

2002). Demoralization is related to both an individual's moral beliefs and actions and

with a loss of morale when important beliefs and values are lost (Gabel, 2013). When

individuals are demoralized, they feel trapped, helpless, and unable to respond to a

stressful situation in a way that feels appropriate to them, all of which results in feelings

of anxiety, depression, and “a sense of meaninglessness of life” (Clarke & Kissane, 2002,

p. 734).

Gabel (2011, 2012, 2013) has examined demoralization in the context of

healthcare professionals and defined demoralization as “a condition of diminished morale

or hopelessness that occurs when one's principles, values, or standards are threatened"

(Gabel, 2011, p. 892). Gabel (2013) argued that medicine and healthcare are rooted in

moral beliefs and practices. Over the centuries, newly graduating physicians have recited

38

oaths and declarations focused on the common theme of “the obligation of physicians to

strive to aid those seeking help” (Gabel, 2013, p. 119). Demoralization can occur when

the moral foundation of healthcare practice is threatened by a lack of resources,

increasing commercialization of healthcare, or policy changes that limit the ability of

professionals to provide the type of care that they feel morally obligated to provide.

Demoralization has also been applied in the field of education by Santoro (2011),

who had defined teacher demoralization as the phenomenon that occurs when a teacher is

unable to access the moral rewards of teaching. Santoro (2011) has argued that “morals,

values, and principles comprise the essence of teaching” (p. 4) and “the moral rewards of

teaching are activated when educators feel that they are doing what is right in terms of

one's students, the teaching profession, and themselves” (p. 2). Teacher demoralization

happens when teachers lose the ability to act pedagogically in a way that feels right to

them due to being overburdened by policies that are not consistent with their beliefs and

values about their profession (Santoro, 2011). Santoro has described demoralized

teachers as feeling “depressed, discouraged, shameful, and hopeless” (2011, p. 18).

Santoro (2011) has cited the hyper-focus on standardized testing after the passage

of No Child Left Behind as a significant source of demoralization for teachers, as they are

unable to exercise their moral agency while operating under policy requirements that

dismiss their pedagogical knowledge, constrain their pedagogical judgement, and restrict

their pedagogical authority (p. 16). When teachers attempt to challenge the policy

requirements regarding standardized testing and measurement, they are characterized as

self-serving, lazy, and incompetent (Santoro, 2017). Santoro (2017) introduced the term

39

“moral madness” to refer to the deep feelings of confusion and disorientation experienced

“when a person’s moral claims are not recognized as moral and the individual is

disregarded as a moral agent” (p. 2).

Measuring demoralization. To date, no scale has been created to measure

Gabel’s (2011, 2012, 2013) conceptualization of demoralization among healthcare

providers. However, Carlson-Jaquez (2016) developed a 27-item, two-factor instrument

to measure K-12 teacher demoralization, as defined by Santoro (2011). However, this

scale was created as part of a doctoral dissertation which has not been published

elsewhere. In addition, the author reported weak convergent and discriminant validity

with relevant constructs and suggested that future refinement of the scale is needed.

Gabel’s (2011, 2012, 2013) and Santoro’s (2011) work on demoralization in the

context of healthcare professionals and educators, respectfully, acknowledged that

demoralization is a contributing factor to the more frequently discussed construct of

burnout, but clarified that the two are distinct constructs. Maslach, Schaufeli, and Leiter

(2001) described burnout as "a psychological syndrome in response to chronic

interpersonal stressors on the job" (p. 399) that consists of three dimensions: exhaustion,

cynicism/depersonalization, and ineffectiveness (Maslach, Jackson,& Leiter, 1997;

Maslach et al., 2001). Gabel (2013) has argued that although demoralization and burnout

share similar symptoms, such as anxiety, depression, and feelings of inefficacy, burnout

can be considered primarily “a prolonged reaction to chronic stressors in the work

environment”, while demoralization “results from a threat to or loss of personal or

40

professional values that are perceived to be crucial to an individual's sense of well-being”

(p. 122).

Santoro (2011) has argued that demoralization, defined as “the inability to access

the moral rewards of teaching” (p. 3), is often “misdiagnosed as burnout” (p. 3). Many

researchers of teacher burnout have conceptualized it as a problem related to the

characteristics and actions of the individual teacher and not the context in which the

teacher operates (Santoro, 2011). For example, teachers who are at most risk of burnout

are often described as overly idealistic and having difficulty establishing a healthy work-

life balance (Chang, 2009; Farber, 2000). From these perspectives, burnout is viewed

primarily as a condition resulting from the depletion of a teacher’s internal resources for

coping with the job and one that can be avoided with better self-care (Santoro, 2011). In

contrast, according to Santoro (2011), demoralization is rooted in the structure and

context of education as a practice. Unlike burnout, demoralization “is not the result of a

lack of personal fortitude or moral sensibility but a fundamental change in the rewards

available through the work” (Santoro, 2011, p. 17).

Discussion

Table 1 provides a summary of the key characteristics of moral injury, moral

distress, and demoralization. The following section presents an integrated analysis of the

three constructs.

Conceptual Similarities

Whereas research on moral injury has been primarily confined to military

contexts, moral distress to healthcare settings, and demoralization to healthcare and

41

education, clear overlap exists among the three constructs. The conceptualizations of all

three constructs describe emotional, psychological, and existential distress related to a

violation of moral expectations and deeply held values (Jameton, 1984; Gabel, 2011; Litz

et al., 2009; Shay, 2014; Webster & Baylis, 2000). Clarke and Kissane’s (2002) assertion

that individuals experience demoralization when “they have lost, or feel they are losing,

something critical to their sense of self” (p. 737) echoes Dombo and colleagues’ (2013)

argument that the core of moral injury is “the threat to self-identity,” (p. 207) and

Webster and Baylis’ (2000) description of the permanent change in self-identity that

results from experiences of moral distress.

Similar to the description of moral injury’s lasting wounds (e.g. Litz et al., 2009),

some scholars of moral distress have described deep wounds and threats to one’s moral

integrity that can occur after violating one’s moral beliefs (McCarthy &Deady, 2008;

Webster & Baylis, 2000). Webster and Baylis (2000) have referred to these lingering

feelings of distress as “moral residue.” Additionally, moral distress has been described as

permanently changing the individual’s sense of identity and the manner in which they

connect with others (Hanna, 2004; Webster & Baylis, 2000). Webster and Baylis (2000)

quoted a medical student who experienced moral distress as saying that “In the deepest

part of yourself, you feel you will never be the same and you carry this with you for the

rest of your life” (p. 224). These types of long-lasting injuries to the self and resulting

existential crises arising from moral distress echo the descriptions of moral injury and its

effects (Litz et al., 2009; Dombo et al., 2013; Drescher et al., 2011; Shay, 1994, 2014).

Similarly, the “sense of meaningless of life” that Clarke and Kissane (2002, p. 734)

42

identif aieds an outcome of demoralization appears equivalent to the “breakdown in

global meaning” that Currier and colleagues (2015b) attributed to moral injury. In fact,

Jinkerson (2016) has pointed out that “the final state of moral injury has been described

as deep demoralization” (p. 124).

Conceptual Differences

Despite some similarities, several clear distinctions exist among moral injury,

moral distress, and demoralization. Conceptualizations of demoralization and moral

distress focus on the inability of the primary actor to change their circumstances (Clarke

& Kissane, 2002; Jameton 1984, 1993; Santoro, 2011). In the demoralization literature,

this inability has been frequently referred to as “impotence,” (Clarke & Kissane, 2002)

while in the moral distress literature “internal and external constraints” (Jameton, 1984,

1993) have been discussed. In both cases, the results are feelings of helplessness and

hopelessness as one is unable to respond in a manner that feels morally right (Corley,

2002; Gabel, 2011; Santoro, 2011). In contrast, internal or external constraints, although

they may be present, are not required to experience moral injury. An individual could

experience moral injury after having mistakenly or freely transgressed their moral

expectations. It is the action and one’s interpretation of the action as being morally

transgressive that leads to moral injury, regardless of whether or not the action occurred

due to any constraints placed on the individual actor. For example, a military veteran

could experience moral injury after accidentally killing a civilian. In this situation, the

veteran may not have been personally forced to kill the civilian but made a mistake that

resulted in the violation of a deeply held belief about the protection of civilians.

43

The role of the individual experiencing distress also varies among

conceptualizations of moral injury, moral distress, and demoralization. A person can

experience moral injury by perpetrating a moral transgression and/or witnessing or being

the victim of someone else’s action, if that action was evaluated by the individual as

being a violation of deeply held moral beliefs and expectations (Litz et al., 2009; Shay,

2014). In contrast, in demoralization and moral distress, the source of distress is the

individual’s own immoral actions (or inactions) or their own inability to act in a way that

is congruent with their moral beliefs (Clarke & Kissane, 2002; Gabel, 2011; Santoro,

2011).

Emerging Conceptual Convergence

As previously stated, in recent years a number of scholars have advocated for a

broadening of the conceptualization of moral distress (Campbell et al., 2016; Fourie,

2017). These broader conceptualizations have functioned to decrease the distinctions

between moral injury and moral distress. Campbell and colleagues (2016) have proposed

the following definition of moral distress: “one or more negative self-directed emotions

or attitudes that arise in response to one’s perceived involvement in a situation that one

perceives to be morally undesirable” (p. 6). By including the phrase “one’s perceived

involvement,” Campbell and colleagues (2016) explained that they were being

intentionally vague to allow for a wide range of roles that the individual could play in

relation to the morally troubling event. In this definition, the individual experiencing

moral distress may be the perpetrator of the moral transgression, but also may be “simply

connected, professionally or personally, to others who are more centrally involved in a

44

morally undesirable situation” (Campbell et al., 2016, p. 6). This broader

conceptualization of the role of the individual in the moral transgression is similar to that

of moral injury, in which the morally injured may be the perpetrator, witness, or victim of

the immoral act.

In addition to broadening the role of the morally distressed individual in the

transgression, Campbell and colleagues (2016) have also advocated for a broadening of

the potential sources of moral distress beyond that of situations involving moral

constraint (Jameton, 1984) and moral uncertainty (Fourie, 2017), to include those

involving “moral luck.” Campbell and colleagues (2016) used the term “moral luck” to

refer to experiences in which “agents perform what they deem to be the morally best

action based on the best information and evidence available to them at the time, without

any internal or external constraints. Yet, their actions, in conjunction with factors beyond

their control, turn out to have morally undesirable consequences” (p. 5). In response to

and support of Campbell and colleagues (2016), McAnich (2016) has pointed out that

their conceptualization of moral distress is “similar to, and perhaps encompasses, another

self-directed negative emotion that is characteristic of a particular domain: namely, moral

injury among combat veterans” (2016, p. 30). A commonly cited event associated with

moral injury is the killing of civilians due to the ambiguity of combatants who are often

embedded within civilian communities (Drescher & Foy, 2008; Litz et al., 2009).

Consistent with Campbell and colleagues’ (2016) description of “moral luck,” this type

of morally injurious event can be characterized as a “morally best action” that resulted in

“morally undesirable consequences.”

45

Conceptualizations of moral injury have also moved from the narrow to the broad.

McAnich (2016) has noted that Shay’s original definition of moral injury was more

narrow, with a focus on the response to a betrayal by a person in authority in high-stakes

context (1994, 2014). However, Litz and colleagues (2009) broadened this

conceptualization to include actions by peers or the service member himself. Most

recently, McDonald (2017) has challenged researchers and clinicians to expand their

understanding of the true sources of moral injury. McDonald (2017) has argued that

when veterans experience moral injury, they are not solely troubled by what they or their

colleagues did or failed to do, but by “the specter of a world without morals” that arises

when one is confronted with deeply morally troubling events. Experiences of war shatter

long held beliefs in rightness and wrongness and leave individuals facing “a world that

has become morally irreconcilable” (McDonald, 2017, p. 6). According to McDonald

(2017), this destruction of one’s belief in the world as a moral place should be considered

the core of moral injury. Interestingly, McDonald’s (2017) insistence on the significance

of moral context as it relates to an individual’s experience of moral injury is echoed in

Santoro’s (2011) writing on teacher demoralization. Santoro (2011) has argued that

teachers experience demoralization when they can no longer access the moral rewards of

teaching because the moral context of teaching is endangered. In Santoro’s (2011) view,

it is not the individual characteristics or even the individual actions of teachers that are

the source of demoralization, but it is teaching itself that has become, in McDonald’s

(2017) words, “morally irreconcilable” (p. 6).

46

Conclusion and Implications

This analysis demonstrates how conceptualizations of moral injury, moral

distress, and demoralization are still being formed, reformed, debated, and tested.

Although some have championed a broadening of the current conceptualizations of moral

injury (McDonald, 2017) and moral distress (Campbell et al., 2016; Fourie, 2017;

McAnich, 2016), others have advocated for sticking with more narrow definitions.

During a panel discussion on moral injury in November 2017 at the Annual Meeting of

the International Society of Traumatic Stress Studies in Chicago, IL, the prominent

clinical researchers on the panel focused their discussion on the need to refine and

possibly narrow the conceptualization of moral injury to create better assessment tools

and treatment strategies to help veterans (Currier, Farnsworth, Frankfurt, Gray

&Yeterian, 2017). No mention was made of the larger philosophical issue, proposed by

McDonald (2017), of moral injury resulting less from individual moral transgressions and

instead from confronting the possibility of a world without morals. This desire to more

clearly define and assess is evident in the number of recently published articles that have

attempted to improve on moral injury measurement and assessment (e.g. Currier et al.,

2017; Farnsworth, Drescher, Evans, & Walser, 2017; Jinkerson, 2016; Koenig et al.,

2017). Similarly, Epstein, Hurst, Mahanes, Marshall, and Hamric (2016) reject Campbell

and colleagues’ (2016) broader conceptualization of moral distress because it renders the

construct “too nebulous to be effectively taught, studied, used in practice, or, frankly,

respected any longer as a powerful phenomenon in bioethics” (p. 15).

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As the conceptualizations of moral injury, moral distress, and demoralization are

broadening, the significant overlaps that have always existed among these constructs are

increasing. These increasing similarities suggest that an integrated model is becoming

both more necessary and more possible. One option for an integrated framework could

be to create an umbrella term, such as “moral suffering” (Papazoglou & Chopko, 2017),

with a broad definition that would encompass current conceptualizations of moral injury,

moral distress, and demoralization. Another framework to consider would be a

continuum model to represent the psychological, social, and existential impacts of moral

transgressions, in which demoralization and moral distress are on the milder end and

moral injury on the more severe.

To achieve an integrated conceptual model, the intensely siloed nature of the

current literature must be addressed. As Table 1 illustrates, most of the constructs have

been researched nearly exclusively within one academic discipline/professional field. In

addition, there appears to be very little communication among the researchers of each

individual construct. In Haight et al.’s (2016) review of 27 empirical studies on moral

injury published between 2011 and 2015, only four mentioned moral distress, and none

of the studies examined moral distress and its relationship to moral injury empirically.

The similarities between moral distress and demoralization, as defined by Gabel (2011,

2012, 2013) and Santoro (2011) are particularly strong, yet neither researcher mentions

moral distress in their work, even though Gabel has conducted research on healthcare

providers, including nurses.

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An integrated conceptual model cannot be created with additional siloed

theorizing, but rather needs rigorous empirical exploration. Cross-conceptual research,

both qualitative and quantitative, as well as interdisciplinary work is needed. Examples

of useful studies could include the testing of the convergent and divergent validity among

the various moral injury, moral distress, and demoralization scales; phenomenological

studies of helping professionals’ lived experiences of moral transgressions; and mixed

methods that combine the administration of multiple scales and in-depth interviews to

illuminate the scales’ meanings. Greater conceptual clarification regarding the sources

of, and impacts of, moral transgressions in the context of helping professions will help to

illuminate not just the suffering of individual professionals and clients but also the larger

political, social, and structural forces that create situations in which moral transgressions

occur. It is these forces and systems that need attention and action from academics and

practitioners in the helping professions, but to do so effectively, we must know what we

are talking about.

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Table 1:

Comparison of the Research Contexts, Characteristics, and Impacts of Moral Injury, Moral Distress, and Demoralization

Impact

Construct Primary

Context of

Research

Role of the

Individual in

the Moral

Transgression

Characteristics of the

Morally Transgressive

Activity

Psychological/

Emotional

Existential Social

Moral Injury Military Perpetrator

Witness

Victim

Individual commits a moral

transgression either

intentionally, accidentally, or

because they feel they have

no other choice. Individual

may or may not be fully

aware of the immorality of

the action prior to it being

carried out

Anxiety,

depression,

anger, shame,

guilt

Loss of trust in

self and

others;

breakdown in

global

meaning

Social withdrawal

Moral Distress Nursing Perpetrator Individual knows what the

moral choice is, but chooses

the immoral choice due to

internal or external

constraints on their actions;

individual experiences moral

uncertainty about the right

action to take

Anxiety,

depression,

frustration,

anger, shame,

guilt,

powerlessness

Threat to

sense of self

Distancing from

patients; Leaving the

profession

50

Demoralization Healthcare

professionals;

teachers

Perpetrator

Witness

Individual is impotent;

unable to act in a way that is

morally congruent with his

beliefs and expectations;

usually due to

structural/systemic

constraints

Helplessness;

hopelessness;

anxiety,

depression;

shame

Threat to

sense of self,

lack of

meaning to the

world

Leaving the

profession

51

Chapter 3

Paper 2

Moral Injury among Professionals in K-12 Education:

An Exploratory Quantitative Assessment

52

Synopsis

This paper presents the quantitative portion of a mixed methods study of moral

injury among professionals in K-12 public education. Two hundred eighteen 218

licensed K-12 professionals in one urban school district in the Midwest completed an on-

line survey that included measures of moral injury and emotional and behavioral

correlates. The K-12 professionals exhibited levels of moral injury similar to those

experienced by military veterans. Experiences of moral injury were associated with

feelings of guilt, troubled conscience, burnout, and the intention to leave one’s job.

Regression analyses demonstrated that professionals working in high-poverty, racially

segregated schools were significantly more likely to endorse experiences of moral injury.

These findings reinforce the significance of the intersectionality of race and class in

reproducing oppressive and immoral educational practices and outcomes. A deeper

understanding of, and greater attention to, potential sources of moral injury are critical in

order to foster a more just and ethical education system.

Key words: Moral injury, moral challenges in K-12 education, survey research,

burnout

53

Over the past decade, a growing body of literature has developed on

the construct of moral injury. Originally coined by mental health professionals working

with American military veterans (Litz et al., 2009; Shay, 1994, 2014), moral injury refers

to the lasting emotional, psychological, and existential harm that occurs when an

individual “perpetrates, fails to prevent, bears witness to, or learns about acts that

transgress deeply held moral beliefs and expectations” (Litz et al., 2009, p. 700). Moral

injury occurs when an individual experiences deeply troubling cognitive dissonance

between their internal moral code and the actions that he or she engaged in or witnessed

(Litz et al., 2009). Symptoms of moral injury include guilt, shame, anxiety, depression,

and anger (Dombo, Gray, & Early, 2013; Jinkerson, 2016; Litz et al., 2009) and can lead

to a loss of trust in oneself or others, existential dread, and deep demoralization

(Jinkerson, 2016). These symptoms can be long-lasting, don’t resolve easily on their

own, and are often resistant to typical psychological treatments for trauma (Litz et al.,

2009). The damage to one’s internal moral schema or moral belief system is a

particularly significant outcome of moral injury that can lead to irreparable change in an

individual’s self-identity (Dombo et al., 2013). Moral injury causes a “disruption in an

individual’s confidence and expectations about one’s own or others’ motivation or

capacity to behave in a just and ethical manner” (Drescher, et al., 2011, p. 9) and a

“breakdown in global meaning” (Currier, Holland, Rojas-Flores, Herrera, & Foy, 2015b,

p. 26).

The majority of research on moral injury has occurred within the military (Haight,

Sugrue, Calhoun, & Black 2016), but a handful of scholars have begun to explore its

54

applicability among populations in other morally high-stakes contexts, such as refugees

(Nickerson et al., 2015), teachers in violent areas of El Salvador (Currier et al., 2015b),

women with substance abuse histories (Hartman, 2015), women who are homeless (Otte,

2015), and parents and professionals involved in the Child Protection System (Haight,

Sugrue, Calhoun, & Black, 2017a; Haight, Sugrue, & Calhoun, 2017b). Keefe-Perry

(2016) and Levinson (2015) have proposed the relevance of moral injury to the American

public education context, due to the morally complex and high-stakes natures of the

settings in which educators work and the ethically challenging actions they are often

required to take. Specifically, Levinson (2015) has argued that educators are frequently

faced with situations in which they “have the obligation to enact justice, but . . . have to

take action under conditions in which no just action is possible” (p. 206). This inability

to act justly is a type of moral transgression, which results in moral injury (Levinson,

2015; Litz et al., 2009). Keefe-Perry (2016) has hypothesized that moral injury may be

widespread among public school teachers in the U.S. In the age of high-stakes testing,

widening racial and economic achievement gaps, and zero-tolerance discipline policies,

teachers are faced with “a daily struggle between a desire to feel like you are part of a

system that produces good in the world and piercing evidence to the contrary” (Keefe-

Perry, 2016, p. 7).

The purpose of this study was to explore the extent of, and factors associated

with, moral injury among professionals in K-12 education. “Professionals in K-12

education” refers to all professionally licensed non-administrative staff who have direct

contact with students, including teachers, school social workers, school psychologists,

55

school counselors, speech pathologists, physical therapists, occupational therapists, and

school nurses. In addition to psychological distress, moral injury may result in decreased

compassion (Haight, Sugrue, Calhoun, & Black, 2017c; Keefe-Perry, 2016), normalizing

of problematic behavior and unethical decisions (Dudzinski, 2016; Webster

& Baylis, 2000), burnout (Currier, Holland, Drescher, & Foy, 2015a), and eventual exit

from the profession (Keefe-Perry, 2016; Levinson, 2015). More importantly, the

presence of moral injury among educators signals that aspects of the education

system are unjust and immoral. Moral injury is not an individual psychological issue, but

rather a social problem, reflecting a betrayal of society’s morals and values (Boudreau,

2011; Levinson, 2015). If educators experience moral injury due to their moral

transgressions, not only are they culpable in violating their moral beliefs, but so are we as

a society by creating situations in which those transgressions occur (Levinson,

2015). Thus, if we believe in the need for a just and moral education system, we have a

responsibility to identify and understand potential sources of moral injury in order to

enact the systemic changes needed to prevent them.

Background

Morals

The terms morals and ethics are often used interchangeably, colloquially, and in

philosophical literature, to refer to systems of values and beliefs about right and wrong

(Crisp, 1998; Sheraton, 2012). Within philosophy, morality tends to be discussed in two

broad senses: descriptively, when referring to “codes of conduct put forward by a society

or a group (such as a religion) or accepted by an individual for her own behavior” (Gert

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& Gert, 2016, no page), and normatively, when discussing “a code of conduct that, given

specified conditions, would be put forward by all rational persons” (Gert & Gert, 2016,

no page). Thus, moral beliefs are, at one level, absolute, and at another, socially and

contextually determined (Buzzelli & Johnston, 2002).

Morality in the Context of Education

Discussions of morals and morality have been traditionally absent from modern

American teacher preparation programs, perhaps due to concerns about their affiliation

with religious or spiritual beliefs (Buzzelli & Johnston, 2002; Hansen, 2001). Yet, over

the past few decades, scholars have written on the inherent moral dimensions of teaching

and education (e.g. Buzzelli& Johnston, 2002; Campbell, 2008; Clark, 1990; Goodlad,

1990; Hansen, 2001; Huebner, 1996; Pring, 2001). The idea of teaching as a moral

endeavor is ancient, dating back to the writings of Plato, Confucius, Aristotle, and the

Buddha (Hansen, 2001). Buzzelli and Johnston (2002) have asserted that two core

aspects of teaching render it moral in nature. First, all teaching involves relationships and

interactions between two or more individuals, and all human relationships are moral in

nature. As echoed by Fenstermacher (1990), “what makes teaching a moral endeavor is

that it is, quite centrally, human action undertaken in regard to other human beings.

Thus, matters of what is fair, right, just, and virtuous are always present” (p. 133).

Second, education is a system for transferring society’s values, beliefs, and expectations

to the future citizenry; and teaching consists of influencing or changing the behavior of

others to meet these prescribed, normative goals (Buzzelli & Johnston, 2002; Hansen,

2001; Goodlad, 1990; Pring, 2012).

57

Education is morally complex (Buzzelli & Johnston, 2002; Campbell, 2008;

Levinson, 2015). Elements that are central to the education context, such as evaluation,

assessment, and the physical control of student bodies in school, are laden with moral

meaning and can be sources of difficult moral dilemmas for educators (Buzzelli &

Johnston, 2002). The ubiquity of moral dilemmas in education requires that educators be

attentive to the moral nature of their work in order to identify just and meaningful

solutions (Buzzelli & Johnston, 2002). Buzzelli & Johnston (2002) have referred to this

awareness of the moral significance of one’s work as “moral sensibility” and stress the

importance of educators cultivating this awareness in order to lead to moral action.

Levinson (2015) has argued that moral sensibility will not lead to just and

appropriate solutions to educational dilemmas because the nature of the political,

economic, and social constraints that shape (and are shaped by) the U.S. education

system place educators in situations in which they are obligated to enact moral justice,

but in which no just action is possible. Despite their obligations, their awareness, and in

many cases their best intentions, educators continue to perpetrate moral wrongs, resulting

in moral injury (Levinson, 2015).

Working Conceptual Model of Moral Injury

As moral injury is a relatively recent topic of empirical research, conceptual

models are continuing to be developed and refined. The most commonly cited moral

injury conceptual framework is Litz and colleagues' (2009) working conceptual model of

moral injury. According to this model, when an individual perpetrates or witnesses an

action that violates deeply held values and moral expectations, cognitive dissonance

58

results due to the discrepancy between the individual’s moral beliefs and the event.

Individuals will attempt to resolve this cognitive dissonance, and when doing so, those

prone to moral injury will make cognitive attributions that are “global (i.e. not context

dependent), internal (i.e. seen as a disposition or character flaw), and stable (i.e.

enduring; the experience of being tainted)” (Litz et al., 2009, p. 700). These beliefs will

lead to feelings of guilt, anxiety, and shame, which will then result in withdrawal

behaviors, which prevent corrective and reparative experiences with peers and the

community that might allow for self-forgiveness for the individual. As time passes, the

resulting isolation leads to a growing belief that not just the act is unforgivable, but that

the individual is unforgiveable. This self-condemnation leads to the individual engaging

in avoidance and/or numbing strategies or self-harming behavior and feelings of

demoralization, all of which feed back into the stable, global, and internal attributions.

The Current Study

This study was guided by a simplified version of Litz and colleagues’ (2009)

working conceptual model of moral injury, with less attention paid to the complex

cognitive processes involved in moral injury and more focus on the ecological, contextual

factors that might contribute to educators’ experiences of moral injury. It is hypothesized

that individual characteristics of K-12 education professionals and characteristics of the

schools in which they work contribute to the likelihood of an individual professional

experiencing moral injury. Additionally, consistent with previous research on moral

injury, it is expected that education professionals’ experiences of moral injury will be

59

characterized by certain emotional, social, and behavioral responses, such as guilt,

burnout, and a desire to leave one’s profession.

The research questions for this study are:

6) To what extent do professionals in K-12 public education experience moral injury

in their workplace?

7) What individual or school-level characteristics are associated with the experiences

of moral injury among professionals in K-12 education?

8)  What emotional, social, and behavioral symptoms are associated with

experiences of moral injury among professionals in K-12 public education?

Methods

Data Source and Sample

Data for this study were taken from a larger study which featured an explanatory

sequential mixed methods design (Creswell, 2014). The quantitative portion of the study

employed a cross-sectional, correlational survey design. Data were collected via a web-

based survey that was developed using Qualtrics (Qualtrics, 2017). Approval for the

study was received from the University of Minnesota’s Institutional Review Board, under

exempt status.

A link to the survey was sent via email to all licensed non-administrative K-12

education professionals in one urban public school district in the Midwest (n = 3,169).

This district was chosen because of its size and diversity, both in terms of types of

schools (elementary, secondary, alternative), size of schools (ranging from 200 to 2000

60

students), and in the racial and economic make-up of the schools (some schools that are

predominantly White and affluent, some that are predominantly students of color and

low-income, some with varying levels of integration in terms of race and class). The

email distribution list of all licensed non-administrative K-12 professionals was created

from information provided by the school district’s staff directory, which was available on

the district website. The survey remained open for six weeks, and weekly reminders

were sent via email. At the end of the survey, participants had the option of entering their

name for inclusion in a drawing for one of two $50 gift cards. During the data collection

period, 553 participants initiated responses. Upon review, 318 respondents were

eliminated from the sample due to substantial missing data. Seventeen respondents

provided complete data but failed to sign the consent form and could not be included in

the study. The final sample consisted of 218 respondents who resemble the population of

professionals in the district on several demographic characteristics (see Table 1).

Measures

Moral injury. Moral injury, the dependent variable in this study, was measured

using a modified version of the nine-item Moral Injury Events Scale (MIES; Nash et al.,

2013) and served as the dependent variable in this study. The MIES has a three-factor

solution—Transgressions-other, Transgressions-self, and Betrayal—with strong internal

consistency estimates for each factor, α = .79, α = .94-.96, and α = .83-.89, respectively

(Bryan et al., 2016). Items include “I saw things that were morally wrong,” and “I am

troubled by having acted in ways that violated my own morals or values,” and responses

are assessed using a six-point Likert scale ranging from 1 = “strongly disagree” to 6 =

61

“strongly agree.” Although there is no clinical cut-off score on the MIES that designates

what score denotes “moral injury,” in their study of parents involved in the child

protection system, Author (2017a) determined that participants with a mean score lower

than 3 exhibited “no reported moral injury” (p. 480). A score of “3” denotes a response

of “slightly disagree” to statements regarding having experienced morally problematic

events and being troubled by those events.

The MIES was designed for use with a military population (Nash et al., 2013;

Bryan et al., 2016), and two modifications were made for use in the current study. First,

participants were prompted to reflect on events that have occurred in the context of their

work in their current school, rather than in the military. Second, the three items that

make up the Betrayal factor were altered to reflect the difference between a military

setting and a school setting. Instead of asking about betrayal by “leaders,” “fellow

service members,” and “others outside the U.S. military” (Nash et al., 2013), education

professionals were asked if they felt betrayed by “administrators in my school and

district,” “colleagues,” and “education leaders and policy makers on the state and/or

federal level.” In this study, the modified MIES demonstrated strong internal consistency

on all three factors: Transgressions-Other (α = .91), Transgressions-Self (α = .91), and

Betrayal (α = .80).

Individual and school-level characteristics. Participants were asked to report

several socio-demographic characteristics. Gender was assessed with three options

(male, female, and transgender) and respondents provided their age in number of years.

Respondents identified their race and ethnicity by selecting all that applied from the

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following options: White, African American, Latino/a, Native American, and Asian. A

multiracial group was created to reflect respondents who selected more than one option.

For analytic purposes, race was recoded from a six-category variable to a binary variable

(white / non-white). Respondents also provided information on their role in the school

(e.g. teacher, school social worker, psychologist), the number of years they had worked in

education, the approximate number of students in their school, and their school level (e.g.

K-5, K-8, K-12, 6-8, 9-12). Role in school was recoded into two dummy variables to

denote: 1) all special education teachers, speech-language pathologists, occupational

therapists, physical therapists, and English Language Learner teachers (versus all other

roles) and 2) mental health professionals, such as school social workers, school

psychologists, school counselors, and school nurses (versus all other roles). School type

was recoded into a binary variable, with all schools containing any grades between K- 5

being coded as “elementary,” and all schools without any students in grades K-5 being

coded as “non-elementary.” Finally, respondents also selected the name of their school

from a drop-down menu. Using the name of the school, the percentage of students of

color and the percentage of students receiving free or reduced lunch in each school was

gathered from the State Department of Education’s online data center.

Guilt. Guilt was measured via the Trauma-Related Guilt Inventory (TRGI;

Kubany et al., 1996). The TRGI is a 32-item scale that assesses six guilt-related factors:

global guilt, distress, guilt cognition, hindsight-bias/responsibility, wrongdoing, and lack

of justification. Participants responded to statements such as “What I did was

inconsistent with my beliefs,” and “I experience intense guilt that relates to what

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happened,” using a 5-point Likert scale, ranging from 0 = “Not at all true,” to 4 =

“Extremely true.” The TRGI has demonstrated good internal reliability estimates across

the six factors (α = .67 - .91) and strong test-retest reliability (rs = 0.75-0.86) (Kubany et

al., 1996). Participants respond to the items while thinking about a specific event,

allowing the measure of guilt to be directly related to the specific morally injurious

events reported on in the MIES. The survey instructions asked participants to recall the

event or events they were thinking about as they completed the MIES, to choose the most

troublesome or distressing event, and to consider this event while completing the TRGI.

Internal reliability estimates across the six factors in the TRGI in this study were strong

(α = .74 - .91).

Stress of conscience. The Stress of Conscience Questionnaire (SCQ; Glasberg et

al., 2006) is a nine-item scale developed to assess “troubled conscience” and its

accompanying stress among practicing nurses. Glasberg and colleagues (2006) have

defined “troubled conscience” as the “the discrepancy between our individual conscience

(personal core values) and external restrictions (e.g. society’s or the profession’s values)”

(p. 635) and “stress of conscience” as “the stress generated by a troubled conscience” (p.

635). This description of “stress of conscience” appears consistent with aspects of moral

injury; and, the “discrepancy” associated with stress of conscience is reminiscent of the

“cognitive dissonance” that leads to moral injury (Litz et al., 2009).

Each SCQ item contains an A and a B question. The A question asks about the

frequency of exposure to the stressful event, and the B question asks about the amount of

distress or troubled conscience the event generated. For example, the A question, “How

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often do you lack the time to provide the instruction and/or support that a student needs?”

is responded to using a six-point Likert scale, with 0 being “Never,” and 5 being “Every

day.” Then the B question asks “Does this give you a troubled conscience?” and the

participant responds on a six-point Likert scale, where 0 = “no, not at all,” and 5 = “yes,

very much.” The SCQ has been found to contain two factors, Internal Demands and

External Demands/Restrictions, with good reliability coefficients (α = .74 and .78,

respectively; Glasberg et al., 2006), but also comes close to meeting the criteria for

unidimensionality, with an internal consistency estimate of .83 for all items, indicating a

total “stress of conscience” score (Glasberg et al., 2006). In the current study, the word

“patient” was replaced with “student,” and “provide care” was replaced with “provide

instruction and/or support.” Cronbach’s alphas for the full scale score (α = .84), the

Internal Demands factor (α = .71), and the External Demands factor (α = .78) were nearly

identical to those found in Glasberg et al. (2006).

Burnout. The Copenhagen Burnout Inventory (CBI; Kristensen, Borritz,

Villadsen, & Christensen, 2005) is a three-scale inventory that measures personal

burnout, work-related burnout, and client-related burnout among human service sector

workers. Participants are asked to report how often they feel tired, how often their work

frustrates them, and whether they find it hard to work with students. Responses are

measured on a five-point Likert scale, where 1 = “Never/almost never or to a very low

degree,” and 5 = “Always or to a very high degree.” The CBI has demonstrated initial

evidence of reliability (α = .85–.87.) and has been argued by its authors to be a more

valid measure of burnout than the Maslach Burnout Inventory (MBI; Maslach, Jackson,

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& Leiter, 1996, 1997) (Kristensen et al., 2005). In this study, “clients” in the “client-

related burnout” scale of the CBI was changed to “students” to be consistent with the

education context. Internal reliability estimates (α = .78 - .91) were strong and consistent

with those found by Kristensen and colleagues (2005).

Intention to leave. The Intention to Leave Scale (ILS; Rosin &Korabik, 1991)

contains four items used to measure an individual’s intentions to leave their current job:

(1) At this time in your career, would you want to quit this job if it were possible? (2) Are

you actually planning to leave your job within the next six months? (3) Are you actively

searching for another job right now? and (4) Please indicate whether you have ever had

thoughts of leaving your job. Items 1 and 2 were rated as 0 = no, 1 = not sure, and 2 =

yes. Item 3 was rated as no = 0 and yes = 1. For item 4, participants responded with 1 =

I never have had such thoughts, 2 = I occasionally have such thoughts, or 3 = I frequently

have such thoughts. Although the intention to leave one’s job is not the same as actual

job turnover, researchers have found that measures of the intention to leave a job are the

strongest predictor of an actual decision to leave (Rosin &Korabik, 1991). Internal

reliability of the ILS in this study (α = .81) was high and nearly identical to the α = .82

found by Rosin &Korabik (1991).

Data Analysis

Univariate analyses (means and standard deviations) were used to answer the first

research question to determine the extent that educators experience moral injury in their

workplace. Regression analyses were performed to answer the second research question

to determine the individual and school-level characteristics associated with moral injury.

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The data included 218 individual professionals from 68 schools, suggesting clustered

data. The largest cluster included 13 professionals from one school and the smallest

included only one participant in a school. Nineteen of the schools in the data set (28%)

contained only one participant. Interclass correlations (ICCs) were calculated for each of

the three MIES factors (transgressions-other, transgressions-self, and betrayal) which

serve as the dependent variables. All three ICCs were non-trivial (≈ .10): ICC

(Transgressions-Other) = 0.199, ICC (Transgressions-Self) = 0.097, ICC (Betrayal) =

0.106. Both multi-level and single-level models for the three dependent variables

(Transgress-other, Transgress-self, and Betrayal) were run and compared. In the

resulting equations, the estimated coefficients were nearly identical between the multi-

level model and the single-level regression for all three outcome variables, varying at

most by one hundredth of a point. Additionally, in the multi-level models, the variance

attributed to the intercept (i.e. the clustering effect) was small and not statistically

significant. Thus, the impact of school-level clusters was not relevant to the accuracy of

the estimated coefficients in the regression models and based on the principal that, when

possible, a simpler model is preferable to a more complex model, a single-level model

was chosen for all analyses. However, multicollinearity was detected between several

variables: the percentage of students of color and the percentage of students on free or

reduced lunch; age of the teacher and number of years in education; and the number of

students in the school and the school level. As such, the percentage of students receiving

free or reduced lunch, the age of the teacher, and the number of students in the school

were removed from the models.

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Correlational analyses were used to answer the third research question, regarding

the emotional and behavioral factors associated with moral injury. Because the MIES

and the scales measuring the emotional and behavioral factors (TRGI, SCQ, CBI, and

ILS) were ordinal scales, and two of the TRGI subscales demonstrated an elevated level

of skewness (see Table 6), Spearman’s Rho correlations were used. All analyses were

performed using SSPS version 24 software (IBM Corp., 2016).

Results

Extent of Moral Injury Among K-12 Professionals

Mean scores for each of the three MIES factors were as follows: 4.4 (SD = 1.5)

for Transgressions-Other, 2.9 (SD = 1.5) for Transgressions-Self, and 3.8 (SD = 1.5) for

Betrayal. 80.2% of participants (n = 175) scored above a 3 on the Transgressions-Other

factor, 45.4% (n = 98) scored above a 3 on Transgressions-Self, and 68.4% (n = 148)

scored above a 3 on the Betrayal factor, denoting agreement with statements regarding

experiencing and being troubled by morally problematic events. Although no clinical

cut-off score exists for the MIES, “3” reflects that the participant “slightly disagrees”

with a statement referencing a morally injurious experience and “4” reflects that the

participant “slightly agrees.” Thus, scores above 3.5 suggest endorsement of morally

injurious experiences. Scores on the Transgressions-Other factor skewed slightly high,

with 52.7% (n = 115) of participants scoring a 5 or higher (out of a 6-point scale),

suggesting moderate to strong agreement with exposure to others’ morally troubling

actions.

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Individual and School-Level Characteristics Associated with Moral Injury

Tables 2, 3, and 4 present the single-level regression models for each of the MIES

factor scores (Transgressions-Other, Transgressions-Self, & Betrayal). The first model

includes only individual-level variables, including the professional’s gender (male or

female), race (white or non-white), the number of years the professional had worked in

education, and whether or not the professional’s role fell into the mental health category

(i.e. psychologist, social worker, counselor, or nurse). Multicollinearity was detected

between the mental health and special education variables, thus the special education

variable was removed from the model. The second model includes the individual-level

variables from Model 1 and two school-level variables, the type of school (elementary or

non-elementary), and the percentage of students of color in the school. The third model

includes only the variables from Model 2 that demonstrated statistical significance (p <

.05).

Gender, being a mental health professional, and the percentage of students of

color in a school were all positive predictors of Transgressions-Other (see Table 2). For

Transgressions-Self (see Table 3), only the percentage of students of color in the school

was a positive predictor. For Betrayal (see Table 4), women were more likely to score

higher and scores increased as the percentage of students of color in the school increased.

The adjusted r-squared values for each MIES factor were quite small, ranging from .045

to .153, suggesting that the variables examined do not explain large amounts of the

variance in MIES scores.

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Emotional, Social, and Behavioral Symptoms Associated with Moral Injury

Means and standard deviations for scores on the TRGI, SCQ, CBI and ILS are

presented in Table 5. Mean scores on the TRGI were relatively low, ranging from .81

(SD = .84) to 1.9 (SD = 1.1), out of a possible range of 0 to 4. Mean scores on the SCQ

Internal, External, and Total mean scores were 46.6 (SD = 26.8, range = 0 – 150), 57.3

(SD = 29.8, range = 0-150), and 88.7 (SD = 47.5, range = 0-225), respectively. On the

CBI, participants scored highest on the Personal Burnout factor (M = 60.0, SD = 20.7),

followed by the Work-Related Burnout factor (M = 58.1, SD = 18.0), and then the Client-

Related Burnout factor (M = 38.7, SD = 22.5). The mean score on the ILS (M = 3.4, SD

= 2.1) was near the mid-point of the scale (range = 1-8). In response to the first question

on the ILS, “At this time in your career, would you want to quit this job if it were

possible?” 25.75% of participants (n = 56) responded “Yes.” 14.2% of participants (n =

31) said they were planning to leave their job within the next six months, and 16.1% (n =

35) stated that they were actively searching for a job at this moment. 30.7% of

participants (n = 67) said they frequently have thoughts of leaving their job.

Spearman’s Rho correlational analyses were used to examine the relationship

between each of the MIES factors (Transgressions-Other, Transgressions-Self, and

Betrayal) and the TGRI, SCQ, CBI, and ILS, (see Table 6). The data show moderate to

large correlations between the Transgressions-Self factor on the MIES and all subscales

on the TRGI, aside from Lack of Justice (𝑟𝑠 =.541, .415, .560, .433, .624). In addition,

all three MIES factors were moderately to largely correlated with the TRGI subscales of

Global Guilt (𝑟𝑠 = .413, .541, & .427) and Distress (𝑟𝑠 = .489, .415, & .589). The data

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show moderate correlations ranging from .328 to .494 across all three SCQ scores and all

three MIES factors. Among the MIES factors, Transgressions-Other and Betrayal were

most highly correlated with the CBI factors, particularly CBI Personal (𝑟𝑠 =

.293 & .413) and CBI Work (𝑟𝑠 = .329 & .459). The ILS scale was moderately

correlated with the Betrayal factor (𝑟𝑠 = .369) and slightly but significantly correlated

with the Transgressions-Other factor (𝑟𝑠 = .214).

Discussion

The results of this study provide empirical support for Levinson (2015) and

Keefe-Perry’s (2016) arguments that moral injury is a relevant concept for K-12

professionals. The mean scores on the MIES suggest that professionals have witnessed

or participated in situations in the context of their work in public education that violate

their moral beliefs. The mean scores for professionals in K-12 education follow a similar

pattern to those in the two other published studies that have used the MIES with Airforce

and Army National Guard members (Bryan et al., 2016) and child protection

professionals (Haight, Sugrue, & Calhoun, 2017b), in which higher scores were found for

the Transgression-Other factor, followed by Betrayal, and then the lowest scores for

Transgression-Self. Although these samples represent different populations and no direct

comparisons can be made, it is still valuable to consider the MIES scores from this

study’s sample in the context of what has been reported in this small but growing

literature.

Interestingly, most of the individual-level variables that were examined, such as

the race of the professional or their years of teaching experience, were not significantly

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predictive of MIES scores in any of the regression models. Gender was significant or

approached significance for Transgressions-Other (p =.091) and Betrayal (p = .04)

scores, with women scoring higher than men. Additionally, women made up over 75%

of the sample and these results must be considered in light of the smaller number of men

in the sample, although these proportions accurately reflect the gender proportions of the

workforce (see Table 1). Mental health professionals demonstrated significantly higher

scores on the Transgressions-Other factor (B = 1.001, p = .002), meaning they were more

likely to endorse having witnessed others in their school engage in morally troubling

actions. One reason for this finding could be that mental health professionals have more

exposure to the actions of other professionals than classroom teachers. Classroom

teachers spend most of their day alone in their classrooms with students. In contrast,

psychologists, social workers, counselors, and nurses are often in the halls, in and out of

different classrooms, interacting with a wide variety of staff and students, and thus they

may be more likely to witness others’ morally troubling actions. In addition, these

professionals frequently work with students who are struggling academically,

emotionally, or behaviorally in the school environment. It may be that close interactions

with students whose needs are not being met by the school is inherently morally

troubling.

The most significant predictor of MIES scores, across all three factors, was the

percent of students of color in the school. As the percent of students of color in the

school was highly correlated with the percent of students receiving free or reduced lunch,

these results can be interpreted as reflecting a similar positive relationship between the

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percentage of students in poverty in a school and a professional’s endorsement of

experiences of moral injury. Levinson (2015) has asserted that educators experience

moral injury when they are required to act justly “in situations where no just action is

open to them” (p. 211). One major constraint on educators’ ability to act justly is “the

impact of contextual injustices” (Levinson, 2015, p. 211; italics original), including

poverty, trauma, and racial and economic segregation. Levinson’s argument is supported

by the data in this study—the more economically and racially segregated the school, the

more likely a professional was to endorse moral injury. Professionals in these schools

may experience moral injury as they come into close contact with the impact of racism

and income inequality, two inherently immoral social forces, on the daily lives of their

students.

Levinson (2015) has also cited “school-based injustices” (p. 211, italics original),

such as discriminatory school policies and insufficient funding, as potential sources of

moral injury for educators. One example of a school-based injustice is the racial

disproportionality in suspension rates. In 2014, the U.S. Department of Education’s

Office of Civil Rights released data demonstrating that African American students have a

suspension rate that is three times that of White students. A 2017 study by the Brown

Center on Education Policy at the Brookings Institute found that African American

students had higher rates of suspension in higher poverty schools than low poverty

schools and higher rates of suspension in schools with more African American students

(Loveless, 2017). The exact nature of moral injury was not assessed in the survey. The

professionals in the current study sample who scored highest on the MIES (e.g. those

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who worked in schools with a higher percentage of students of color and students on

free/reduced lunch) may experience more exposure to school-based injustices such as

high suspension rates for African American students, leading to increased moral injury.

This study adds important information to the understanding of the emotional and

behavioral symptoms associated with exposure to morally injurious events outside of the

military context. Previous researchers have found guilt to be associated with moral injury

(e.g. Currier et al., 2015a; Drescher et al., 2011; Jinkerson, 2016; Litz et al., 2009). Most

of the mean scores on the TRGI subscales were moderately to strongly correlated with

mean MIES scores, lending support to the relationship between guilt and moral injury

among K-12 professionals. However, overall the TRGI mean scores were relatively low,

suggesting that K-12 professionals did not experience a great deal of guilt related to their

experiences of moral injury. McDonald (2017) has argued that moral injury is less about

guilt and shame related to what an individual has done or failed to do in “singular events”

(p. 5) and more about the feelings of loss and hopelessness due to experiences that shatter

one’s sense of a moral world. Similarly, in her work on teacher demoralization, a

concept closely related to moral injury, Santoro (2011) has described teachers as

experiencing demoralization not due to singular acts, but because of a general sense that

they are unable to do what is right in their work. In this study, K-12 professionals who

scored high on moral injury may have still experienced relatively low levels of guilt

because their moral injury was due less to individual actions and more due to a general

sense that the education system has become morally untenable.

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The moderate correlations between all three SCQ scales and all three MIES

factors lend support to the hypothesis that moral injury and stress of conscience are

related concepts. This finding suggests that as the conceptualization of moral injury

continues to be shaped and refined, researchers should look to work being done on stress

of conscience (e.g. Glasberg, Eriksson, & Norberg, 2007; Glasberg, Eriksson, & Norberg,

2008; Juthberg, Eriksson, Norberg, &Sundin, 2010; Ahlin, Ericson-Lidman, Eriksson,

Norberg, & Strandberg, 2013). Not only could the stress of conscience literature aid in

conceptual development of moral injury, but the Stress of Conscience Questionnaire

appears to have significant strengths over the MIES and other current quantitative

measures for moral injury, such as the Moral Injury Questionnaire (MIQ) (Currier et al.,

2015a). The SCQ allows for the measurement of both the exposure to the troubling event

and the individual’s moral appraisal of that event. In contrast, the MIES and the MIQ are

limited in that they conflate exposure to specific events with appraisal of these events.

Burnout scores on the CBI among the study sample were notably larger than

scores in previous studies of healthcare providers (Kristensen et al., 2005) and secondary

teachers in New Zealand (Milfont, Denny, Ameratunga, Robinson, and Merry, 2008).

One possible reason for burnout scores being so high among this sample could be due to

the time period when data were collected. Participants completed the survey between

mid-May and the end of June, a period that straddles the last weeks of school in this

district. General levels of exhaustion related to work are likely to be at their highest near

the end of a long school year and this may have inflated the professionals’ scores. It is

notable, however, that the Client-Related mean score (M = 38.7) was relatively smaller

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than those on the Personal- (M= 58.1) and Work-Related (M = 60.0) subscales. This

suggests that the K-12 professionals found aspects of their work to be a source of

exhaustion, but not their direct work with students themselves. The small to moderate

correlations between the MIES scores and CBI subscales suggest that a relationship exists

between burnout and moral injury. This finding lends some support to Gabel’s (2012)

assertion that the similar construct of demoralization may be a precursor to burnout,

though the cross-sectional nature of the data does not allow for any conclusions regarding

temporal order of the phenomena.

Levinson (2015) has posited that one response educators may have to moral injury

is to leave the profession. Santoro & Morehouse (2011) have called educators

“principled leaders” and “conscientious objectors” when they leave the field because they

cannot stand being complicit any more with wide-spread oppression and injustice. The

results from this study demonstrate a small but significant positive relationship between

moral injury due to others’ transgressions and the intention to leave one’s job, and a

moderate, significant positive relationship between betrayal and intention to leave one’s

job. No relationship was found between moral injury related to one’s own actions and

scores on the ILS.

The findings of this study must be considered within the context of several

limitations. The response rate for the on-line survey was quite low (< 7%). Although the

demographics of the sample closely mirrored those of the larger district population of

licensed non-administrative professionals, attempts to generalize these findings to the

entire district population must be done with caution because there might be differences

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between survey responders, survey completers, and those who did not initiate the survey.

Additionally, the MIES has limitations as a standardized tool to measure moral injury.

First, the MIES does not allow for identification of the specific events that participants

perceived to be morally injurious. Thus, conclusions regarding the specific sources of

moral injury among K-12 professionals can only be hypothesized based on this data.

Secondly, the MIES conflates exposure to, and the appraisal of, morally injurious events.

For example, the Transgressions-Other factor contains two items, “I saw things that were

morally wrong,” and “I am troubled by having witnessed others’ immoral acts.” A K-12

professional could potentially give a high rating (e.g. 6, strongly agree) to having

witnessed acts that were morally wrong while also giving a low rating (e.g. 1, strongly

disagree) to the statement regarding being troubled by having witnessed these actions.

When these scores are averaged, per the scoring instructions, the result is a

Transgressions-Other score of 3.5. The meaning of this score is difficult to interpret

because it is equally influenced by both one’s exposure to and appraisal of an event

effectively washing out meaningful information in the data and compromising the scale’s

overall validity. However, the high correlations between the MIES and the SCQ, a scale

that does not confound the exposure to the immoral event with the emotional appraisal of

the event, suggests that despite the design flaws, moral injury can be validly measured by

the MIES.

The most significant finding from this study is the relationship between the racial

or economic make-up of a school’s student-body and a professional’s experience of

moral injury. However, because of the high correlation between percent of students of

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color and the percent of students on free/reduced lunch in this dataset, it was impossible

to untangle the impact of the student body’s racial make-up from the impact of the

student body’s socio-economic make-up on the likelihood of and intensity of moral injury

among the K-12 professionals. Intersectionality theory (Crenshaw, 1989) posits that race

and class are interwoven identities and cannot and should not be untangled when

understanding the experiences of individuals (Powell, 2007). Powell (2007) has argued

that “race and class are distinct and at the same time mutually constitutive, recursive

processes in the United States that render race and class radically incoherent without

understanding their interactive nature” (p. 358). Viewed through intersectionality theory,

the limitation in this study is not the high correlation between the racial and economic

make-up of the schools in the dataset, but rather the limits of traditional regression

analyses in trying to understand how the racialized and classed elements of the

educational context may relate to K-12 professionals’ experiences of moral injury.

Although moral injury is most frequently associated with the combat experiences

of military veterans, this study provides empirical evidence of the relevance of moral

injury to professionals in the U.S. K-12 education system, particularly for those working

in segregated schools with high percentages of students of color and students living in

poverty. Examining moral injury within the K-12 education context allows for

discussions of problems in the education system to move beyond policy and pedagogy to

encompass considerations of the morality (and immorality) inherent in the racialized and

classed structure and practices of American public education. To mitigate moral injury in

education, future research will need to further explore these contextual sources of moral

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injury in order to identify and implement systemic changes to increase educational and

social justice.

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Table 1

Individual- and School-Level Demographics, Study Sample vs. Population

Sample (n = 218) District Population4

Educator Characteristics percentage (n)

Gender

Male 22.9% (50) 28%

Female 76.6% (167) 72%

No Gender Listed .5% (1) NA

Race

White 77.1% (168) 85.1%

African American 4.1% (9) 6.4%

Asian American 2.8% (6) 3.3%

Latinx 2.3% (5) 3.1%

Native American 0.5% (1) 1.2%

Multi-Racial 11.5% (25) N/A

No Race Listed 1.8% (4) N/A

Age Mean = 42.6 years

(sd = 11.9)

Range: 22-65 years

No age data available

from district

Years Working in Education Mean = 15.0 years

(sd = 10.1)

Range: 1- 44 years

Mean = 12 years

Role

Classroom Teachers 50.5% (120) No data available5

4District percentages are estimates based on the number of FTE in a certain category, as reported by the

district to the State Department of Education, divided by the number of licensed professionals in the district

(n=3169), as identified by the author of this study. 5 State data combines ELL teachers with other classroom teachers and teachers of specialist subjects (e.g.

music, visual arts).

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Special Ed Staff 19.3% (42) 19.0%

Non-Classroom Instructional

Support 10.1% (22) 6.5%

School Social Workers 5.0% (11) 4.0%

English Language Learner

Teachers 5.0% (11) No data available

Specialist Teachers 4.6% (10) No data available

School Psychologists 3.7% (8) 1.4%

School Counselors .9% (2) 2.2%

School Nurses .5% (1) 1.7%

School Characteristics6

School Type

Elementary Educators 53.2% (116) No data available

Non-Elementary Educators 46.8% (102)

% of Students Receiving

Free/Reduced Lunch

No data available7

< 10% .9% (2)

10-30% 6.4% (14)

31-50% 14.7% (32)

51-75% 24.3% (53)

76-90% 30.3% (66)

> 90% 23.4% (52)

% of Students of Color

No data available8

< 10% 0% (0)

11-30% 4.6% (10)

31-50% 9.6% (21)

51-75% 28.0% (61)

76-90% 21.1% (46)

>90% 36.7% (79)

6 Percentages refer to the percentage of participants represented at each category of school, not the

percentage of schools represented in the sample. 7 Data from the district regarding the percentage of educators represented at each category of school is not

available. However, data regarding the percentage of schools in the district in each category is available.

53% of schools in the district have more than 75% of their students receiving free or reduced lunch. 8 Data from the district regarding the percentage of educators represented at each category of school is not

available. However, data regarding the percentage of schools in the district in each category is available.

62% of schools in the district have greater than 70% students of color.

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Table 2

Regression Analysis Summary for Individual- and School-Level Variables Predicting MIES Transgressions-Other Scores

Model 1 Model 2 Model 3

Variable B SE B β t p B SE B β t p B SE B β t p

Gender* .419 .230 .123 1.824 .070 .402 .219 .118 1.835 .068 .361 .214 .106 1.684 .094

Race_White** .150 .247 .041 .607 .545 .059 .234 .016 .254 .800 -- -- -- -- --

Mental Health

Professional***

1.098 .340 .217 3.234 .001 1.024 .321 .202 3.190 .002 1.001 .318 .198 3.152 .002

Years in

Education

-.001 .010 -.007 -.104 .917 0.10 .010 .069 1.059 .291 -- -- -- -- --

Elementary

School**** -- -- -- -- -- -0.91 .195 -.030 -.468 .640 -- -- -- -- --

Percentage of

Students of

Color in the

School

-- -- -- -- -- 2.376 .451 .342 5.269 .000 2.264 .436 .326 5.190 .000

Adjusted 𝑅2 = .043 Adjusted 𝑅2 = .147 Adjusted 𝑅2 = .153

* 0 = Male; 1 = Female. No participants identified as transgender.

**0 = White; 1 = Non-White.

***1 = Mental health professional (i.e. school psychologist, school social worker, school counselor, school nurse); 0 = all other professionals

****1 = Elementary school (i.e. any school including students in grades K-5); 0 = Non-elementary school (i.e. any school without any students in

grades K-5)

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Table 3

Regression Analysis Summary for Individual- and School-Level Variables Predicting MIES Transgressions-Self Scores



Gender* .041 .229 .012 .179 .858 .032 .221 .010 .143 .886 -- -- -- -- --

Race_White** -.110 .246 -.031 -.448 .655 -.193 .236 -.054 -.818 .414 -- -- -- -- --

Mental health

professionals*** .211 .338 .043 .625 .532 .143 .324 .029 .443 .659 -- -- -- -- --

Years in

Education

-.016 .010 -.111 -1.601 .111 -.006 .010 -.040 -.595 .552 -- -- -- -- --

Elementary

School**** -- -- -- -- -- -.102 .197 -.034 -.515 .607 -- -- -- -- --

Percentage of

Students of

Color in the

School

-- -- -- -- -- 2.102 .456 .312 4.611 .000 2.138 .438 .317 4.883 .000

Adjusted 𝑅2 = −.002 Adjusted 𝑅2 = .082 Adjusted 𝑅2 = .096





grades K-5)

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Table 4

Regression Analysis Summary for Individual- and School-Level Variables Predicting MIES Betrayal Scores



Gender* .497 .225 .152 2.213 .028 .481 .223 .147 2.157 .032 .446 .218 .136 2.047 .042

Race_White** .096 .241 .028 .399 .690 .050 .238 .014 .208 .835 -- -- -- -- --

Mental Health

Professionals***

.251 .332 .052 .756 .450 .213 .327 .044 .650 .516 -- -- -- -- --

Years in

Education

.005 .010 .033 .478 .633 .011 .010 .076 1.101 .272 -- -- -- -- --

Elementary

School**** -- -- -- -- -- -- -- -- -- --

Percentage of

Students of

Color in the

School

-- -- -- -- -- 1.258 .451 .186 2.789 .006

Adjusted 𝑅2 = .007 Adjusted 𝑅2 = .036 Adjusted 𝑅2 = .047





grades K-5)

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Table 5

Means and Standard Deviations for Measures of Guilt, Troubled Conscience, Burnout,

and Intention to Leave a Job

M SD n

TRGI

(range = 0 – 4)

Global Guilt* .93 .88 213

Distress Scale 1.2 1.1 206

Guilt Cognitions 1.1 .53 194

Hindsight Bias 1.1 .69 201

Wrongdoing** .81 .84 207

Lack of Justice 1.9 1.1 203

SCQ

Internal

(range = 0 – 125) 46.6 26.8 207

External

(range = 0 – 125)

57.3 29.8 207

Total

(range = 0 – 225)

88.7 47.5 199

CBI

(range = 0 – 100)

Client 38.7 22.5 216

Work 58.1 18.0 217

Personal 60.0 20.7 216

Intention to Leave

(range = 1 – 8)

3.4 2.1 216

Note. TRGI = Trauma-Related Guilt Inventory; SCQ = Stress of Conscience Questionnaire;

CBI = Copenhagen Burnout Inventory

*Distribution was slightly skewed to the right at 1.207 (SE = .167)

**Distribution was slightly skewed to the right at 1.424 (SE = .169)

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Table 6

Correlations between MIES Score and Measures of Guilt, Stress of Conscience, Burnout, and Intention to Leave a Job

TRGI SCQ CBI ILS

MIES

Factor

Global

Guilt

Distress

Scale

Guilt

Cogni-

tions

Hindsight

Bias

Wrong-

doing

Lack

of

Justifi-

cation

Internal External Total Personal Work Client

Transgress

- Other

.413** .489** .199** .163* .388** -.081 .446** .328** .416** .293** .329** .144* .214**

Transgress

- Self

.541** .415** .560** .433** .624** .233** .448** .360** .432** .199** .189** .133 .109

Betrayal .427** .589** .236** .206** .386** -.013 .454** .440** .494** .413** .459** .211** .369**

* Correlation is significant at the 0.05 level (2-tailed).

** Correlation is significant at the 0.01 level (2-taled).

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Chapter 4

Paper 3

Moral Injury in Racially & Economically Marginalized Public Schools:

A Phenomenological Inquiry

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Synopsis

This paper presents the results of a phenomenological study of moral injury among K-12

educators in racially and economically segregated urban schools. This study is the

qualitative portion of a larger mixed methods study of moral injury among professionals

in K-12 education. Results from the quantitative portion of the study demonstrated a

strong relationship between the percent of students of color and the percent of students in

poverty in a school and professionals' experiences of moral injury. The purpose of this

study is to explore how racial and economic segregation in schools can produce moral

injury among K-12 professionals. Using Critical Race Theory and Intersectionality

Theory, I identify how race and class oppression produce an education context that is rife

with moral wrongs and accompanying distress. I end with recommendations for how the

construct of moral injury can be employed to work towards eliminating educational

injustice.

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Introduction

Moral injury refers to the lasting emotional, psychological, and existential harm

that occurs when an individual “perpetrates, fails to prevent, bears witness to, or learns

about acts that transgress deeply held moral beliefs and expectations” (Litz et al., 2009, p.

700). Individuals who experience moral injury may report feelings of guilt, shame,

anxiety, and depression, (Dombo, Gray, & Early, 2013; Jinkerson, 2016; Litz et al.,

2009). Moral injury can result in an existential crisis when one’s sense of one’s self as a

moral actor and the world as a moral place is shattered (McDonald, 2017).

Although the term “moral injury” was originally coined by mental health

professionals working with American military veterans (Litz et al., 2009; Shay, 1994,

2014), in recent years researchers have found evidence of experiences of moral injury in

a variety of other morally significant sociocultural contexts, including among Middle

Eastern refugees living in Europe (Nickerson et al., 2015), teachers in violent areas of El

Salvador (Currier, Holland, Rojas-Flores, Herrera, & Foy, 2015b), women with substance

abuse histories (Hartman, 2015), and parents and professionals involved in the Child

Protection System (Haight, Sugrue, Calhoun, & Black, 2017a; Haight, Sugrue, Calhoun,

2017b). The U.S. public education system is another important setting in which to

consider moral injury, as it is both produced by, and a reproducer of, the knowledge,

skills, behaviors, and values deemed important by American society; and, thus, by nature,

carries significant moral weight and significance. The purpose of this study is to explore

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phenomenologically how moral injury takes shape among professionals9 in K-

12 education.

Background

Morality in the K-12 Education Context

The term morals refers to systems of values and beliefs about right and wrong

(Crisp, 1998; Sheraton, 2012). Within philosophy, morality is discussed in both

descriptive and normative senses (Gert & Gert, 2016). Descriptively, morals refer to

“codes of conduct put forward by a society or a group (such as a religion), or accepted by

an individual for her own behavior” (Gert & Gert, 2016, no page). Normatively, morals

are “a code of conduct that, given specified conditions, would be put forward by all

rational persons” (Gert & Gert, 2016, no page). Thus, philosophically, moral beliefs can

be considered both absolute and socially and contextually determined (Buzzelli &

Johnston, 2002, p. 4).

Modern American teacher preparation programs have often neglected to engage

students in discussions of morals or morality, perhaps due to concerns about their

affiliation with religious or spiritual beliefs (Buzzelli & Johnston, 2002; Hansen, 2001);

yet, the idea of teaching as a moral endeavor is ancient, dating back to the writings of

Plato, Confucius, Aristotle, and the Buddha (Hansen, 2001). Two core aspects of

teaching render it a moral practice. First, teaching involves “human action undertaken in

regard to other human beings” (Fenstermacher, 1990, p. 133) and thus, “matters of what

9In this study, professionals refers to all professionally licensed non-administrative staff who have direct

contact with students, including teachers, school social workers, school psychologists, school counselors,

speech pathologists, physical therapists, occupational therapists, and school nurses.

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is fair, right, just, and virtuous are always present” (p. 133). Second, teaching consists of

influencing or changing the behavior of students to meet prescribed, normative goals,

based on ideas of good and bad, right and wrong (Buzzelli & Johnston, 2002; Hansen,

2001; Goodlad, 1990; Pring, 2012).

In addition to the moral nature of the practice of teaching, the context of

education itself is morally complex (Buzzelli & Johnston, 2002; Campbell, 2008;

Levinson, 2015). Elements that are central to the education context, such as evaluation,

assessment, and the physical control of student bodies in school, are laden with moral

meaning and can be sources of moral dilemmas for educators (Buzzelli & Johnston,

2002). According to Buzzelli & Johnston (2002), the ubiquity of moral dilemmas in

education requires that educators be attentive to the moral nature of their work. Referring

to this attentiveness as moral sensibility, Buzzelli & Johnston (2002) have stressed the

importance of educators cultivating this awareness in order to identify and engage in

moral action. In contrast, in her conceptual article on moral injury in education,

Levinson (2015) has argued that moral sensibility will not lead to just and appropriate

solutions to educational dilemmas because the nature of the political, economic, and

social constraints in which the education system exists frequently renders moral action

impossible. Despite their obligations, their awareness, and in many cases their best

intentions, educators perpetrate moral wrongs, and it is these immoral actions, in the

context of an immoral system, that result in K-12 professionals’ moral injury (Levinson,

2015).

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Moral Injury

As moral injury is a relatively recent topic of empirical research, conceptual

models are continuing to be developed and refined. The most commonly cited moral

injury conceptual framework is by Litz and colleagues' (2009). According to this model,

when an individual perpetrates or witnesses a morally transgressive act, they experience

cognitive dissonance due to the discrepancy between their moral beliefs and the

transgression. When individuals attempt to resolve this cognitive dissonance, those prone

to moral injury will make cognitive attributions that are “global (i.e. not context

dependent), internal (i.e. seen as a disposition or character flaw), and stable (i.e.

enduring; the experience of being tainted)” (Litz et al., 2009, p. 700). These attributions

will cause the individual to experience guilt, anxiety, and shame, and engage in

withdrawal behaviors, which prevent corrective and reparative experiences that might

allow for self-forgiveness and healing.

McDonald (2017) has proposed an alternative theoretical understanding of moral

injury. Whereas Litz and colleagues’ (2009) model assumes an individual is troubled by

a specific morally troubling action or event (or set of events), McDonald (2017) has

argued that it is the shattering of “one’s sense of rightness and wrongness altogether” that

results from the experience of deeply, morally troubling events that is at the heart of

moral injury. When individuals witness or participate in moral transgressions, this

changes the way they understand the world and the way they experience themselves in

the world (McDonald, 2017). Thus, a theoretical discussion of moral injury should focus

less on understanding how individuals cognitively respond to individual moral

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transgressions and more on how one copes with a world in which the moral structures on

which they had based their beliefs and expectations no longer hold (McDonald, 2017).

The Current Study

This study is the qualitative portion of a larger explanatory sequential mixed

methods study (Creswell, 2014) of moral injury among K-12 education professionals. In

the quantitative portion of the study (Author, under review), I measured the extent of, and

factors related to, experiences of moral injury among 218 professionals in an urban public

school district in the Midwest. The results showed a significant relationship between the

racial and economic make-up of a school’s student body and experiences of moral injury

among its staff – the more students of color and the more low-income students in a

school, the more likely the professionals in that school were to experience moral injury

(Author, under review). Based on these results, in the qualitative portion of the study, I

sought to explore the following questions:

How does moral injury take shape within the context of segregated public schools

with high percentages of low-income students of color? More specifically, how

does the context of a racially and economically segregated and marginalized

public school produce moral injury among K-12 professionals?

Guiding Theoretical Perspectives

The conceptualizations by both Litz et al. (2009) and McDonald (2017) have

shaped my understanding of moral injury and guided how I interpret professionals’

descriptions of morally troubling events and their accompanying distress throughout this

study. However, because the focus of this study is on understanding how a specific

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racialized and classed public education context produces moral injury, my approach is

informed by two theoretical frameworks: Critical Race Theory (CRT; Bell, 1980;

Delgado &Stefancic, 2012) and Intersectionality Theory (Crenshaw, 1989).

Critical Race Theory. Critical Race Theory is both a theoretical framework and

a social movement that attempts to understand, challenge, and transform the relationship

among race, racism, and power (Delgado &Stefancic, 2012). CRT centers race and

racism in analyses of social problems. In contrast to traditional approaches to civil rights

and ethnic studies, CRT questions “the very foundations of the liberal order” (Delgado

&Stefancic, 2012, p. 3), challenges White normative social process and standards, and

provides insight into how the relationship among race, racism, and power produces,

maintains, and supports racial inequality (Kolivoski, Weaver, & Constance-Huggins,

2014).

In this study, I focus on four tenets of CRT: the ordinariness of racism (Delgado

&Stefancic, 2012), interest convergence (Bell, 1980), Whiteness as property (Harris,

1993) and White supremacy (Leonardo, 2004). The concept of the ordinariness of

racism asserts that because racism is an ingrained part of American life, it appears

ordinary, normal, and natural (Delgado &Stefancic, 2012). This ordinariness makes it

difficult to address anything but the most egregious and extreme acts of racial injustice,

such as the Jim Crow laws of the pre-1970 American South. Interest convergence (Bell,

1980) refers to the idea that civil rights advances for people of color occur not because of

changing public commitments to equality and social justice, but only when these

advances converge with the interests of Whites. Civil rights gains for people of color

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only occur when those gains do not truly threaten the social, political, and economic

domination of Whites.

Whiteness as property (Harris, 1993) describes how the intersection of race and

property can be used to understand inequality (Kolivoski et al., 2014). Under early

American law, property rights were only afforded to White men, formally solidifying the

ideology of the supremacy of Whites to other races, who were thus deemed

“fundamentally antithetical to ownership” (Vaught, 2012, p. 53). This ideology was used

to produce additional rights, such as voting and representation that were also only

available to White men (Vaught, 2012). The institution of slavery further cemented

Whites’ power of ownership (in this case the literal ownership of Black bodies), making

Whiteness “the right to own property and to never be owned . . . in other words, Whites

owned the right to humanity” (Vaught, 2012, p. 53). In contemporary contexts,

“Whiteness as property” is exercised through the claim of Whites “to craft and instantiate

meaning, to accrue benefit, and to expect exclusivity and legal protection” (Vaught, 2012,

p. 53).

White supremacy refers to the “political, economic, and cultural system in which

whites overwhelmingly control power and material resources, conscious and unconscious

ideas of white superiority and entitlement are widespread, and relations of white

dominance and non-white subordination are daily reenacted across a broad array of

institutions and social settings (Ansley, 1997, p. 592). Leonardo (2004) has argued that

analyses guided by CRT need to go beyond examining White privilege, which he asserts

is conceptualized as a passive state of being for Whites, to identifying White supremacy,

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the active process of domination carried out by Whites, regardless of their professed

beliefs and desires (hooks, 1989).

Intersectionality theory. Intersectionality theory posits that identities of race,

class, gender, sexuality, ethnicity, ability, and age do not operate mutually exclusively,

but instead are “reciprocally constructing phenomena that in turn shape complex social

inequities” (Collins, 2015). Intersectionality theory originated out of a critique by Black

feminist scholars of the hegemony of White feminist scholarship that posited that

“women constituted a universal category” and that race was unimportant to feminist

research (Jibrin& Salem, 2015). Black feminists argued that one could not understand

the experiences of African American women by combining previous research on gender

with previous research on race, as the former focused on White women and the latter on

Black men (McCall, 2005). The experiences of Black women exist not in the sum of

gender and race but at their point of intersection of these social identities.

Similar to CRT, intersectionality theory is an activist theory, with roots in

empiricism and advocacy (Gilborn, 2015), whose focus is on understanding systems of

power and resulting social inequalities (Collins, 2015). Also consistent with CRT,

intersectionality theory, with its roots in Black feminist scholarship, calls for the

centering of race and racism in social analyses (Jibrin& Salem, 2015). Intersectionality

expands on CRT by addressing how the experience of one’s racial identity and racism

intersects with other categories of marginalized identity. For example, the experiences

and positionality of African Americans who lives below the poverty line differs in certain

ways from that of African Americans who inhabit the upper middle class. In this

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example, it is at the intersection of race and class identities that the complexity of social

inequities and power relations can be best understood.

Methodology

This study employed a post-intentional phenomenological design (Vagle, 2018).

In Vagle’s (2018) conceptualization of post-intentional phenomenology, researchers are

urged to adopt a post-structural epistemological perspective, in which knowledge is

viewed as “partial, situated, endlessly deferred, and circulating, through relations” (p.

126). In contrast to more traditional conceptualizations of phenomenological research,

when using a post-intentional phenomenological approach, the researcher acknowledges

that there is no one, static essence of a phenomenon to be discovered (Vagle, 2018) but

rather phenomena are constantly being produced and provoked (Vagle, 2018). Vagle

(2018) has argued that a post-intentional phenomenological approach allows the

“outcomes” of phenomenological research to “become multiple and shifting in and over

time, rather than essentialized and transcendental” (p. 131), ultimately resulting in a

deeper understanding of the phenomenon.

Participants

I derived the sample for this portion of the study by using purposive sampling. In

the quantitative portion of the study (Author, under review), 218 K-12 professionals

employed in one urban public school district in the Upper Midwest of the U.S. completed

an on-line survey which included the Moral Injury Events Scale (MIES) (Nash et al.,

2013). From the completed surveys, I identified the professionals who scored highest on

the MIES (i.e. those who scored a mean of 5 or above on a six-point scale on at least two

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of the three factors, indicating high endorsement of moral injury) who had indicated in

the on-line survey that they would be willing to be contacted by the researcher to discuss

their experiences (n=36). I sent emails to all 36 professionals, inviting them to schedule a

60-90 minute interview with me at a time and place of their convenience. I scheduled

and completed interviews with 21 participants (n=21). Approval for the study was

received from the University of Minnesota’s Institutional Review Board, under exempt

status.

Demographic information for the sample is presented in Table 1. The sample was

predominantly female and White, with a wide range of years of experience in teaching.

Half of the sample worked in an elementary school. Of particular note is the racial and

economic make-up of the schools in which all of the participants are employed. Orfield,

Ee, Frankenburg, and Siegel-Hawley (2016) define racially segregated schools as those in

which more than two-thirds of the student body are students of color (or, conversely,

White students). All participants in the sample worked in schools that meet this criteria.

Additionally, 17 of the participants worked in schools with greater than 90% students of

color, which Orfield and colleagues (2016) describe as intensely segregated schools.

Orfield and colleagues (2016) use the term double segregation to refer to schools that are

segregated by race and class. Students who attend schools with double segregation

experience “serious isolation from race and class diversity and exposure to the many

problems that systematically afflict poor families and communities” (Orfield et al, 2016).

All participants in this sample worked in schools that experience double segregation with

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eight participants having worked in schools that are intensely segregated in terms of race

and income level.

Phenomenological Material10

I scheduled individual interviews with each of the 21 participants between July

and October of 2017. Interviews were audio-recorded and lasted anywhere from 45 to 90

minutes and took place in a variety of settings, including the participants’ homes,

classrooms or school offices, public libraries, and coffee shops. I began the interview by

presenting participants with an informed consent form and responding to any initial

questions about the project. After receiving written informed consent, I gave each

participant a $10 Target gift card as compensation for their participation in the study. In

their seminal work, Naturalistic Inquiry, Lincoln and Guba (1985) stressed the

importance of building and maintaining trust with participants when conducting a

qualitative inquiry. To aid in the establishment of rapport and trust, I began each

interview by identifying myself as a current doctoral student in social work and a former

school social worker, with 11 years of experience working in a neighboring suburban

school district. This self-disclosure allowed me to gain some credibility in terms of my

familiarity with public education and to present myself as a peer to participants. I

informed participants that they could feel free to use common educational acronyms and

terminology and that I would ask questions if I did not understand. I then presented the

participant with a blank copy of the modified Moral Injury Events Scale (MIES) (Nash et

10Vagle (2018) prefers the use of “phenomenological material” over “data collection” in phenomenological research as a difference between a post-intentional approach to research and post-positivist notions of data.

99

al., 2013). I explained to participants that they may remember filling out the MIES when

they completed the on-line survey in May or June of 2017. I explained that they had been

selected to participate in a follow-up interview because they scored fairly high on the

MIES, meaning they agreed with many of the statements indicating that they had

witnessed or participated in events that they found to be morally troubling. I asked

participants to review the items on the MIES and to share any events or experiences that

came to mind as they reflected on the questions.

Throughout the interview, I attempted to expand on participants’ descriptions by

asking deepening questions regarding the feelings and outcomes they experienced related

to the morally injurious events. I also attempted to get participants to articulate which

specific aspects of situations they found to be the most morally troubling. I asked how

participants coped with their experiences, how the experiences changed them, and what

could prevent similar events from happening in the future. As a phenomenological

researcher, my role was as a supportive, affirming listener of the participants’ stories.

Vagle (2018) states that the first rule of phenomenological interviewing is to always

agree. Vagle is not asserting that the researcher needs to agree with everything that the

participant is saying but that she should agree with “what they are opening up – how they

are helping us gain access to a complex phenomenon” (p. 91). During interviews, I asked

clarifying questions if I did not understand what was being said, but I did not attempt to

challenge or question any of the statements the participants’ made regarding their

perspectives and experiences. Consistent with Vagle’s (2018) approach to

phenomenological interviewing, I attempted to interrogate my assumptions of

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understanding and definiteness by asking participants questions such as, “Can you tell me

more about that?” and “I want to make sure I understand you; can you say a little more

about what you mean?”

Post-Reflexivity

Vagle (2018) identified post-reflexivity, or reflexivity from a post-structural

perspective, as possibly the most important component of the post-intentional

phenomenological approach. Throughout all stages of research (design, data gathering,

analysis), post-intentional phenomenological researchers must constantly examine their

own assumptions, experiences, values, and beliefs and consider how these may shape the

interpretations of the phenomenon being studied (Vagle, 2018). Throughout the three

months of interviewing, I kept a post-reflexion journal (Vagle, 2018). After each

interview I wrote down key ideas that stood out to me from the interview – both ideas

that supported the assumptions I had going into the interview and those that surprised me

or contradicted my expectations. I noted questions that were raised by what the

participant shared. I tried to be aware of how my own assumptions and beliefs were

shaping how I was making sense of what each participant had shared. Prior to beginning

the interviews, I wrote an initial post-reflexion statement (Vagle 2018), which is similar

to subjectivity statements used in other forms of qualitative research, in that you begin

with an identification of your role and your perspectives and how that may influence the

research. However, post-reflexion statements differ from subjectivity statements in that

the researcher to continue to write and revise the post-reflexion statements throughout the

research process (Vagle, 2018). The purpose of a post-reflexion statement is to identify

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“your role as a researcher, your assumptions, beliefs, and perspectives, and your

background – especially as all of these relate to the phenomenon” (Vagle, 2018, p. 155),

as well as “what frames your perspectives, beliefs, and perceptions” (p. 155). In post-

intentional phenomenology, researchers should revisit post-reflexion statements

throughout the data gathering and analysis phases of research and regularly write new

statements (Vagle, 2018).

In my post-reflexion statements, I identified the significance of my 13 years

working in schools, 11 of which I worked as an elementary school social worker. Due to

my professional background, I approached this research with considerable existing

knowledge of how schools operate and beliefs about how they can be improved. As a

former school social worker, I am particularly attuned to how students whose needs and

experiences deviate from established norms, (e.g. students with disabilities, students from

marginalized racial, cultural, or economic communities), are often marginalized in public

education. I also approached this study with strong feelings about the devastating

impacts of increasing racial and economic segregation in U.S. public school systems,

both on individual students and American society as a whole. According to Vagle (2018),

making clear the assumptions that are brought to the research, and regularly examining

them throughout the research process, “gives you a better chance of seeing your

assumptions rather than your assumptions taking hold of you and in turn the phenomenon

under investigation” (p. 156).

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Analysis

All audio-recordings were transcribed by either myself (n = 18) or a professional

on-line transcription service, (n = 3). I loaded all transcriptions into the on-line

qualitative research program, Dedoose. My analytic approach was guided by Vagle’s

(2018) approach to post-intentional phenomenological analysis and Jackson and Mazzei’s

(2012) approach to “thinking with theory.” I began the analysis process using Vagle’s

(2018) “whole-part-whole” analytic approach. First, I read each transcript in full and

reviewed my post-reflexion journal entries as a way to immerse myself in the data, much

of which I had collected months prior to beginning my analysis. Then, I conducted

careful line-by-line readings of each transcript in Dedoose, using the coding function to

deconstruct each transcript into parts, paying particular attention to elements of the

transcripts that might “mark” the phenomenon (Vagle, 2018). After deconstructing each

transcript, I began to examine how the different parts were forming into new thematic

wholes, or what Vagle (2018) refers to as “productions and provocations” of the

phenomenon. Finally, I began the process of interpreting these productions and

provocations through and against my own assumptions and experiences, as well as in the

context of relevant theoretical frameworks, including Critical Race Theory (Delgado

&Stefancic, 2012) and Intersectionality Theory (Crenshaw, 1989). According to Vagle

(2018), in post-intentional phenomenology, the three key components of analysis are:

phenomenological material, theories, and post-reflexions. All three components are

equally important in understanding how a phenomenon might take shape, although this

does not mean that they need to be equally employed during each analytic moment.

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Throughout this process, I tried to maintain an open stance to the research and resisted

the urge to rush to conclusions that erroneously “attempt to make definite what is

indefinite” (Vagle, 2018, p. 74).

Results & Discussion

As previously discussed, McDonald (2017) has argued that moral injury may stem

less from individual moral violations and more from a context in which moral beliefs,

expectations, and practices can no longer be upheld. Using this approach to

understanding moral injury, I examined how K-12 professionals viewed elements of the

racialized and classed context in which they worked as creating an environment rife with

moral transgressions. Levinson (2015) has suggested that sources of educators’ moral

injury may include contextual injustices, “the historical and/or present-day injustices that

exist beyond the school, such as poverty, trauma, lack of health care, and racial and

economic segregation” (p. 211), and school-based injustices, “including discriminatory

school policies and insufficient resources, training, and professional support for

educators” (p. 211). In the following section, I present examples of the contextual and

school-based injustices that led to the professionals’ moral injury.

Contextual Injustice - The Trauma of Racism & Poverty

The majority of research on moral injury has occurred among populations who

have experienced or witnessed some form of trauma (Haight, Sugrue, Calhoun, & Black,

2016), such as the trauma of war (e.g. Litz et al, 2009), ethnic persecution and national

displacement (Nickerson et al., 2015), domestic violence (Otte, 2015), and child abuse

(Haight et al., 2017a, 2017b; Haight, Sugrue, Calhoun, & Black 2017c). A growing body

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of literature has demonstrated that children and families living in poverty have increased

exposure to traumatic experiences (e.g. Collins et al., 2010; Evans & English, 2002;

Felitti et al., 1998; Kiser, 2006). Professionals in this study demonstrated a keen

awareness of the trauma their low-income students experience on a daily basis, citing

homelessness, food insecurity, foster care, neighborhood violence, parental incarceration,

parental substance abuse, and family deaths. In addition to traumas related to poverty,

respondents stated that many students in their schools experience the trauma of racism.

Interpersonal and systemic racism are sources of chronic stress and trauma for children of

color living in the U.S (Carter, 2007; Ponds, 2013; Sanchez-Hucles, 1999). One teacher

of color expressed an awareness of how the trauma of racism impacts students’ behavior

but is often ignored or misunderstood by many school staff:

The other kind of struggle I have is also being a minority and then working [in

this neighborhood] which is high with minorities, especially African American

students, and you know, the trauma that they go through and things like that, and

I think that a lot of times we are over-identifying or sending kids on this wrong

track because they are displaying some behavior and it might just be “I need help

and I don't know how to deal with this situation.”

The fact that the schools represented in this study were highly segregated in terms

of race and class means that trauma due to poverty and racism was highly concentrated in

these buildings. A White social worker at a high school that had a few years earlier been

slated for closure explained that:

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A lot of the kids who are still here, who were still here after the almost closure,

were the kids who didn't necessarily have the resources to go someplace else. A

lot of the kids from the community ended up going out of district or busing down

to [schools on the south side]. The kids that were here were really some of the

highest needs kids concentrated into one place.

When asked if she felt this resulted in the school having a high concentration of kids who

have experienced trauma, she responded, “Yeah, we do, and they all play off each other,

you know?” A high concentration of students with trauma can translate to a high

proportion of students with mental health and behavioral issues in one classroom. One

kindergarten teacher explained that 5 out of her 20 students regularly exhibited extreme

aggressive behaviors and struggled with dysregulation. A first-grade teacher shared that

during the previous school year 7 out of her 17 students were either waiting to be

admitted to or had just been discharged from a therapeutic day treatment program for

children with severe emotional and behavioral needs.

How does the concentration of trauma due to racism and poverty in a school relate

to professionals’ experiences of moral injury? All sources of trauma can be morally

violating. They betray a belief in a fair, just world, where good wins over evil. War is

immoral; child abuse is immoral; poverty is immoral; racism is immoral. As

professionals in racially and economically segregated schools, their close contact with the

moral violations of racism and poverty may both increase the frequency of their exposure

to morally injurious experiences and sensitize them to the inherent moral deficiency of

the social environment in which they live and work.

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Additionally, the concentration of racism and poverty in the schools in which the

professionals in this study work is a result of school segregation. If we consider present

day school segregation through the lens of Critical Race Theory (CRT), it is a prime

example of the “ordinariness of racism” (Delgado &Stefancic, 2012). Despite the fact

that more African American students attend racially and economically isolated schools

today than in 1970 (Rothstein, 2013), present day school segregation is often viewed as

being a natural result of communities’ tendencies to self-sort, an issue of individual

choice, and not a problem that requires government intervention (Orfield, Frankenberg,

Ee, & Kuscera, 2014; Whitehurst, 2017). Although this ordinariness allows much of

[White] American society to ignore the persistent inequalities that are produced by racial

and economic school segregation, such as greater racial and economic academic

achievement gaps (Rothstein, 2013), the professionals in this study, with their daily

immersion in this racist context, may be less able to ignore the troubling nature of its

ordinariness.

In the next section, I discuss how specific practices which are rooted in the

intersection of racism and class bias were identified as specific sources of moral injury

for K-12 professionals in racially and economically isolated schools.

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School-Based Injustices - Morally Injurious Practices at the Intersection of Race &

Class

“Colonizing the natives.”11 In popular discourse, schools with high

concentrations of low-income students of color are frequently characterized as having

low levels of academic achievement, problems with truancy, a lack of parental

involvement, and high levels of violence and disruptive behavior (Dudley-Marling, 2007;

Milner, 2012; Picower, 2009). Picower (2009) has referred to this characterization as

“the deficit construction of urban schools, students, and families” (p. 202). In this

hegemonic story of urban schools (Picower, 2009), the source of their assumed deficits is

often explained by cultural deprivation theory (Ladson-Billings, 1999; Gorski, 2011).

Cultural deprivation theory explains racial and economic disproportionality in academic

achievement as resulting from pathologies in students’ inferior sociocultural backgrounds

(Ladson-Billings, 1999; Dudley-Marling, 2007). Cultural deprivation explanations

illustrate Intersectionality Theory (Crenshaw, 1989), where students of color who are

from low-income families are pathologized based on both their marginalized racial and

class identities. The deficit discourse constructed for “low-income students of color”

reflects a unique identity and experience, existing at the intersection of the marginalized

identities of race and class.

11 I created this heading from the title of a blog post by Ramon Griffin, titled “Colonizing the Black

Natives: Reflections from a former NOLA Charter School Dean of Students,”

https://cloakinginequity.com/2014/03/24/colonizing-the-black-natives-reflections-from-a-former-nola-

charter-school-dean-of-students/

https://cloakinginequity.com/2014/03/24/colonizing-the-black-natives-reflections-from-a-former-nola-charter-school-dean-of-students/

https://cloakinginequity.com/2014/03/24/colonizing-the-black-natives-reflections-from-a-former-nola-charter-school-dean-of-students/

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Schools that operate from the cultural deprivation and deficit construction

frameworks tend to respond to academic achievement disparities among low-income

students of color with policies and practices aimed at changing students’ individual

behaviors (Dudley-Marling, 2007). Proponents of this approach have argued that low-

income students of color have poor educational outcomes because they have not been

held to high academic and behavior expectations (Whitman, 2008). In order to get

students to meet these expectations, this approach to education advocates strict behavior

codes, token economies, and rigid systems of rewards and punishment (Dudley-Marling,

2007; Green, 2016; Kozol, 2005; Griffin, 2014). Critics of this approach to education

have noted that these suffocating practices intended to socialize students into hegemonic

norms is a form of neo-colonialism, in which the goal is to sanction and control the

bodies of low-income students of color (Griffin, 2014). A White elementary special

education teacher in this study offered an explanation of what she found morally

troubling about the concept of ‘high expectations’ for students in her school: “It's

interesting because I feel like the word ‘high expectations’ is a lot like the word

‘inclusion’—where it can be used as a blanket way to actually not be treating kids the

way they need to be treated or giving them the support or the resources they need.”

Charges of neo-colonialism and structural racism under the guise of high

expectations have often been brought up in response to significant racial disparities in

school suspension rates (Skiba, Michael, Nardo, Peterson, 2002; Skiba et al., 2011;

Griffin, 2014). In 2014, the U.S. Department of Education’s Office of Civil Rights

released data showing that African American students were three times more likely to be

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suspended from school than White students. In a less widely-cited 2017 study of

suspension rates in California public schools, African American suspension rates were

correlated with the percent of students in a school receiving free or reduced lunch – the

higher percentage of students in a school receiving free or reduced lunch, the higher the

rate of suspension of African American students (Loveless, 2017). In this example, the

frequency of racially biased disciplinary practices was dependent on the class context in

which these practices are enacted. Interpreting this finding through Intersectionality

theory, one can see how the intersection of the race and class identities and contexts

which African American students inhabit shapes their exposure to and experiences of

oppressive practices.

All of the schools represented in this study were composed primarily of low-

income African American students; thus, the issue of suspension rates for these students

and its moral implications was particularly salient for professionals in these settings. A

White elementary social worker was so morally troubled by the frequent suspensions at

her school that she considered resigning. She explained to her principal, “Ethically I

can't stay here. If we continue to suspend kids in this manner, I won't stay here because

we need kids to be in the school to learn the skills to be in school and we keep shoving

them out.” When asked if there were any particular incidents of suspension that pushed

her to the point of considering a resignation she responded, “ALL OF THEM! For me, I

don't believe in suspension for kids, especially in pre-K through 5th grade. We'd have 10

suspensions every three days.” A White high school social worker was particularly

troubled by dishonest practices regarding suspension reduction in the district. She

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explained “We're having all these conversations about [the problematic nature of high

rates of] suspensions of Black boys, but what happened last year is that the district was

like, ‘Every building has to reduce their suspensions overall,’ but then what that turned

into is, ‘ok, we won't suspend them we'll just ‘remove’ them and code it differently. Or

not code it all and just send them home, you know.’ That's WRONG.”

“Restorative justice” as a buzzword, not a practice. Although suspensions

were still happening in some schools, the district in this study had directed schools to

significantly decrease their use of out-of-school suspension after the result of a 2014

investigation by the U.S. Department of Education’s Office of Civil Rights that found

that African American students were significantly overrepresented in disciplinary actions

(U.S. Department of Education, 2014). According to educators in this study, schools

were directed to replace suspensions with a restorative justice approach, in which

students would be held accountable for their behaviors and given opportunities to make

amends for their mistakes—all the while remaining in school so that they do not miss out

on learning. Although professionals in this study agreed on the problematic nature of

suspension, they expressed dismay that the schools were not actually implementing

restorative justice practices with fidelity. Training in restorative practices was not

provided to staff, additional personnel were not allocated in order to implement

restorative tools (like circles) and help the school make a major paradigm shift in their

approach to student discipline and creating community. In essence, restorative justice

began to function as a buzzword signaling the absence of suspensions rather than an

actual shift in how schools respond to the needs of students. As a White elementary art

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teacher explained, “It was supposed to be restorative practices and they keep talking

about restorative practices. They've been talking about that for three years, I've never

been trained in it and I keep asking for it.” A Native American high school social studies

teacher said, “I think that there has to be more real, what we call, restorative justice

within the buildings. We talk about it in words but it, it doesn't happen. It does not

happen.” A White middle school program coordinator explained:

It's this idea that we would do restitution, which I would say everyone is like,

‘Sure! Yeah!’ But no training. No extra people. I did some successful

mediations. I had a kid and he was so rude to me and he came and apologized to

me and we talked about it and it was all good. But it took time. It took somebody

to help him. I feel like that was the missing piece. We said, we're not going to

suspend anybody anymore but then we don't have anything in place to say, ‘So,

we're also going to do this.’

Using the lens of CRT, the district’s response to the racial disproportionality in

disciplinary practices is an example of interest convergence (Bell, 1980). Rather than

being motivated by a desire for racial equity and justice, the changes to the district’s

suspension practices were motivated by the threat of potential legal consequences from

the Office of Civil Rights. By directing schools to stop suspending students without

doing a comprehensive investigation into the structural and social issues that were

contributing to racial disparities in suspensions, the district’s actions appeared to be more

about meeting political demands rather than implementing the systemic and cultural

changes needed to promote racial and economic equity and justice for students.

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With a significant decrease in the use of suspension without a formal, consistent

implementation of a restorative justice model, professionals described school

environments that were marred by confusion and chaos for students and staff. A school

psychologist in a special education program for students with significant emotional and

behavior needs explained:

We've gone from a strict behavioral model . . . now to this restorative [approach].

You can punch me in the face and you can still have recess. Ok? Is that good?

You can come back to school the next day and you can bite? I don't know. The

suspension doesn't teach them anything either. But how do you restore? You can't

really restore a punch in the face or a concussion. I think we had nine

concussions last year, of staff. It's bad. It was our worst year ever. Because it

was a little more gray.

Professionals described how, when confronted with student behaviors, many

administrators replaced a suspension response with no response at all. The middle school

program coordinator explained, “We have about 600 students in our school and we have

at any given time during the course of the day, 30 kids, 35 kids, maybe more, wandering

the halls that we do not seem to be reaching -- and they just tell me to ‘fuck off’ if I say

anything to them and then nothing happens with administration.” An African American

5th grade teacher described a similar approach in her elementary school: “I've watched the

administration see something going on that they should intervene in and turn and go the

opposite way. We were told at one point that if you see anything going on, don't do

anything, just leave it alone, stay out of it. I have trouble with that.”

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K-12 professionals viewed the increase in violent behavior they saw as a result of

unclear discipline practices and community behavior norms as being dangerous to staff

and students. An Asian American 4th grade teacher told a particularly harrowing story of

an incident in her classroom involving a student who had significant mental health needs

but was not receiving the appropriate supports to address them. She began the story by

referring to a different student in her class whom she had been struggling with, “This kid

that I was telling you about that was calling me a bitch every day and was super

dysregulated and crazy. He kicked a pane of -- we had glass on the doors -- so he kicked

the pane through.” A couple of days later, the glass pane next to her door hadn’t been

replaced when:

This other kid comes in my room, a 2nd grader, looking for his sister [who was

her student]. I was teaching 5th grade at the time and all the kids were freaking

out because this student was going around hitting kids because that's just what he

does. So I get him out, but I can't lock -- well I can lock my door – but I have a

pane missing. So all he did was reach in [through the pane] to try to open the

door and all the kids are like, ‘Don't let him in!’ So I'm holding the door, literally

holding it up, and he's reaching through the pane trying to punch me. And there

was nothing I could do because I couldn't call anyone because I was holding the

door. So I sat there for like a good, I don't know, 15 minutes until someone came.

When asked specifically about what aspects of these incidents they found to be

most morally troubling, professionals were quick to point out that the individual students’

behaviors were not the source of their moral injury. They viewed the students’ behaviors

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as reflections of their own struggles and unmet needs. Instead, they felt morally injured

by systemic failures that created the chaotic and unsafe environments. The 4th grade

teacher who told the story of the student punching her through the broken glass pane on

her classroom door explained: “I feel most betrayed by the lack of support from not just

the administration but from the district at large; for creating a very unsafe environment

for teachers and students, because in this case there were so many students that were

really afraid to come to school because of these crazy things and I, you know, I couldn't

always protect them.”

After completing my interview with the 4th grade teacher who was holding onto a

door handle while a student reached through a broken pane of glass and attempted to

enter her classroom, I spent a significant amount of time writing in my post-reflexive

journal. In addition to concern about the physical and emotional safety of the students in

the story told by the teacher, what particularly troubled me about this situation was the

fact that this type of dangerous and chaotic situation was allowed to occur. I spent over a

decade as a school social worker in an upper middle-class, predominantly White

suburban school district. I could not imagine this situation occurring in this district. Not

because there are not students in that district who have histories of trauma exposure, who

struggle with significant mental health issues, and who can exhibit potentially dangerous

behaviors, but because the expectation in schools with majority White students is that

children’s educational, physical and mental health, and safety needs will be met at school.

Whiteness as property (Harris, 1993) is reflected in the implicit belief in White U.S.

society that White children have the right to attend schools that are academically

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rigorous, emotionally nurturing, and physically safe, but that students of color,

particularly low-income African American students, have no such rights. Although the

4th grade teacher in this story was forever morally troubled by the dangerous situations

her students were regularly subjected to, she explained that there was no dramatic

response from school or district leadership in response to these frequent crises, no

community outcry regarding the trauma that students were being subjected to at school.

We, as Whites, have come to expect and accept trauma, suffering, and oppression for

low-income African American students, while we insist on opportunities, benefits, and

legal protections for White children.

Don’t look under the hood. Along with racial disparities in suspension rates,

graduation rates throughout this district also vary significantly by racial group, with

White students having an 84.7% graduation rate in 2016, and African American, Latino,

and Native American students having graduation rates of 59.4%, 50.1%, and 37.4%,

respectively (Gotlieb, 2017). In response to this data, the district has stressed the need for

schools to raise graduation rates, particularly for African American, Latino, and Native

American students. However, similar to the changes to the discipline policy, which

seemed focused on decreasing the number of suspensions rather than changing the way

students’ needs are addressed, according to the K-12 professionals in this sample, the

push to increase graduation rates has focused on producing good graduation numbers

rather than better addressing the learning needs of marginalized students. Secondary

teachers described extreme pressure from administrators to give students higher grades

and pass students regardless of their performance. A Native American high school social

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studies teacher shared an example of an email she received during the last week of the 4th

quarter of the school year regarding a student:

The AP [Assistant Principal] sent an email to all of this student's teachers saying

this student needed to pass all of her classes with GOOD GRADES. And I hadn't

seen her. I don't think I even knew who she was. I hadn't seen her until the last

week and a half of the year. She had been accepted into a college and she needed

to, you know, get good grades. So, you know, no work from her. No teaching. No

summative assessments. But she needed to pass so do what you have to do. . .

We're hurting them by pretending that they're achieving -- yeah. It’s just SO

WRONG. It's SO WRONG.

A White high school social worker explained how she feels they are facing a

conundrum at her school. She acknowledged that not graduating from high school leads

to very poor economic and social outcomes for students, but if they are graduating kids

from high school without the skills to be successful in college or the job market, does the

diploma really mean anything? She explained:

We do whatever is necessary to get these kids to graduate. When I first started I

was like, “Yeah, let's give them all kind of accommodations.” But now we're

seeing the kids who we pretty much pushed to graduation and told that they were

college ready and I mean we've had maybe a handful of kids who've actually

made it through their first year of college. They go to college and are not at ALL

prepared because we've hand-held them all of high school and now where are

they? We are still setting them up to fail.

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Not only were students graduating ill-prepared for college, but they were also ill-

prepared for even some low-level service jobs. This same social worker told the story of

a former student who had received special education services for an emotional or

behavioral disorder. When she graduated she took a job at McDonald’s but was fired

because she could not count change. The social worker explained how these experiences

led her to feel morally injured: “We have kids who graduate and can't get really good

jobs and end up selling drugs and going to jail. You know? It's hard not to feel somewhat

responsible for that sometimes.” A White high school English teacher with over 25 years

of teaching experience used a metaphor of a broken-down car to capture her concerns

about the way the district has been educating students and the moral injury it caused for

her: “It bothers me. A LOT. The idea that someday, when all is said and done, we're

going to look under the hood and realize that the only thing keeping the whole thing

together has been wishful thinking and duct tape. And that -- I'm conflicted about that.

Both because it's the meaning of my work, and it's the meaning of their [students’]

work.”

Low academic expectations as sources of moral injury were not limited to

professionals in secondary schools, but were also expressed by elementary professionals.

An African American 5th grade teacher who had been in the district for nearly 30 years

began to cry when talking about the academic progress of students in her school. When

asked to explain what the tears were about, she replied:

It’s pain. It is pain of watching children who you know have great potential just

be pushed to the side like okay, it doesn't matter, you don't matter. Because we're

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just going to let you keep doing what you're doing. They're not going to leave

academically ready for the work of next year, but they're not also not going to be

ready socially for next year. It is painful.

Three participants in the sample all worked at the same high school: a White

English teacher, an Asian American social studies teacher, and a Native American social

studies teacher. All three teachers frequently referred to the moral injury they

experienced due to the dishonesty that they and their school practiced towards students

and families. By feeling pressured to give students higher grades, the Asian American

social studies teacher explained that she was lying to students—telling them that a C

paper is actually an A paper. She explained, “It’s like you're telling them [students]

‘You're awesome. You're awesome.’ and they get to the real world and it’s like, ‘How

come the world doesn't think that?’ They're confused. As a teacher, I think that's

wrong.” She explained that these low academic standards and dishonest practices are

“not fair to the kids, but they don't know it yet.” In contrast, she knows that students are

being harmed but is unable to change the systemic practices in which she participates.

The English teacher stated bluntly, “we may just be a professional class of liars. We may

be claiming to do more than we actually can for the communities we serve.” The Native

American social studies teacher echoed these feelings of moral injury stemming from a

system, in which she participates, that promotes dishonest statistics while harming

students:

The sad thing about it is . . . our graduation rates are up. So, we're working

miracles, you know? We're working miracles. Everybody in the District -- we had

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people from the office come and say “Washington’s12 doing something right!”

Everybody wants to know “What is it that they're doing that's working so well at

Washington?” Well, we're being bullied into passing all students. We are being

called into the office if we fail students. Kids are made to believe that they

successfully passed classes -- now Ds aren't even good enough, we have to give

them Cs. Parents are being lied to, because they think “Wow, my student is doing

well at school.” But you know what, your student is graduating without being

able to write a complete sentence or be able to do some basic things. And then

they go off believing that they can be successful in college and they have to take

all remedial courses or they just have to drop out because, you know, you were

fed a lie.

As with the changes to the district’s suspension practices, the focus on increasing

graduation rates for students of color can be interpreted as another example of interest

convergence (Bell, 1980). It is in the interest of both students of color and the school

district to raise graduation rates for non-White students. However, the district has

focused attention on increasing graduation rates for students of color not out of a moral

imperative toward racially equitable education practices, but because it is in its best

interest to respond to public criticism for its racially disproportionate graduation rates.

This interest convergence led to the district’s approach to addressing racial

disproportionality in academic achievement to be focused on improving the data (i.e.

graduating more students of color) rather than in transforming the pedagogy, practices,

12 Not the actual name of the school.

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and structures that have led to the racial disproportionality in the first place. This

approach reflects a core characteristic of interest convergence, where “people in power

are sometimes, in theory, supportive of policies and practices that do not oppress and

discriminate against others as long as they—those in power—do not have to alter their

own ways and systems, statuses, and privileges of experiencing life” (Milner, 2008). The

result of this approach is that the interests of the district (i.e. higher graduation rates for

students of color) are met while the interests of students of color for equitable, rigorous,

transformative educational experiences continue to be denied.

The fine line between empathy & pity. The sociologist Pedro Noguera (2008)

has written of the “pobrecito syndrome,” in which educators (often White) feel sympathy

for low-income students of color, and out of that sense of sympathy, lower the academic

expectations and experiences for those students. Pobrecito syndrome is evident in the

way a White high school social worker describes her school’s approach to working with

students: “It's PITY is what it is. There's a line between being supportive and wanting to

advocate for these kids and pitying them. And then it kind of turns into a ‘White savior’

attitude in a way, and it's icky. It feels really icky.” A Native American high school

social studies teacher noted similar racial condescension when she worked with White

colleagues in a program for Native students, aimed at increasing their attendance and

academic performance. She explained that she wanted to set up a system in which the

students could earn special field trips and other experiences for improving their

attendance and/or class performance. However, she found that her White colleagues

wanted to take them on field trips regardless of their school performance, arguing, “Well

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they [Native American students] never get to do this. If we don't do it, they never in their

lives will.” She explained that her White colleagues perceived Native students as “very

helpless victims of poverty without any control in their lives.” She ended up leaving the

program due to her objections to how it was run and noted that the program has had very

little academic success with its students. A White kindergarten teacher who held high

expectations for her students reflected on how students, even kindergartners, can tell

when adults are pitying them:

I honestly think not having expectations for them [low-income students of color]

is pretty disrespectful and I don't think they [students] like that. They can sense

when someone thinks they're going to be a clown or when they're not going to get

it. I guess that right there is a really big moral conflict for me.

Some K-12 professionals in this sample brought up the district’s push to adopt a

trauma-informed approach to educating low-income students of color. Trauma-informed

approaches in education are based on the idea that many students have experienced

trauma in their lives that can have significant impact on their cognitive, emotional, and

social development (Cole et al., 2015). A trauma-informed school attempts to “create a

flexible framework that provides universal supports, is sensitive to the unique needs of

students, and is mindful of avoiding re-traumatization” (Arndt et al., 2018, no page).

Trauma-informed approaches in education are gaining increasing attention and support

throughout the U.S., with some states, like Wisconsin, developing extensive training tools

and resources and running a pilot evaluation study in 75 schools state-wide (Wisconsin

Department of Public Instruction, 2018). However, similar to the implementation of

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restorative justice practices in this district, professionals felt that insufficient training and

leadership around trauma-informed approaches meant that the framework was being

misinterpreted and misapplied. Just as some administrators seemed to be using

restorative justice as a directive to not respond to students’ mental health needs and

violent behaviors, professionals in this sample gave examples of a trauma-informed

approach reflecting Noguera’s (2008) pobrecito syndrome. The White high school social

worker, who supported trauma-informed approaches, shared her feelings on the

misapplication of this approach as well as the tendency for White middle-class educators

to stereotype all low-income students of color as severely traumatized:

Since our district has done a lot more training around trauma-informed teaching

strategies, our principal’s done a lot to start embracing these trauma ideas -- how

kids with trauma are experiencing the world, which I think honestly has taken us

too far the other way. We are assuming that every kid in this building has some

kind of trauma, just because of who they are and where they live, which isn't fair.

Then we're not holding them to the same expectations because we're making a

blanket statement that every kid in this building has been seriously traumatized

somehow. There are some that have, but not everyone. Then we're overall

lowering our expectations and rigor because we're making these assumptions

about these kids.

Professionals talked about the value of a trauma-informed lens in understanding

where kids’ difficult behaviors and lagging skills may be stemming from, but that this

must be coupled with coaching and guiding kids through their trauma to experience

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academic success. The high school social worker explained, “We're really focused on

understanding trauma and not "How do you help a kid with trauma?" Neglecting the

“where do we go from here” part of the trauma-informed approach cultivates a pitying,

deterministic approach to students, where they are seen as having sad, difficult lives for

which nothing can be done. An elementary special education teacher explained:

I feel like we have to be careful when we talk about trauma-informed, and look at

it as how it changed the brain and impacted the behavior, and not like “Well,

guys, you have to remember that where these kids are from, they can't be calm,

because they always have to be fight or flight. When we ask them to be calm, they

just can’t.” I feel like that is lowering the expectation.

One example of this misapplication of the trauma-informed approach was given by a

White elementary art teacher. She described how a student in her school had torn down

and destroyed all the student art work that had been hanging in the hall. When the art

teacher asked the principal if they could have the student rehang any artwork that was not

destroyed and apologize to the students whose artwork was damaged, the principal

responded “That’s too shaming. That will be traumatic for him.” The art teacher

questioned what type of community the staff were attempting to create in their school if

students are not able to make amends to each other.

The district’s move to trauma-informed approaches, to restorative justice

practices, and to changing academic expectations were done, in part, in response to

critiques about the racist practices in the district contributing to enormous racial

disparities in academic achievement and disciplinary practices. However, as Noguera

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(2008) and others (e.g. Kiuchi, 2016) have pointed out, pobrecito syndrome represents

the other side of the racist educational practices coin. Harsh punishments and

exclusionary practices are replaced with low expectations and pity. Both approaches

result in the reproduction of racial and class-based education, economic, and social

inequities, and maintain the racist and classist status quo. The participants in this study

seemed keenly aware of the racism and classism inherent in these practices and identified

them as key sources of moral injury. The White middle school program coordinator

lamented:

They [students] all have sad stories -- dad's dead, mom's in jail, whatever -- but I

just feel like we're holding those kids to lower standards so it feels like we're

telling those kids that they're not worth it. “Oh, ok, you have a lot going on? Why

don't you just do whatever.” I mean, oh my God?! We're reinforcing this message

that they're getting that they are not worth anything. That we don't think they can

do it. It feels awful. It feels terrible.

The pitying “pobrecito” attitude towards low-income students of color reflected in

the district’s practices illustrates the active domination of White supremacy (Leonardo,

2004). Responding to racial inequity in educational practices and outcomes with pity and

lowered expectations, (rather than structural transformation), reinforces the idea of White

superiority, (i.e. low-income students of color are too traumatized to learn and succeed),

while ensuring the continuation of white supremacy (i.e. students of color graduate from

high school without the skills needed to be successful in college or the labor market).

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Conclusion

The results of this study illustrate how racism, classism, and the intersection of

these two oppressive forces produce and shape the structures and practices within the

education system, while at the same time the education system reproduces these same

oppressive social realities. Within this context, it is not surprising that K-12

professionals experience moral injury as they regularly come into contact with what

McDonald (2017) has called “the specter of a world without morals” (p. 1).

Although the research on moral injury in the military context has been primarily

used to understand the psychological suffering of veterans and to inform new intervention

strategies to promote healing and re-integration in civilian life (e.g. Litz et al., 2009),

moral injury as a construct is useful in the education context as a tool for identifying and

understanding injustice. In the future, researchers will need to examine how the

identified practices and structures that produce moral injury can be mitigated or

eliminated. During my interviews with participants, I often heard the phrases “I don’t

have the answers,” or “No one knows what to do,” when discussing their sense of

hopelessness and impotence to change the morally troubling situations they encountered

in their work. As researchers, we have a responsibility to discover what can be done to

create a moral and just education system. We must examine ways that K-12

professionals, who, in many systems, are members of one of the nation’s most powerful

professional unions, can mobilize via collective action to address their moral

responsibilities. Most importantly, we need to move the discussion of moral violations in

education beyond the school walls. Levinson (2015) has argued that:

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As a polity, we delegate to educators the responsibility to enact justice toward

students and to enable students’ experience of justice in school. At the same time,

however, we retain the responsibility of ensuring the justice of the educational

system as a whole; this is the obligation of the polity, not of the individual

educator.

As communities, we are accountable for the moral suffering of educators and the

injustices enacted on children. Addressing moral injury in education may require nothing

short of dismantling White supremacy and the capitalist system of economic inequality

that has allowed moral wrongs to be perpetrated and tolerated.

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Table 1

Individual- and School-Level Demographics of the K-12 Professionals in the Sample

Educator Characteristics

Sample (N = 21)

n or M(SD)

Gender

Male 2

Female 19

Race

White 15

African American 1

Asian American 2

Native American 1

Multi-Racial 2

Years in Education (range: 3-35) 19.6 (10.2)

Role

Classroom Teachers 10

Special Education Teachers 4

English Language Learner Teachers 1

School Social Workers 2

School Psychologists 3

Non-Classroom Instructional Support 1

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School Characteristics13

School Type14

Elementary Educators 11

Non-Elementary Educators 10

% of Students Receiving Free/Reduced Lunch

< 60% --

60-69% 1

70-79% 1

80-90% 11

> 90% 8

% of Students of Color

< 60% --

60-69% --

70-79% 2

80-89% 2

>90% 17

13Numbers refer to the number of participants represented at each category of school, not the number of

schools in each category represented in the sample. 14 “Elementary refers to all schools that have students in grades K-5. These may include K-2, K-12, and K-

8 schools. Non-elementary refers to schools that do not have any students in grades K-5.

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Chapter 5: Conclusion

In the concluding chapter of this dissertation, I summarize the major findings and

limitations of my study. I then present an integrated discussion of the three papers,

highlighting how the three papers fit together to make a valuable contribution to the

understanding of moral stress in the public education context. I end this section with

recommendations for a future research agenda that stems from the results of this study.

Major Findings

The results of this study presented the first empirical evidence of the relevance of

moral injury to the U.S. K-12 public education context. Both the scores on the Moral

Injury Events Scale (Nash et al., 2013) and the interviews demonstrated that some

professionals in K-12 education perpetrate or witness morally troubling structures and

practices in their workplace and experience emotional distress in relation to these events.

This study also presented important information regarding how the context of the

U.S. public K-12 education system, particularly in terms of racialized and classed

structures and practices, can produce moral injury. The results of the quantitative study

demonstrated that the race and class make-up of the student body of a school was not

only the most significant predictor of moral injury among professionals in the school, but

one of the only significant predictors among all the individual and school-level factors

examined. The results of the qualitative study explained how racialized and classed

elements of schools with a large proportion of low-income students of color were deeply

morally troubling to staff. Globally, professionals experienced moral injury in response

to the persistent injustice and trauma of the racism and poverty that characterized the

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lives of their students. Specifically, professionals were morally injured by school

practices such as harsh discipline practices, low expectations, dishonest data reporting,

and attitudes of pity and condescension, all of which reinforce white supremacy and the

continued oppression of their students.

Limitations

Conceptual muddiness. The findings of this dissertation must be considered

within the context of several limitations. First, as illustrated in the first paper, this entire

study was marked by conceptual muddiness regarding the psychological, social, and

behavioral impact of moral transgressions on individuals. Although moral injury was

used as the guiding construct of this dissertation, multiple constructs, including moral

distress, demoralization, and stress of conscience—due to their conceptual similarities—

could have also been considered. In fact, in the quantitative paper, the moderate

correlations found between scores on the Moral Injury Events Scale (Nash et al., 2013)

and the Stress of Conscience Questionnaire (Glasberg et al., 2006) demonstrate the

overlap between these two constructs. A consequence of this and other conceptual

overlap is that although the results of the study describe K-12 professionals’ experiences

of moral injury, it is possible that their experiences could have been better described as

moral distress or demoralization or stress of conscience.

Despite the conceptual ambiguities that characterized this study, the results could

be useful in the development of an integrated conceptual model of the psychological,

social, and existential impacts of moral transgressions on individuals and communities.

By illustrating the conceptual similarities between moral injury and demoralization and

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the correlations between measures of moral injury and stress of conscience, these results

lend support to the idea that a unified conceptual model is both possible and preferable.

It is also important to note that, from a post-intentional phenomenological perspective,

which was employed in the qualitative portion of this study, the term used to describe the

experiences of professionals in this study – whether moral injury, moral distress,

demoralization, stress of conscience, or some new umbrella term – is not important.

Rooted in a post-structural epistemological perspective, post-intentional phenomenology

considers phenomena to be fluid, constantly shaping and being shaped by social relations

in the world around it (Vagle, 2018). Thus, a post-intentional phenomenological

approach to research is concerned with the understanding of these multiple, partial, and

ever-shifting productions and provocations and their meanings (Vagle, 2018). A belief

that no concept is ever fixed and permanently defined renders a debate about conceptual

definitions moot.

Limitations of the sample. As previously discussed in the second paper, a

limitation of this study is the low response rate of 7% to the quantitative survey. In

addition to the generalizability limitation of this response rate, the resulting sample of

218 was marked by a small number of males (n = 50) and people of color (n = 46).

Although these proportions are similar to that of the population of professionals in the

district as a whole, the study would have been strengthened if there were greater racial

and gender diversity in the sample to provide potentially richer data. The sample was

also problematic in terms of the nature of its school clusters. The 218 professionals in the

sample were spread out among 68 schools. The largest number of professionals clustered

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in one school was 13 and the smallest was 1. In fact, 19 of the schools (28%) contained

only 1 participant. These unequal clusters are problematic for conducting hierarchical

linear analyses (M. Harwell, personal communication, July 21, 2017). However, I

compared the fit of a multi-level model and a single-level model. The results produced

nearly identical coefficients, and thus a single-level model was chosen. Still, given the

findings of the significance of the racial and class make-up of the school to moral injury

experienced by professionals in that school, the inability to employ a multi-level model to

consider clustering effects is a limitation. Had I recruited equal (or close to equal)

numbers of participants at each school to complete the survey, I may have gained a more

complex understanding of the impact of the school context on professionals’ moral

injury.

Additionally, these findings are limited by the fact that all of the data comes from

one urban school district in the Midwest. Some characteristics of the district, such as

racial and economic segregation and a shortage of financial resources, are similar to

many other urban districts across the U.S. However, other elements, such as the specifics

of its historical and present-day racial make-up of the students and staff, a recent history

of frequent leadership turnover, and the economic and political characteristics of the

region, may be more unique to this district and may contribute to the context of

professionals’ moral injury. In the future, researchers should consider how moral injury

may be experienced in rural and suburban school districts, as well as in urban districts

with different demographic, political, and cultural environments.

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Phenomenological material– too much and too little. Prior to beginning this

study, it was suggested to me by a committee member, Dr. Mark Vagle, that, if

acceptable to the other committee members, I consider interviewing a small number of

participants, maybe three or four, in my phenomenological study. Having previously

only conducted qualitative studies that employed a grounded theory approach in which

more participants were interviewed until the point of data saturation (Charmaz, 2014), I

rejected this suggestion—not even bringing it to the rest of the committee, as I felt certain

that I would need to interview many more participants in order to draw any meaningful

conclusions from my qualitative inquiry. However, after having collected and analyzed

the data and delved more into the post-intentional phenomenological approach, I

concluded that I interviewed too many people and for too short of time. I was surprised

as I began my analysis to discover that I had “too much” data from too many participants-

- I would have liked deeper, richer material from a few select participants. Using a post-

intentional phenomenological approach, I was not interested in consistency of responses

across participants; rather, I was searching for understanding of moral injury’s

productions and provocations within the context of racially and economically segregated

and marginalized schools. Thus, conducting multiple, deep, probing interviews with a

handful of participants may have given me a deeper understanding of how moral injury

takes shape in this context, and would have allowed me to avoid time spent wading

extensive amounts of less relevant interview material.

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Implications

In this section I discuss the theoretical, methodological, and practice contributions

of my dissertation.

Contributions to conceptualization. In the first paper of this dissertation, I

argued for the need for an integrated conceptual model of the impact of moral

transgressions in the helping professions and suggested that additional empirical

exploration could be useful in this endeavor. Although the explicit goal of this mixed

methods inquiry was not to develop a theoretical model, the results from both the

quantitative and qualitative portions of the study provide additional information that can

aid in conceptual refinement. The moderate correlations between scores on the Moral

Injury Events Scale (MIES; Nash et al, 2013) and the Stress of Conscience Questionnaire

(SCQ; Glasberg et al., 2006) support the notion that moral injury and stress of conscience

are related and possibly equivalent constructs. As explained in the first paper of this

dissertation, stress of conscience appears to be very similar to moral distress with both

terms originating in nursing literature (the former coming from Scandinavian nursing

scholars and the latter from American). Thus, the correlations between the MIES and the

SCQ also lend support to the idea proposed by McAnich (2016) that moral distress is

“similar to, and perhaps encompasses . . . moral injury” (p. 30).

In the qualitative portion of the study, participants shared examples of sources of

moral injury that are also consistent with conceptualizations of moral distress and

demoralization. For example, professionals expressed moral injury due to being ordered

by administration to give students higher grades than they had earned. This example

135

could be considered a source of moral injury, as it describes an educator perpetrating an

action that they feel violates their moral beliefs. It could also be characterized as a source

of moral distress, as it reflects an external constraint on the educator’s ability to act

morally (Jameton, 1984). Additionally, the example is consistent with Santoro’s (2011)

description of demoralization as happening when teachers lose the ability to act

pedagogically in a way that feels moral and right to them. Other examples that could be

considered sources of moral injury, moral distress, or demoralization include

professionals’ inability to intervene when students are roaming the halls and not

benefiting from education, participating in or witnessing suspensions of young students,

and being unable to keep their students physically and emotionally safe at school due to

administrative practices and mandates outside of their control.

In addition to supporting the notion of an integrated conceptual model that would

encompass moral distress, moral injury, and demoralization as potentially equivalent

terms, the results of this study also support McDonald’s (2017) argument that moral

injury stems less from individual moral violations (as conceptualized in Litz et al.’s 2009

working conceptual model of moral injury) and more from exposure to a context in which

moral beliefs, expectations, and practices can no longer be upheld. Although at times

they described specific acts which were morally troubling, the professionals in this study

spoke at length about broader sources of moral injury, including the traumatizing effects

of racism and poverty on their students, the pity directed at low-income students of color

that masqueraded as empathy, and the acceptance of, and reproduction of, race and class

oppression that characterizes the U.S. public education system. This broader

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understanding of moral injury as a normative consequence of exposure to, and awareness

of, social injustice is a critical first step in challenging and addressing its sources.

Centering race and the intersection of race & class in discussions of moral

injury. In Santoro’s (2011, 2013) work on demoralization and threats to moral integrity

among teachers, examples of sources of demoralization all related to the change in the

practice and demands of teaching within the context of high-stakes standardized testing.

Santoro (2011, 2013) described how teachers expressed deep demoralization and a

betrayal of their sense of personal and professional integrity due to the heightened focus

on pedagogical practices and outcomes that seem rote, meaningless, and ultimately

harmful to children. Although some of Santoro’s (2011, 2013) participants worked in

high-poverty schools with significant numbers of students of color, the role of race or

class in the participants’ experiences was not directly explored or discussed.

Prior to beginning the qualitative interviews in this study, I assumed that the

culture of high-stakes standardized testing would be a common topic for participants

when discussing the sources of their moral injury. I was surprised to find that this topic

almost never came up. Occasionally, if I asked directly about standardized testing, a

teacher might say something about it taking up a lot of time during the school year; but in

fact, one participant said she thought the tests were important because it forced the

district to acknowledge that they were not doing right by students of color and low-

income students who consistently scored much lower on the tests. I believe standardized

testing was not a major source of moral injury among my sample because the

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professionals were preoccupied with much larger sources of injustice—namely racism

and its intersection with classism.

After analyzing my quantitative data and finding the relationship between the

racial and class context of the school and moral injury among professionals, I chose to

use Critical Race Theory (CRT; Delgado & Stefancic, 2012) and Intersectionality Theory

(Crenshaw, 1989) to guide my inquiry, which allowed me to be particularly attuned to

how participants’ morally troubling experiences reflected racialized and classed

structures and practices in the school. The result was the first study that empirically and

theoretically connects moral injury with CRT. This connection is an important

contribution, as we need to move away from discussing issues like the racial achievement

gap and racial segregation in schools as solely pedagogical, sociological, or political

issues, and instead see them as inherently moral in nature. Racism and classism violate

our individual and collective moral codes and addressing them is essential to our

humanity.

Strengths of a mixed methods design. This study is an illustration of the

strengths of a mixed methods design when exploring a conceptually complex, emerging

construct. Creswell (2014) states that mixed methods designs are particularly useful

when a researcher wants to “both generalize the findings to a population as well as

develop a detailed view of the meaning of a phenomenon or concept for individuals” (p.

20). As moral injury had been theorized as a relevant concept to K-12 education (see

Keefe-Perry, 2016; Levinson, 2015), I wanted to empirically test this idea. A quantitative

survey approach was a useful way to understand the extent of, and applicability of moral

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injury in a different socio-cultural context. At the same time, standardized measures of,

moral injury (e.g. Nash et al., 2013; Currier et al, 2015; 2017) do not allow for an

understanding of the events that lead to moral injury or the feelings and behaviors

associated with moral injury. As the military context, where moral injury was first

conceptualized and where it has been most extensively studied, differs in a multitude of

ways from the education context, the results of a quantitative survey of moral injury

would not provide sufficient information to fully understand what moral injury means

and how it takes shape within the U.S. public K-12 education system. Hence, it was

critical to include a qualitative component. The results of the quantitative and qualitative

data in this study have produced a rich, complex understanding of moral injury that will

be useful in addressing moral injury and moral transgressions in the education context

and also in contributing to the growing, multi-disciplinary research on moral injury.

This dissertation also contributes to the small but growing literature employing

phenomenology as part of a mixed methods study. In their 2013 review of published

mixed methods phenomenological research, Mayoh & Onwuegbuzie (2014) found only

24 studies published between 2003 and 2012, with over 70% of the studies appearing in

the field of health research. One article was found in the field of education and none in

social work (Mayoh & Onwuegbuzie, 2014). The flexibility of phenomenological

research methods and its focus on understanding the meanings of complex phenomena

make it an excellent fit for mixed methods research, despite differences in

epistemological paradigms (Mayoh & Onwuegbuzie, 2015). The results of this

dissertation support Mayoh & Onwuegbuzie’s (2014; 2015) assertions and illustrate how

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a mixed methods phenomenological approach can be useful for education and social

work researchers.

School social work as a moral practice. Despite this study’s being conducted in

the public education context and with participants who play a variety of roles in the

education system, this dissertation is written by a social worker, and thus offers

contributions specific to social work research, education, and practice. First, the findings

from this study highlight the need to identify and address sources of injustice in the

education context. Due to our Code of Ethics and professional value of social justice,

school social workers are particularly primed to identify moral transgressions and grapple

with ethically challenging experiences. In social work education and practice, school

social workers should be supported in approaching their work from a moral perspective

and be given the skills to work for change in systems-level sources of injustice and

oppression.

The need for a critical approach to trauma-informed practices. Another

finding from this study of particular value to social workers is the current limitations and

difficulties with the implementation of trauma-informed practices in some schools. As

mental health practitioners in the schools, social workers are often some of the leaders in

encouraging and implementing trauma-informed approaches. However, the results of this

study highlight how “trauma-informed” can be used to justify condescending, racist, and

classist practices when not implemented with sufficient training, staffing, funding—and a

critical lens towards the intersections of trauma with racism and classism. Poor

implementation of trauma-informed practices could also lead to a backlash against

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approaches to education that attempt to address trauma. For example, if poorly

implemented trauma-informed practices in some schools result in increased physical

violence, greater emotional distress for students and staff, and decreased time for

meaningful learning, educational professionals and community members may reject the

entire philosophy behind the trauma-informed approach and advocate for a return to, or

expansion of, practices that aim to punish and control children.

As the term “trauma-informed” continues to gain in popularity in school districts

around the country, school social work practitioners and researchers will need to play a

leading role in ensuring these practices do not reproduce and reinforce existing race and

class oppression. Specifically, the findings of this dissertation suggest the need to

incorporate critical theories into trauma-informed approaches. If we want to implement

trauma-informed practices in schools, we must acknowledge the significant traumatic

impacts of racism and poverty. We must explore how trauma-informed approaches can

produce healing and transformation, while questioning if they are simultaneously being

used to maintain white supremacy and justify oppressive economic and political systems.

Is the popularity of trauma-informed practices due to their ability to allow communities

to ignore the immorality and devastation of poverty and racism? Is it ethical to promote

trauma-informed practices in schools without simultaneously working to address and

alleviate sources of trauma?

Identifying structures and processes for macro-level change in education.

One issue that came up in many of the interviews I conducted in this study, but was not

presented in-depth in any of the three papers due to space limitations, was a sense of

141

helplessness and hopelessness on the part of the professionals. Many of the professionals

expressed that they were morally troubled by what they saw happening in their schools

but that they did not know what to do to make the situation better. They made comments

such as, “I don’t have the answers, nobody does,” or “I don’t feel like I can make a

difference anymore.”

Levinson (2015) has proposed that educators can respond to moral injury by one

of three ways: 1) loyal subversion, in which educators “try to make the most just

decisions in the moment” (p. 214) and subvert “unjust policies, institutions, or structures

whenever they think they can get away with it” (p. 214); 2) exercising voice, in which

educators speak out publicly about the challenges and injustices in education and, in the

process, “recover some of their personal moral integrity, as well as perhaps restore their

professional integrity” (p. 216); and 3) exit, in which in the face of intractable moral

dilemmas, educators leave the system or the profession altogether. Among the

participants in my study, I found examples of both loyal subversion and exit, but rarely

exercising voice. Very few professionals seemed to feel capable of using their voice,

individually or collectively, to push for changes in the system. Some professionals

expressed fear of punishment from administration for speaking up, and some shared

examples of previous attempts at exercising voice that resulted in what they perceived to

be retaliatory monitoring and other consequences from administration. Others expressed

an inability to speak up because they did not believe it would make a difference, they did

not know how to engage in effective advocacy, and/or they were already so overwhelmed

by the day-to-day demands of their jobs.

142

What was particularly interesting to me about professionals’ sense of

powerlessness and inability to exercise voice is that all professionals in the sample were

members of the state teacher’s union. They were members of a collective body that, in

theory, is structured to allow for collective exercise of voice by providing both the

organizational infrastructure to launch collective action and the legal protections from

administrative retaliation. However, in a few interviews, when I asked directly about the

union’s role in addressing sources of moral injury, professionals expressed that the union

did not direct energy or resources to these issues. They saw the union as being solely

focused on renegotiating the teacher contract, which dealt primarily with salaries and

benefits, as well as occasionally addressing individual teacher grievances and providing

due process support for teachers who were being investigated for wrongdoing. The

professionals in this sample did not feel confident they would have the backing of the

union if they individually attempted to engage in advocacy related to systemic moral

failings, nor that they could work with the union to build collective action on these

issues15. These findings suggest the need for research on how professionals in public

education can or could exercise voice to address sources of moral injury in the education

system, with specific attention paid to the role of the teacher’s union. A deeper

understanding of the union’s current and potential role in advocating for structural

15 Having been a member of the teacher’s union for 11 years during my time as a public school social

worker in a neighboring district to the one in which this sample was taken, I was not surprised by these

beliefs about the union’s role. During my years of union membership, including two years as a building

representative in the district’s chapter, I noted that all discussions revolved around salary, health benefits,

and workload issues. Larger discussions of systemic racism and classism and how these may be impacting

students and professionals were absent from any official union meetings and activities.

143

changes, rather than solely focusing on salary and benefits negotiation and job protection

for members, is critical for understanding the likelihood and potential for meaningful

change. Research could provide insight into how professionals in public education can

exercise voice—both within the union structure and outside of it—to promote social

justice within their schools.

144

Bibliography

Åhlin, J., Ericson-Lidman, E., Eriksson, S., Norberg, A., & Strandberg, G. (2013).

Longitudinal relationships between stress of conscience and concepts of

importance. Nursing Ethics, 20(8), 927-942.

AMA Council on Ethical & Judicial Affairs. (2016). Code of ethics of the American

Medical Association. Chicago, IL: American Medical Association.

American Nurses Association. (2015). Code of ethics for nurses with interpretive

statements. Silver Spring, MD: American Nurses Association.

American Psychological Association. (2017) .Ethical principles of psychologists and

code of conduct. Retrieved from http://www.apa.org/ethics/code/.

Ansley, F. L. (1997). White supremacy (and what we should do about it). In R. Delgado

& J. Stefancic (Eds.), Critical white studies looking behind the mirror, (pp. 592-

595). Philadelphia, PA: Temple University Press.

Arndt, L., Black, P., Deboer, B., Buege, P., Daniel, S. . . .Nelson, C. (2018). Creating

trauma supported schools. Retrieved from https://dpi.wi.gov/sspw/mental-

health/trauma/presentations.

Bandura, A. (1991). Social cognitive theory of moral thought and action. In W.M.

Kurtines& J.L. Gewirtz (Eds.), Handbook of moral behavior and development,

Volume 1: Theory. Hillsdale, NJ: Lawrence Erlbaum Associates.

Bell, D. (1980). Brown v. Board of Education and the interest-convergence dilemma.

Harvard Law Review, 93(3), 518-533.

http://www.apa.org/ethics/code/

https://dpi.wi.gov/sspw/mental-health/trauma/presentations

https://dpi.wi.gov/sspw/mental-health/trauma/presentations

145

Benight, C.C. & Bandura, A. (2004). Social cognitive theory of post-traumatic recovery:

The role of perceived self-efficacy. Behaviour Research and Therapy, 42, 1129-

1148.

Boudreau, T. (2011). The morally injured. The Massachusetts Review, 52(3/4), 746-754.

Bryan, C.J., Bryan, A.O., Anestis, M.D., Anestis, J.C., Green, B.A., Etienne, N., Morrow,

C.E., & Ray-Sannerud, B. (2016). Measuring moral injury: Psychometric

properties of the Moral Injury Events Scale in two military samples. Assessment,

23(5), 557-570.

Buzzelli, C.A. & Johnston, B. (2002). The moral dimensions of teaching: Language,

power, and culture in classroom interaction. New York, NY: Routledge Falmer.

Campbell, E. (2008). The ethics of teaching as a moral profession. Curriculum Inquiry,

38(4), 357-385.

Campbell, S.M., Ulrich, C.M. & Grady, C. (2016). A broader understanding of moral

distress. The American Journal of Bioethics,16(12), 2-9.

Carls, P. (n.d.). Emile Durkheim. Internet Encyclopedia of Philosophy: A Peer Reviewed

Academic Resource. Retrieved from https://www.iep.utm.edu/durkheim/#H5.

Carlson-Jaquez, H.A. (2016). Development of an instrument to measure K-12 teacher

demoralization in a test-based accountability context. (Doctoral dissertation)

Virginia Commonwealth University, Department of Education, Richmond, VA.

Carr, D. (2000). Professionalism and ethics in teaching. London, UK: Routledge.

146

Carter, R.T. (2007). Racism and psychological and emotional injury: Recognizing and

assessing race-based traumatic stress. The Counseling Psychologist, 35(1), 13-

105.

Chang, M. (2009). An appraisal perspective of teacher burnout: Examining the emotional

work of teachers. Educational Psychology Review, 21(3), 193-218.

Charmaz, K. (2014). Constructing grounded theory (2nd ed.). Thousand Oaks, CA: Sage.

Clark, C.M. (1990). The teacher and the taught: Moral transactions in the classroom. In

J.I. Goodland, R. Soder, & K.A. Sirotnik (Eds.), The moral dimensions of

teaching. San Francisco, CA: Jossey-Bass.

Clarke, D. M. & Kissane, D.W. (2002). Demoralization: Its phenomenology and

importance. Australian and New Zealand Journal of Psychiatry, 36(6), 733-742.

Cole, S.F., O’Brien, J.G., Gadd, M.G., Ristuccia, J., Wallace, D.L., Gregory, M. (2015).

Helping traumatized children learn: Supportive school environments for children

traumatized by family violence. Boston, MA: Massachusetts Advocates for

Children. Retrieved from https://traumasensitiveschools.org/wp-

content/uploads/2013/06/Helping-Traumatized-Children-Learn.pdf.

Collins, P.H. (2015). Intersectionality’s definitional dilemmas. Annual Review of

Sociology, 41, 1-20.

Collins, K., Connors, K., Davis, S., Donohue, A., Gardner, S., Goldblatt, E., Hayward,

A., Kiser, L., Strieder, F., & Thompson, E. (2010). Understanding the impact of

trauma and urban poverty on family systems: Risks, resilience, and interventions.

https://traumasensitiveschools.org/wp-content/uploads/2013/06/Helping-Traumatized-Children-Learn.pdf

https://traumasensitiveschools.org/wp-content/uploads/2013/06/Helping-Traumatized-Children-Learn.pdf

147

Baltimore, MD: Family Informed Trauma Treatment Center. Retrieved from:

http://nctsn.org/nccts/nav.do?pid=ctr_rsch_prod_ar.

Corley, M.C. (2002). Nurse moral distress: A proposed theory and research agenda.

Nursing Ethics, 9(6), 636-650.

Corley, M.C., Elswick, R.K., Gorman, M., &Clor, T. (2001). Development and

evaluation of a moral distress scale. Journal of Advanced Nursing, 33, 250-256.

Crenshaw, K. (1989). Demarginalizing the intersection of race and sex: A Black feminist

critique of antidiscrimination doctrine, feminist theory, and antiracist politics. The

University of Chicago Legal Forum, 139-167.

Creswell, J.W. (2014). Research design: Qualitative, quantitative, and mixed methods

approaches. Thousand Oaks, CA: Sage.

Crisp, R. (1998). Ethics and meta-ethics. The Routledge encyclopedia of philosophy.

Retrieved 14 Mar. 2017, from https://www-rep-routledge-

com.ezp1.lib.umn.edu/articles/overview/ethics/v-1/sections/ethics-and-meta-

ethics.

Currier, J.M, Farnsworth, J.K., Drescher, K.D., McDermott, R.C., Sims, B.M., &

Albright, D.L. (2017a). Development and evaluation of the Expressions of Moral

Injury Scale – Military Version. Clinical Psychology and Psychotherapy.

https://doi.org/10.1002/cpp.2170

Currier, J. M., Farnsworth, J.K., Frankfurt, S., Gray, M., &Yeterian, J. (2017b) Moral

injury conceptualization and recovery: Definitional distinctions and intervention

http://nctsn.org/nccts/nav.do?pid=ctr_rsch_prod_ar

https://www-rep-routledge-com.ezp1.lib.umn.edu/articles/overview/ethics/v-1/sections/ethics-and-meta-ethics



https://doi.org/10.1002/cpp.2170

148

implementation. Panel Presentation at the International Traumatic Stress Studies

Annual Conference, Chicago, IL, November 11, 2017.

Currier, J.M., Holland, J. M., Drescher, K. & Foy, D. (2015a). Initial psychometric

evaluation of the Moral Injury Questionnaire-Military Version. Clinical

Psychology & Psychotherapy, 22(1), 54–63.

Currier, J. M., Holland, J. M., Rojas-Flores, L., Herrera, S., & Foy, D. (2015b). Morally

injurious experiences and meaning in Salvadorian teachers exposed to violence.

Psychological Trauma: Theory, Research, Practice, and Policy, 7(1), 24–33.

Daniel, S., Zindler, M., & McCoy, K. (2017). Trauma-sensitive schools: Moving from

awareness to classroom application. Presentation at the International Society for

Traumatic Stress Studies Annual Conference, November 10, 2017, Chicago, IL.

Delgado, R. & Stefancic, J. (2012). Critical race theory: An introduction. New York:

New York University Press.

Dombo, E. A., Gray, C., & Early, B. P. (2013). The trauma of moral injury: Beyond the

battlefield. Journal of Religion & Spirituality in Social Work: Social Thought,

32(3), 197–210.

Drescher, K.D. & Foy, D.W. (2008). When they come home: Post-traumatic stress, moral

injury, and spiritual consequences for veterans. Reflective Practice: Formation

and Supervision in Ministry, 28, 85-102.

Drescher, K. D., Foy, D. W., Kelly, C., Leshner, A., Schutz, K., &Litz, B. (2011). An

exploration of the viability and usefulness of the construct of moral injury in war

veterans. Traumatology, 20(10), 1–6.

149

Dudley-Marling, C. (2007). Return of the deficit. The Journal of Educational

Controversy, 2(1), 1-13.

Dudzinski, D. M. (2016). Navigating moral distress using the Moral Distress Map.

Journal of Medical Ethics, 42, 321-324.

Epstein, E.G., Hurst, A.R., Mahanes, D., Marshall, M.F., & Hamric, A.B. (2016). Is

broader better? The American Journal of Bioethics, 16(12), 15-17.

Esterson, A. (1982). The “helping” professions. Theoretical Medicine and Bioethics, 3

(3), 325-335.

Evans, G.W., & English, K. (2002). The environment of poverty: Multiple stressor

exposure, psychophysiological stress, and socioemotional adjustment. Child

Development, 73(4), 1238-1248.

Farber, B. A. (2000). Treatment strategies for different types of teacher burnout.

Psychotherapy in Practice, 56(5), 675-689.

Farnsworth, J. K., Drescher, K.D., Evans, W., & Walser, R.D. (2017. A functional

approach to understanding and treating military-related moral injury. Journal of

Contextual Behavioral Science, 6(4), 391-397.

Felitti, V. J., Anda, R. F., Nordenberg, D., Williamson, D. F., Spitz, A. M., Edwards, V.,

... & Marks, J. S. (1998). Relationship of childhood abuse and household

dysfunction to many of the leading causes of death in adults: The Adverse

Childhood Experiences (ACE) Study. American Journal of Preventive

Medicine, 14(4), 245-258.

150

Fenstermacher, G.D. (1990). Some more considerations on teaching as a profession. In

J.I. Goodland, R. Soder, & K.A. Sirotnik (Eds.), The moral dimensions of

teaching, (pp. 130-154). San Francisco, CA: Jossey-Bass.

Fenton, J. & Kelly, B. (2017). “Risk is king and needs to take a backseat!” Can social

workers’ experiences of moral injury strengthen practice? Journal of Social Work

Practice, 31(4), 461-475.

Fourie, C. (2017). Who is experiencing what kind of moral distress? Distinctions for

moving from a narrow to a broad definition of moral distress. AMA Journal of

Ethics, 19(6), 578-584.

Gabel, S. (2011). Addressing demoralization in clinical staff: A true test of leadership.

The Journal of Nervous and Mental Disease, 199(11), 892-895.

Gabel, S. (2012). Demoralization: A precursor to physician burnout? American Family

Physician, 86(9), 861-862.

Gabel, S. (2013). Demoralization in health professional practice: Development,

amelioration, and implications for continuing education. Journal of Continuing

Education in the Health Professions, 33(2), 118-126.

Gert, B. & Gert, J. (2016). The definition of morality. In E.N. Zalta (Ed.), The Stanford

Encyclopedia of Philosophy. Retrieved from https://plato-stanford-

edu.ezp1.lib.umn.edu/entries/morality-definition/.

Gilborn, D. (2015). Intersectionality, critical race theory, and the primacy of racism:

Race, class, gender, and disability in education. Qualitative Inquiry, 21(3), 277-

287.

https://plato-stanford-edu.ezp1.lib.umn.edu/entries/morality-definition/

https://plato-stanford-edu.ezp1.lib.umn.edu/entries/morality-definition/

151

Glasberg, A., Eriksson, S., Dahlquist, V., Lindahl, E., Strandberg, G., Soderberg, A.,

Sorlie, V., & Norberg, A. (2006). Development and initial validation of the Stress

of Conscience Questionnaire. Nursing Ethics, 13(6), 633-648.

Glasberg, A. L., Eriksson, S., & Norberg, A. (2007). Burnout and “stress of conscience”

among healthcare personnel. Journal of Advanced Nursing, 57(4), 392-403.

Glasberg, A. L., Eriksson, S., & Norberg, A. (2008). Factors associated with “stress of

conscience” in healthcare. Scandinavian Journal of Caring Sciences, 22(2), 249-

258.

Goodlad, J. (1990). The occupation of teaching in schools. In J. Goodlad, R. Soder, &

K.A. Sirontnik (Eds.), The moral dimensions of teaching, (pp. 3-34). San

Francisco, CA: Jossey-Bass.

Gorski, P. C. (2011). Unlearning deficit ideology and the scornful gaze: Thoughts on

authenticating the class discourse in education. Counterpoints, 402, 152-173.

Gotlieb, N. (2017, February 24). MPS graduation rate up for fifth year in a row.

Southwest Journal. Retrieved from

http://www.southwestjournal.com/news/schools/2017/02/mps-graduation-rate-up-

for-fifth-straight-year/

Green, E. (2016, March 8). Beyond the viral video: Inside educators’ emotional debate

about “no excuses” discipline. Chalkbeat: New York. Retrieved from

http://ny.chalkbeat.org/2016/03/08/beyond-the-viral-video-inside-educators-

emotional-debate-about-no-excuses-discipline/#.VvF5flUrJpj

Greene, J.C. (2007). Mixed methods in social inquiry. San Francisco, CA: Jossey-Bass.

http://www.southwestjournal.com/news/schools/2017/02/mps-graduation-rate-up-for-fifth-straight-year/

http://www.southwestjournal.com/news/schools/2017/02/mps-graduation-rate-up-for-fifth-straight-year/

http://ny.chalkbeat.org/2016/03/08/beyond-the-viral-video-inside-educators-emotional-debate-about-no-excuses-discipline/#.VvF5flUrJpj

http://ny.chalkbeat.org/2016/03/08/beyond-the-viral-video-inside-educators-emotional-debate-about-no-excuses-discipline/#.VvF5flUrJpj

152

Griffin, R. (2014). Colonizing the black natives; Reflections from a former NOLA

charter school Dean of Students. (Blog post). Retrieved from

http://cloakinginequity.com/2014/03/24/colonizing-the-black-natives-reflections-

from-a-former-nola-charter-school-dean-of-students/

Haight, W., Sugrue, E., Calhoun, M., & Black, J. (2016). A scoping study of moral

injury: Identifying directions for social work research. Children and Youth

Services Review, 70, 190-200.

Haight, W., Sugrue, E., Calhoun, M., & Black, J. (2017a). “Basically, I look at it like

combat.”: Reflections on moral injury by parents involved with child protection

services. Children and Youth Services Review, 82, 477-489.

Haight, W., Sugrue, E., & Calhoun, M. (2017b). Moral injury among child protection

professionals: Implications for the ethical treatment and retention of workers.

Children and Youth Services Review, 82, 27-41.

Haight, W., Sugrue, E., Calhoun, M., & Black, J. (2017c). Everyday coping with moral

injury: The perspectives of professionals and parents involved with child

protection services. Children and Youth Services Review, 82, 108-121.

Hamric, A.B. (2012). Empirical research on moral distress: Issues, challenges, and

opportunities. HEC Forum, 24, 39-49.

Hamric, A.B., Borchers, C.T., & Epstein, E.G. (2012). Development and testing of an

instrument to measure moral distress in healthcare professionals. AJOB Primary

Research, 3 (2), 1-9.

http://cloakinginequity.com/2014/03/24/colonizing-the-black-natives-reflections-from-a-former-nola-charter-school-dean-of-students/

http://cloakinginequity.com/2014/03/24/colonizing-the-black-natives-reflections-from-a-former-nola-charter-school-dean-of-students/

153

Hanna, D.R. (2004). Moral distress: The state of the science. Research and Theory for

Nursing Practice, 18(1), 73-93.

Hansen, D.T. (2001). Teaching as moral activity. In V. Richardson (Ed.), Handbook of

research on teaching (4th ed.). Washington, D.C.: American Educational Research

Association.

Harris, C.I. (1993). Whiteness as property. Harvard Law Review, 106(8), 1709-1791.

Hartman, J. S. (2015). The implications of moral injury among African American females

with a history of substance abuse: A preliminary study. (Doctoral dissertation).

Available from ProQuest Dissertations and Theses (#3716286).

Hawkins, P., Shohet, R., Ryde, J., & Wilmot, J. (2012). Supervision in the helping

professions, (4th ed.). Berkshire, UK: Open University Press.

hooks, b. (1989). Talking back: Thinking feminist, thinking Black. Boston, MA: South

End Press.

Huebner, D. (1996). Teaching as a moral activity. Journal of Curriculum & Supervision,

11(3), 267-275.

Jackson, A.Y. & Mazzei, L.A. (2012). Thinking with theory in qualitative research:

Viewing data across multiple perspectives. New York: Routledge.

Jameton, Andrew. 1984. Nursing Practice: The Ethical Issues. Englewood Cliffs, NJ:

Prentice Hall.

Jameton, Andrew. 1993. “Dilemmas of Moral Distress: Moral Responsibility and

Nursing Practice.” Clinical Issues in Perinatal Women’s Health Nursing 4: 542-

551.

154

Jibrin, R. & Salem, S. (2015). Revisiting intersectionality: Reflections on theory and

praxis. Trans-Scripts: An Interdisciplinary Online Journal in the Humanities and

Social Sciences, 5, 7-24.

Jinkerson, J. D. (2016). Defining and assessing moral injury: A syndrome perspective.

Traumatology, 22(2), 122.

Johnstone, M. & Hutchinson, A. (2015). “Moral distress” – Time to abandon a flawed

nursing construct? Nursing Ethics, 22 (1), 5-14.

Juthberg, C., Eriksson, S., Norberg, A., & Sundin, K. (2010). Perceptions of conscience,

stress of conscience, and burnout among nursing staff in residential elder

care. Journal of advanced nursing, 66(8), 1708-1718.

Keefe-Perry, L.C. (2016). Called into crucible: Vocation and moral injury in public

school teachers. Paper presented at the 2016 Religious Education Association

Annual Meeting, November 4-6, 2016.

Kiuchi, Y. (2016). Race still matters: The reality of African American lives and the myth

of a postracial society. Albany, NY: State University of New York Press.

Koenig, H.G., Ames, D., Youssef, N.A., Oliver, J.P., Volk, F., Teng, E.J., Haynes, K., &

Erickson, Z.D., Arnold, I., O’Garo, K. & Pearce, M. (2018). The Moral Injury

Symptom Scale – Military Version. Journal of Religious Health, 57(1), 249-265.

Kolivoski, K.M., Weaver, A., & Constance-Huggins, M. (2014). Critical race theory:

Opportunities for application in social work practice and policy. Families in

Society: The Journal of Contemporary Social Services, 95(4), 269-276.

155

Kozol, J. (2005). Confections of apartheid: A stick-and-carrot pedagogy for the children

of our inner-city poor. Phi Delta Kappan, 87(4), 265-275.

Kristensen, T.S., Borritz, M., Villadsen, E., & Christensen, K.B. (2005). The

Copenhagen Burnout Inventory: A new tool for the assessment of burnout. Work

& Stress, 19(3), 192-207.

Kubany, E.S., Hayes, S.N., Abueg, F.R., Manke, F.P., Brenna, J.M., Stahura, C. (1996).

Development and validation of the Trauma-Related Guilt Inventory (TRGI).

Psychological Assessment, 8(4), 428-444.

Ladson-Billings, G. (1999). Preparing teachers for diverse student populations: A Critical

Race Theory perspective. Review of Research in Education, 24, 211-247.

Leonardo, Z. (2004). The color of supremacy: Beyond the discourse of “white privilege.”

Educational Philosophy and Theory, 36(2), 138-167.

Lev, S. & Ayalon, L. (2016). Moral distress among long-term care social workers:

Questionnaire validation. Research on Social Work Practice,

https://doi.org/10.1177/1049731516672070.

Levinson, M. (2015). Moral injury and the ethics of educational injustice. Harvard

Educational Review, 85(2), 203-228.

Lincoln, Y.S. & Guba, E.G. (1985). Naturalistic inquiry. Newbury Park, CA: Sage.

Litz, B. T., Stein, N., Delaney, E., Lebowitz, L., Nash, W. P., Silva, C., &Maguen, S.

(2009). Moral injury and moral repair in war veterans: A preliminary model and

intervention strategy. Clinical Psychology Review, 29(8), 695–706.

https://doi/

156

Loveless, T. (2017). How Well are American Students Learning, 3(6). Washington, D.C.:

The Brookings Institution. Retrieved from https://www.brookings.edu/w-

content/uploads/2017/03/2017-brown-center-report-on-american-education.pdf.

Lützén, K., Cronqvist, A., Magnusson, A., & Andersson, L. (2003). Moral stress:

synthesis of a concept. Nursing Ethics, 10(3), 312-322.

Lynch, D. & Forde, C. (2016). Moral distress and the beginning practitioner: Preparing

social work students for ethical and moral challenges in contemporary contexts.

Ethics & Social Welfare, 10 (2), 94-107.

Maslach, C., Jackson, S. E., & Leiter, M. P. (1996). Maslach Burnout Inventory manual

(3rd ed.). Mountain View, CA: CPP Inc.

Maslach, C., Jackson, S. E., & Leiter, M. P. (1997). Maslach burnout inventory. In C.P.

Zalaquett & R.J. Wood (Eds.), Evaluating stress: A book of resources. (pp. 191-

218). Lanham, MD: Scarecrow Press.

Maslach, C., Schaufeli, W.B., & Leiter, M.P. (2001). Job burnout. Annual Review of

Psychology, 52(1), 397-422.

Mayoh, J. & Onwuegbuzie, A.J. (2015). Surveying the landscape of mixed methods

phenomenological research. International Journal of Multiple Research

Approaches, 8(1), 2-14.

Mayoh, J. & Onwuegbuzie, A.J. (2014). Towards a conceptualization of mixed methods

phenomenological research. Journal of Mixed Methods Research, 9(1), 91-107.

McAnich, A. (2016). Moral distress, moral injury, and moral luck. The American Journal

of Bioethics, 16(12), 29-31.

https://www.brookings.edu/w-content/uploads/2017/03/2017-brown-center-report-on-american-education.pdf

https://www.brookings.edu/w-content/uploads/2017/03/2017-brown-center-report-on-american-education.pdf

157

McCall, L. (2005). The complexity of intersectionality. Signs: Journal of Women in

Culture and Society, 30(3), 1771-1800.

McCarthy, J. & Deady, R. (2008). Moral distress reconsidered. Nursing Ethics, 15 (2),

254-262.

McDonald, M. (2017). Haunted by a different ghost: Re-thinking moral injury. Essays in

Philosophy, 18(2), 1-16.

McIntyre, A. (1998). A short history of ethics: A history of moral philosophy from the

Homeric age to the twentieth century, (2nd ed.). Notre Dame, IN: University of

Notre Dame Press.

Milfont, T. L., Denny, S., Ameratunga, S., Robinson, E., & Merry, S. (2008). Burnout

and well-being: Testing the Copenhagen Burnout Inventory in New Zealand

teachers. Social Indicators Research, 89(1), 169-177.

Milner, H.R. (2008). Critical Race Theory and interest convergence as analytic tools in

teacher education policies and practices. Journal of Teacher Education, 59(4),

332-346.

Milner, H. R. (2012). “But What Is Urban Education?” Urban Education 47(3): 556-561.

Minnesota Administrative Rules. (2015). 8710.2100 Code of Ethics for Minnesota

Teachers.

Nash, W. P., Marino Carper, T. L., Mills, M. A., Au, T., Goldsmith, A., & Litz, B.

(2013). Psychometric evaluation of the Moral Injury Events Scale. Military

Medicine, 178(6), 646–652.

158

National Association of Educators. (1975). Code of ethics. Retrieved from

http://www.nea.org/home/30442.htm.

National Association of Social Work. (2008). Code of ethics of the National Association

of Social Workers. Washington, DC: NASW Press.

Nickerson, A., Schnyder, U., Bryant, R. A., Schick, M., Mueller, J., & Morina, N. (2015).

Moral injury in traumatized refugees. Psychotherapy and Psychosomatics, 84(2),

122–123.

Nittle, N. (2015, October 1). San Diego Unified transitions toward a trauma-informed

school district. The Chronicle for Social Change,

https://chronicleofsocialchange.org/featured/san-diego-school-drives-progress-

toward-trauma-informed-school-district.

Noguera, P.A. (2008). The trouble with black boys: And other reflections on race, equity,

and the future of public education. San Francisco, CA: Jossey-Bass.

Office of Civil Rights, U.S. Department of Education (2014). Civil rights data collection.

Data snapshot: School discipline. Retrieved from

https://ocrdata.ed.gov/downloads/crdc-school-discipline-snapshot.pdf

Orfield, G., Frankenberg, E., Eee, J., &Kuscera, J. (2014). Brown at 60: Great progress, a

long retreat, and an uncertain future. The Civil Rights Project, University of

California, Los Angeles. Retrieved from

https://civilrightsproject.ucla.edu/research/k-12-education/integration-and-

diversity/brown-at-60-great-progress-a-long-retreat-and-an-uncertain-

future/Brown-at-60-051814.pdf

http://www.nea.org/home/30442.htm

https://chronicleofsocialchange.org/featured/san-diego-school-drives-progress-toward-trauma-informed-school-district

https://chronicleofsocialchange.org/featured/san-diego-school-drives-progress-toward-trauma-informed-school-district

https://ocrdata.ed.gov/downloads/crdc-school-discipline-snapshot.pdf

https://civilrightsproject.ucla.edu/research/k-12-education/integration-and-diversity/brown-at-60-great-progress-a-long-retreat-and-an-uncertain-future/Brown-at-60-051814.pdf



159

Orfield, G., Ee, J., Frankenberg, E., Siegel-Hawley, G. (2016). Brown at 62: School

segregation by race, poverty, and state. The Civil Rights Project, University of

California, Los Angeles. Retrieved from

https://www.civilrightsproject.ucla.edu/research/k-12-education/integration-and-

diversity/brown-at-62-school-segregation-by-race-poverty-and-state.

Otte, K. A. (2015). Exploring themes of moral injury and resilience among women in a

transitional living center. (Doctoral dissertation) Pepperdine University.

Papazoglou, K. (2017). The examination of different pathways leading towards police

traumatization: Exploring the role of moral injury and personality in police

compassion fatigue. (Doctoral dissertation). University of Toronto, Department of

Psychology, Toronto, CA.

Papazoglou, K. & Chopko, B. (2017). The role of moral suffering (moral distress and

moral injury) in police compassion fatigue and PTSD: An unexplored topic.

Frontiers in Psychology ,8(15), 1999.

Pauly, B. M., Varcoe, C. & Storch, J. (2012). Framing the issues: Moral distress in health

care. HEC Forum, 24, 1-11.

Penny, N.H., Bires, S.J., Bonn, E.A., Dockery, A.A. &, Pettit, N.L. (2016). Moral

Distress Scale for Occupational Therapists: Part 1: Instrument development and

content validity. American Journal of Occupational Therapy, 70(4), 1-10.

Picower, B. (2009). The unexamined whiteness of teaching: How white teachers retain

and enact dominant racial ideologies. Race, Ethnicity and Education,12(2), 197-

215.

https://www.civilrightsproject.ucla.edu/research/k-12-education/integration-and-diversity/brown-at-62-school-segregation-by-race-poverty-and-state

https://www.civilrightsproject.ucla.edu/research/k-12-education/integration-and-diversity/brown-at-62-school-segregation-by-race-poverty-and-state

160

Ponds, K. T. (2013). The trauma of racism: America’s original sin. Reclaiming Children

and Youth, 22(2), 22.

Porosoff, L. (2015). Healing from moral injury. Teaching Tolerance, 51,

https://www.tolerance.org/magazine/fall-2015/healing-from-moral-injury.

powell, j.a. (2007). The race and class nexus: An intersectional perspective. Law &

Inequality, 25, 355-539.

Pring, R. (2001). Education as moral practice. Journal of Moral Education, 30(2), 101-

112.

Qualtrics (2017). Qualtrics. Provo, Utah. Available from http://www.qualtrics.com.

Raines, M. L. (2000). Ethical decision-making in nurses: Relationships among moral

reasoning, coping style, and ethics stress. JONA’S Healthcare Law, Ethics and

Regulation, 2(1), 29-41.

Reamer, F. G. (2013). Social work values and ethics. New York, NY: Columbia

University Press.

Rosin, H.M. &Korabik, K. (1991). Workplace variables, affective responses, and

intention to leave among women managers. Journal of Occupational Psychology,

64, 317-330.

Rothstein, R. (2013). For public schools, segregation then, segregation since: Education

and the unfinished march. Economic Policy Institute. Retrieved from

https://www.epi.org/files/2013/Unfinished-March-School-Segregation.pdf

Sanchez-Hucles, J. V. (1999). Racism: Emotional abusiveness and psychological trauma

for ethnic minorities. Journal of Emotional Abuse, 1(2), 69-87.

https://www.tolerance.org/magazine/fall-2015/healing-from-moral-injury

http://www.qualtrics.com/

https://www.epi.org/files/2013/Unfinished-March-School-Segregation.pdf

161

Santoro, D.A. (2011). Good teaching in difficult times: Demoralization in the pursuit of

good work. American Journal of Education, 118, 1-23.

Santoro, D.A. (2013). “I was becoming increasingly uneasy about the profession and

what was being asked of me”: Preserving integrity in teaching. Curriculum

Integrity, 43(5), 563-587.

Santoro, D. A. (2017). Cassandra in the classroom: Teaching and moral madness. Studies

in Philosophy and Education, 36(1), 49-60.

Santoro, D.A. & Morehouse, L. (2011). Teaching’s conscientious objectors: Principled

leavers of high-poverty schools. Teachers Collee Record, 113(12), 2670-2704.

Schaefer, R., Zoboli, E.L.C.P., & Viera, M.M. (2017). Psychometric evaluation of the

Moral Distress Risk Scale: A methodological study.” Nursing Ethics

https://doi.org/10.1177/0969733017707347

Shay, J. (1994). Achilles in Vietnam: Combat trauma and the undoing of character. New

York, NY: Scribner.

Shay, J. (2009). The trials of homecoming: Odysseus returns from Iraq/Afghanistan.

Smith College Studies in Social Work, 79(3/4), 286–298.

Shay, J. (2011). Casualties. Daedalus, 140(3), 179–188.

Shay, J. (2014). Moral injury. Psychoanalytic Psychology, 31(2), 182–191.

Sheraton, L. (2012). Morals vs. ethics. Retrieved 11 April 2017, from

http://www.ethicsdefined.org/what-is-ethics/morals-vs-ethics/.

https://doi.org/10.1177/0969733017707347

http://www.ethicsdefined.org/what-is-ethics/morals-vs-ethics/

162

Skiba, R. J., Michael, R. S., Nardo, A. C., & Peterson, R. L. (2002). The color of

discipline: Sources of racial and gender disproportionality in school

punishment. The Urban Review, 34(4), 317-342.

Skiba, R.J., Horner, R.H., Chung, C., Rausch, M.K., May, S.L., Tobin, T. (2011). Race is

not neutral: A national investigation of African American and Latino

disproportionality in school discipline. School Psychology Review, 40(1), 85-107.

Skorupski, J. (1998). Morality and ethics. The Routledge encyclopedia of philosophy.

Retrieved 14 Mar. 2017, from https://www-rep-routledge-

com.ezp1.lib.umn.edu/articles/thematic/morality-and-ethics/v-1.

Strike, Kenneth A. and Jonas F. Soltis. 2009. The Ethics of Teaching. 5th ed.New York,

NY: Teacher’s College Press.

U.S. Department of Education, Office of Civil Rights (2014). U.S. Education Department

reaches voluntary resolution agreement following Minneapolis Public School

District discipline investigation. Retrieved from https://www.ed.gov/news/press-

releases/us-education-department-reaches-voluntary-resolution-agreement-

following-minneapolis-public-school-district-discipline-investigation

Vagle, M.D. (2018). Crafting phenomenological research (2nd ed.). New York:

Routledge.

Vaught, S. E. (2012). Institutional racist melancholia: A structural understanding of grief

and power in schooling. Harvard Educational Review, 82(1), 52-77.

https://www-rep-routledge-com.ezp1.lib.umn.edu/articles/thematic/morality-and-ethics/v-1

https://www-rep-routledge-com.ezp1.lib.umn.edu/articles/thematic/morality-and-ethics/v-1

https://www.ed.gov/news/press-releases/us-education-department-reaches-voluntary-resolution-agreement-following-minneapolis-public-school-district-discipline-investigation



163

Webster, G. C. & Baylis, F.E. (2000). Moral residue. In S.B. Rubin & L. Zoloth (Eds.),

Margin of error: The ethics of mistakes in the practice of medicine, (pp. 217-232).

Hagerstown, MD: University Publishing Group.

Weinberg, M. (2009). Moral distress: A missing but relevant concept for ethics in social

work. Canadian Social Work Review, 26(2), 139-151.

Whitehurst, G.J. (2017). New evidence on school choice and racially segregated schools.

Brookings Institute. Retrieved from https://www.brookings.edu/research/new-

evidence-on-school-choice-and-racially-segregated-schools/

Whitman, D. (2008). Sweating the small stuff: Inner-city schools and the new

paternalism. Washington, D.C.: Thomas B. Fordham Institute.

Wilkinson, J. (1988). Moral distress in nursing practice: Experience and effect. Nursing

Forum, 23(1), 17–29.

Wisconsin Department of Public Instruction (2018). Module 1: Introduction to trauma-

sensitive schools professional development. Retrieved from

https://media.dpi.wi.gov/sspw/av/trauma_sensitive_schools_mod_1/story_html5.h

tml.

https://www.brookings.edu/research/new-evidence-on-school-choice-and-racially-segregated-schools/

https://www.brookings.edu/research/new-evidence-on-school-choice-and-racially-segregated-schools/

https://media.dpi.wi.gov/sspw/av/trauma_sensitive_schools_mod_1/story_html5.html

https://media.dpi.wi.gov/sspw/av/trauma_sensitive_schools_mod_1/story_html5.html

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Methodological Appendix

This section contains additional details on the measures, data collection, and

analysis processes used in the quantitative and qualitative portions of the study that were

not included in the journal-ready individual papers (i.e. Chapters 3 and 4).

Measures and Data Collection

The measures used in this study include five standardized quantitative measures, a

demographic form, and a semi-structured interview. Each are explained in depth below,

and copies of the actual measures can be found at the end of the appendix.

Quantitative measures.

Moral injury. Moral injury was measured using a modified version of the 9-item

Moral Injury Events Scale (MIES; Nash et al., 2013). The MIES has a three-factor

solution—Transgressions-other, Transgressions-self, and Betrayal—with strong internal

consistency estimates for each factor, α = .79, α = .94-.96, and α = .83-.89, respectively

(Bryan et al., 2016). Participants are asked to respond to statements such as “I saw things

that were morally wrong,” and “I am troubled by having acted in ways that violated my

own morals or values,” using a 6-point Likert scale, with responses ranging from 1 =

“strongly disagree” to 6 = “strongly agree.” Although the MIES was designed for use

with a military population (Nash et al., 2013; Bryan et al., 2016), among the two moral

injury scales in existence at the time of this study (the other being the Moral Injury

Questionnaire [Currier, Holland, Drescher, & Foy, 2015a]), the MIES contained items

that were less specific to the military context, making it a better fit for use in the

education setting. However, two modifications to the MIES did still have to be made for

165

use in the education setting. First, participants were prompted to reflect on events that

have occurred in the context of their work in their current school, rather than in the

military. Second, the three items that make up the Betrayal factor were altered to reflect

the difference between a military setting and a school setting. Instead of asking about

betrayal by “leaders,” “fellow service members,” and “others outside the U.S. military”

(Nash et al., 2013), education professionals were asked if they felt betrayed by

“administrators in my school and district,” “colleagues,” and “education leaders and

policy makers on the state and/or federal level. In this study, the modified MIES

demonstrated strong internal consistency on all three factors: Transgressions-Other (α =

.91), Transgressions-Self (α = .91), and Betrayal (α = .80).

Guilt. Guilt was measured via the Trauma-Related Guilt Inventory (TRGI;

Kubany et al., 1996). The TRGI is a 32-item scale that assesses six guilt-related factors:

global guilt, distress, guilt cognition, hindsight-bias/responsibility, wrongdoing, and lack

of justification. Participants responded to statements such as “What I did was

inconsistent with my beliefs,” and “I experience intense guilt that relates to what

happened,” using a 5-point Likert scale, ranging from 0 = “Not at all true,” to 4 =

“Extremely true.” The TRGI has demonstrated good internal reliability estimates across

the six factors (α = .67 - .91) and strong test-retest reliability (rs = 0.75-0.86) (Kubany et

al., 1996). In addition to its psychometric properties, the TRGI was chosen as a measure

of guilt in this study because it asks participants to respond to the items while thinking

about a specific event, allowing the measure of guilt to be directly related to the specific

morally injurious events reported on in the MIES. The survey instructions asked

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participants to recall the event or events they were thinking about as they completed the

MIES, to choose the most troublesome or distressing event, and to consider this event

while completing the TRGI. Internal reliability estimates across the six factors in the

TRGI in this study were strong (α = .74 - .91).

Stress of conscience. The Stress of Conscience Questionnaire (SCQ; Glasberg,

Eriksson, & Norberg, 2006) is a 9-item scale developed to assess “troubled conscience”

and its accompanying stress among practicing nurses. Glasberg and colleagues (2006)

define “troubled conscience” as the “the discrepancy between our individual conscience

(personal core values) and external restrictions (e.g. society’s or the profession’s values)”

(p. 635) and “stress of conscience” as “the stress generated by a troubled conscience” (p.

635). This description of “stress of conscience” appears consistent with aspects of moral

injury; and, the “discrepancy” associated with stress of conscience is reminiscent of the

“cognitive dissonance” that leads to moral injury (Litz et al., 2009). The SCQ was

included in this study to assess potential conceptual similarity with moral injury.

Correlations between scores on the SCQ and the MIES could aid in further conceptual

development of moral injury, as well as begin to connect the emerging work being done

on moral injury with existing research on stress of conscience in Scandinavia.

Each SCQ item contains an A and a B question. The A question asks about the

frequency of exposure to the stressful event, and the B question asks about the amount of

distress or troubled conscience the event generated. For example, the A question, “How

often do you lack the time to provide the instruction and/or support that a student needs?”

is responded to using a six-point Likert scale, with 0 being “Never,” and 5 being “Every

167

day.” Then the B question asks, “Does this give you a troubled conscience?” and the

participant responds on a 6-point Likert scale, where 0 = “no, not at all,” and 5 = “yes,

very much.” The SCQ has been found to contain two factors, Internal Demands and

External Demands/Restrictions, with good reliability coefficients (α = .74 and .78,

respectively; Glasberg et al., 2006), but also comes close to meeting the criteria for

unidimensionality, with an internal consistency estimate of .83 for all items, indicating a

total “stress of conscience” score (Glasberg et al., 2006). In the current study, again two

minor modifications to language were made. The word “patient” was replaced with

“student,” and “provide care” was replaced with “provide instruction and/or support.”

Cronbach’s alphas for the full scale score (α = .84), the Internal Demands factor (α = .71),

and the External Demands factor (α = .78) were nearly identical to those found in

Glasberg et al. (2006).

Burnout. The Copenhagen Burnout Inventory (CBI; Kristensen, Borritz,

Villadsen, & Christensen, 2005) is a three-scale inventory that measures personal

burnout, work-related burnout, and client-related burnout among human service sector

workers. Participants are asked to respond to questions such as “How often do you feel

tired?” “Does your work frustrate you?” and “Do you find it hard to work with

students?” using a five-point Likert scale, where 1 = “Never/almost never or to a very

low degree,” and 5 = “Always or to a very high degree.” Burnout has been hypothesized

to be a potential outcome of “demoralization,” a construct which is conceptually similar

to moral injury (Gabel, 2012; Santoro, 2011). No studies have empirically measured the

relationship between burnout and moral injury, and thus including the CBI in this study

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provided information on the relationship among these constructs as they relate to the

experience of education professionals.

The CBI was designed as an alternative to the well-known Maslach Burnout

Inventory (Maslach, 1996, 1997), which the CBI authors criticized for its unclear and at

times contradictory and circular conceptualization of burnout, its lack of clarity between

the structure of the scale and its operationalized definition of burnout, inventory

questions that are culturally biased and are inappropriate outside the dominant American

context, and the lack of access to the MBI in the public domain (Kristensen et al., 2005).

Initial psychometric testing of the CBI on a sample of 1914 employees at a variety of

human service sector agencies in Denmark demonstrated high internal reliability

estimates for all three scales, with Cronbach alphas ranging from .85 - .87. In this study,

“clients” in the “client-related burnout” scale of the CBI was changed to “students” to be

consistent with the education context. Internal reliability estimates (α = .78 - .91) were

strong and consistent with those found by Kristensen and colleagues (2005).

Intention to leave. The Intention to Leave Scale (ILS; Rosin &Korabik, 1991)

contains four items used to measure an individual’s intentions to leave their current job:

1) At this time in your career, would you want to quit this job if it were possible? (2) Are

you actually planning to leave your job within the next six months? (3) Are you actively

searching for another job right now? (4) Please indicate whether you have ever had

thoughts of leaving your job. Items 1 and 2 were rated as 0 = no, 1 = not sure, and 2 =

yes. Item 3 was rated as no = 0 and yes = 1. For item 4, participants responded with 1 = I

never have had such thoughts, 2 = I occasionally have such thoughts, or 3 = I frequently

169

have such thoughts. Citing Santoro & Morehouse’s (2011) study of “principled leaders”

– teachers who have left the profession because they can no longer bear the

responsibility for carrying out the oppressive and unjust obligations of their school

systems – Levinson (2015) asserts that one way educators respond to and cope with

moral injury is by leaving the profession. The ILS was included to allow for empirical

investigation of this hypothesis. Although the intention to leave one’s job is not the same

as actual job turnover and is not perfectly predictive of future job departure, researchers

have found that measures of the intention to leave a job are the strongest predictor of an

actual decision to leave (Rosin & Korabik, 1991). Internal reliability of the ILS in this

study (α = .81) was high and nearly identical to the α = .82 found by Rosin &Korbik

(1991).

Individual and school-level characteristics. Participants were asked to report

their gender (male, female, transgender), age, race (White, African American, Latino/a,

Native American, Asian, and Multi-racial), role in the school (e.g. teacher, school social

worker, psychologist), the number of years they had worked in education, the

approximate number of students in their school, and their school level (e.g. K-5, K-8, K-

12, 6-8, 9-12). Respondents also selected the name of their school from a drop-down

menu. Using the name of the school provided by each participant and data available on-

line from the State Department of Education, I was able to identify the percentage of

students of color and the percentage of students receiving free or reduced lunch in each

school.

Qualitative measure & data collection.

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Phenomenological interview. A semi-structured interview guide was used a as a

basic framework for the phenomenological interviews. However, consistent with Vagle’s

(2018) discussion of data gathering in post-intentional phenomenological research,

interviews did not rigidly follow the interview guide. Rather, a “dialogic, open, and

conversational” (Vagle, 2018, p. 86) approach was prioritized. In their seminal work,

Naturalistic Inquiry, Lincoln and Guba (1985) stress the importance of building and

maintaining trust with participants when conducting a qualitative inquiry. After receiving

written informed consent and giving each participant a $10 Target gift card as

compensation for their participation in the study, I began the interview with some self-

disclosure to aid in the establishment of rapport and trust. I identified myself as a current

doctoral student in social work and a former school social worker, with 11 years of

experience working in a neighboring suburban school district. This self-disclosure

allowed me to gain some credibility in terms of my familiarity with public education and

to present myself as a peer to participants. I informed participants that they could feel

free to use common educational acronyms and terminology and that I would ask

questions if I did not understand. I then presented the participant with a blank copy of the

modified Moral Injury Events Scale (MIES) (Nash et al., 2013). I explained to

participants that they may remember filling out the MIES when they completed the on-

line survey in May or June of 2017. I explained that they had been selected to participate

in a follow-up interview because they scored fairly high on the MIES, meaning they

agreed with many of the statements indicating that they had witnessed or participated in

events that they found to be morally troubling. I asked participants to review the items

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on the MIES and to share any events or experiences that came to mind as they reflected

on the questions.

Throughout the interview I attempted to expand on participants’ descriptions by

asking deepening questions regarding the feelings and outcomes they experienced related

to the morally injurious events. I also attempted to get participants to articulate which

specific aspects of situations did they find to be the most morally troubling. I asked how

participants coped with their experiences, how the experiences changed them, and what

could prevent similar events from happening in the future. As a phenomenological

researcher, I saw my role as a supportive, affirming listener of the participants’ stories.

Vagle (2018) states that the first rule of phenomenological interviewing is to “always

agree” (p. 91). Vagle (2018) is not asserting that the researcher needs to agree with

everything that the participant is saying, but that she should agree with “what they are

opening up – how they are helping us gain access to a complex phenomenon” (p. 91).

During interviews, I asked clarifying questions if I did not understand what was being

said, but I did not attempt to challenge or question any of the statements the participants

made regarding their perspectives and experiences. Consistent with Vagle’s (2018)

approach to phenomenological interviewing, I attempted to interrogate my assumptions

of understanding and “definiteness” (p. 89) by asking participants questions such as,

“Can you tell me more about that?” and “I want to make sure I understand you, can you

say a little more about what you mean?” All interviews were audio-recorded and later

transcribed.

Analysis

172

Quantitative analysis. After the Qualtrics survey was closed, data were

downloaded and transferred to the Statistical Package for the Social Sciences, v. 24 (IBM

Corp., 2016). Three of the demographic variables were recoded. Race was recoded from

a six-category variable to a binary variable (white / non-white). Role in school was

recoded from a 19-category variable into two dummy variables: “SpEd_ELL,” in which

a “1” was assigned to all special education teachers, speech-language pathologists,

occupational therapists, physical therapists, and English Language Learner teachers, and

all other roles were assigned a “0;” and “Mental_Health,” in which a “1” was assigned to

school social workers, school psychologists, school counselors, and school nurses, and a

“0” was assigned to all other roles. School type was recoded from 5-category variable to

a binary variable, with all schools containing any grades between K- 5 being coded as

“elementary,” and all schools without any students in grades K-5 being coded as “non-

elementary.”

Descriptive statistics were calculated to answer the first research question on the

extent that educators experience moral injury in their workplace. Regression analyses

were performed to answer the second research question on what individual and school-

level characteristics are associated with moral injury. In terms of regression assumptions,

linearity, homoscedasticity, and normality of distribution were met, but multicollinearity

was detected among a few key study variables – the percentage of students of color and

the percentage of students on free or reduced lunch; age and number of years in

education; and the number of students in the school and the school level. I removed age

of teacher from the regression analyses, as I was more interested in how a professional’s

173

years of experience in the education field related to their experiences of moral injury. I

removed the number of students in the school as I was more interested in how

experiences of moral injury might differ depending on the age of the students in the

school (elementary vs. secondary) than on the size of the school. Finally, although I was

interested in the relationship of both the racial and class make-up of a school to moral

injury, due to my interest in Critical Race Theory and my belief in the centrality of race

and racism in the U.S. education system, I chose to eliminate the variable measuring the

percent of students receiving free or reduced lunch.

The data included 218 individual professionals from 68 schools, suggesting

clustered data. The largest cluster included 13 professionals from one school and the

smallest included only one participant in the school. Nineteen of the schools in the data

set (28%) contained only one participant. Interclass correlations (ICCs) were calculated

for each of the three MIES factors (transgressions-other, transgressions-self, and betrayal)

which serve as the dependent variables. All three ICCs were non-trivial: ICC

(transgressions-others) = 0.199, ICC (transgressions-self) = 0.097, ICC (betrayal) =

0.106. Due to the non-trivial ICCs, both multi-level and single-level models for all three

dependent variables (Transgress-other, Transgress-self, and Betrayal) were run and

compared. In the resulting equations, the estimated coefficients were nearly identical

between the multi-level model and the single-level regression for all three outcome

variables, varying at most by one hundredth of a point (see Tables 1, 2, &3).

Table 1

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Unstandardized Coefficients for Transgressions-Other, Mixed-Level and Single-Level

Models

Variables Unstandardized Coefficients

Mixed-Level Model Single-Level Model

% Students of Color 2.383 2.398

Years in Education .009 .010

Elementary School -.073 -.070

Mental Health

Professionals .961 .968

Special Ed / ELL

Professionals -.199 -.191

Race of Professional _

White .085 .080

Gender .413 .438

Table 2

Unstandardized Coefficients for Transgressions-Self, Mixed-Level and Single-Level

Models




Years in Education -.005 -.005


Mental Health


Special Ed / ELL


175


White -.139 -.139

Gender -.011 -.011

Table 3

Unstandardized Coefficients for Betrayal, Mixed-Level and Single-Level Models




Years in Education .001 .011


Mental Health


Special Ed / ELL

Professionals -.122 -.124


White .083 .071

Gender .505 .507

Additionally, in the multi-level models, the variance attributed to the intercept

(i.e. the clustering effect) was small and statistically insignificant (see Table 4). Thus, the

impact of school-level clusters was not relevant to the accuracy of the estimated

coefficients in the regression models and based on the principle that, when possible, a

simpler model is preferable to a more complex model, single-level regression models

were used.

Table 4

176

Variance Estimates for the Three MIES Factors (Transgressions-Other, Transgressions-

Self, & Betrayal) Attributed to the School-Level Clustering Effect

Estimate SE p

Intercept [subject = School] Transgressions-Other .133716 .154315 .386

Intercept [subject = School] Transgressions-Self .000271 .113836 .998

Intercept [subject = School] Betrayal .051208 .182683 .779

Correlational analyses were used to answer the third research question, regarding

the emotional and behavioral factors associated with moral injury. The MIES and the

scales measuring the emotional and behavioral factors (TRGI, SCQ, CBI, and ILS) are

ordinal scales. Two of the TRGI subscales, Global Guilt and Wrongdoing, demonstrated

elevated levels of skewness, at 1.207 (SE = .167) and 1.424 (SE = .169), respectively.

For these reasons, Spearman’s Rho correlations were used.

Qualitative analysis. All audio-recordings were transcribed by either myself (n =

18) or a professional transcription service, Transcribe Me (n = 3). I then loaded all

transcriptions into the on-line qualitative research program, Dedoose. My analytic

approach was guided by Vagle’s (2018) approach to post-intentional phenomenological

analysis and Jackson and Mazzei’s (2012) approach to “thinking with theory.” I began

the analysis process using Vagle’s (2018) “whole-part-whole” analytic approach. First, I

read each transcript in full and reviewed my post-reflexion journal entries, in order to

immerse myself in the data, much of which I had collected months prior to beginning my

analysis. I then conducted careful line-by-line readings of each transcript in Dedoose,

177

using the coding function to deconstruct each transcript into parts, paying particular

attention to elements of the transcripts that might mark the phenomenon (Vagle, 2018).

After deconstructing each transcript, I began to examine how the different parts were

forming into new thematic wholes, or what Vagle (2018) refers to as productions and

provocations of the phenomenon. I then began the process of interpreting these

productions and provocations through and against my own assumptions and experiences,

as well as in the context of relevant theoretical frameworks, including Critical Race

Theory (Delgado &Stefancic, 2012) and Intersectionality Theory (Crenshaw, 1989).

Vagle (2018) argues that in post-intentional phenomenology the three key components of

analysis are data, theories, and post-reflexions and that all three components are equally

important in understanding how a phenomenon might take shape. Throughout this

process, I tried to maintain an open stance to the research and resisted the urge to rush to

conclusions that erroneously “attempt to make definite what is indefinite” (Vagle, 2018,

p. 74).

Quantitative Measures

Moral Injury Events Scale (Nash et al., 2013) - Modified

We’re interested in learning about some of the moral issues involved in working in public

K-12 education. By “moral,” we mean your own standards of behavior or beliefs about

right and wrong.

In reflecting on your experiences working in your current school, please respond to

each of the following statements by placing an X in one of the columns on the right.

Strongly

Agree

Moderately

Agree

Slightly

Agree

Slightly

Disagree

Moderately

Disagree

Strongly

Disagree

1. I saw things

that were

178

morally

wrong.

2. I am troubled

by having

witnessed

others’

immoral acts.

3. I acted in

ways that

violated my

own moral

code or

values.

4. I am troubled

by having

acted in ways

that violated

my own

morals or

values.

5. I violated my

own morals

by failing to

do something

that I felt I

should have

done.

6. I am troubled

because I

violated my

morals by

failing to do

something

that I felt I

should have

done.

7. I feel

betrayed by

the education

179

system that I

once trusted.

8. I feel

betrayed by

superiors

(e.g.,

principals,

superintende

nts,

administrator

s) who I once

trusted.

9. I feel

betrayed by

colleagues

who I once

trusted.

Trauma-Related Guilt Inventory (Kubany et al., 1996)

On the previous page, you were asked to reflect on experiences you have had at your

current school that you found to be morally wrong or troubling. For the following

questions, we would like you to reflect on the most morally troubling of these

experiences. All the items below refer to events related to this experience. Place an X in

the box that best describes how you feel about each statement.

Extremely

True Very True

Somewhat

True Slightly True

Not at All

True

1. I could have

prevented what

happened.

2. I am still

distressed about

what happened.

3. I had some

feelings that I

should not have

had.

4. What I did was

completely

justified.

180

5. I was responsible

for causing what

happened.

6. What happened

causes me

emotional pain.

7. I did something

that went against

my values.

8. What I did made

sense.

9. I knew better

than to do what I

did.

10. I feel sorrow or

grief about the

outcome.

11. What I did was

inconsistent with

my beliefs.

12. If I knew today –

only what I knew

when the event

occurred – I

would do exactly

the same thing.

13. I experience

intense guilt that

relates to what

happened.

14. I should have

known better.

15. I experience

severe emotional

distress when I

think about what

happened.

16. I had some

thoughts or

beliefs that I

should not have

had.

17. I had good

reasons for doing

what I did.

Never Seldom Occasionally Often Always

181

18. Indicate how

frequently you

experience guilt

related to what

happened.

Extremely

True Very True

Somewhat

True Slightly True

Not at All

True

19. I blame myself

for what

happened.

20. What happened

causes a lot of

pain and

suffering.

21. I should have had

certain feelings

that I did not

have.

None Slight Moderate Considerable Extreme

22. Indicate the

intensity or

severity of guilt

that you typically

experience about

the event.

Extremely

True Very True

Somewhat

True Slightly True

Not at All

True

23. I blame myself

for something I

did, thought, or

felt.

Always

True

Frequently

True

Sometimes

True Rarely True Never True

24. When I am

reminded of the

event, I have

strong physical

reactions such as

sweating, tense

muscles, dry

mouth, etc.

Not guilty

at All

Slightly

Guilty

Moderately

Guilty Very Guilty

Extremely

Guilty

25. Overall, how

guilty do you

feel about the

event?

182

Extremely

True Very True

Somewhat

True Slightly True

Not at all

True

26. I hold myself

responsible for

what happened.

27. What I did was

not justified in

any way.

28. I violated

personal

standards of right

and wrong.

29. I did something I

should not have

done.

30. I should have

done something

that I did not do.

31. What I did was

unforgivable.

32. I didn’t do

anything wrong.

Stress of Conscience Questionnaire (Glasberg et al., 2006)

In reflecting on your experiences working in your current school, please respond to

each of the following statements by placing an X in one of the columns on the right for

each of the (a) items and then provide a rating between 0 and 5 (0 = not at all; 5 = very

much) for the (b) items.

Never Less than

once in 6

months

More than

once in 6

months

Every

month

Every

week

Every

day

1a) How often do

you lack the time to

provide the

instruction and/or

support that a

student needs?

1b) Does this give you a troubled conscience? (Answer on a scale of 0 - 5, with 0 = “no, not at

all” and 5 = “yes, very much”) _____________

183

Never Less than

once in 6

months

More than

once in 6

months

Every

month

Every

week

Every

day

2a) Are you ever

forced to teach or

provide support to

students in a way

that feels wrong?



Never Less than

once in 6

months

More than

once in 6

months

Every

month

Every

week

Every

day

3a) Do you ever

have to deal with

incompatible

demands in your

work?



Never Less than

once in 6

months

More than

once in 6

months

Every

month

Every

week

Every

day

4a) Do you ever

see students being

insulted and/or

injured?



Never

Less than

once in 6

months

More than

once in 6

months

Every

month

Every

week

Every

day

5a) Do you ever

find yourself

avoiding students

or their family

members who need

help or support?



184

Never Less than

once in 6

months

More than

once in 6

months

Every

month

Every

week

Every

day

6a) Is your private

life ever so

demanding that you

don’t have the

energy to devote

yourself to your

work as you would

like?



Never Less than

once in 6

months

More than

once in 6

months

Every

month

Every

week

Every

day

7a) Is your work at

your school ever so

demanding that you

don’t have the

energy to devote

yourself to your

family as you

would like?



Never Less than

once in 6

months

More than

once in 6

months

Every

month

Every

week

Every

day

8a) Do you ever

feel that you cannot

live up to others’

expectations of

your work?



Never Less than

once in 6

months

More than

once in 6

months

Every

month

Every

week

Every

day

9a) Do you ever

lower your

aspirations to

provide good

185

instruction and

support to students

and families?



Copenhagen Burnout Inventory (Kristensen et al., 2005)

Please respond to the following items by marking an X in the corresponding column on

the right.

Always

or

To a very high

degree

Often

or

To a high

degree

Sometimes

or

Somewhat

Seldom

or

To a low

degree

Never /

almost never

or

To a very

low degree

1. How often do

you feel tired?

2. How often are

you physically

exhausted?

3. How often are

you emotionally

exhausted?

4. How often do

you feel like, “I

can’t take it

anymore”?

5. How often do

you feel worn

out?

6. How often do

you feel weak

and susceptible

to illness?

7. Do you ever feel

worn out at the

end of the

working day?

8. Are you

exhausted in the

morning at the

thought of

another day at

work?

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9. Do you feel that

every working

hour is tiring for

you?

10. Do you have

enough energy

for family and

friends during

leisure time?

11. Is your work

emotionally

exhausting?

12. Does your work

frustrate you?

13. Do you feel burn

out because of

your work?

14. Do you find it

hard to work

with students?

15. Does it drain

your energy to

work with

students?

16. Do you find it

frustrating to

work with

students?

17. Do you feel you

give more than

you give back

when you work

with students?

18. Are you tired of

working with

students?

19. Do you

sometimes

wonder how long

you will be able

to work with

students?

Intention to Leave Scale (Rosin &Korabik, 1991)

187

Please respond to the following items by marking an X in the corresponding column on

the right.

YES NO NOT SURE

1. At this time in

your career, would

you want to quit

this job if it were

possible?

2. Are you actually

planning to leave

your job within the

next six months?

3. Are you actively

searching for

another job right

now

I have never

had such

thoughts

I occasionally

have such

thoughts

I frequently

have such

thoughts

4. Please indicate

whether you have

ever had thoughts

of leaving your

job:

Open-Ended Question

If there is anything else you would like to comment on regarding morally challenging or

stressful experiences in your current job, please feel free to add them here:

Demographics

188

Please respond to the following items by placing an X in the columns to the right or, for

#2, #4, and #5, writing your answer in the blank space provided.

Male Female Transgender I do not identify

with any gender

1. What is your

gender?

2. What is your age? _________

African

American

Asian

American Latino/a Native

American White Multi-

racial

3. What is your

race?

4. What is your role in your school (e.g. general education teacher, special education teacher,

school social worker, school counselor, speech pathologist, etc.)?

_________________________________________

5. How many years have you worked in K-12 education? ____________________

Elementary

School

Middle

School

High

School K-12

Combined

Elementary

/ Middle

Combined

Middle /

High

School

6. What level

school do you

work in?

< 300 300-600

601-

1000

1001-

2000 2001-3000 > 3000

7. Approximately

how many

students attend

your school?

< 10%

10% -

30%

31% -

50%

51% -

75%

76% -

90% > 90%

8. Approximately

what

percentage of

students in your

school receive

free or reduced

lunch?

9. Approximately

what

189

percentage of

students in your

school are

White?

Rural area Suburban area Urban area

10. Where is your

school located?

Public Public Charter Private

11. What type of

school do you

work at?

Qualitative Interview Guide

1. I notice that you marked “strongly agree” for….. Can you tell me what

experience or experiences you were thinking about when you gave that

response?

Probe: Can you tell me more about how you felt in that situation(s)?

Types of feelings. What types of feelings did you experience? (e.g. anger,

guilt, shame, betrayal, sadness)

Duration of feelings. How long have you been bothered, or were you

bothered, by these feelings?

Frequency of feelings. How often are you, or were you, bothered by these

feelings?

Intensity of feelings. Do you experience (or tell me more about) any

unwanted/intrusive memories or thoughts about the incident? Any

recurrent dreams or nightmares related to the incident? Any feelings of

numbness – feeling empty or disconnected? Do you avoid thinking about

the incident – for example, try not to talk or think about it, or do

something to distract yourself? Any physical feelings related to the

incident, for example, feelings of heartache, being sick to your stomach, or

otherwise physically distressed when recalling it? Anything spiritual like a

weakening of faith, or feelings of religious guilt or sin?

What about the experience did you find most troubling?

2. Have these experiences and feelings affected or changed you? How?

Probe: Self. What about how you view yourself? Your professional

identity? Your personal identity?

190

Probe. Other people. Your relationships with others?

Probe. Behaviors. Your own actions and behaviors?

Probe. Decisions re: your work?

3. How have you coped with these experiences and feelings?

Probe: What or who has helped you?

4. This study deals with moral issues. How do you define the term “moral” or

“morality”? Do you think morality is relevant to your job and/or to the

education system in general? Would you describe teaching [social work, nursing]

as a moral profession?

5. Anything else you’d like to tell me about these experiences and feelings?

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