Caring for Caregivers: System-Level Solutions to Moral Injury in Burn Teams.

Burn care teams-nurses, physicians, rehabilitation therapists, respiratory therapists, and unlicensed care providers such as burn technicians or patient care assistants-work amid catastrophic injury, disfigurement, severe pain, and complex end-of-life decisions, creating high risk for moral distress, moral injury, and compassion fatigue. This structured, PRISMA-informed narrative review synthesized burn-specific evidence and literature from analogous high-acuity settings. PubMed, CINAHL, PsycINFO, and Google Scholar were searched (English, 2010-2025; foundational earlier works retained). Eligible publications addressed ethically mediated workforce outcomes and organizational, systemic, or team-level drivers and responses; resilience-only studies were excluded unless conceptually informative. Burn-focused studies were sparse but aligned with ICU findings: antecedents included resource scarcity and staffing mismatch, perceived futility and contested goals of care, hierarchical role conflict and constrained voice, and ethically unsafe climates. Consequences clustered around emotional exhaustion, secondary traumatic stress, moral residue, turnover intention, and downstream risks to safety and quality. Across settings, the most promising protections were organizational: accessible leadership, safe staffing and predictable workload, psychologically safe communication, structured peer support and debriefings, reflective forums (eg, Schwartz Rounds), and proactive ethics consultation and moral distress consultation services that surface remediable policy and culture gaps. Moral suffering in burn units should be treated as an organizational ethics problem; embedding moral protection into governance, quality metrics, and ethics infrastructure is essential. Such system-level approaches can reduce preventable moral harm, sustain workforce retention, and protect patient and family experience in burn centers.