Clinician grief, moral distress, and moral injury in traumatic brain injury care: an integrative narrative.

Traumatic brain injury (TBI) is among the most emotionally demanding conditions encountered in neurosurgical and acute neurotrauma practice. Sudden neurological deterioration, unexpected death in young and previously healthy individuals, persistent prognostic uncertainty, and systemic resource constraints together create a uniquely intense emotional environment for clinicians involved in TBI care. While the psychosocial consequences of TBI for patients and caregivers have been extensively studied, the emotional burden borne by treating clinicians-particularly experiences of grief, moral distress, and moral injury-remains comparatively underexplored. This integrative narrative review synthesizes established conceptual frameworks of clinician grief, second-victim phenomena, burnout, and moral injury with the clinical realities of TBI management. Key emotional stressors intrinsic to neurotrauma care are identified, including rapid neurological deterioration, prognostic ambiguity, ethically complex decision-making, prolonged intensive care trajectories, exposure to family distress, and episodes of hostility or violence directed toward healthcare workers. Evidence from low- and middle-income countries highlights how high patient volumes, resource limitations, financial constraints, and medicolegal pressures amplify clinician distress and vulnerability to emotional exhaustion and moral injury. The authors further examine the psychological mechanisms underlying clinician responses to TBI care, including intrusive recollections, anticipatory anxiety, value dissonance, and the cumulative emotional residue that accrues across repeated high-stakes encounters. Finally, institutional and system-level strategies to mitigate these effects, including structured debriefing, peer-support programs, resilience-oriented training, transparent communication frameworks, and protections against workplace violence, are outlined. Recognizing clinician grief as an inherent component of TBI practice is essential for sustaining neurosurgeons' well-being, ethical decision-making, and long-term workforce resilience in high acuity neurotrauma systems.