Centre for Research on Healthcare in Disasters, Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden.
National Centre for Disaster Psychiatry, Department of Neuroscience, Uppsala University, Uppsala, Sweden.
Prehosp Disaster Med. 2020 Apr;35(2):212-219. doi: 10.1017/S1049023X20000096. Epub 2020 Jan 28.
Current research of moral distress is mainly derived from challenges within high-resource health care settings, and there is lack of clarity among the different definitions. Disaster responders are prone to a range of moral challenges during the work, which may give rise to moral distress. Further, organizations have considered increased drop-out rates and sick leaves among disaster responders as consequences of moral distress. Therefore, initiatives have been taken to address and understand the impacts of moral distress and its consequences for responders. Since there is unclarity among the different definitions, a first step is to understand the concept of moral distress and its interlinkages within the literature related to disaster responders.
HYPOTHESIS/PROBLEM: To examine how disaster responders are affected by moral challenges, systematic knowledge is needed about the concepts related to moral distress. This paper aims to elucidate how the concept of moral distress in disaster response is defined and explained in the literature.
The paper opted to systematically map the existing literature through the methods of a scoping review. The searches derived documents which were screened regarding specific inclusion criteria. The included 16 documents were analyzed and collated according to their definitions of moral distress or according to their descriptions of moral distress.
The paper provides clarity among the different concepts and definitions of moral distress within disaster response. Several concepts exist that describe the outcomes of morally challenging situations, centering on situations when individuals are prevented from acting in accordance with their moral values. Their specific differences suggest that to achieve greater clarity in future work, moral stress and moral distress should be distinguished.
Based on the findings, a conceptual model of the development of moral distress was developed, which displays a manifestation of moral distress with the interplay between the responder and the context. The overview of the different concepts in this model can facilitate future research and be used to illuminate how the concepts are interrelated.
目前对道德困境的研究主要来源于高资源医疗保健环境中的挑战，不同的定义之间缺乏明确性。灾难应对人员在工作中容易面临一系列道德挑战，这可能导致道德困境。此外，组织认为灾难应对人员的离职率和病假率增加是道德困境的后果。因此，已经采取了一些措施来应对和理解道德困境及其对应对人员的影响。由于不同的定义之间存在不明确性，因此首先要了解道德困境的概念及其在与灾难应对人员相关的文献中的相互关系。
假设/问题：要了解灾难应对人员如何受到道德挑战的影响，系统地了解与道德困境相关的概念是必要的。本文旨在阐明灾难应对中道德困境的概念是如何在文献中定义和解释的。
本文选择通过范围综述的方法系统地映射现有文献。通过搜索得出的文件经过特定的纳入标准筛选。纳入的 16 份文件根据其对道德困境的定义或根据其对道德困境的描述进行了分析和整理。
本文在灾难应对中的道德困境的不同概念和定义之间提供了清晰性。有几个概念存在，描述了道德挑战情况下的结果，这些概念集中在个人被阻止按照自己的道德价值观行事的情况。它们的具体差异表明，为了在未来的工作中获得更大的清晰性，应该区分道德压力和道德困境。
基于研究结果，本文提出了一个道德困境发展的概念模型，该模型展示了道德困境的表现，以及应对者和背景之间的相互作用。该模型中不同概念的概述可以促进未来的研究，并用于阐明这些概念是如何相互关联的。
