Gustavsson Martina E, Juth Niklas, Arnberg Filip K, von Schreeb Johan
Department of Global Public Health, Centre for Research on Healthcare in Disasters, Health Systems and Policy (HSP), Karolinska Institutet, Stockholm, Sweden.
Department of Learning, Informatics, Management and Ethics (LIME), Stockholm Centre for Healthcare Ethics (CHE), Karolinska Institutet, Stockholm, Sweden.
Confl Health. 2022 May 8;16(1):24. doi: 10.1186/s13031-022-00456-y.
Disasters are chaotic events with healthcare needs that overwhelm available capacities. Disaster healthcare responders must make difficult and swift choices, e.g., regarding who and what to prioritize. Responders dealing with such challenging choices are exposed to moral stress that might develop into moral distress and affect their wellbeing. We aimed to explore how deployed international disaster healthcare responders perceive, manage and are affected by moral challenges.
Focus groups discussions were conducted with 12 participants which were Swedish nurses and physicians with international disaster healthcare experience from three agencies. The transcribed discussions were analyzed using content analysis.
We identified five interlinked themes on what influenced perceptions of moral challenges; and how these challenges were managed and affected responders' wellbeing during and after the response. The themes were: "type of difficult situation", "managing difficult situations", "tools and support", "engagement as a protective factor", and "work environment stressors as a risk factor. Moral challenges were described as inevitable and predominant when working in disaster settings. The responders felt that their wellbeing was negatively affected depending on the type and length of their stay and further; severity, repetitiveness of encounters, and duration of the morally challenging situations. Responders had to be creative and constructive in resolving and finding their own support in such situations, as formal support was often either lacking or not considered appropriate.
The participating disaster healthcare responders were self-taught to cope with both moral challenges and moral distress. We found that the difficult experiences also had perceived positive effects such as personal and professional growth and a changed worldview, although at a personal cost. Support considered useful was foremost collegial support, while psychosocial support after deployment was considered useful provided that this person had knowledge of the working conditions and/or similar experiences. Our findings may be used to inform organizations' support structures for responders before, during and after deployment.
灾难是具有医疗需求的混乱事件，这些需求超出了现有能力。灾难医疗救援人员必须做出艰难而迅速的选择，例如确定优先救助对象和事项。应对此类具有挑战性选择的救援人员会面临道德压力，这种压力可能会发展为道德困扰并影响他们的身心健康。我们旨在探讨参与国际灾难医疗救援的人员如何看待、应对道德挑战以及受到这些挑战的影响。
对12名参与者进行了焦点小组讨论，他们是来自三个机构的具有国际灾难医疗救援经验的瑞典护士和医生。使用内容分析法对转录的讨论内容进行分析。
我们确定了五个相互关联的主题，内容涉及影响道德挑战认知的因素；以及在救援期间和之后如何应对这些挑战以及它们如何影响救援人员的身心健康。这些主题是：“困难情况的类型”“应对困难情况”“工具与支持”“投入作为保护因素”以及“工作环境压力源作为风险因素”。道德挑战在灾难环境中工作时被描述为不可避免且普遍存在。救援人员认为，他们的身心健康受到负面影响的程度取决于停留的类型和时长，以及遭遇情况的严重程度、重复性和道德挑战情况的持续时间。在这种情况下，由于往往缺乏正式支持或认为其不合适，救援人员必须发挥创造力并积极应对，自行寻找支持。
参与研究的灾难医疗救援人员自学应对道德挑战和道德困扰。我们发现，尽管付出了个人代价，但这些艰难经历也有一些积极影响，如个人和职业成长以及世界观的改变。被认为有用的支持主要是同事间的支持，而部署后提供的心理社会支持如果此人了解工作条件和/或有类似经历则被认为是有用的。我们的研究结果可用于为组织在部署前、部署期间和部署后为救援人员提供支持结构提供参考。
