Webb Elanor Lucy, Ireland Jane L, Lewis Michael, Morris Deborah
Centre for Developmental and Complex Trauma, St Andrew's Healthcare, Northampton, UK.
University of Central Lancashire, Preston, UK.
Trauma Violence Abuse. 2024 Apr;25(2):918-934. doi: 10.1177/15248380231167390. Epub 2023 Apr 21.
The current research examines potentially morally injurious events (PMIEs) faced by healthcare professionals working in forensic and psychiatric environments. A systematic literature review was conducted to identify peer-reviewed articles reporting on sources of moral injury or similar concepts (e.g., moral distress) for healthcare workers in such settings. Thirty articles were included and analyzed using a meta-ethnographic approach. Synthesis yielded three third-order factors, each reflecting a moral dichotomy: (a) "between profession and system," (b) "between relations with patients and relations with others," and (c) "between principles and practices." Findings illustrated the hierarchical relationships between dichotomies, with discordance between values of the healthcare profession and features of the healthcare system providing the conditions for PMIEs to occur. The review advances conceptual understandings of PMIEs in forensic and psychiatric settings, illustrating the multilayered dimensions within which morally injurious events are experienced. Theoretical and practical implications are offered that may support the early detection and prevention of moral injury in healthcare professionals.
当前的研究考察了在法医和精神科环境中工作的医护人员所面临的潜在道德伤害事件（PMIEs）。我们进行了一项系统的文献综述，以识别那些报道此类环境中医护人员道德伤害来源或类似概念（如道德困扰）的同行评审文章。共纳入30篇文章，并采用元民族志方法进行分析。综合分析得出了三个三阶因素，每个因素都反映了一种道德二分法：（a）“职业与系统之间”，（b）“与患者的关系和与他人的关系之间”，以及（c）“原则与实践之间”。研究结果说明了二分法之间的层级关系，即医疗行业价值观与医疗系统特征之间的不一致为潜在道德伤害事件的发生提供了条件。该综述推进了对法医和精神科环境中潜在道德伤害事件的概念理解，阐明了体验道德伤害事件的多层次维度。还提出了理论和实践意义，可能有助于早期发现和预防医护人员的道德伤害。
