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“违背了你从事这份工作的初衷”:加拿大公共安全人员经历的潜在道德伤害事件。

'Against everything that got you into the job': experiences of potentially morally injurious events among Canadian public safety personnel.

机构信息

Research and Policy, Atlas Institute for Veterans and Families, Royal Ottawa Mental Health Centre, Ottawa, ON, Canada.

Institute of Mental Health Research, Royal Ottawa Mental Health Centre, Ottawa, ON, Canada.

出版信息

Eur J Psychotraumatol. 2023;14(2):2205332. doi: 10.1080/20008066.2023.2205332.

Abstract

Moral injury (MI) has become a research and organizational priority as frontline personnel have, both during and in the years preceding the COVID-19 pandemic, raised concerns about repeated expectations to make choices that transgress their deeply held morals, values, and beliefs. As awareness of MI grows, so, too, does attention on its presence and impacts in related occupations such as those in public safety, given that codes of conduct, morally and ethically complex decisions, and high-stakes situations are inherent features of such occupations. This paper shares the results of a study of the presence of potentially morally injurious events (PMIEs) in the lived experiences of 38 public safety personnel (PSP) in Ontario, Canada. Through qualitative interviews, this study explored the types of events PSP identify as PMIEs, how PSP make sense of these events, and the psychological, professional, and interpersonal impacts of these events. Thematic analysis supported the interpretation of PSP descriptions of events and experiences. PMIEs do arise in the context of PSP work, namely during the performance of role-specific responsibilities, within the organizational climate, and because of inadequacies in the broader healthcare system. PMIEs are as such because they violate core beliefs commonly held by PSP and compromise their ability to act in accordance with the principles that motivate them in their work. PSP associate PMIEs, in combination with traumatic experiences and routine stress, with adverse psychological, professional and personal outcomes. The findings provide additional empirical evidence to the growing literature on MI in PSP, offering insight into the contextual dimensions that contribute to the sources and effects of PMIEs in diverse frontline populations as well as support for the continued application and exploration of MI in the PSP context.

摘要

道德伤害 (MI) 已成为研究和组织的优先事项,因为前线人员在 COVID-19 大流行期间和之前就已经多次提出担忧,称他们反复被要求做出违背自己根深蒂固的道德、价值观和信仰的选择。随着对 MI 的认识不断提高,人们也越来越关注其在相关职业中的存在和影响,如公共安全领域的职业,因为行为准则、道德和伦理上复杂的决策以及高风险情况是这些职业的固有特征。本文分享了一项针对加拿大安大略省 38 名公共安全人员 (PSP) 生活经历中潜在道德伤害事件 (PMIE) 存在情况的研究结果。通过定性访谈,本研究探讨了 PSP 确定为 PMIE 的事件类型、 PSP 如何理解这些事件以及这些事件对心理、职业和人际关系的影响。主题分析支持了 PSP 对事件和经历描述的解释。PMIE 确实在 PSP 工作中出现,即在履行特定角色责任、在组织氛围中以及由于更广泛的医疗保健系统的不足时出现。PMIE 之所以如此,是因为它们违反了 PSP 普遍持有的核心信念,并损害了他们按照激励他们工作的原则行事的能力。 PSP 将 PMIE 与创伤经历和日常压力结合起来,导致心理、职业和个人方面的不良后果。这些发现为 PSP 中 MI 的不断增长的文献提供了额外的经验证据,深入了解导致不同一线人群中 PMIE 来源和影响的背景维度,并为 MI 在 PSP 背景下的持续应用和探索提供了支持。

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'It hurts your heart': frontline healthcare worker experiences of moral injury during the COVID-19 pandemic.
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