Smigelsky Melissa A, Trimm Victoria, Meador Keith, Jackson George L, Wortmann Jennifer H, Nieuwsma Jason A
Integrative Mental Health, Department of Veterans Affairs, Durham, NC.
VA Mid-Atlantic Mental Illness Research, Education, and Clinical Center, Durham, NC.
Spiritual Clin Pract (Wash D C ). 2022;9(3):159-174. doi: 10.1037/scp0000297.
Despite increasing interest in moral injury, there is not yet consensus around what it is (and is not), who can have it and under what circumstances, or the degree and form of distress necessary to distinguish moral injury from other psychological and spiritual difficulties. The novelty of moral injury has created space for frontline Veterans Health Administration mental health and spiritual care providers to creatively apply their core professional skills and identities to moral injury. This paper presents findings of a core components analysis (CCA) derived from seven co-led chaplain-mental health moral injury group facilitation teams that were involved in a 16-month quality improvement endeavor of the Dynamic Diffusion Network (DDN). The DDN initiative engages providers in collaborative and iterative refinement of practices to promote rapid improvements in care for complex problems that lack a codified evidence base. Using CCA, we identified 10 core components of co-facilitated moral injury group care. Components include a clear conceptualization of moral injury, an inclusive approach to spirituality, and exploration of forgiveness, among others. This paper offers guidance that can be widely applied and readily adapted as our collective understanding of moral injury continues to expand and clarify. The core components are articulated here as principles for ongoing review and revision in response to future moral injury advances in the DDN and elsewhere.
尽管人们对道德伤害的兴趣日益浓厚，但对于道德伤害是什么（以及不是什么）、谁可能会有道德伤害以及在何种情况下会有道德伤害，或者将道德伤害与其他心理和精神困扰区分开来所需的痛苦程度和形式，尚未达成共识。道德伤害的新颖性为退伍军人健康管理局前线心理健康和精神护理提供者创造性地将其核心专业技能和身份应用于道德伤害创造了空间。本文介绍了一项核心成分分析（CCA）的结果，该分析源自七个共同领导的牧师 - 心理健康道德伤害小组促进团队，这些团队参与了动态传播网络（DDN）为期16个月的质量改进工作。DDN倡议让提供者参与协作和迭代式的实践改进，以促进对缺乏编纂证据基础的复杂问题的护理快速改善。通过CCA，我们确定了共同促进的道德伤害小组护理的10个核心成分。这些成分包括对道德伤害的清晰概念化、对灵性的包容方法以及对宽恕的探索等。随着我们对道德伤害的集体理解不断扩展和明晰，本文提供了可广泛应用且易于调整的指导。这里阐述的核心成分作为原则，以便在DDN及其他地方未来道德伤害进展的情况下进行持续审查和修订。
