Bell Verity, Murray Esther, Muñoz Luna, Krahé Charlotte
Department of Primary Care and Mental Health, Institute of Population Health, University of Liverpool, Liverpool, UK.
Institute of Health Sciences Education (IHSE), Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK.
Eur J Psychotraumatol. 2025 Dec;16(1):2513107. doi: 10.1080/20008066.2025.2513107. Epub 2025 Jul 2.
Moral injury describes the impact of witnessing or being part of events that violate one's values. Initially described in relation to conflict and war, recent work shows that moral injury is a relevant concept for professionals working in emergency situations. Emergency responders work in contexts of human suffering and make complex decisions in time-pressured, high-stakes situations, but emergency responders' viewpoints regarding moral injury and how strongly they align with different viewpoints is currently not well understood. We sought to investigate how moral injury is conceptualised and how emergency responders in the United Kingdom (UK) relate to experiences of moral injury. In this Q-methodology (mixed-methods) study, seven experts co-created a set of 45 opinion statements (Q-set) capturing different facets of moral injury in the context of emergency responding. Subsequently, = 21 emergency responders (police, fire service, emergency medicine, ambulance, and community first-response staff) completed an online Q-sort task, sorting statements according to how much they identified with them. A by-person factor analysis yielded a three-factor solution mapping onto theoretical positions of moral injury, including loss of trust in others (Factor 1), loss of trust in oneself (Factor 2), and loss of trust in authority (Factor 3). Our findings support the assumption that moral injury is not a unitary concept but instead comprises different facets that people may identify with to a greater or lesser extent, depending on their role. Our results suggest differences between police vs. hospital ward workers and length of time in the profession. Future research into tailored relational and systemic interventions may be required to address the variety of experiences of moral injury in emergency responders.
道德伤害描述了目睹或参与违背个人价值观的事件所产生的影响。最初是在冲突和战争背景下被描述的，最近的研究表明，道德伤害对于在紧急情况下工作的专业人员来说是一个相关概念。应急人员在人类苦难的环境中工作，并在时间紧迫、风险高的情况下做出复杂的决策，但目前对应急人员关于道德伤害的观点以及他们与不同观点的契合程度了解不足。我们试图调查道德伤害是如何被概念化的，以及英国的应急人员如何看待道德伤害经历。在这项Q方法（混合方法）研究中，七位专家共同创建了一组45条意见陈述（Q集），涵盖了应急响应背景下道德伤害的不同方面。随后，21名应急人员（警察、消防、急诊医学、救护车和社区急救人员）完成了一项在线Q分类任务，根据他们对陈述的认同程度对陈述进行分类。个体因素分析得出了一个三因素解决方案，对应于道德伤害的理论立场，包括对他人信任的丧失（因素1）、对自己信任的丧失（因素2）和对权威信任的丧失（因素3）。我们的研究结果支持这样一种假设，即道德伤害不是一个单一的概念，而是由不同的方面组成，人们可能会根据自己的角色在不同程度上认同这些方面。我们的结果表明警察与医院病房工作人员之间存在差异，以及在该职业中的工作时间长短也有影响。未来可能需要针对量身定制的关系性和系统性干预措施进行研究，以应对应急人员道德伤害的各种经历。
