'It hurts your heart': frontline healthcare worker experiences of moral injury during the COVID-19 pandemic.
'It hurts your heart': frontline healthcare worker experiences of moral injury during the COVID-19 pandemic.
复制标题
DOI：
10.1080/20008066.2022.2128028
复制
发表时间：
2022
影响因子：
5
通讯作者：
Wessely, Simon
中科院分区：
文献类型：
--
作者：
Hegarty, Siobhan;Lamb, Danni;Stevelink, Sharon A. M.;Bhundia, Rupa;Raine, Rosalind;Doherty, Mary Jane;Scott, Hannah R.;Marie, Anne;Williamson, Victoria;Dorrington, Sarah;Hotopf, Matthew;Razavi, Reza;Greenberg, Neil;Wessely, Simon
关键词：
背景：道德伤害被定义为与某人的道德准则、价值观或期望相冲突的事件后的强烈情感和认知反应。在2019冠状病毒病大流行期间，暴露于潜在道德伤害事件（pmii）的风险增加，使卫生保健工作者面临道德伤害的风险。然而，人们对累积的PMIE暴露的生活经历以及NHS工作人员对此的反应知之甚少。目的：我们试图通过定性地探索应对COVID-19的临床一线NHS工作人员的生活经历和观点来纠正这一知识差距。方法：我们从NHS CHECK研究队列中招募了30名临床一线医护人员，进行单时间点定性访谈。所有的参与者都认可了9项道德伤害事件量表（MIES）中的至少一个项目[Nash et al., 2013]。道德伤害事件量表的心理测量评价。军事医学，178(6),646-652]。访谈遵循半结构化指南，并使用反身性主题分析进行分析。结果：卫生保健工作者经常暴露于道德冲突中，这些冲突是由先前存在的系统问题（包括人员配备和资源不足）加剧造成的。我们发现医护人员经历了一系列的心理健康症状，这些症状主要与机构背叛的感觉以及无法履行对患者的照顾义务有关。结论：这些结果表明，一个多方面的组织策略是必要的，以准备PMIE暴露，促进解决与道德伤害相关的症状的机会，并防止组织脱离。在2019冠状病毒病大流行期间，临床一线医护人员（HCWs）暴露在一系列潜在的道德伤害事件（pmii）中，包括感觉被政府和NHS领导人背叛，以及感觉无法向患者提供护理义务。卫生保健工作者描述了这种接触对其精神健康的严重不利影响，包括焦虑和抑郁症状增加以及睡眠障碍。大多数受访的卫生保健工作者认为，为了防止过度的PMIE暴露和促进道德困境的解决，NHS内部的组织变革是必要的。
Background: Moral injury is defined as the strong emotional and cognitive reactions following events which clash with someone’s moral code, values or expectations. During the COVID-19 pandemic, increased exposure to Potentially Morally Injurious Events (PMIEs) has placed healthcare workers (HCWs) at risk of moral injury. Yet little is known about the lived experience of cumulative PMIE exposure and how NHS staff respond to this. Objective: We sought to rectify this knowledge gap by qualitatively exploring the lived experiences and perspectives of clinical frontline NHS staff who responded to COVID-19. Methods: We recruited a diverse sample of 30 clinical frontline HCWs from the NHS CHECK study cohort, for single time point qualitative interviews. All participants endorsed at least one item on the 9-item Moral Injury Events Scale (MIES) [Nash et al., 2013. Psychometric evaluation of the moral injury events scale. Military Medicine, 178(6), 646–652] at six month follow up. Interviews followed a semi-structured guide and were analysed using reflexive thematic analysis. Results: HCWs described being routinely exposed to ethical conflicts, created by exacerbations of pre-existing systemic issues including inadequate staffing and resourcing. We found that HCWs experienced a range of mental health symptoms primarily related to perceptions of institutional betrayal as well as feeling unable to fulfil their duty of care towards patients. Conclusion: These results suggest that a multi-facetted organisational strategy is warranted to prepare for PMIE exposure, promote opportunities for resolution of symptoms associated with moral injury and prevent organisational disengagement. HIGHLIGHTS Clinical frontline healthcare workers (HCWs) have been exposed to an accumulation of potentially morally injurious events (PMIEs) throughout the COVID-19 pandemic, including feeling betrayed by both government and NHS leaders as well as feeling unable to provide duty of care to patients. HCWs described the significant adverse impact of this exposure on their mental health, including increased anxiety and depression symptoms and sleep disturbance. Most HCWs interviewed believed that organisational change within the NHS was necessary to prevent excess PMIE exposure and promote resolution of moral distress.
登录
查看更多内容
影响因子：
168.9
作者：
Aiken, Linda H.;Sloane, Douglas M.;Bruyneel, Luk;Van den Heede, Koen;Griffiths, Peter;Busse, Reinhard;Diomidous, Marianna;Kinnunen, Juha;Kozka, Maria;Lesaffre, Emmanuel;McHugh, Matthew D.;Moreno-Casbas, M. T.;Rafferty, Anne Marie;Schwendimann, Rene;Scott, P. Anne;Tishelman, Carol;van Achterberg, Theo;Sermeus, Walter
通讯作者：
Sermeus, Walter
焦虑，抑郁，与创伤有关的医疗保健工作者中，在COVID-19大流行期间：系统评价和荟萃分析。
影响因子：
8.2
作者：
Marvaldi, Maxime;Mallet, Jasmina;Dubertret, Caroline;Moro, Marie Rose;Guessoum, Selim Benjamin
通讯作者：
Guessoum, Selim Benjamin
影响因子：
2.9
作者：
Lamb D;Greenberg N;Hotopf M;Raine R;Razavi R;Bhundia R;Scott H;Carr E;Gafoor R;Bakolis I;Hegarty S;Souliou E;Rafferty AM;Rhead R;Weston D;Gnangapragasam S;Marlow S;Wessely S;Stevelink S
通讯作者：
Stevelink S
影响因子：
12.8
作者：
Litz, Brett T.;Stein, Nathan;Maguen, Shira
通讯作者：
Maguen, Shira
影响因子：
0.9
作者：
MacLeish, Kenneth
通讯作者：
MacLeish, Kenneth