Moral Injury: Understanding the causes, processes, and consequences in the UK Ambulance Service

道德伤害（MI）是由于“犯下、未能阻止、目睹或了解违反根深蒂固的道德信仰和期望的行为”而产生的心理困扰。MIs与压力性职业事件有关，包括弱势群体的生命损失，以及事件发生后缺乏社会支持。虽然与创伤后应激障碍有关，但MI与创伤后应激障碍不同，创伤后应激障碍是被他人伤害的人所经历的一种临床症状，而MI是参与与羞耻有关的道德和创伤性违法行为的心理反应。MIs几乎只在美国军队样本中进行过研究，它们与创伤后应激障碍、抑郁症和自杀倾向有关。通过与西北救护车服务（NWAS）的合作，博士候选人将开发一个MI的理论框架。学生将以Litz1开发的军事MI的概念框架为基础。尽管该框架概述了心肌梗死的潜在原因和后果，但由于在军事领域进行的有限且主要是定量的研究，它并没有解释心肌梗死的心理过程及其随时间的表现。我们在框架中添加了颜色代码，以帮助构建对人工智能的理解。学生将使用该框架作为开展研究的初步指南，同时通过利用丰富的定性数据，寻求适应和扩展这些概念思想，以产生一个超越军事领域的更强大的人工智能理论框架。

Moral injury (MI) is psychological distress that arises from "perpetrating, failing to prevent, bearing witness to, or learning about acts that transgress deeply held moral beliefs and expectations"1. MIs have been associated with stressful occupational events including loss of life to vulnerable people, and a lack of social support following exposure to an event2. MI is distinct from, albeit related to, PTSD, where PTSD is a clinical condition experienced by those who have been harmed by others, whereas MI is the psychological reaction to being involved in the perpetration of moral and traumatic transgressions linked to shame1. MIs have almost exclusively been studied in US military samples, where they have been linked to PTSD, depression, and suicidality3.Through partnership with North West Ambulance Service (NWAS), the PhD candidate will develop a theoretical framework of MI. The student will build on the conceptual framework of military MI developed by Litz1. Although this framework outlines potential causes and consequences of MI, it does not explain the psychological process of MI and how it manifests over time due to the limited, and largely quantitative, research conducted within the military domain. We have added colour codes to the framework to help structure understanding of MI. The student will use this framework as an initial guide to develop their research, whilst seeking to adapt and extend these conceptual ideas by drawing on rich qualitative data to produce a more robust theoretical framework of MI, beyond the military domain.