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

精神伤害：了解英国救护车服务的原因、过程和后果

• 批准号: 2887319
• 金额: --
• 依托单位: University of Liverpool
• 依托单位国家: 英国
• 项目类别: Studentship
• 财政年份: 2023
• 资助国家: 英国
• 起止时间: 2023 至 无数据
• 项目状态: 未结题
• 来源: https://gtr.ukri.org/projects?ref=studentship-2887319
• 关键词: Moral; Injury; Understanding; causes; processes

Moral Injury (MI) is a form of psychological distress that usually presents after being involved in or witnessing events that contradict a person's moral or ethical values. This can lead to experiences such as emotional numbing, avoidance, and demoralisation. While much of the previous research has been undertaken within a military context, and more recently within hospital environments, Ambulance Service employees are at high risk of MI due to the nature of their work. Ambulance staff make ethical decisions in high-intensity situations as part of their role, making them vulnerable to psychological distress. Through a partnership with the North West Ambulance Service (NWAS), this research will develop the existing theoretical framework of MI. A combination of semi-structured interviews and daily diaries will be used to gather qualitative data to identify how MI manifests both psychologically and behaviourally over time and what influences the experiences of MI.The Critical Decision Method will be used to design the interviews. This methodology allows for insight as to the goals and decision methods which are used in high-intensity work environments and has previously been used to research the Emergency Services. Data will be analysed using template and thematic analysis, allowing for identification and organisation of common themes within the data.A 4-week daily diary study will be conducted after the interviews. This study will focus on participants who present with the highest level of exposure to potentially morally injurious events. Participants will be asked to complete the diary after each shift, where they will answer questions in relation to MI connected to their work experiences that day. Data will be analysed using thematic trajectory analysis (TTA), which is an extended form of template analysis. This methodology is optimal for diary data which often consists of fluid and variable qualitative data. Following on from this study, a second stage of interviews will be conducted to further understand the results of the diaries. As such, the direction of these interviews will be informed by the content of their diary and will also be analysed using TTA. The results will provide insight as to what events are likely to lead to MI and which personnel are at high risk. The combination of methods will provide data on both retrospective reflections on past events, and the psychological processes involved in real time reactions to recent events. The diary data will be able to inform on how personnel cope with experiencing a morally distressing event over time, and whether these coping strategies or psychological processes lead to beneficial or harmful outcomes.Such data should lead to the development of a theoretical framework of MI within ambulance service personnel, using the rich and meaningful data on the acquirement and progression of MI. Further, this project will provide practical recommendations for at-risk organisations which can be included in training or support initiatives. This may include structured debriefs to promote emotional reassurance and validation after distressing events, and prevent the progression of MI.

道德伤害（MI）是一种心理困扰的一种形式，通常在参与或目睹与一个人的道德或道德价值观相矛盾的事件后出现。这可能会导致情绪麻木，回避和沮丧。尽管以前的大部分研究都是在军事背景下进行的，最近在医院环境中，由于其工作性质，救护车服务员工面临MI的高风险。救护人员在高强度情况下做出道德决定，作为其角色的一部分，使他们容易受到心理困扰。通过与西北救护车服务（NWAS）的合作，这项研究将开发现有的MI理论框架。半结构化访谈和每日日记的结合将用于收集定性数据，以确定MI随着时间的流逝如何在心理和行为上表现出来，以及如何影响MI的经验。关键决策方法将用于设计访谈。这种方法可以洞悉在高强度工作环境中使用的目标和决策方法，并以前已用于研究紧急服务。将使用模板和主题分析对数据进行分析，从而允许数据中的常见主题识别和组织。访谈后将进行4周的每日日记研究。这项研究将集中于最高暴露于潜在道德上有害事件的参与者。每次班次后，将要求参与者完成日记，他们将回答与当天与他们的工作经历相关的MI的问题。将使用主题轨迹分析（TTA）分析数据，这是模板分析的扩展形式。该方法对于日记数据是最佳的，该数据通常由流体和可变的定性数据组成。从这项研究开始，将进行第二阶段的访谈，以进一步了解日记的结果。因此，这些访谈的方向将通过日记的内容告知，也将使用TTA分析。结果将对哪些事件可能导致MI以及哪些人员高风险提供见解。方法的组合将提供有关过去事件的回顾性思考的数据，以及对最近事件的实时反应中涉及的心理过程。日记数据将能够告知人员应对随着时间的推移经历道德上令人痛苦的事件的应对，以及这些应对策略或心理过程是否会导致有益或有害的结果。这些数据应使用救护车人员在MI的收购和MI的收购和进步的富裕数据和有意义的数据中发展MI在救护人员中的理论框架的发展。此外，该项目将为高危组织提供实用建议，这些建议可以包括在培训或支持计划中。这可能包括结构化的汇报，以促进令人痛苦的事件后的情绪放心和验证，并防止MI的发展。