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

精神伤害（Moral Injury，MI）是一种心理痛苦，通常在参与或目睹与一个人的道德或伦理价值观相矛盾的事件后出现。这可能会导致情感麻木、逃避和士气低落等经历。虽然以前的大部分研究都是在军事环境中进行的，最近在医院环境中进行的，但救护车服务人员由于其工作性质而面临MI的高风险。救护车工作人员在高强度的情况下做出道德决定，这是他们角色的一部分，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，这项研究将发展现有的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如何随着时间的推移在心理和行为上表现出来，以及影响MI体验的因素。这种方法允许洞察的目标和决策方法，在高强度的工作环境中使用，以前被用来研究紧急服务。将使用模板和主题分析对数据进行分析，以便识别和组织数据中的共同主题。访谈后将进行为期4周的每日日记研究。这项研究将重点关注那些暴露于潜在道德伤害事件的最高水平的参与者。参与者将被要求在每次轮班后完成日记，在那里他们将回答与当天工作经历相关的MI相关的问题。将使用专题轨迹分析对数据进行分析，这是模板分析的一种扩展形式。这种方法是最佳的日记数据，往往包括流体和可变的定性数据。在这项研究之后，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他们的日记内容来确定，并将使用TTA进行分析。结果将提供关于哪些事件可能导致MI以及哪些人员处于高风险的见解。方法的结合将提供有关对过去事件的回顾性反思以及对最近事件的真实的时间反应所涉及的心理过程的数据。日记数据将能够告知人员如何科普经历一个道德上的痛苦事件随着时间的推移，以及这些应对策略或心理过程是否会导致有益或有害的outcome.Such数据应导致MI的理论框架内救护车服务人员的发展，使用丰富和有意义的数据MI的收购和进展。此外，该项目还将为处于风险中的组织提供实用建议，这些建议可纳入培训或支持举措。这可能包括结构化的汇报，以促进痛苦事件后的情绪安慰和确认，并防止MI的进展。

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.