Moral Distress and Moral Injury in Military Healthcare Clinicians: A Scoping Review

Wilson, Melissa A.; Shay, Amy; Harris, J. Irene; Faller, Nicole; Usset, Timothy J.; Simmons, Angela

doi:10.1016/j.focus.2023.100173

Cited by 4 publications

(2 citation statements)

References 104 publications

(271 reference statements)

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“…Future research should explore other potential factors and mechanisms that contribute to moral distress, aiming to develop targeted interventions to support nurses in these high-risk environments. These results are in line with the ndings of a recent systematic review in which moral distress in military critical care nurses related to inconsistency between their personal and professional beliefs led to a loss of moral integrity in everyday settings [12,33]. Klimentidou et al noted that the compassion satisfaction of military nurses differs based on their professional rank, which is lower for head nurses than for nurse managers [34].…”

Section: Discussionsupporting

confidence: 84%

“…A review of the literature revealed few studies highlighting the distressing psychological effects of wars and armed con icts on the mental health of nurses [10,11]. Moral distress in military healthcare personnel, compared to civilians, as outlined in a systematic literature review, manifests through immediate physiological, psychological, social, or spiritual symptoms [12]. These symptoms include a heightened heart rate, elevated respiration, increased anxiety, deep disturbances, uncontrolled emotional reactions, and distancing oneself from colleagues and patients.…”

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confidence: 99%

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War-related continuous traumatic stress as a potential mediator of associations between moral distress and professional quality of life in nurses: a cross-sectional study in Ukraine

Zasiekina,

Martyniuk

2024

Preprint

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Background. At the beginning of 2022, Central Europe entered a state of emergency due to the Russian invasion of Ukraine. Nurses were particularly vulnerable to a decline in their professional quality of life, facing repeated exposure to military trauma, ethical dilemmas, prolonged working hours, and increased stress and fatigue. This study aimed to contribute to our understanding of the potential mediating effect of war-related continuous traumatic stress on the association between moral distress and professional quality of life, including compassion satisfaction, compassion fatigue, represented by burnout and secondary traumatic stress. Methods. This study used the Professional of Life Scale (ProQOL) to assess compassion fatigue, including burnout, secondary traumatic stress, and compassion satisfaction; the Moral Distress Questionnaire for Nurses to examine everyday moral distress in healthcare facilities and everyday ethical dilemmas of nurses; and the Continuous Traumatic Stress Response Scale (CTSR) to assess ongoing threats, resulting in exhaustion/detachment, rage/betrayal, and fear/helplessness. The sample consisted of 130 female nurses (mean age 40.20 ± 12.15 years) from surgical departments who had been undergoing advanced training to work with injured military personnel at the Volyn Medical Institute (Ukraine) from March to May 2023. All nurses had experienced direct and indirect exposure to military trauma, and 105 participants were working with injured military personnel. Results. Nurse moral distress did not differ according to demographic variables, particularly marital status, degree of nursing, or combatant care. Moral distress and age, moral distress and job experience were not found to be correlated. The results of the mediation analysis indicated that war-related continuous traumatic stress fully mediated the relationship between moral distress and different components of professional quality of life, namely, compassion fatigue, including burnout and secondary traumatic stress, and compassion satisfaction. Conclusion. Research has shown that continuous traumatic stress has a significant effect on the relationship between moral distress and various aspects of professional quality of life, underscoring the need for targeted interventions for nurses facing war-related trauma.

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Section: Discussionsupporting

confidence: 84%

mentioning

confidence: 99%

War-related continuous traumatic stress as a potential mediator of associations between moral distress and professional quality of life in nurses: a cross-sectional study in Ukraine

Zasiekina,

Martyniuk

2024

Preprint

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Moral distress as a persistent risk factor for impaired mental health among healthcare workforce

Fattori,

Comotti,

Brambilla

et al. 2024

Journal of Affective Disorders Reports

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Military Nurses’ Deployment Experiences: A Qualitative Metasynthesis

Christiansen,

Tice,

Kessinger

et al. 2024

Military Medicine

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Introduction Military medical personnel, including nurses, face a wide array of emotional and psychological issues while deployed. Understanding the challenges military nurses face in the deployed setting may prove useful in effectively preparing nurse leaders for future disaster responses in the military and civilian sectors. The purpose of this metasynthesis is to answer the following research question: What are the experiences of U.S. military and allied nurses deployed to medical facilities in combat operations and support areas since 9/11/2001? Methods A qualitative metasynthesis was conducted to determine commonality of combat-related deployment experiences for U.S. military and allied nurses. After development of the research question, this metasynthesis included 4 steps: (1) perform structured literature search, (2) critical appraisal, (3) reciprocal translation, and (4) synthesize findings. Studies were limited to the years 2004-2023 to focus the search on Operation Enduring Freedom and Operation Iraqi Freedom-related deployments. Reference review of studies retrieved through database search also contributed to the final sample. Screening criteria included: (1) qualitative or mixed methods studies, (2) sample comprised of U.S. or allied country medical/nursing personnel, and (3) care primarily occurring in a fixed facility located in Iraq, Afghanistan, or Kuwait. Studies focusing on reintegration after deployment or air evacuation personnel/nonfixed facility settings were excluded. A total of 11 studies met inclusion criteria. Critical appraisal was conducted on all studies. Data analysis utilized an inductive and iterative process. Reciprocal translation and meta-ethnographic techniques were used to identify words/phases that contained significant meaning and to identify themes/subthemes. Themes formed that described commonalities across nurses’ experiences. Results Three primary themes arise from critical examination of military nurses’ deployment experiences: (1) “care in a combat zone,” (2) “leadership in a combat zone,” and (3) “personhood.” The subthemes address experiences or concerns related to an individual participant’s role as a “care giver,” “leader,” or “person.” The 3 themes formed by this qualitative metasynthesis represent a holistic view of a military nurse in a deployed setting. Conclusions Military nurses’ deployment experiences relate to their multiple role(s) as a clinician, officer, and human being. By better understanding military nurses’ past deployment experiences and related themes, nurse leaders and individuals can better prepare for supporting staff in future combat operations. The complexities of “caring,” “leading,” and “personhood” may contribute to emotional distress among deployed military medical personnel.

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Moral Distress and Moral Injury in Military Healthcare Clinicians: A Scoping Review

Cited by 4 publications

References 104 publications

War-related continuous traumatic stress as a potential mediator of associations between moral distress and professional quality of life in nurses: a cross-sectional study in Ukraine

War-related continuous traumatic stress as a potential mediator of associations between moral distress and professional quality of life in nurses: a cross-sectional study in Ukraine

Moral distress as a persistent risk factor for impaired mental health among healthcare workforce

Military Nurses’ Deployment Experiences: A Qualitative Metasynthesis

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