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A Critical Review: Moral Injury in Nurses in the Aftermath of a Patient Safety Incident.
J Nurs Scholarsh. 2020 May; 52(3):320-328.JN

Abstract

BACKGROUND

To date, there has been no published work towards understanding or classifying patient safety incidents (PSIs) or their aftermath as potential morally injurious experiences (pMIEs). A morally injurious experience is one that violates deeply held moral values and beliefs, and can put an individual at risk for burnout, post-traumatic stress disorder, and other trauma-related problems. This can also set the stage for moral injury, which can occur when there has been a betrayal of what is right by someone in a position of legitimate authority, or by one's self, in a high-stakes situation.

OBJECTIVE

The objective of this review of nurse second victim literature is to describe symptoms of moral injury empirically observed in nurses in the aftermath of a PSI.

METHODS

A critical review using a SALSA (search, appraisal, synthesis, analysis) method commenced with a search of electronic data base-indexed original evidence between 1980 and December 2018, focusing on registered nurses involved with a PSI.

RESULTS

The nurse empirical literature reviewed included qualitative (n = 10), quantitative (n = 7), and mixed-methods (n = 4) studies (total n = 21). Core moral injury symptoms included guilt (67%), shame (71%), spiritual-existential crisis (9%), and loss of trust (52%). Secondary symptoms of moral injury included depression (33%), anxiety (57%), anger (71%), self-harm, (19%), and social problems (48%).

IMPLICATIONS

Moral injury better describes what historically has been called the nurse second victim phenomenon. Through identification of pMIEs and symptoms of moral injury, nurses and organizations can be empowered to advance training and intervention programs addressing pMIEs that affect nurses' safety and retention in the aftermath of a PSI.

CLINICAL RELEVANCE

By describing the experiences associated with a PSI as potentially morally injurious, we set the stage to describe the potential consequences associated with the aftermath of the PSI. Furthermore, this language avoids victimizing those involved by more accurately reflecting the pMIEs of the aftermath.

Authors+Show Affiliations

Delta Alpha at Large, PhD Student, Oregon Health & Science University, School of Nursing, Portland, OR, USA.Beta Psi, Professor, Oregon Health & Science University, School of Nursing, Portland, OR, USA.Professor, Oregon Health & Science University, School of Nursing, Portland, OR, USA.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

32222036

Citation

Stovall, Mady, et al. "A Critical Review: Moral Injury in Nurses in the Aftermath of a Patient Safety Incident." Journal of Nursing Scholarship : an Official Publication of Sigma Theta Tau International Honor Society of Nursing, vol. 52, no. 3, 2020, pp. 320-328.
Stovall M, Hansen L, van Ryn M. A Critical Review: Moral Injury in Nurses in the Aftermath of a Patient Safety Incident. J Nurs Scholarsh. 2020;52(3):320-328.
Stovall, M., Hansen, L., & van Ryn, M. (2020). A Critical Review: Moral Injury in Nurses in the Aftermath of a Patient Safety Incident. Journal of Nursing Scholarship : an Official Publication of Sigma Theta Tau International Honor Society of Nursing, 52(3), 320-328. https://doi.org/10.1111/jnu.12551
Stovall M, Hansen L, van Ryn M. A Critical Review: Moral Injury in Nurses in the Aftermath of a Patient Safety Incident. J Nurs Scholarsh. 2020;52(3):320-328. PubMed PMID: 32222036.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - A Critical Review: Moral Injury in Nurses in the Aftermath of a Patient Safety Incident. AU - Stovall,Mady, AU - Hansen,Lissi, AU - van Ryn,Michelle, Y1 - 2020/03/28/ PY - 2020/02/28/accepted PY - 2020/3/30/pubmed PY - 2020/3/30/medline PY - 2020/3/30/entrez KW - Betrayal trauma KW - moral injury KW - patient safety KW - second victim SP - 320 EP - 328 JF - Journal of nursing scholarship : an official publication of Sigma Theta Tau International Honor Society of Nursing JO - J Nurs Scholarsh VL - 52 IS - 3 N2 - BACKGROUND: To date, there has been no published work towards understanding or classifying patient safety incidents (PSIs) or their aftermath as potential morally injurious experiences (pMIEs). A morally injurious experience is one that violates deeply held moral values and beliefs, and can put an individual at risk for burnout, post-traumatic stress disorder, and other trauma-related problems. This can also set the stage for moral injury, which can occur when there has been a betrayal of what is right by someone in a position of legitimate authority, or by one's self, in a high-stakes situation. OBJECTIVE: The objective of this review of nurse second victim literature is to describe symptoms of moral injury empirically observed in nurses in the aftermath of a PSI. METHODS: A critical review using a SALSA (search, appraisal, synthesis, analysis) method commenced with a search of electronic data base-indexed original evidence between 1980 and December 2018, focusing on registered nurses involved with a PSI. RESULTS: The nurse empirical literature reviewed included qualitative (n = 10), quantitative (n = 7), and mixed-methods (n = 4) studies (total n = 21). Core moral injury symptoms included guilt (67%), shame (71%), spiritual-existential crisis (9%), and loss of trust (52%). Secondary symptoms of moral injury included depression (33%), anxiety (57%), anger (71%), self-harm, (19%), and social problems (48%). IMPLICATIONS: Moral injury better describes what historically has been called the nurse second victim phenomenon. Through identification of pMIEs and symptoms of moral injury, nurses and organizations can be empowered to advance training and intervention programs addressing pMIEs that affect nurses' safety and retention in the aftermath of a PSI. CLINICAL RELEVANCE: By describing the experiences associated with a PSI as potentially morally injurious, we set the stage to describe the potential consequences associated with the aftermath of the PSI. Furthermore, this language avoids victimizing those involved by more accurately reflecting the pMIEs of the aftermath. SN - 1547-5069 UR - https://www.unboundmedicine.com/medline/citation/32222036/A_Critical_Review:_Moral_Injury_in_Nurses_in_the_Aftermath_of_a_Patient_Safety_Incident_ L2 - https://doi.org/10.1111/jnu.12551 DB - PRIME DP - Unbound Medicine ER -
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