Citation

Roycroft M, Wilkes D, Fleming S, Pattani S, Olsson-Brown A. BMJ 2020; 369: m1702.

Affiliation

Trainee Doctors' Group, Academy of Medical Royal Colleges, London EC1V 0DB, UK.

Comment On:

BMJ 2020;368:m1211.

Copyright

(Copyright © 2020, BMJ Publishing Group)

DOI

10.1136/bmj.m1702

PMID

32366504

Abstract

Greenberg and colleagues rightly state that the development of psychological injury is “influenced by the way [staff] are supported before, during, and after a challenging incident.”1 But identifying, supporting, and treating people after they have developed moral injuries can be very difficult, so we need a greater focus on preventive measures. Healthcare organisations, with their duty to protect the mental health of employees,2 should adopt three key strategies urgently: enhanced decision making support; the provision of time and space for clinicians to decompress; and staff working consistently in the same team.

Complex decisions are more likely to lead to moral injury. Although evidence is limited, we think that sharing (moral) responsibility with other clinicians will help to reduce the intensity of dilemmas and reduce the emotional arousal. This would fit with the well established social psychological principles of diffusion of responsibility and moral disengagement. Local clinical ethics committees or similar might also have a role if a further opinion is needed.

Time to process events and to decompress is key to limiting moral distress (a precursor to moral injury). Early evidence indicates that healthcare professionals need time and space to rest and to be able to talk about their experiences if they want to ...

Language: en