Journal articles: 'Potentially Morally Injurious Events'

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Hansen, Kevin T., Charles G. Nelson, and Kenneth Kirkwood. "Prevalence of Potentially Morally Injurious Events in Operationally Deployed Canadian Armed Forces Members." Journal of Traumatic Stress 34, no. 4 (June 19, 2021): 764–72. http://dx.doi.org/10.1002/jts.22710.

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Usset, Timothy J., Erika Gray, Brandon J. Griffin, Joseph M. Currier, Marek S. Kopacz, John H. Wilhelm, and J. Irene Harris. "Psychospiritual Developmental Risk Factors for Moral Injury." Religions 11, no. 10 (September 24, 2020): 484. http://dx.doi.org/10.3390/rel11100484.

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There is increasing theoretical, clinical, and empirical support for the hypothesis that psychospiritual development, and more specifically, postconventional religious reasoning, may be related to moral injury. In this study, we assessed the contributions of exposure to potentially morally injurious events, posttraumatic stress symptoms, and psychospiritual development to moral injury symptoms in a sample of military veterans (N = 212). Psychospiritual development was measured as four dimensions, based on Wulff’s theory juxtaposing conventional vs. postconventional levels of religious reasoning, with decisions to be an adherent or a disaffiliate of faith. After controlling for exposure to potentially morally injurious events and severity of posttraumatic stress symptoms, veterans who were conventional disaffiliates reported higher scores on the Moral Injury Questionnaire than conventional adherents, postconventional adherents, or postconventional disaffiliates. We conclude that the role of psychospiritual development offers a theoretical approach to moral injury that invites collaboration between social scientists, philosophers, theologians, and medical professionals.

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Jones, Edgar. "Moral injury in a context of trauma." British Journal of Psychiatry 216, no. 3 (February 28, 2020): 127–28. http://dx.doi.org/10.1192/bjp.2020.46.

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SummaryMoral injury, characterised by guilt, shame and self-condemnation, is conceptualised either as an adjunct to post-traumatic stress disorder or as a new syndrome. Studies of symptoms and potentially morally injurious events have produced a possible definition and informed the design of rating scales. The current challenge remains the design of effective interventions. Because moral injury relates to ethical behaviour, the meaning attached to events and perceptions of the self, moral philosophy and spirituality could contribute to the design of treatments.

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Maftei, Alexandra, and Andrei-Corneliu Holman. "The prevalence of exposure to potentially morally injurious events among physicians during the COVID-19 pandemic." European Journal of Psychotraumatology 12, no. 1 (January 1, 2021): 1898791. http://dx.doi.org/10.1080/20008198.2021.1898791.

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Zerach, Gadi, Yossi Levi-Belz, Brandon J. Griffin, and Shira Maguen. "Patterns of exposure to potentially morally injurious events among Israeli combat veterans: A latent class analysis approach." Journal of Anxiety Disorders 79 (April 2021): 102378. http://dx.doi.org/10.1016/j.janxdis.2021.102378.

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Maguen, Shira, Brandon J. Griffin, Laurel A. Copeland, Daniel F. Perkins, Erin P. Finley, and Dawne Vogt. "Gender differences in prevalence and outcomes of exposure to potentially morally injurious events among post-9/11 veterans." Journal of Psychiatric Research 130 (November 2020): 97–103. http://dx.doi.org/10.1016/j.jpsychires.2020.06.020.

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Zerach, Gadi, and Yossi Levi‐Belz. "Intolerance of Uncertainty Moderates the Association Between Potentially Morally Injurious Events and Suicide Ideation and Behavior Among Combat Veterans." Journal of Traumatic Stress 32, no. 3 (February 5, 2019): 424–36. http://dx.doi.org/10.1002/jts.22366.

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Borges, Lauren M., Ryan Holliday, Sean M. Barnes, Nazanin H. Bahraini, Adam Kinney, Jeri E. Forster, and Lisa A. Brenner. "A longitudinal analysis of the role of potentially morally injurious events on COVID-19-related psychosocial functioning among healthcare providers." PLOS ONE 16, no. 11 (November 12, 2021): e0260033. http://dx.doi.org/10.1371/journal.pone.0260033.

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Medical leaders have warned of the potential public health burden of a “parallel pandemic” faced by healthcare workers during the COVID-19 pandemic. These individuals may have experienced scenarios in which their moral code was violated resulting in potentially morally injurious events (PMIEs). In the present study, hierarchical linear modeling was utilized to examine the role of PMIEs on COVID-19 pandemic-related difficulties in psychosocial functioning among 211 healthcare providers (83% female, 89% White, and an average of 11.30 years in their healthcare profession [9.31]) over a 10-month span (May 2020 –March 2021). Reported exposure to PMIEs was associated with statistically significant poorer self-reported psychosocial functioning at baseline and over the course of 10-months of data collection. Within exploratory examinations of PMIE type, perceptions of transgressions by self or others (e.g., “I acted in ways that violated my own moral code or values”), but not perceived betrayal (e.g., “I feel betrayed by leaders who I once trusted”), was associated with poorer COVID-19 related psychosocial functioning (e.g., feeling connected to others, relationship with spouse or partner). Findings from this study speak to the importance of investing in intervention and prevention efforts to mitigate the consequences of exposure to PMIEs among healthcare providers. Interventions for healthcare providers targeting psychosocial functioning in the context of moral injury is an important area for future research.

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Smith-MacDonald, Lorraine, Ashley Pike, Chelsea Jones, and Suzette Bremault-Phillips. "Exploration of Trauma-Oriented Retreats: Quantitative Changes in Mental Health Measures for Canadian Military Members, Veterans and Royal Canadian Mounted Police with Posttraumatic Stress Disorder and Moral Injury." Trauma Care 2, no. 2 (March 24, 2022): 114–30. http://dx.doi.org/10.3390/traumacare2020010.

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Background: Military members, veterans, and public safety personnel have been noted to have a higher risk of exposure to potentially traumatic events and potentially morally injurious events resulting in operational stress injuries (OSI) such as posttraumatic stress disorder (PTSD) and moral injury (MI). Treatments that can quickly and effectively address these conditions are desperately needed. The purpose of this research was to identify the impact of participation in a non-evidence-based trauma-oriented retreat for the above populations experiencing PTSD and MI. Methods: This study was an embedded mixed-methods longitudinal study with parallel repeated quantitative measures designed to evaluate outcomes at 1, 3, 6, and 12 months after completion of the retreat. Results: Analysis showed a statistically significant reduction in self-reported symptoms of PTSD, anxiety, stress, depression, MI, anger, and emotional dysregulation pre/post-retreat, and an increase in resilience. Self-reported longitudinal results did not see a change in symptom scores, with participants continuing to maintain their clinical diagnoses post-retreat. Conclusions: The results from this study illustrate that trauma-oriented retreats may be a complementary treatment modality for OSI-related conditions but should not be seen as a first-line treatment option. Program evaluation, determination of the evidence-based nature of retreats, and standardization are yet needed.

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Gherman, Mihaela Alexandra, Laura Arhiri, Andrei Corneliu Holman, and Camelia Soponaru. "Injurious Memories from the COVID-19 Frontline: The Impact of Episodic Memories of Self- and Other-Potentially Morally Injurious Events on Romanian Nurses’ Burnout, Turnover Intentions and Basic Need Satisfaction." International Journal of Environmental Research and Public Health 19, no. 15 (August 4, 2022): 9604. http://dx.doi.org/10.3390/ijerph19159604.

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Nurses have been frequently exposed to Potentially Morally Injurious Events (PMIEs) during the COVID-19 pandemic. Due to resource scarcity, they both perpetrated (self-PMIEs) and passively witnessed (other-PMIEs) moral transgressions toward the patients, severely violating their moral values. Our study investigated the impact of self- and other-PMIEs on work outcomes by exploring nurses’ episodic memories of these events and the basic psychological need thwarting associated with them. Using a quasi-experimental design, on a convenience sample of 463 Romanian nurses, we found that PMIEs memories were uniquely associated with burnout and turnover intentions, after controlling for socio-demographic characteristics, general basic psychological need satisfaction at work and other phenomenological characteristics. Both self- and other-PMIEs memories were need thwarting, with autonomy and competence mediating their differential impact on burnout, and with relatedness—on turnover intentions. Our findings emphasize the need for organizational moral repair practices, which should include enhancing nurses’ feelings of autonomy, relatedness and competence. Psychological counseling and psychotherapy should be provided to nurses to prevent their episodic memories of PMIEs to be (fully) integrated in autobiographical knowledge, because this integration could have severe consequences on their psycho-social function and occupational health, as well as on the organizational climate in healthcare institutions.

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Gherman, Mihaela Alexandra, Laura Arhiri, Andrei Corneliu Holman, and Camelia Soponaru. "Protective Factors against Morally Injurious Memories from the COVID-19 Pandemic on Nurses’ Occupational Wellbeing: A Cross-Sectional Experimental Study." International Journal of Environmental Research and Public Health 19, no. 18 (September 19, 2022): 11817. http://dx.doi.org/10.3390/ijerph191811817.

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The COVID-19 pandemic was a fertile ground for nurses’ exposure to self- and other-Potentially Morally Injurious Events (PMIEs). Our study explored the effects of nurses’ memories of self- and other-PMIEs on occupational wellbeing and turnover intentions. Using an experimental design on a convenience sample of 634 Romanian nurses, we tested a conceptual model with PLS-SEM, finding adequate explanatory and predictive power. Memories of self- and other-PMIEs were uniquely associated with work engagement, burnout, and turnover intentions, compared to a control group. These relationships were mediated by the three basic psychological needs. Relatedness was more thwarted for memories of other-PMIEs, while competence and autonomy were more thwarted for memories of self-PMIEs. Perceived supervisor support weakened the indirect effect between type of PMIE and turnover intentions, through autonomy satisfaction, but not through burnout. Self-disclosure weakened the indirect effect between type of PMIE and turnover intentions, through autonomy satisfaction, and both burnout and work engagement. Our findings emphasize the need for different strategies in addressing the negative long-term effects of nurses’ exposure to self- and other-PMIEs, according to the basic psychological need satisfaction and type of wellbeing indicator.

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Gherman, Mihaela Alexandra, Laura Arhiri, Andrei Corneliu Holman, and Camelia Soponaru. "The Moral Impact of the COVID-19 Pandemic on Nurses’ Burnout, Work Satisfaction and Adaptive Work Performance: The Role of Autobiographical Memories of Potentially Morally Injurious Events and Basic Psychological Needs." International Journal of Environmental Research and Public Health 19, no. 13 (June 22, 2022): 7645. http://dx.doi.org/10.3390/ijerph19137645.

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The COVID-19 pandemic resulted in unprecedented exposure to Potentially Morally Injurious Events (PMIEs) for nurses, in which they were both moral transgressors and moral victims, with deleterious consequences on their psycho-social health and functioning. Our experimental design compared memories of PMIEs with memories of severe moral transgressions (SMTs), in which participants were only moral transgressors. Drawing from Self-Determination Theory and research on moral auto-biographical episodic memories, we assessed a conceptual model describing the impact of recalling a single PMIE or SMT event on nurses’ burnout, work satisfaction and adaptive performance. Our convenience sample comprised 614 Romanian nurses, and data was analyzed with path analysis, general linear modelling, and t-tests. Findings showed that memories of PMIEs, compared to SMTs, were more autonomy thwarting, being associated with more controlled work motivation, less moral learning, higher burnout, less work satisfaction, and adaptive performance. Burnout, moral learning, and work satisfaction were significant mediators of the relationships between PMIE and SMT recall and, respectively, adaptive performance. Our results highlight the urgency for organizational practices of moral repair for nurses after the pandemic, along with interventions meant to increase their autonomy and self-determined work motivation.

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Ricciardelli, Rosemary, Matthew S. Johnston, Brittany Bennett, Andrea M. Stelnicki, and R. Nicholas Carleton. "“It Is Difficult to Always Be an Antagonist”: Ethical, Professional, and Moral Dilemmas as Potentially Psychologically Traumatic Events among Nurses in Canada." International Journal of Environmental Research and Public Health 19, no. 3 (January 27, 2022): 1454. http://dx.doi.org/10.3390/ijerph19031454.

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Aims: We explore social and relational dynamics tied to an unexplored potentially psychologically traumatic event (PPTE) that can impact nurses’ well-being and sense of their occupational responsibilities: namely, the moral, ethical, or professional dilemmas encountered in their occupational work. Design: We used a semi-constructed grounded theory approach to reveal prevalent emergent themes from the qualitative, open-ended component of our survey response data as part of a larger mixed-methods study. Methods: We administered a national Canadian survey on nurses’ experiences of occupational stressors and their health and well-being between May and September 2019. In the current study, we analyzed data from four open text fields in the PPTE section of the survey. Results: In total, at least 109 participants noted that their most impactful PPTE exposure was a moral, professional, and/or ethical dilemma. These participants volunteered the theme as a spontaneous addition to the list of possible PPTE exposures. Conclusions: Emergent theme analytic results suggest that physicians, other nurses, staff, and/or the decision-making power of patients’ families can reduce or eliminate a nurse’s perception of their agency, which directly and negatively impacts their well-being and may cause them to experience moral injury. Nurses also report struggling when left to operationalize patient care instructions with which they disagree. Impact: Nurses are exposed to PPTEs at work, but little is known about factors that can aggravate PPTE exposure in the field, impact the mental wellness of nurses, and even shape patient care. We discuss the implications of PPTE involving moral, professional, and ethical dilemmas (i.e., potentially morally injurious events), and provide recommendations for nursing policy and practice.

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Zerach, G., and Y. Levi-Belz. "Moral Injury, Depression and Anxiety among Israeli Health and Social Care Workers During the COVID-19 Pandemic: The Moderating Role of Thwarted Belongingness." European Psychiatry 65, S1 (June 2022): S533. http://dx.doi.org/10.1192/j.eurpsy.2022.1361.

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Introduction The COVID-19 pandemic can affect the mental health of health and social care workers (HSCWs) who are frontline workers in this continuous crisis. Following exposure to potentially morally injurious events (PMIEs) that undermine deeply held moral beliefs and expectations, HSCWs might experience moral injury (MI) and deleterious psychiatric consequences such as depression and anxiety symptoms. Objectives To examine associations between exposure to PMIEs, MI symptoms, depression, and anxiety symptoms. We also aim to assess the moderating role of thwarted belongingness in these associations. Methods A sample of 243 Israeli HSCWs completed online validated self-report questionnaires in a cross-sectional designed survey in February and March 2021. Results About one-third (33.6%) of the sample met the criteria for major depressive disorder, 21.5% met the criteria for generalized anxiety disorder, and 19.1 % reported comorbidity of depression and anxiety. A moderated-mediation model shows that high thwarted belongingness intensified the relations between exposure to PMIEs and MI symptoms, and between MI symptoms and depression and anxiety symptoms. Importantly, the indirect effect of exposure to PMIEs on both depression and anxiety symptoms via MI symptoms existed only among those with high levels of thwarted belongingness. Conclusions The study’s findings highlight the mental burden of HSCWs during the COVID-19 pandemic and the contribution of MI to possible mental health consequences. Clinicians should be aware of the importance of high thwarted belongingness in depression and anxiety sequelae of exposure to PMIEs among HSCWs. Disclosure No significant relationships.

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Riedel, Priya-Lena, Alexander Kreh, Vanessa Kulcar, Angela Lieber, and Barbara Juen. "A Scoping Review of Moral Stressors, Moral Distress and Moral Injury in Healthcare Workers during COVID-19." International Journal of Environmental Research and Public Health 19, no. 3 (February 1, 2022): 1666. http://dx.doi.org/10.3390/ijerph19031666.

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Ethical dilemmas for healthcare workers (HCWs) during pandemics highlight the centrality of moral stressors and moral distress (MD) as well as potentially morally injurious events (PMIEs) and moral injury (MI). These constructs offer a novel approach to understanding workplace stressors in healthcare settings, especially in the demanding times of COVID-19, but they so far lack clear identification of causes and consequences. A scoping review of moral stressors, moral distress, PMIEs, and MI of healthcare workers during COVID-19 was conducted using the databases Web of Science Core Collection and PsycINFO based on articles published up to October 2021. Studies were selected based on the following inclusion criteria: (1) the measurement of either moral stress, MD, PMIEs, or MI among HCWs; (2) original research using qualitative or quantitative methods; and (3) the availability of the peer-reviewed original article in English or German. The initial search revealed n = 149,394 studies from Web of Science and n = 34 studies from EBSCOhost. Nineteen studies were included in the review. Conditions representing moral stressors and PMIEs as well as MD and MI as their potential outcomes in healthcare contexts during COVID-19 are presented and discussed. Highlighting MD and MI in HCWs during COVID-19 brings attention to the need for conceptualizing the impact of moral stressors of any degree. Therefore, the development of a common, theoretically founded model of MD and MI is desirable.

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Jones, Kimberley A., Isabella Freijah, Lindsay Carey, R. Nicholas Carleton, Peter Devenish-Meares, Lisa Dell, Sara Rodrigues, et al. "Moral Injury, Chaplaincy and Mental Health Provider Approaches to Treatment: A Scoping Review." Journal of Religion and Health 61, no. 2 (March 15, 2022): 1051–94. http://dx.doi.org/10.1007/s10943-022-01534-4.

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AbstractThe aim of this research was to describe the evidence examining the approaches taken by mental health providers (MHPs) and chaplains to address symptoms related to moral injury (MI) or exposure to potentially morally injurious events (PMIEs). This research also considers the implications for a holistic approach to address symptoms related to MI that combines mental health and chaplaincy work. A scoping review of literature was conducted using Medline, PsycINFO, Embase, Central Register of Controlled Trials, Proquest, Philosphers Index, CINAHL, SocINDEX, Academic Search Complete, Web of Science and Scopus databases using search terms related to MI and chaplaincy approaches or psychological approaches to MI. The search identified 35 eligible studies: 26 quantitative studies and nine qualitative studies. Most quantitative studies (n = 33) were conducted in military samples. The studies examined interventions delivered by chaplains (n = 5), MHPs (n = 23) and combined approaches (n = 7). Most studies used symptoms of post-traumatic stress disorder (PTSD) and/or depression as primary outcomes. Various approaches to addressing MI have been reported in the literature, including MHP, chaplaincy and combined approaches, however, there is currently limited evidence to support the effectiveness of any approach. There is a need for high quality empirical studies assessing the effectiveness of interventions designed to address MI-related symptoms. Outcome measures should include the breadth of psychosocial and spiritual impacts of MI if we are to establish the benefits of MHP and chaplaincy approaches and the potential incremental value of combining both approaches into a holistic model of care.

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Levi-Belz, Y., G. Zerach, G. Schwartz, and E. Halperin. "Moral Injury and Suicide Ideation Among Combat Veterans: The Role of Trauma-Related Shame and Collective Hatred." European Psychiatry 65, S1 (June 2022): S844. http://dx.doi.org/10.1192/j.eurpsy.2022.2187.

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Introduction Exposure to potentially morally injurious events (PMIEs) among combat veterans has been acknowledged as a significant stressful combat event that may lead to mental health problems, including suicide ideation (SI). Several studies have examined the risk and protective factors that can explain the conditions in which PMIEs may contribute to the development and maintenance of SI. However, the contribution of social-emotional factors has yet to be examined. Objectives In the current study, we examined the association between PMIE-Self and SI among combat veterans and explored the mediating role of trauma-related shame and the moderation role of collective hatred in this association. Methods A volunteer sample of 336 Israeli combat veterans was recruited, completing self-report questionnaires in a cross-sectional study. Results indicated that PMIE-Self was positively associated with SI, and trauma-related shame mediated this association. Moreover, collective hatred moderated both their direct (PMIE -SI) and indirect (PMIE-Shame-SI) association. Notably, collective hatred had an inverse role for each of the associations. Thus, collective hatred was found to comprise both a risk and a protective factor for SI following PMIE-Self. Conclusions The current findings highlight the crucial contribution of trauma-related shame and collective hatred to the association between moral injury and suicidality. Moreover, the findings demonstrate that even years after their military service release, combat veterans exposed to PMIEs may still feel consumed by painful memories and maintain premonitions of a foreshortened future. Furthermore, the findings help to better understand the dynamics of collective hatred and the challenge of modifying it. Disclosure No significant relationships.

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Rodríguez, Elizabeth A., Maitée Agüero-Flores, Miguel Landa-Blanco, David Agurcia, and Cindy Santos-Midence. "Moral Injury and Light Triad Traits: Anxiety and Depression in Health-Care Personnel During the Coronavirus-2019 Pandemic in Honduras." Hispanic Health Care International 19, no. 4 (October 19, 2021): 230–38. http://dx.doi.org/10.1177/15404153211042371.

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The purpose of the current study was to determine the influence of moral injury and Light Triad (LT) personality traits on anxiety and depression symptoms of health-care personnel during the coronavirus-2019 pandemic. A quantitative, cross-sectional research design was used, the study included a sample of 169 health-care workers from Honduras. Data was gathered through the Moral Injury Symptom Scale for Health Professionals (MISS-HP), Light Triad Scale (LTS), the Generalized Anxiety Disorder-7, and the Patient-Health Questionnaire-9. Results suggest that almost 9 out of 10 respondents experienced at least one potentially morally injurious event, 45.6% were at significant risk of impairment related to moral injury. Working with limited staff and resources, and the implications of it, was the most common potentially morally injurious situation reported by the respondents. Results suggest that MISS-HP Mistrust has significant negative correlations with LT traits. A hierarchical regression model determined that Moral Injury, but not LT traits, significantly affected depression symptoms. On the other hand, anxiety symptoms were significantly predicted by Moral Injury, as did LTS-Humanism. The results were discussed according to their implications for public health policy in Latin America.

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Evans, Wyatt R., Yvette Z. Szabo, Melinda A. Stanley, Terri L. Barrera, Julie J. Exline, Kenneth I. Pargament, and Ellen J. Teng. "Life satisfaction among veterans: Unique associations with morally injurious events and posttraumatic growth." Traumatology 24, no. 4 (December 2018): 263–70. http://dx.doi.org/10.1037/trm0000157.

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Jordan, Alexander H., Ethan Eisen, Elisa Bolton, William P. Nash, and Brett T. Litz. "Distinguishing war-related PTSD resulting from perpetration- and betrayal-based morally injurious events." Psychological Trauma: Theory, Research, Practice, and Policy 9, no. 6 (November 2017): 627–34. http://dx.doi.org/10.1037/tra0000249.

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Michaud, Kathy, Cindy Suurd Ralph, and Sarah Jayne A. Connick-Keefer. "Operational stressors, psychological distress, and turnover intentions: The impact of potentially morally injurious experiences." Military Psychology 33, no. 4 (April 26, 2021): 250–63. http://dx.doi.org/10.1080/08995605.2021.1906075.

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Harper, Kelly L., Melinda A. Stanley, Julie J. Exline, Kenneth I. Pargament, Terri L. Fletcher, and Ellen J. Teng. "The impact of social support and morally injurious events on PTSD symptoms in Veterans." Military Psychology 32, no. 4 (July 3, 2020): 352–62. http://dx.doi.org/10.1080/08995605.2020.1760684.

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Currier, Joseph M., Wesley McCormick, and Kent D. Drescher. "How do morally injurious events occur? A qualitative analysis of perspectives of veterans with PTSD." Traumatology 21, no. 2 (June 2015): 106–16. http://dx.doi.org/10.1037/trm0000027.

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Houle, Stephanie A., Colin Vincent, Rakesh Jetly, and Andrea R. Ashbaugh. "A qualitative analysis of the impact of potentially morally injurious experiences in the Canadian Armed Forces." Journal of Military, Veteran and Family Health 6, no. 1 (May 1, 2020): 67–69. http://dx.doi.org/10.3138/jmvfh-2019-0064.

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Battles, Allison R., Michelle L. Kelley, Jeremy D. Jinkerson, Hannah C. Hamrick, and Brittany F. Hollis. "Associations Among Exposure to Potentially Morally Injurious Experiences, Spiritual Injury, and Alcohol Use Among Combat Veterans." Journal of Traumatic Stress 32, no. 3 (June 2019): 405–13. http://dx.doi.org/10.1002/jts.22404.

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Held, Philip, Brian J. Klassen, Victoria L. Steigerwald, Dale L. Smith, Karyna Bravo, David C. Rozek, Rebecca Van Horn, and Alyson Zalta. "Do morally injurious experiences and index events negatively impact intensive PTSD treatment outcomes among combat veterans?" European Journal of Psychotraumatology 12, no. 1 (January 1, 2021): 1877026. http://dx.doi.org/10.1080/20008198.2021.1877026.

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Rak, Joanna. "The Impact of Morally Injurious Events on the Dynamics of Mobilization for Women’s Rights in Poland." Przegląd Politologiczny, no. 3 (October 27, 2022): 35–45. http://dx.doi.org/10.14746/pp.2022.27.3.3.

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Why did the registration of the Gals for Gals name as a trademark and the publication of the Constitutional Tribunal’s ruling stop the largest protest movements for women’s rights in democratic Poland despite unaccomplished goals? What was the source of the 2018 and 2021 demobilization acts and subsequent waves of non-mobilization? Drawing on the theory of moral injury and narrative research methodology, this article aims to account for the determinants of the Gals for Gals’ and the All-Poland Women’s Strike’s demobilization and the lack of mobilization. The main argument is that during the fight for women’s rights, a part of Polish society involved in civic activity experienced two severe traumas. Each of the two waves of mobilization ended in a moral injury development. In both cases, a moral injury involved the loss of trust in self and others. Moreover, in both cases, the moral injuries were so severe that they turned out long-lasting. At the stage of the cognitive dissonance, there were no attempts to resolve it. In other words, activists did nothing to prevent cognitive dissonance from turning into a moral injury. In the first case, it may indicate the organizational and emotional immaturity of activists. In turn, the second case may indicate the weakening of civil society, building Poland’s political culture of withdrawal and submission.

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Smith-MacDonald, Lorraine, Liana Lentz, David Malloy, Suzette Brémault-Phillips, and R. Nicholas Carleton. "Meat in a Seat: A Grounded Theory Study Exploring Moral Injury in Canadian Public Safety Communicators, Firefighters, and Paramedics." International Journal of Environmental Research and Public Health 18, no. 22 (November 19, 2021): 12145. http://dx.doi.org/10.3390/ijerph182212145.

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The work of public safety personnel (PSP) is inherently moral; however, the ability of PSP to do what is good and right can be impeded and frustrated, leading to moral suffering. Left unresolved, moral suffering may develop into moral injury (MI) and potential psychological harm. The current study was designed to examine if MI is relevant to frontline public safety communicators, firefighters, and paramedics. Semi-structured interviews (n = 3) and focus groups (n = 3) were conducted with 19 participants (public safety communicators (n = 2); paramedics (n = 7); and firefighters (n = 10)). Interviews and focus groups were audio-recorded, transcribed, coded, and constantly compared in accordance with the grounded theory method. A conceptual theory of “frustrating moral expectations” emerged, with participants identifying three interrelated properties as being potentially morally injurious: chronic societal problems, impaired systems, and organizational quagmires. Participants navigated their moral frustrations through both integrative and disintegrative pathways, resulting in either needing to escape their moral suffering or transforming ontologically. The current study results support MI as a relevant concept for frontline PSP. Given the seriousness of PSP leaving their profession or committing suicide to escape moral suffering, the importance of the impact of MI on PSP and public safety organizations cannot be ignored or underestimated. Understanding the similarities and differences of morally injurious exposures of frontline PSP may be critical for determining mental health and resilience strategies that effectively protect PSP.

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Evans, Wyatt R., Melinda A. Stanley, Terri L. Barrera, Julie J. Exline, Kenneth I. Pargament, and Ellen J. Teng. "Morally injurious events and psychological distress among veterans: Examining the mediating role of religious and spiritual struggles." Psychological Trauma: Theory, Research, Practice, and Policy 10, no. 3 (May 2018): 360–67. http://dx.doi.org/10.1037/tra0000347.

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Hamrick, Hannah C., Michelle L. Kelley, and Adrian J. Bravo. "Morally Injurious Events, Moral Injury, and Suicidality among Recent-Era Veterans: The Moderating Effects of Rumination and Mindfulness." Military Behavioral Health 8, no. 1 (September 30, 2019): 109–20. http://dx.doi.org/10.1080/21635781.2019.1669509.

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Held, Philip, Brian J. Klassen, Denise S. Zou, Blake S. Schroedter, Niranjan S. Karnik, Mark H. Pollack, and Alyson K. Zalta. "Negative Posttrauma Cognitions Mediate the Association Between Morally Injurious Events and Trauma-Related Psychopathology in Treatment-Seeking Veterans." Journal of Traumatic Stress 30, no. 6 (November 15, 2017): 698–703. http://dx.doi.org/10.1002/jts.22234.

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Kelley, Michelle L., Adrian J. Bravo, Jeremy D. Jinkerson, Alan D. Ogle, Reed Reichwald, and J. Brian Rutland. "Remote exposure to traumatic events and PTSD symptoms among U.S. Air Force intelligence personnel: Moderating effects of morally injurious experiences." Psychological Trauma: Theory, Research, Practice, and Policy 13, no. 4 (May 2021): 412–16. http://dx.doi.org/10.1037/tra0000681.

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Brennan, Chloe J., Michael T. McKay, and Jon C. Cole. "Morally injurious events and post-traumatic embitterment disorder in UK health and social care professionals during COVID-19: a cross-sectional web survey." BMJ Open 12, no. 5 (May 2022): e054062. http://dx.doi.org/10.1136/bmjopen-2021-054062.

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ObjectiveTo estimate the prevalence and predictors of morally injurious events (MIEs) and post-traumatic embitterment disorder (PTED) in UK health and social care professionals during the COVID-19 pandemic.DesignCross-sectional study.SettingSeptember–October 2020 in the UK. Online survey hosted on Qualtrics, and recruited through Prolific.Participants400 health and social care workers, aged 18 or above and living and working in the UK during the pandemic.Main outcome measuresMIEs were assessed using the Moral Injury Events Scale and PTED was assessed using the PTED self-rating scale. Potential predictors were measured using surveys of exposure to occupational stressors, optimism, self-esteem, resilient coping style, consideration of future consequences and personal belief in a just world.Results19% of participants displayed clinical levels of PTED, and 73% experienced at least one COVID-related MIE. Exposure to occupational stressors increased the risk of experiencing PTED and MIEs, whereas personal belief in a procedurally just world, which is the belief that they experienced fair processes, was a protective mechanism.ConclusionsMIEs and PTED are being experienced by UK health and social care professionals, particularly in those exposed to work-related stressors.

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Bhalla, Arjun, Elizabeth Allen, Keith Renshaw, Jessica Kenny, and Brett Litz. "Emotional numbing symptoms partially mediate the association between exposure to potentially morally injurious experiences and sexual anxiety for male service members." Journal of Trauma & Dissociation 19, no. 4 (March 30, 2018): 417–30. http://dx.doi.org/10.1080/15299732.2018.1451976.

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Kopacz, Marek S., Mary S. Adams, Robert Searle, Harold G. Koenig, and Craig J. Bryan. "A Preliminary Study Examining the Prevalence and Perceived Intensity of Morally Injurious Events in a Veterans Affairs Chaplaincy Spiritual Injury Support Group." Journal of Health Care Chaplaincy 25, no. 2 (December 26, 2018): 76–88. http://dx.doi.org/10.1080/08854726.2018.1538655.

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Scott, Sasha A. Q. "Mediatized Witnessing and the Ethical Imperative of Capture." International Journal of E-Politics 8, no. 1 (January 2017): 1–13. http://dx.doi.org/10.4018/ijep.2017010101.

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What does it mean to witness in an age saturated with media technology? This paper argues the need to rescue witnessing as a concept from its conflation with the watching and passive consumption of events. As an inherently political practice, the mediatization of witnessing is bound within questions of ethics and morality and has the potential to realign power and control in society. This article explores these issues through the witnessing of public death events: those shocking, exceptional and morally significant deaths that become ‘public' through their mediation, observing that the continuous and contiguous production and consumption of media content has given rise to new performative rituals of local witnessing for (potentially) global audiences. I argue that the mediatization of witnessing serves to increase our moral awareness of seeing, rendering an ethical imperative of capture on those that witness, and thereby closing the veracity gap between events and their meaning.

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Canny, Geraldine, and Sean P. Colgan. "Events at the Host-Microbial Interface of the Gastrointestinal Tract I. Adaptation to a microbial world: role of epithelial bactericidal/permeability-increasing protein." American Journal of Physiology-Gastrointestinal and Liver Physiology 288, no. 4 (April 2005): G593—G597. http://dx.doi.org/10.1152/ajpgi.00506.2004.

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Epithelial cells of many mucosal organs have adapted to coexist with microbes and microbial products. In general, most studies suggest that epithelial cells benefit from interactions with commensal microorganisms present at the lumenal surface. However, potentially injurious molecules found in this microenvironment also have the capacity to elicit local inflammatory responses and even systemic disease. In this environment, the epithelium has evolved effective mechanisms to cope with microbial products and to provide appropriate responses to potential pathogens. Although our understanding of these mechanisms is clearly in its infancy, a number of recent findings provide insight into phenotypic characteristics that allow for this discrimination. Here, we briefly review some of these mechanisms, with particular attention to epithelial expression of the anti-infective molecule bactericidal/permeability-increasing protein.

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Asaoka, Hiroki, Yuichi Koido, Yuzuru Kawashima, Miki Ikeda, Yuki Miyamoto, and Daisuke Nishi. "Longitudinal Change of Psychological Distress among Healthcare Professionals with and without Psychological First Aid Training Experience during the COVID-19 Pandemic." International Journal of Environmental Research and Public Health 18, no. 23 (November 26, 2021): 12474. http://dx.doi.org/10.3390/ijerph182312474.

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This study aimed to compare longitudinal change of the psychological distress of a group with psychological first aid (PFA) experience and a group without PFA experience among physicians and other healthcare professionals from before the novel coronavirus disease (COVID-19) pandemic to during the pandemic. The baseline survey was conducted in January 2020 (T1). The respondents in T1 were invited to participate in March (T2) and November 2020 (T3). Psychological distress was assessed by the Kessler 6 Scale. Participants were divided into two categories: a group with and a group without PFA experience. Participants were further divided between physicians and healthcare professionals other than physicians, because physicians are more likely to experience morally injurious events. A mixed-model repeated-measures ANOVA was conducted as an indicator of the group differences. In T1, 398 healthcare professionals participated. The longitudinal analysis of healthcare professionals other than physicians showed that psychological distress was significantly greater in the group without PFA experience than in the group with PFA experience (T1 vs. T3). This study showed psychological distress among healthcare professionals other than physicians was significantly greater in the group without PFA experience than in the group with PFA experience during the COVID-19 pandemic, but the results were not consistent among physicians.

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Williamson, Victoria, Sharon A. M. Stevelink, and Neil Greenberg. "Occupational moral injury and mental health: systematic review and meta-analysis." British Journal of Psychiatry 212, no. 6 (May 22, 2018): 339–46. http://dx.doi.org/10.1192/bjp.2018.55.

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BackgroundMany people confront potentially morally injurious experiences (PMIEs) in the course of their work which can violate deeply held moral values or beliefs, putting them at risk for psychological difficulties (e.g. post-traumatic stress disorder (PTSD), depression, etc.).AimsWe aimed to assess the effect of moral injury on mental health outcomes.MethodWe conducted a systematic review and meta-analysis to assess the association between work-related PMIEs and mental health disorders. Studies were independently assessed for methodological quality and potential moderator variables, including participant age, gender and PMIE factors, were also examined.ResultsThirteen studies were included, representing 6373 participants. PMIEs accounted for 9.4% of the variance in PTSD, 5.2% of the variance in depression and 2.0% of the variance in suicidality. PMIEs were associated with more symptoms of anxiety and behavioural problems (e.g. hostility), although this relationship was not consistently significant. Moderator analyses indicated that methodological factors (e.g. PMIE measurement tool), demographic characteristics and PMIE variables (e.g. militaryv.non-military context) did not affect the association between a PMIE and mental health outcomes.ConclusionsMost studies examined occupational PMIEs in military samples and additional studies investigating the effect of PMIEs on civilians are needed. Given the limited number of high-quality studies available, only tentative conclusions about the association between exposure to PMIEs and mental health disorders can be made.Declaration of interestNone.

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Sørup, Freja Karuna Hemmingsen, Robert Eriksson, David Westergaard, Jesper Hallas, Søren Brunak, and Stig Ejdrup Andersen. "Sex differences in text-mined possible adverse drug events associated with drugs for psychosis." Journal of Psychopharmacology 34, no. 5 (February 12, 2020): 532–39. http://dx.doi.org/10.1177/0269881120903466.

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Background: Understanding sex differences in adverse drug reactions to drugs for psychosis could potentially guide clinicians in optimal drug choices. Aims: By applying a text-mining approach, this study aimed to investigate the relationship between drugs for psychosis and biological sex differences in frequencies and co-occurrences of potential adverse drug events (ADEs). Methods: Electronic patient records of a psychiatric population (1427 men and 727 women) were text mined for potential ADEs. The relative risk of experiencing specific ADEs and co-occurrence of ADEs were calculated for each sex. Results: Findings included 55 potential ADEs with significantly different frequencies between the two sexes. Of these, 20 were more frequent in men, with relative risks of 1.10–7.64, and 35 were more frequent in women, with relative risks of 1.19–21.58. Frequent potential ADEs were psychiatric symptoms, including sexual dysfunction and disturbances in men, and gastrointestinal symptoms, suicidal and self-injurious behaviour and hyperprolactinemia-related events in women. Mention of different hyperprolactinemia-related ADEs often co-occurred in female patients but not in male patients. Conclusion: Several known sex-related ADEs were identified, as well as some previously not reported. When considering the risk–benefit profile of drugs for psychosis, the patient’s sex should be considered.

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Stocker, Roland, and John F. Keaney. "Role of Oxidative Modifications in Atherosclerosis." Physiological Reviews 84, no. 4 (October 2004): 1381–478. http://dx.doi.org/10.1152/physrev.00047.2003.

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This review focuses on the role of oxidative processes in atherosclerosis and its resultant cardiovascular events. There is now a consensus that atherosclerosis represents a state of heightened oxidative stress characterized by lipid and protein oxidation in the vascular wall. The oxidative modification hypothesis of atherosclerosis predicts that low-density lipoprotein (LDL) oxidation is an early event in atherosclerosis and that oxidized LDL contributes to atherogenesis. In support of this hypothesis, oxidized LDL can support foam cell formation in vitro, the lipid in human lesions is substantially oxidized, there is evidence for the presence of oxidized LDL in vivo, oxidized LDL has a number of potentially proatherogenic activities, and several structurally unrelated antioxidants inhibit atherosclerosis in animals. An emerging consensus also underscores the importance in vascular disease of oxidative events in addition to LDL oxidation. These include the production of reactive oxygen and nitrogen species by vascular cells, as well as oxidative modifications contributing to important clinical manifestations of coronary artery disease such as endothelial dysfunction and plaque disruption. Despite these abundant data however, fundamental problems remain with implicating oxidative modification as a (requisite) pathophysiologically important cause for atherosclerosis. These include the poor performance of antioxidant strategies in limiting either atherosclerosis or cardiovascular events from atherosclerosis, and observations in animals that suggest dissociation between atherosclerosis and lipoprotein oxidation. Indeed, it remains to be established that oxidative events are a cause rather than an injurious response to atherogenesis. In this context, inflammation needs to be considered as a primary process of atherosclerosis, and oxidative stress as a secondary event. To address this issue, we have proposed an “oxidative response to inflammation” model as a means of reconciling the response-to-injury and oxidative modification hypotheses of atherosclerosis.

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McNeill, Charleen, Danita Alfred, Tracy Nash, Jenifer Chilton, and Melvin S. Swanson. "Characterization of nurses’ duty to care and willingness to report." Nursing Ethics 27, no. 2 (May 21, 2019): 348–59. http://dx.doi.org/10.1177/0969733019846645.

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Background: Nurses must balance their perceived duty to care against their perceived risk of harm to determine their willingness to report during disaster events, potentially creating an ethical dilemma and impacting patient care. Research aim: The purpose of this study was to investigate nurses’ perceived duty to care and whether there were differences in willingness to respond during disaster events based on perceived levels of duty to care. Research design: A cross-sectional survey research design was used in this study. Participants and research context: Using a convenience sample with a snowball technique, data were collected from 289 nurses throughout the United States in 2017. Participants were recruited through host university websites, Facebook, and an American Nurses Association discussion board. Ethical considerations: Institutional review board approval was obtained from the University of Texas at Tyler and the University of Arkansas. Findings: Analysis of willingness to report to work based on levels of perceived duty to care resulted in the emergence of two groups: “lower level of perceived duty to care group” and “higher level of perceived duty to care group.” The most discriminating characteristics differentiating the groups included fear of abandonment by co-workers, reporting because it is morally the right thing to, and because of imperatives within the Nursing Code of Ethics. Discussion: The number of nurses in the lower level of perceived duty to care group causes concern. It is important for nursing management to develop strategies to advance nurses’ safety, minimize nurses’ risk, and promote nurses’ knowledge to confidently work during disaster situations. Conclusion: Level of perceived duty to care affects nurses’ willingness to report to work during disasters. Primary indicators of low perceived duty to care are amenable to actionable strategies, potentially increasing nurses’ perceived duty to provide care and willingness to report to work during disasters.

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Beier, Colin M., Scott E. Sink, Paul E. Hennon, David V. D’Amore, and Glenn P. Juday. "Twentieth-century warming and the dendroclimatology of declining yellow-cedar forests in southeastern Alaska." Canadian Journal of Forest Research 38, no. 6 (June 2008): 1319–34. http://dx.doi.org/10.1139/x07-240.

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Decline of yellow-cedar ( Chamaecyparis nootkatensis ((D. Don) Spach) has occurred on 200 000 ha of temperate rainforests across southeastern Alaska. Because declining forests appeared soon after the Little Ice Age and are limited mostly to low elevations (whereas higher elevation forests remain healthy), recent studies have hypothesized a climatic mechanism involving early dehardening, reduced snowpack, and freezing injury. This hypothesis assumes that a specific suite of microclimatic conditions occurs during late winter and declining cedar populations across the region have responded similarly to these conditions. Based on the first geographically extensive tree ring chronologies constructed for southeastern Alaska, we tested these assumptions by investigating regional climatic trends and the growth responses of declining cedar populations to this climatic variation. Warming winter trends were observed for southeastern Alaska, resulting in potentially injurious conditions for yellow-cedar due to reduced snowfall and frequent occurrence of severe thaw–freeze events. Declining cedar forests shared a common regional chronology for which late-winter weather was the best predictor of annual growth of surviving trees. Overall, our findings verify the influence of elevational gradients of temperature and snow cover on exposure to climatic stressors, support the climatic hypothesis across large spatial and temporal scales, and suggest cedar decline may expand with continued warming.

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L. Gyemi, Danielle, Don Clarke, Paula M. van Wyk, William J. Altenhof, and David M. Andrews. "Quantifying Forearm Soft Tissue Motion from Massless Skin Markers following Forward Fall Hand Impacts." International Journal of Kinesiology and Sports Science 6, no. 3 (July 31, 2018): 1. http://dx.doi.org/10.7575/aiac.ijkss.v.6n.3p.1.

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Background: Investigating soft tissue motion related to impact events is important for understanding how the body mitigates potentially injurious forces through shock attenuation. Objectives: The aims of this study were to: 1) quantify displacement and velocity of the forearm soft tissues following forward fall impacts; and 2) compare two massless skin marker designs (single layer, uniform (SLU) design; stacked, non-uniform (SNU) design) in terms of how well they could be tracked over varying skin pigmentations using automated motion capture software. Methods: Two participant groups (skin pigmentation: light – 9F, 8M; dark – 9F, 6M) underwent simulated forward fall hand impacts for each marker design using a torso-release apparatus. Marker positions associated with planar motion of forearm soft tissues during impact were automatically tracked (ProAnalyst®) in the proximal-distal and anterior-posterior axes from high speed recordings (5000 f/s). Mean peak displacements and velocities for eight forearm regions were then calculated (LabVIEW®). Results: Overall, soft tissue displacement and velocity increased from distal to proximal forearm regions. The greatest displacement (1.47 cm) and velocity (112.8 cm/s) occurred distally toward the wrist. Soft tissue impact responses between sexes did not differ, on average (p > 0.05). The SLU and SNU markers produced different kinematic values (p < 0.05); however, the magnitudes of, and consequently meaningfulness of these statistical differences for automatically tracking soft tissue motion, were negligible (displacement: ≤ 0.05 cm; velocity: ≤ 2.5 cm/s). Conclusions: Forearm soft tissue motion was successfully quantified for forward fall hand impacts; both marker designs were deemed functionally equivalent.

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Abraczinskas, Alicia, Ardyn Olszko, Christine Beltran, Jamie L. Baisden, Narayan Yoganandan, James McGhee, Shannon McGovern, Grace Lidl, Kimberly B. Vasquez, and Valeta C. Chancey. "A Comparison of Nonhuman Primate Injuries in Horizontal Versus Vertical Sled +Gz (Head-to-Foot) Impact Accelerations." Military Medicine 186, Supplement_1 (January 1, 2021): 610–18. http://dx.doi.org/10.1093/milmed/usaa354.

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ABSTRACT Introduction Accelerative events commonly expose military pilots to potentially injurious + Gz (axial, caudal to cranial) accelerations. The Naval Biodynamics Laboratory exposed nonhuman primates (NHPs) to + Gz loading in two subject orientations (supine or upright) to assess the effect of orientation and accelerations associated with injury at accelerations unsafe for human participation. Materials and Methods Archived care records, run records, and necropsy and pathology reports were used to identify acceleration-related injuries. Injuries were categorized as central nervous system (CNS), musculoskeletal (MSK) system, or thoracic (THR). The occurrence of injuries relative to corresponding peak sled acceleration (PSA) and subject orientation were compared. A t-test was applied within each injury category to test for a significant difference in mean PSA between orientations. Results For all 63 + Gz runs conducted, PSA ranged between 6 and 86 G. Of these runs, 17 (6 supine, 11 upright) resulted in acceleration-related injury. The lowest PSAs associated with injury for supine and upright were 69.8 G and 39.6 G, respectively. Individual injury occurrences for supine runs (CNS [n = 5], MSK [n = 6], and THR [n = 6]) occurred at/above 75.7 G, 69.8 G, and 69.8 G, respectively. For upright runs, injury occurrences (CNS [n = 3], MSK injuries [n = 9], and THR injuries [n = 6]) occurred at/above 60.1 G, 39.6 G, and 50.5 G, respectively. The applied t-test showed significant difference between the mean orientation accelerations within each category. Injuries to supine NHPs included compression fracture, organ damage, brain hemorrhage, spinal cord hemorrhage, cervical hemorrhage, paresis/paraplegia, and THR bruising, whereas injuries to upright NHPs included compression fracture, organ damage, spinal cord hemorrhage, paresis/paraplegia, THR bruising, and difficulty breathing. Conclusions Axial loading to supine occupants produced more CNS injuries, whereas upright produced more MSK injuries. Both orientations produced equal THR injuries. NHP injuries reported reflected those reported following human + Gz acceleration events, highlighting the importance of orientation during acceleration to mitigate injury for next generation equipment design and testing.

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Hartunyunyan, Hakob, Attila J. Hertelendy, Alexander Hart, Todd Benham, Artak Muekhaelyan, and Greg Ciottone. "The Impact of Moral Distress on Clinicians Treating Patients during the COVID-19 Pandemic and the Concurrent Armenian War in 2020: Implications for WHO – EMT Teams." Prehospital and Disaster Medicine 37, S2 (November 2022): s114. http://dx.doi.org/10.1017/s1049023x22002138.

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Background/Introduction:Moral distress is a well-described phenomenon in medical providers. It has been linked to mental health deterioration, decreased job satisfaction, and early retirement. No study has been done on the level of moral distress associated with treating patients in simultaneous disasters.Objectives:1.To learn what is known about the experience of moral distress in frontline health care providers during the COVID-19 pandemic and the concurrent conflict in Armenia during 2020.2.To determine how WHO EMTs can support their frontline staff experiencing moral distress.Method/Description:A survey was designed to test the moral distress felt by Armenian EMS providers who had cared for both COVID-19 and war casualty patients. This was adapted from the Moral Distress Scale Revised (MDS-R).Results/Outcomes:Of the questions asked, respondents most often responded that they were disturbed by: “Continuing to participate in care for a hopelessly ill or injured person who is being sustained on a ventilator when no one will make a decision to withdraw support” (Mean 2.68/Median 3/Mode 4); and “Initiated extensive life-saving actions when I think they only prolong death” (2.47/3/3), which caused the next most distress to subjects.Conclusion:It is expected that some health care workers in Armenia are likely facing on-going consequences of the moral distress they faced during this unprecedented period of global pandemic and war. Clinics and teams who are more likely to encounter potentially morally distressing events, such as disaster medicine workers, need to address their moral distress mitigation plan by identifying strategies across the continuum of disaster management.

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Bhalodia, Vidya M., Daniel M. Schwartz, Anthony K. Sestokas, Gary Bloomgarden, Thomas Arkins, Patrick Tomak, Judith Gorelick, Shirvinda Wijesekera, John Beiner, and Isaac Goodrich. "Efficacy of intraoperative monitoring of transcranial electrical stimulation–induced motor evoked potentials and spontaneous electromyography activity to identify acute-versus delayed-onset C-5 nerve root palsy during cervical spine surgery." Journal of Neurosurgery: Spine 19, no. 4 (October 2013): 395–402. http://dx.doi.org/10.3171/2013.6.spine12355.

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Object Deltoid muscle weakness due to C-5 nerve root injury following cervical spine surgery is an uncommon but potentially debilitating complication. Symptoms can manifest upon emergence from anesthesia or days to weeks following surgery. There is conflicting evidence regarding the efficacy of spontaneous electromyography (spEMG) monitoring in detecting evolving C-5 nerve root compromise. By contrast, transcranial electrical stimulation–induced motor evoked potential (tceMEP) monitoring has been shown to be highly sensitive and specific in identifying impending C-5 injury. In this study the authors sought to 1) determine the frequency of immediate versus delayed-onset C-5 nerve root injury following cervical spine surgery, 2) identify risk factors associated with the development of C-5 palsies, and 3) determine whether tceMEP and spEMG neuromonitoring can help to identify acutely evolving C-5 injury as well as predict delayed-onset deltoid muscle paresis. Methods The authors retrospectively reviewed the neuromonitoring and surgical records of all patients who had undergone cervical spine surgery involving the C-4 and/or C-5 level in the period from 2006 to 2008. Real-time tceMEP and spEMG monitoring from the deltoid muscle was performed as part of a multimodal neuromonitoring protocol during all surgeries. Charts were reviewed to identify patients who had experienced significant changes in tceMEPs and/or episodes of neurotonic spEMG activity during surgery, as well as those who had shown new-onset deltoid weakness either immediately upon emergence from the anesthesia or in a delayed fashion. Results Two hundred twenty-nine patients undergoing 235 cervical spine surgeries involving the C4–5 level served as the study cohort. The overall incidence of perioperative C-5 nerve root injury was 5.1%. The incidence was greatest (50%) in cases with dual corpectomies at the C-4 and C-5 spinal levels. All patients who emerged from anesthesia with deltoid weakness had significant and unresolved changes in tceMEPs during surgery, whereas only 1 had remarkable spEMG activity. Sensitivity and specificity of tceMEP monitoring for identifying acute-onset deltoid weakness were 100% and 99%, respectively. By contrast, sensitivity and specificity for spEMG were only 20% and 92%, respectively. Neither modality was effective in identifying patients who demonstrated delayed-onset deltoid weakness. Conclusions The risk of new-onset deltoid muscle weakness following cervical spine surgery is greatest for patients undergoing 2-level corpectomies involving C-4 and C-5. Transcranial electrical stimulation–induced MEP monitoring is a highly sensitive and specific technique for detecting C-5 radiculopathy that manifests immediately upon waking from anesthesia. While the absence of sustained spEMG activity does not rule out nerve root irritation, the presence of excessive neurotonic discharges serves both to alert the surgeon of such potentially injurious events and to prompt neuromonitoring personnel about the need for additional tceMEP testing. Delayed-onset C-5 nerve root injury cannot be predicted by intraoperative neuromonitoring via either modality.

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Williamson, Victoria, Dominic Murphy, Sharon A. M. Stevelink, Shannon Allen, Edgar Jones, and Neil Greenberg. "The impact of moral injury on the wellbeing of UK military veterans." BMC Psychology 9, no. 1 (May 5, 2021). http://dx.doi.org/10.1186/s40359-021-00578-7.

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Abstract Background Experiences of potentially morally injurious events (PMIEs) have been found to negatively impact the mental health of US personnel/veterans, yet little is known about the effect of PMIEs on the mental health of the UK Armed Forces (AF). This cross-sectional study aimed to examine the association between PMIEs and the mental health outcomes of UK AF veterans. Method Assessments of PMIE exposure and self-report measures of common mental disorders were administered using an online questionnaire to 204 UK veterans. Subjects were classified as having experienced a morally injurious event (n = 66), a non-morally injurious traumatic event (n = 57), a ‘mixed’ event (n = 31), or no event (n = 50). Results Potentially morally injurious experiences were associated with adverse mental health outcomes, including likely anxiety disorders and suicidal ideation, compared to those who reported no event exposure. The likelihood of meeting criteria for probable PTSD was greatest in those who had experienced a non-morally injurious trauma. No statistically significant association between alcohol misuse and experiencing a PMIE or traumatic event was observed. Conclusions The results provide preliminary evidence that potentially morally injurious experiences are associated with adverse mental health outcomes in UK AF veterans. Further work is needed to better understand the interplay between morally injurious events and threat-based trauma in order to design effective pathways for prevention and intervention for people exposed to highly challenging events.

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Looi, Jeffrey CL, Paul A. Maguire, Stephen R. Kisely, and Stephen Allison. "Psychiatrist and trainee moral injury during the organisational long COVID of Australian acute psychiatric inpatient services." Australasian Psychiatry, November 23, 2022, 103985622211424. http://dx.doi.org/10.1177/10398562221142448.

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Objective This paper provides a commentary on the risk of moral injury amongst psychiatrists and trainees working in the acute psychiatric hospital sector, during the third winter of the COVID-19 pandemic. Conclusions Moral injuries arise from observing, causing or failing to prevent adverse outcomes that transgress core ethical and moral values. Potentially, morally injurious events (PMIEs) are more prevalent and potent while demand on acute hospitals is heightened with the emergence of highly infectious SARS-CoV-2-Omicron subvariants (BA.4 and BA.5). Acute hospital inpatient services were already facing extraordinary stresses in the context of increasingly depleted infrastructure and staffing related to the pandemic. These stresses have a high potential to be morally injurious. It is essential to immediately fund additional staff and resources and address workplace health and safety, to seek to arrest a spiral of moral injury and burnout amongst psychiatrists and trainees. We discuss recommended support strategies.

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Forkus, Shannon R., and Nicole H. Weiss. "Examining the relations among moral foundations, potentially morally injurious events, and posttraumatic stress disorder symptoms." Psychological Trauma: Theory, Research, Practice, and Policy, September 7, 2020. http://dx.doi.org/10.1037/tra0000968.

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Journal articles on the topic 'Potentially Morally Injurious Events'

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