Research Progress on Moral Injury of Foreign Medical Staff under the Background of COVID -19 Pandemic / 中国医学伦理学

This paper reviewed the research on moral injury among foreign medical staff in the background of the COVID -19 pandemic. It was found that foreign medical staff bore multiple moral pressures and impacts in the face of the epidemic, including the collision between medical practice and utilitarian policy, the inability to meet personal needs, the rapid transformation of medical mode, and a variety of comprehensive factors. Therefore, the moral injury of foreign medical staff is particularly prominent. In order to avoid and reduce the occurrence of moral injury, it is necessary to strengthen the cultivation of moral resilience, provide psychological and social support, and carry out personalized treatment for medical staff.

Analysis of Moral Emotion from the Perspective of Moral Injury Research / 中国医学伦理学

Moral emotion is a kind of psychological activity that generated when dealing with realistic moral relationship or analyzing human behaviors, expressed as emotional emotions of love and hatred. From the perspective of moral injury research, on the one hand, moral emotion expresses as emotional collapse, which reflects the huge gap between reality and moral cognition, and deviates from values; on the other hand, it shows the typical symptoms of moral injury, such as shame, guilt, anger, apathy and so on. Based on this, the therapy of moral injury should start from solving the ethical conflict of moral injury, and carry out the healing process of "ethical and moral cognitive education, enlightening the thinking of core value issues, encouraging and guiding independent moral practice" in stages according to the different levels of individual moral emotion. As a result, moral emotion can be rational enough to promote healing moral injury.

Moral Schema Based on the Integration of the Mechanism of Moral Injury / 中国医学伦理学

Moral injury is a kind of trauma symptom caused by the impact of external immoral events on the internal moral value system of individuals or groups. Its origin lies in the deviation between individual’s internal moral schema and external moral situation. As a collection of moral consciousness units with value orientation in the regular activities of individuals in the moral environment, moral schema is composed of periphery and core. Moral schema realizes the domination of moral ego by supervising individual’s speech and behavior, exercising moderate control over individuals based on moral practice, and examining individual behavior with self-guilt as the tool of judgment. Moral schema is selective about what happened and acts as a filter for trauma events. Based on this, individuals can interpret or be subverted by moral events, thus playing a preventive role in moral injury.

Analysis on Collective Moral Injury / 中国医学伦理学

The previous moral injury theory implied the premise of taking individual as the research object, while there were few studies on collective moral injury. Collective moral injury is defined as a series of consequences of violating widely accepted moral beliefs rather than simply adding up symptoms of injured individuals within a group. From the America "Floyd Case", this paper analyzed the functional elements and generating mechanism of collective moral injury, that was, the diversification of trauma sources events could appear alone or interweave, collective moral resilience showed the characteristics of social integrity and time accumulation, the interaction between collective trauma sources and collective moral resilience determined whether collective moral injury occurs. As the We-Media become popular, collective feature of moral injury is more evident, which presents two new features that the Internet platform becomes a hub for trauma events and the information Internet recorded consolidates collective moral resilience. To deal with collective moral injury, it was needed to respond to social concerns and guidance moral public opinion, respect the original endogenous order and inherit the traditional culture, satisfy reasonable moral needs and enlighten moral sense of people as well.

Silêncio na redação ­ a saúde mental de jornalistas na abordagem da comunicação de riscos / Silence in the newsroom ­ journalist's mental health from the risk communication approach / Silencio en la redacción ­ la salud mental de los periodistas en el abordaje de la comunicación de riesgo

Desde a década de 1990, o psiquiatra sul-africano Anthony Feinstein tem abordado o tema da saúde mental de jornalistas na cobertura de tragédias humanitárias, com foco no Transtorno do Estresse Pós-traumático (TEPT) e em moral injury (lesão moral), definido como uma ferida na alma. Em 2020, primeiro ano da pandemia da covid-19, o artigo "The covid reporters are not okay. Extremely not okay", da jovem jornalista Olivia Messer, trabalhando on-line, chamou a atenção não apenas para o tema da saúde mental dos repórteres, como também para a invisibilidade do assunto. Este artigo objetiva investigar como a comunicação de riscos pode contribuir para descortinar e enfrentar os riscos à saúde mental de jornalistas no Brasil, especialmente no contexto das redações híbridas e da plataformização do jornalismo, um dos campos que compõem o referencial teórico em seu cruzamento com a comunicação de riscos e a psiquiatra. A metodologia contempla a pesquisa bibliográfica nessas três áreas, a plataformização do jornalismo, a comunicação de riscos e a psiquiatria, a partir da conexão entre elas, e da análise de conteúdo, de base quantitativa, da cobertura do assunto pelos jornais Folha de S.Paulo e O Globo. Os resultados apontam a urgência da retirada do tema da invisibilidade midiática e social e confirmam a potencialidade da comunicação de riscos para o seu enfrentamento.

Since the 1990s, South African psychiatrist Anthony Feinstein has addressed the issue of the mental health of journalists covering humanitarian tragedies, focusing on Post-traumatic Stress Disorder (PTSD) and moral injury, defined as a wound in the soul. In 2020, the first year of the covid-19 pandemic, the article "The covid reporters are not okay. Extremely not okay", by young journalist Olivia Messer, working online drew attention not only to the issue of reporters' mental health, but also to the invisibility of the issue. This article aims to investigate how risk communication can contribute to uncover and address the risks to the mental health of journalists in Brazil, especially in the context of hybrid newsrooms and the plat-formization of journalism, one of the fields that make up the theoretical framework in its intersection with risk communication and psychiatry. The methodology includes bibliographic research in these three areas, platformization of journalism, risk communication and psychiatry, from the connection between them, and content analysis, of quantitative basis, of the coverage of the subject by Folha de S.Paulo and O Globo newspapers. The results point to the urgency of removing this issue of media and social invisibility and recognising the potential of risk communication to face it.

Desde la década de 1990, el psiquiatra sudafricano Anthony Feinstein ha abordado la cuestión de la salud mental de los periodistas que cubren tragedias humanitarias, centrándose en el Trastorno de Estrés Pos-traumático (TEPT) y el moral injury (el daño moral), definidos como una herida en el alma. En 2020, el primer año de la pandemia de covid-19, el artículo "The covid reporters are not okay. Extremely not okay", de la joven periodista Olivia Messer, que trabaja en línea, llamó la atención no sólo sobre la cuestión de la salud mental de los periodistas, sino también sobre la invisibilidad del tema. Este artículo pretende investigar cómo la comunicación de riesgo puede contribuir a descubrir y abordar los riesgos para la salud mental de los periodistas en Brasil, especialmente en el contexto de las redacciones híbridas y la plata-formización del periodismo, uno de los campos que conforman el marco teórico en su intersección con la comunicación de riesgo y la psiquiatría. La metodología contempla la investigación bibliográfica en estas tres áreas, plataformización del periodismo, comunicación de riesgo y la psiquiatría, a partir de la conexión entre ellas, y el análisis de contenido, de base cuantitativa, de la cobertura del tema por los periódicos Folha de S.Paulo y O Globo. Los resultados apuntan a la urgencia de sacar el tema de la invisibilidad mediática y social y confirman la potencialidad de la comunicación de riesgos para su confrontación

Enlightenment on the Construction of Medical Professionalism from the Perspective of Moral Injury / 中国医学伦理学

The purpose of medicine is to preserve and develop the treatment in the process of saving lives and helping injuries. Medical professionalism is a comprehensive expression of physician’s clinical abilities, relationships and values between different subjects. In practice, white robed doctors utilize high standards of professionalism to practice the medical purpose and goals of "always centering on the interests of the patient" in specific diagnosis and treatment behaviors. At the same time, fulfilling the promises and expectations of medicine to the public. For these reasons, selfless dedication, self-sacrifice, and one-way pure altruism are all internalized into the basic requirements of medical professionalism: doctors should not only have the skill to revive the dead, but also have the benevolence of evangelists; they not only need to achieve maximum efficiency in technology, but also achieve the highest truth, goodness, and beauty in virtue. When these qualities are exaggerated or unattainable due to uncontrollable reasons, there will be a rift between the entrenched value systems and practical needs. In recent years, the global epidemic has had a huge impact on the medical system and medical staff, and the moral beliefs, role expectations, and value systems of doctors have also been impacted unprecedentedly, resulting in moral injury. The international research on moral injury in medical field has also received attention. China is currently in the adjustment period of epidemic related policies, with medical personnel bearing the brunt. Therefore, referring to relevant international research on moral injury to re-examine the relationship between the medical professionalism, which emphasizes one-way pure altruism, dedication and weakening or even neglecting personal well-being, and current medical practices. And constructing a moral injury early warning-repair system that focuses on doctors, patients, medical teams, medical institutions, medical environments, health systems, and other stakeholders, and ensuring its healthy operation. Not only in extreme periods, but also in ordinary daily diagnosis and treatment, it can support doctors to actively, safely, and healthily fulfill their mission of saving lives and helping injuries.

Nursing Ethics from the Perspective of Moral Injury / 中国医学伦理学

Due to the specialty of the profession, nursing staff often face more traumatic events in which their self-moral cognition is contrary to the reality, and gradually turn to moral injury on this basis. The level of nursing ethical literacy of nursing staff greatly affects their differences in moral cognition and the strength of moral resilience, thus determining the development and recovery of moral injury. The latest ethical code for nurses, the Expert Consensus on Nursing Ethics for the Prevention and Control of Major Infectious Diseases, has improved the rights and interests of nursing staff. The active practice of this code can help nursing staff effectively respond to the endogenous and exogenous injury sources brought about by the epidemic, eliminate negative moral cognition, improve the moral resilience of nursing staff, as well as has positive effects on the prevention of moral injury for nursing staff.

Investigation of Diagnosis and Treatment of Post-Traumatic Stress Disorder with Moral Injury / 中国医学伦理学

Post-Traumatic Stress Disorder ( PTSD) is a common psychiatric disorder with complicated symp-toms and prolonged course of disease, seriously damages social function of patients and can cause excessive con-sumption of medical resources. As pathogenic factor of PTSD, moral injury has its special pathogenic mechanism. PTSD with moral injury has more symptoms and poorer prognosis, leading to a higher risk of suicide and more com-plicated treatment. Theoretical research from the perspective of psychology and ethics, etiological and clinical re-search from the perspective of biomedical may provide the solution to PTSD with moral injury.

Introduction and Commentary of Measurement for Moral Injury of Foreign Army / 中国医学伦理学

In recent years, foreign army researches showed that moral injury emerged in the war had gradually become a new traumatic act to the veterans. How to effectively evaluate and prevent moral injury has drawn exten-sive attention of scholars. This paper introduced and commented the measurement of the foreign army moral injury. At present, foreign measurement scales of moral injury mainly had three kinds of MIES, MIES ( improved ver-sion) , and MIQ-M. Moral injury is the new horizon of ethical research in our country, and it is of great applica-tion prospect to carry out the research on measurement of moral injury.

Analysis of Occurrence Mechanism of Moral Injury / 中国医学伦理学

The occurrence of moral injury begins with combat behaviors which break the ethical rules of fair-ness and justice, good and evil, and the value of life. Those behaviors effect on the moral intuition formed by indi-vidual moral beliefs, cultural traditions, and personality traits, and acts on the moral reasoning of the soldiers, thus this traumatic event is internalized into a moral event. And then the strength of the moral events or its re-experi-ence breaks through the tenacity of moral emotion, therefore the moral subject moves towards moral injury, which is manifested as self-condemnation, withdrawal, self-injury, killing, and other cognitive or emotional symptoms. As self-condemnation intensifies, the victim will fall into an increasingly vicious circle of moral injury. Mean-while, self-forgiveness means a way of restoration and reconciliation, which asks the victim to forgive himself and to adjust moral conflicts in time.

Analysis of the Causes of Moral Injury—Based on the Ethical Reflection of American War Films / 中国医学伦理学

Moral injury in the war has been taken seriously since it has been gradually raised as an important military psychological problem.War is not the flavor of a quiet life,nor is it the ideal place to achieve the hero dream.Strong battlefield impact and ethical challenges likely cause moral injury to those innocent soldiers.Based on the American classic war films such as“ Closed Island”,“Born on July 4”,“Field Row” and “Snowden”,this paper mainly expounded the ethical thinking off our causes of moral injury including massacre of the prisoners of war,injustice war,betrayal of the senior officer,and hegemonic government.

Discussion on Moral Health in Modern Medical Mode / 中国医学伦理学

Medical mode , as the concept of combination of medicine and philosophy , is an abstract summary of the nature of medicine in the process of exploring health , disease prevention and control , and is developing with the change of human conception and the deepening of cognition to health and disease .The Bio-Psycho-Social Medi-cal Mode is gradually changing people ' s cognition to the nature of medicine , and prompting people to examine the disease and health from the physiological , psychological , social and multi -angle.But this mode also needs to be further enriched and perfected , does not fully reflect the moral factors of health and the nature of medical ethics . It' s mainly manifested as that the biological basis of life science abandoned the moral health , the psychological mechanism of physical and mental trauma shielded the moral injury , and the social attributes of medicine replaced the moral essence .

Discussion on Moral Health in Modern Medical Mode / 中国医学伦理学

Medical mode , as the concept of combination of medicine and philosophy , is an abstract summary of the nature of medicine in the process of exploring health , disease prevention and control , and is developing with the change of human conception and the deepening of cognition to health and disease .The Bio-Psycho-Social Medi-cal Mode is gradually changing people ' s cognition to the nature of medicine , and prompting people to examine the disease and health from the physiological , psychological , social and multi -angle.But this mode also needs to be further enriched and perfected , does not fully reflect the moral factors of health and the nature of medical ethics . It' s mainly manifested as that the biological basis of life science abandoned the moral health , the psychological mechanism of physical and mental trauma shielded the moral injury , and the social attributes of medicine replaced the moral essence .

Assédio moral: estudo com enfermeiros da estratégia saúde da família / Asedio moral: un estudio con enfermeras de la estrategia de salud de la família / Moral harassment: a study with nurses of the family health strategy

Objective: Investigating the occurrence of the practice of moral harassment in the workplace of nurses ofthe Family Health Strategy; ascertaining who are the harassers; identifying the characteristics of aggressors; verifying the consequences of the moral harassment practice for the health of the professional. Method: this is an exploratory research, with quantitative approach, developed at Family Health Units, of the city of João Pessoa, with 30 nurses, with the application of a questionnaire. The data were analyzed by frequency and percentage. Results: from the 30 nurses of the research, ten (33,3%) suffered moral harassment, and in 46,1% of the cases, the aggressors were supporters. Regarding health problems as aconsequence of the harassment, stands out the stress (92,3%). Conclusion: The study evidenced that asignificantly number of nurses were victims of moral harassment in their workplaces, in a repetitive and systematically way, which causes health problems for the worker...

Objetivo: Investigar a ocorrência da prática do assédio moral no ambiente de trabalho de enfermeiros da Estratégia Saúde da Família; averiguar quem são os assediadores; identificar as características dos agressores; verificar as consequências da prática do assédio moral para a saúde do profissional. Método:Trata-se de uma pesquisa exploratória, com abordagem quantitativa, desenvolvida em Unidades de Saúde da Família, do município de João Pessoa, com 30 enfermeiros, com a aplicação de um questionário. Os dados foram analisados por meio de frequência e percentual. Resultados: Dos trinta enfermeiros da pesquisa, dez (33,3%) sofreram assédio moral, e em 46,1% dos casos, os agressores eram apoiadores. No que tange a problemas de saúde em consequência do assédio, destaca-se o estresse (92,3%). Conclusão: O estudo evidenciou que um número significativo de enfermeiros foram vítimas de assédio moral em seu ambiente de trabalho, de forma repetitiva e sistemática, o que acarreta problemas de saúde para o trabalhador...

Objetivo: Investigar la ocurrencia de acoso en el lugar de trabajo de enfermeros de la Estrategia de Salud de la Familia; determinar quién son los acosadores, identificar las características de los agresores; verificar las consecuencias de la práctica de intimidación para la salud del profesional. Método: Esta es una investigación exploratoria, enfoque cuantitativo, desarrollada en Unidades Salud de la Familia, del municipio de João Pessoa, con 30 enfermeras, con la aplicación de un cuestionario. Los datos se analizaron mediante el uso de frecuencia y porcentaje. Resultados: De las treinta enfermeras de la investigación, diez(33,3%) sufrieron acoso moral, y enel 46,1% de los casos, los agresores eran partidarios. Con respecto a los problemas de salud como consecuencia del acoso, se destacan el estrés (92,3%). Conclusión: el estudio mostró que un número considerable de enfermeras fueron víctimas de acoso moral en el lugar de trabajo, de forma repetitiva y sistemática, lo que causa problemas de salud a los trabajadores...