Ep 261 - Moral Injury with Caroline Leech at Tactical Trauma 24
Feb 19, 2025
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Caroline Leech, a Consultant in Emergency Medicine and expert in trauma care, discusses the pressing issue of moral injury in healthcare. She clarifies how moral injury differs from moral distress and outlines its three key mechanisms: acts of commission, acts of omission, and betrayal. Through compelling examples from emergency situations, Caroline highlights the emotional toll on responders and stresses the critical need for psychological support. The conversation shines a light on the healthcare system’s responsibility to address these issues for the well-being of providers.
Moral injury arises from cumulative distressing experiences in emergency medicine, necessitating professional psychological support for affected healthcare providers.
The concept of betrayal in healthcare emerges from systemic limitations, highlighting the emotional toll on providers unable to deliver optimal patient care.
Deep dives
Understanding Moral Injury and Moral Distress
Moral injury is defined as a strong cognitive and emotional response that occurs when an individual experiences events that violate their moral and ethical code. It is suggested that while moral distress is often felt on a daily basis due to individual incidents, moral injury results from the accumulation of these distressing experiences over time. Professionals in emergency medicine and pre-hospital care frequently encounter situations that lead to moral injury, particularly during critical incidents where decisions must be made quickly in high-stress environments. The distinction between moral injury and moral distress is important, as it highlights the potential need for professional psychological support when the impact becomes significant.
Categories of Moral Injury: Acts of Commission and Omission
Moral injury manifests in various forms, with two notable categories being acts of commission and acts of omission. Acts of commission involve situations where something harmful occurs that should not have happened, such as a medical personnel witnessing a patient harmed due to negligence or injustice. Conversely, acts of omission refer to instances where necessary actions are not taken, leading to feelings of guilt and shame, particularly when life-saving interventions are missed. Both categories underscore the emotional toll on healthcare providers who grapple with the repercussions of their choices, emphasizing the importance of compassion and self-forgiveness in their professional journey.
The Betrayal of Systemic Limitations
Betrayal within healthcare contexts often arises from systemic limitations that hinder providers from delivering optimal care to patients. This betrayal can manifest in situations where emergency departments are overwhelmed, leaving vulnerable patients in waiting rooms for extended periods without adequate support or resources. The emotional burden felt by healthcare workers in such scenarios can be compounded by the awareness that they are unable to meet the standards of care they aspire to provide. Recognizing betrayal as a form of moral injury can aid in identifying appropriate interventions and fostering open conversations among peers about their experiences and the challenges they face in delivering care.
In this episode of the St Emlyn's podcast, hosts Iain Beardsell and Liz Crowe welcome back Caroline Leech, a emergency medicine consultant with extensive pre-hospital care experience. Caroline discusses the concept of moral injury, delving into its distinction from moral distress. She introduces three mechanisms of moral injury: acts of commission, acts of omission, and betrayal. Caroline provides insightful examples from emergency medicine to illustrate these concepts, emphasizing the importance of identifying and addressing moral injury to support healthcare professionals. The discussion highlights the emotional and cognitive distress faced by emergency responders and the necessity for professional psychological support when moral distress accumulates into moral injury.
00:00 Introduction and Welcome
00:23 Introducing Caroline Leech
01:10 Defining Moral Injury and Distress
03:42 Acts of Commission
07:12 Acts of Omission
12:30 Betrayal in Healthcare
15:00 Conclusion and Final Thoughts
The Guest - Caroline Leech
Caroline Leech is Deputy Clinical Lead of The Air Ambulance Service and has 25 years of prehospital clinical experience. She is a Consultant in Emergency Medicine at University Hospital Coventry, the West Midlands Trauma Network Director, and the Trauma Lead for the Institute for Applied & Translational Technologies in Surgery (IATTS). Caroline is currently undertaking a NIHR funded Clinical Research Scholarship with Warwick University. Her research interests include maternal out-of-hospital cardiac arrest, calcium in traumatic haemorrhage, and frailty in major trauma. She is committed to improving equality and diversity in PHEM, and promoting strategies for supporting the wellbeing and psychosocial care of prehospital responders.
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