Financial medicine as a source of moral distress: An unrecognised pathway to moral injury in the South African EMS systems

IF 1.4 4区 医学 Q3 EMERGENCY MEDICINE African Journal of Emergency Medicine Pub Date : 2023-09-18 DOI:10.1016/j.afjem.2023.09.003
Colin Giovanni Mosca , Jaco P Kruger
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Abstract

Introduction

The phenomenon of Financial Medicine is a wide spread practice within the South African prehospital domain, which remains poorly researched. Similarly the impact of this phenomenon is not well understood, with many healthcare providers grappling with the moral dilemmas introduced into the work systems through the effects of the practice of Financial Medicine. Persisting, repetitive moral dilemmas can lead to instances of Moral Distress and Moral Injury. The practice of Financial Medicine in the South African prehospital domain proves to introduce many moral dilemmas and subsequently can serve as a source of Moral Distress and Moral Injury.

Methods

This study used a qualitative research methodology in the form of a constructivist grounded theory design. Participants voluntarily consented to be enrolled into one-on-one in-depth interviews, and were selected using purposive and theoretical sampling techniques. Data was subjected to validated coding procedures and analysed using the constant comparative analysis approach, analytical diagramming, and supported by researcher theoretical sensitivity.

Results

The sub-category presented in this study stems from the development of 6 final analytical labels that were abstracted in the process of a theory construction, not presented in this article. This sub-category is nested under 1 of the final analytical labels, and comprised of 3 preliminary analytical labels and an associated code and proposition list.

Conclusion

Understanding the sources of Moral Distress and Moral Injury within the South African prehospital domain are key steps in promoting and supporting the adoption and sustainability of ethical practices. This article presents a key finding that demonstrates a link between the experience of the phenomenon of Financial Medicine and the suffering of a Moral Injury by South African prehospital personnel.

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金融医学作为道德困境的来源:南非EMS系统中通往道德伤害的未被认识的途径
金融医学现象是南非院前医学领域中广泛存在的一种实践,目前研究较少。同样,这种现象的影响也没有得到很好的理解,许多医疗保健提供者正在努力解决由于金融医学实践的影响而引入工作系统的道德困境。持续的、重复的道德困境会导致道德困境和道德伤害。事实证明,金融医学在南非院前领域的实践引入了许多道德困境,随后可能成为道德困境和道德伤害的根源。方法本研究采用建构主义理论设计的定性研究方法。参与者自愿同意参加一对一的深度访谈,并使用目的性和理论抽样技术进行选择。数据经过验证的编码程序,并使用恒定比较分析方法、分析图表进行分析,并得到研究人员理论敏感性的支持。结果本研究中提出的子类别源于6个最终分析标签的发展,这些标签是在理论构建过程中抽象出来的,本文中没有提出。该子类别嵌套在1个最终分析标签下,由3个初步分析标签以及相关的代码和命题列表组成。结论了解南非院前领域道德痛苦和道德伤害的来源是促进和支持道德实践的采用和可持续性的关键步骤。这篇文章提出了一个关键发现,证明了金融医学现象的经历与南非院前人员遭受的道德伤害之间的联系。
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来源期刊
CiteScore
2.40
自引率
7.70%
发文量
78
审稿时长
85 days
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