Yazar
Mustafa Volkan KAVAS
Doç. Dr., İzmir Ekonomi Üni. Tıp Fakültesi, Tıp Tarihi ve Etik AD.(ORCID No:0000-0003-1252-3469)

Yazar
Ayşenur DALDABAN BERBEROĞLU
Arş. Gör. Ankara Üni., SBE., Tıp Tarihi ve Etik Dok. Prg. (ORCID NO: 0000-0002-9374-2593)

Yazar
Hüseyin Erkut SÖĞÜT
Dr., Ankara Üni., SBE, Tıp Fakültesi, Tıp Tarihi ve Etik Dok. Prg.(ORCID NO: 0009-0001-2872-3257)

Yazar
Fatih BİLGİLİ
İnt.,Dr., Ankara Üni. Tıp Fakültesi (ORCID NO: 0009-0004-7613-4758 )

Yazar
Fatma Zehra ÖZTEK ÇELEBİ
Dr., Doç. Dr., Sağlık Bil. Üni., Etlik Şehir Hast., Çocuk Sağlığı ve Hastalıkları Kliniği, Ankara Üni., SBE., Tıp Fakültesi, Tıp Tarihi ve Etik Doktora Prg.(ORCID NO: 0000-0002-2203-5904 )

Özet

  • Olağandışı durumlarda, sağlık çalışanları, kendilerini profesyonel ve kişisel olarak zorlayıcı etik ikilemler karşısında karar verici ve uygulayıcı pozisyonlarda bulabilir ve ahlaki yaralanmaya maruz kalabilirler. Ahlaki yaralanma, şiddetli duygusal hasara, yoğun insan ıstırabına ve zulmüne tanıklık edenlerde görülen, kişinin temel etik değer, tutum ve açıklamalarını sarsacak denli güçlü, özgül bir etkilenme biçimidir. Bu çalışmada, sağlık çalışanlarında ahlaki yaralanma olgusunu, neden geliştiğini ve nasıl önlenebileceğini olağandışı durumlara hazırlık bağlamında tartışmak amaçlanmıştır. Ahlaki yaralanma, kişinin etkin ve bağımsız bir özne olma algısını törpülemekte, değer bütünlüğünü ve temel iyilik algısını aşındırmakta, onu psikolojik, sosyal ve manevi açıdan olumsuz etkilemektedir. Ahlaki yaralanmaya maruz kalan sağlık çalışanı kendisine ve mesleğine yabancılaşabilir, tükenmişlik ve umutsuzluk duygularıyla baş etmek durumunda kalabilir. Bu ise sağlık çalışanlarında depresyon, öfke, yetersizlik duygularının ve meslekten ayrılma olgularının baş göstermesi ile sonuçlanabilir. Genel farkındalığı yükseltme, risk altındaki kişileri güçlendirme ve kolektif kültürel dönüşüm çalışmaları ile kişileri dayanıklı kılarak ahlaki yaralanmanın olumsuz etkilerini telafi etmek mümkündür. Bu girişimlerin, olağandışı durumlara hazırlık ve direnç geliştirme çabalarının birer parçası olarak bütünsel yaklaşımla planlanması ve kişiler arası ilişkiler (sağlık çalışanı – hasta ilişkisi) kadar kurum, sistem ve toplum düzeylerindeki çalışmalarla entegre edilmesi gerekmektedir.  Sağlık işgücünün yetkinliği ve ahlaki dayanıklılığı olağandışı durumlara hazırlığın önemli bir bileşeni olarak görülmelidir. Tersi de doğrudur; olağandışı durumlara hazırlıksız yakalanmak sağlık çalışanlarında ahlaki yaralanmaya neden olabilmektedir. Olağandışı durumların sık yaşandığı ülkemizde sağlık çalışanlarının ahlaki açıdan zorlandığı deneyimlere ilişkin ileri görgül çalışmaların bu önemli olgunun anlaşılmasına ve ahlaki dayanıklılığı yükseltme çabalarına katkıda bulunacağını düşünmekteyiz.  

Summary

  •  In extraordinary situations, healthcare workers may find themselves in positions of decision-making and practicing in the face of professionally and personally challenging ethical dilemmas which may result in moral injury. Moral injury is a spesific form of affect that is strong enough to shake one’s fundamental ethical values, attitudes, and explanations. It is seen in those who witness severe emotional damage, intense human suffering, and cruelty. This study aims to discuss the phenomenon of moral injury in healthcare workers, the factors that contribute to its development, and the strategies for prevention in the context of preparation for extraordinary situations. Moral injury erodes a person’s perception of being an active and independent subject, his/her value integrity, and basic sense of well-being, and negatively affects him/her psychologically, socially and spiritually. Healthcare workers who are exposed to moral injury may become alienated from themselves and their profession, and may have to cope with feelings of burnout and hopelessness. This may lead to depression, anger, feelings of inadequacy, and disengagement from the profession in healthcare workers. By raising general awareness, empowering those at risk, and implementing collective cultural transformation efforts, it is possible to compensate for the negative effects of moral injury by helping people become morally resilient. These initiatives must be planned holistically as part of preparation for and building resilience to adverse events. They should be integrated with work processes at the organizational, system, and community levels, as well as at interpersonal (healthcare worker – patient) level. The competence and moral resilience of the health workforce should be regarded as an essential element of emergency preparedness. Conversely, being inadequately prepared for extraordinary situations may result in moral injury among healthcare workers. We posit that further empirical studies on the morally challenging experiences of healthcare workers in our country, where extraordinary situations are frequently encountered, will facilitate the comprehension of this significant phenomenon and the advancement of initiatives to enhance moral resilience.        

Anahtar Sözcükler / Keywords

  • TR: Ahlaki yaralanma, Ahlaki özne, Ahlaki dayanıklılık, Ahlaki bütünlük, Sağlık çalışanı, Olağandışı durum
    EN: Moral injury, Moral agency, Moral resilience, Moral integrity, Healthcare worker, Disaster

Dipnot / Footnote

  • 1. Kavramın detaylı bir incelemesi için Bkz. American Nurses Association (ANA) (2017) A Call to Action: Exploring Moral Resilience Toward a Culture of Ethical Practice, Erişim Tarihi 30 Mayıs 2024, https://www.nursingworld.org/~4907b6/globalassets/docs/ana/ana-call-to-action?exploring-moral-resilience-final.pdf 2. Temellendirilmiş teori de denir. Araştırma sonuçlarına dayanarak belirli bir olgu hakkında kuram geliştirmeyi amaçlayan nitel veri analizi yaklaşımıdır (Bryman, 2016). Gömülü kuram, temsil ettiği olgunun incelenmesinden tümevarımsal olarak türetilir. Veri toplama, analiz ve kuram birbirleriyle karşılıklı ilişki içindedir. Gömülü kuramda, başlangıçta elde yalnızca genel bir soru ve bir çalışma alanı vardır.  Araştırmacı hazır bir kuramsal çerçeveyi kanıtlamaya çalışmaz, daha ziyade, çalışma alanında veri toplamakla işe başlanır ve bu alanla ilgili kuramsal açıklamanın ortaya çıkmasın izin verilir (Corbin ve Strauss, 2008). Bir başka deyişle veri, kuramdan önce gelir.

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Geliş Tarihi / Received Date

  • 25.12.2024

Kabul Tarihi / Accepted Date

  • 19.02.2025