Browsing by Author "Smith-MacDonald, Lorraine"

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Open Access
A Scoping Review of the Components of Moral Resilience: Its Role in Addressing Moral Injury or Moral Distress for High-Risk Occupation Workers
(Springer, 2023-12-14) Osifeso, Temitope; Crocker, Sierra J.; Lentz, Liana; Smith-MacDonald, Lorraine; Seliman, Merna; Limenih, Gojjam; MacPhee, Renée, S.; Anderson, Gregory S.; Brémault-Phillips, Suzette; Malloy, David C.; Carleton, R. Nicholas
Purpose of Review: High-risk occupation workers (HROWs) are often exposed to potentially morally injurious events (PMIEs) which can contribute to moral distress (MD) or moral injury (MI). Moral resilience (MR) has been proposed as a protective or moderating factor to protect HROWs from harm caused by PMIE exposures. The current review was designed to: 1) update the definition of MR to a broader context of HROWs; 2) identify components of MR for HROWs; and 3) determine demographic variables that may impact MR development.
Open Access
Compromised Conscience: A Scoping Review of Moral Injury Among Firefighters, Paramedics, and Police Officers
(Frontiers Media, 2021-03-31) Lentz, Liana; Smith-MacDonald, Lorraine; Malloy, David; Carleton, R. Nicholas; Brémault-Phillips, Suzette
Background: Public Safety Personnel (e.g., firefighters, paramedics, and police officers) are routinely exposed to human suffering and need to make quick, morally challenging decisions. Such decisions can affect their psychological wellbeing. Participating in or observing an event or situation that conflicts with personal values can potentially lead to the development of moral injury. Common stressors associated with moral injury include betrayal, inability to prevent death or harm, and ethical dilemmas. Potentially psychologically traumatic event exposures and post-traumatic stress disorder can be comorbid with moral injury; however, moral injury extends beyond fear to include spiritual, cognitive, emotional or existential struggles, which can produce feelings of severe shame, guilt, and anger.
Open Access
Measuring moral distress and moral injury: A systematic review and content analysis of existing scales
(Elsevier BV, 2024-03) Houle, Stephanie A.; Ein, Natalie; Gervasio, Julia; Plouffe, Rachel A.; Litz, Brett T.; Carleton, R. Nicholas; Hansen, Kevin T.; Liu, Jenny J.W.; Ashbaugh, Andrea R.; Callaghan, Walter; Thompson, Megan M.; Easterbrook, Bethany; Smith-MacDonald, Lorraine; Rodrigues, Sara; Bélanger, Stéphanie A.H.; Bright, Katherine S.; Lanius, Ruth A.; Baker, Clara; Younger, William; Brémault-Phillips, Suzette; Hosseiny, Fardous; Richardson, J. Don; Nazarov, Anthony
Background: Moral distress (MD) and moral injury (MI) are related constructs describing the negative conse- quences of morally challenging stressors. Despite growing support for the clinical relevance of these constructs, ongoing challenges regarding measurement quality risk limiting research and clinical advances. This study summarizes the nature, quality, and utility of existing MD and MI scales, and provides recommendations for future use. Method: We identified psychometric studies describing the development or validation of MD or MI scales and extracted information on methodological and psychometric qualities. Content analyses identified specific out- comes measured by each scale. Results: We reviewed 77 studies representing 42 unique scales. The quality of psychometric approaches varied greatly across studies, and most failed to examine convergent and divergent validity. Content analyses indicated most scales measure exposures to potential moral stressors and outcomes together, with relatively few measuring only exposures (n = 3) or outcomes (n = 7). Scales using the term MD typically assess general distress. Scales using the term MI typically assess several specific outcomes.
Open Access
Meat in a Seat: A grounded theory study exploring moral injury in Canadian public safety communicators, firefighters, and paramedics
(Multidisciplinary Digital Publishing Institute, 2021-11-19) Smith-MacDonald, Lorraine; Lentz, Liana; Malloy, David; Brémault-Phillips, Suzette; Carleton, R. Nicholas
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.
Open Access
Perspectives and Experiences of Public Safety Personnel Engaged in a Peer-Led Workplace Reintegration Program Post Critical Incident or Operational Stress Injury: A Qualitative Thematic Analysis
(MDPI AG, 2024-07-19) Jones, Chelsea; Spencer, Shaylee; O’Greysik, Elly; Smith-MacDonald, Lorraine; Bright, Katherine S.; Beck, Amy J.; Carleton, R. Nicholas; Burback, Lisa; Greenshaw, Andrew; Zhang, Yanbo; Sevigny, Phillip R.; Hayward, Jake; Cao, Bo; Brémault-Phillips, Suzette
Introduction: Public safety personnel (PSP) experience operational stress injuries (OSIs), which can put them at increased risk of experiencing mental health and functional challenges. Such challenges can result in PSP needing to take time away from the workplace. An unsuccessful workplace reintegration process may contribute to further personal challenges for PSP and their families as well as staffing shortages that adversely affect PSP organizations. The Canadian Workplace Reintegration Program (RP) has seen a global scale and spread in recent years. However, there remains a lack of evidence-based literature on this topic and the RP specifically. The current qualitative study was designed to explore the perspectives of PSP who had engaged in a Workplace RP due to experiencing a potentially psychologically injurious event or OSI. Methods: A qualitative thematic analysis analyzed interview data from 26 PSP who completed the RP. The researchers identified five themes: (1) the impact of stigma on service engagement; (2) the importance of short-term critical incident (STCI) program; (3) strengths of RP; (4) barriers and areas of improvement for the RP; and (5) support outside the RP. Discussion: Preliminary results were favorable, but further research is needed to address the effectiveness, efficacy, and utility of the RP. Conclusion: By addressing workplace reintegration through innovation and research, future initiatives and RP iterations can provide the best possible service and support to PSP and their communities.
Open Access
A Qualitative Analysis of the Mental Health Training and Educational Needs of Firefighters, Paramedics, and Public Safety Communicators in Canada
(Multidisciplinary Digital Publishing Institute, 2022-06-07) Lentz, Liana; Smith-MacDonald, Lorraine; Malloy, David C.; Anderson, Gregory S.; Beshai, Shadi; Ricciardelli, Rosemary; Brémault-Phillips, Suzette; Carleton, R. Nicholas
Background—Public safety personnel (PSP) are at heightened risk of developing mental health challenges due to exposures to diverse stressors including potentially psychologically traumatic experiences. An increased focus on protecting PSP mental health has prompted demand for interventions designed to enhance resilience. While hundreds of available interventions are aimed to improve resilience and protect PSPs’ mental health, research evidence regarding intervention effectiveness remains sparse. Methods—Focus groups with PSP elicited a discussion of psychoeducational program content, preferred modes of program delivery, when such training should occur, and to whom it ought to be targeted. Results—The results of thematic analyses suggest that PSP participants feel that contemporary approaches to improving mental health and resilience are lacking. While welcomed, the provision of sporadic one-off mental health and resilience programs by organizations was seen as insufficient, and the available organizational mental health supports were perceived as being questionable. The available programs also left participants feeling insufficiently prepared to deal with personal mental health problems and in discussing mental health concerns with co-workers. Conclusions—Participants reported needing more engaging methods for delivering information, career-long mental health knowledge acquisition, and a systems approach to improve the workplace culture, particularly regarding mental health.