Resources produced from the project
From ‘The Reset ethics: the moral harm project’ we have co-created resources for wellbeing professionals (those who support healthcare staff, such as clinical psychologists, chaplains, support workers) to help them in their day-to-day work with healthcare staff in hospitals.
We developed these resources with our co-creation group, made up of hospital wellbeing professions. This group identified the need for resources that alerted healthcare staff to what moral harm (distress and injury) is, highlighted the ethical features of moral harm in different healthcare settings and encouraged them to seek support if experiencing it.
The Scenarios
We have created five scenarios, with accompanying videos and discussion materials, which are designed to show how healthcare workers might experience moral harm. These scenarios are based on our co-creation work, both the format and content were developed by the co-creation group, and are composites of many stories, so that no one hospital or person can be identified.
The scenarios have three aims:
- To raise awareness moral harm (distress and injury) in the NHS.
- To help wellbeing staff to promote understanding of moral distress in a healthcare setting, the threat it poses to individuals and the health service as a whole and ways of managing the experience of moral distress (including seeking help from wellbeing services).
- To introduce wellbeing staff to the concepts and language of clinical ethics when they engage with the ethical dimensions of moral distress with NHS healthcare workers.
We briefly describe how we co-created our scenarios in our 'How we co-created our resources' document.
For the actor brief template we used, please see our blank scenario template.
Each scenario has a:
- A video of a healthcare worker talking about moral distress (performed by an actor).
- A slide deck that outlines key issues raised by the incident of moral harm, with questions and discussion points.
- Written text of the scenario to give further background.
- A transcript of the video.
The videos of the scenarios were performed by actors from the simulated patient team at Warwick University and are designed to show the emotion and personal reaction to issues and circumstances that can lead to feelings of moral harm. They are not meant to be accurate reflections of real cases or clinical situations, but to prompt reflection and discussion.
Please be aware that some of these scenarios contain distressing content. Each scenario contains a specific Content Warning to alert users of these materials to this.
Please click on each scenario to see the accompanying resources.
Scenario 1 - Paediatric Intensive Care Unit Nurse
Scenario 1 – The Paediatric Intensive Care Unit Nurse
It’s not just you – moral harm can happen to anyone. This scenario depicts a paediatric intensive care nurse who is concerned about the treatment of a child in her care, who has a poor prognosis but is still being ‘treated’ and this treatment is causing the child physical distress.
Content warning
Please be aware the following scenario depicts events that may cause upset or distress. This includes challenges of difference of opinion between professional and patients relating to post-operative care of a child, personal sense of responsibility for patient discomfort when administering procedures, and the emotional and moral harm this causes for staff. Please take the steps necessary for your emotional safety when engaging with this.
Scenario 2 - Consultant Obstetrician
Scenario 2 – The Consultant Obstetrician
It’s not just you – moral harm can happen to anyone. The scenario is a consultant obstetrician who is caring for a woman who has a severe cardiac condition and is refusing appropriate care. There are two parts to this scenario, the case outlined (part 1) and how the case was approached, don’t suffer alone – how I reached out for help (part 2).
Content warning
Please be aware the following scenario centres on the decision of a pregnant patient not to follow medical advice, the consequences of which could be harmful to patient and fetus, and the emotional and moral harm this causes for staff. Please consider your potential emotional responses to these topics before engaging with this scenario and related discussions.
Part 1
Part 2
Scenario 3 - Mental health support worker
Scenario 3 - Mental health support worker
It’s not just you – moral harm can happen to anyone. This scenario is about a mental health support worker who experiences racism and witnesses patients being restrained at their place of work, a mental health in-patient setting.
Content warning
Please be aware the following scenario depicts events that may cause upset or distress. This includes experiences of racism, the use of containment practices on an in-patient on a mental health ward, and the emotional and moral harm this causes for staff. Please take the necessary steps for your emotional safety when engaging with this scenario and related discussions.
Scenario 4 - Porter
Scenario 4 - Porter
Don’t suffer alone – how I reached out for help. The scenario is about a hospital porter who witnesses the death of a child after a multi-causality event and how they had to follow a protocol that they thought was very difficult for the parents of the child.
Content warning
Please be aware the following scenario contains depictions of A&E response to a major incident, reference to death and injuries in children (no details), and the emotional and moral harm this causes for staff. Please consider your potential emotional responses to these topics before engaging with this scenario and related discussions.
Scenario 5 – FI Junior doctor
Scenario 5 – FI Junior doctor
Why I left the NHS. The scenario about a junior doctor who leaves medicine due to the difficulties he experienced that were caused by resource pressures in the NHS that stopped them being able to deliver the kind of care they thought all patients deserved.
Content warning
Please be aware the following scenario contains depictions of the challenges of winter pressures and poor care for a patient with a suspected stroke, and the emotional and moral harm this causes for staff. Please consider your potential emotional responses to these topics before engaging with this scenario and related discussions.
Scenario 6 – A clinical psychologist and chaplain in conversation
Scenario 6 – A clinical psychologist and chaplain in conversation
This scenario is a conversation between a hospital chaplain and a hospital clinical psychologist on their experiences of working with staff who are experiencing feelings of moral distress. This scenario is to help raise awareness amongst healthcare professionals about different forms of support and does not have accompanying discussion materials. Clinical psychology and chaplain support can be accessed by staff through most hospital trusts.
How to use the scenarios
The scenarios are designed to be used to facilitate discussion of moral harm in the hospital workplace. The primary aim of the scenarios is to raise awareness moral harm in the NHS, and to signpost ways of addressing or alleviating it. The scenarios can also serve as a means of promoting discussion by NHS wellbeing staff of the ethical dimensions of the events depicted. To this end, the scenarios include a set of facilitated discussion materials to accompany each of the videos.
The scenarios are designed to address a need identified by the Reset Project for ways of promoting and enhancing the confidence of wellbeing staff in their ability to identify and discuss the contributory ‘moral’ elements of moral distress with those they are supporting through this experience.
Permissions to use the resources
These resources are open access, and we place no restrictions on how or where they can be used. Although our focus is on wellbeing staff teams, you are welcome to adapt them to prompt informal discussion of clinical ethics and/or moral harm in clinical teams, or to incorporate them within formal undergraduate or postgraduate learning, or CPD training.
We ask only that when you use our videos you are careful to show the content warning (at the start of the videos) and acknowledgements (at the end of the videos), and, if you adapt our slides, you acknowledge the contribution made by this project.
Please note:
- The resulting resources are not designed to provide ethics/clinical ethics training.
- They are not a substitute for formal ethics/clinical ethics training.
- They are not comprehensive.
Instead, they provide a structure for informal discussion within wellbeing teams of some of the common ethical challenges faced by NHS workers known to contribute to moral distress.
Further resources
We have created a list of resources on moral harm (injury and distress). These are a collection of academic articles that we think are useful if you want to explore moral harm further. We have not included web-resources as links date very quickly.
Scenario 6 above has been created specifically to help raise awareness amongst healthcare professionals about different forms of support (and therefore does not have accompanying facilitated discussion materials like the other scenarios do).
Feedback
We invite you to feedback on these materials and how you have used them. You can do this on our feedback form or by email to the project lead Professor Lucy Frith.