道德傷害的沉默傷痕──護理人員在疫情中的心理衝擊

The Silent Scars of Moral Injury: The Psychological Impact of the Pandemic on Nursing Professionals

全球疫情暴露了醫療體系在資源分配、倫理挑戰與人力管理上的深層問題，醫護人員在此期間經歷的道德傷害對其心理健康與職涯發展產生重大影響及增加離職意圖，影響全球護理人力穩定性。本文分析疫情如何加劇道德傷害且其對個人、團隊與系統層面的影響，並提出應對策略。針對道德傷害，本文建議醫療機構建立安全的工作環境、推行公平文化、提供心理支持及進行教育訓練。也鼓勵護理人員重視自我照顧，並在面臨道德困境時能適時表達，同時，機構需建立匿名通報系統作為支持機制。未來需要專家來制定道德傷害的處理標準，並加強預防措施的研究。國家政策應確保護理人員的聲音納入決策過程，以減少結構性不公現象，並重視護理人員的權益，以確保醫療照護的永續性。

Systemic problems in healthcare exposed during the recent global pandemic include issues involving resource allocation, ethical challenges, and workforce management. During the pandemic, healthcare professionals, and nurses in particular, experienced moral injuries that have significantly impacted their psychological well-being and career development and fueled intent to leave the profession. This threatens the stability of the global nursing workforce. This article was developed to examine how the pandemic intensified the experience of moral injury and the effects of this type of injury at the individual, team, and system levels, and to propose strategies in response. Based on the results, healthcare institutions are encouraged to proactively create safe work environments, foster fair culture, offer psychological support, and provide ethics training. Nurses should be supported in their self-care, encouraged to voice moral concerns, and use anonymous reporting systems to report problems and concerns. Also, experts should establish standardized protocols for the management of moral injury as well as advance related prevention-focused research. Furthermore, to sustain and optimize current healthcare systems, national policies should prioritize the inclusion of nurses’perspectives in related decision-making, address structural inequities, and protect the rights of nurses.