Introduction: Healthcare missionaries (HCMs) experience moral distress while serving in the field. Moral distress and subsequent injury prevention and intervention efforts may become more effective by analyzing the progression of practice experiences of Western healthcare missionaries. The purpose of this qualitative study is to analyze themes of experiences that may be associated with moral distress and potentially morally injurious experiences (PMIEs) among healthcare missionary careers. Methods: A recent qualitative study of moral injury1 included twenty-one healthcare missionaries being interviewed on the clinical, cultural, and spiritual factors associated with possible moral distress. Thematic content from that study was analyzed by high total frequency of participant responses and high variation among participants’ years of service. Five resulting themes were analyzed by the respondents’ years of field experience. Quotes were selected from the transcripts to provide key-informant perspectives on the themes. These themes and quotes were examined together to identify experience-based practice insights. Results: The ratio of early career and advanced career missionaries experiencing each theme is listed. The qualitative analysis shows variations among five practice themes by participant’s varied length of time in the field: (1) early career practitioners appear most likely to feel distress from personal responsibility and capability for care, (2) healthcare missionaries of all experience ranges rarely have patients ask for the reason for suffering, often due to patient fatalism, (3) early career practitioners appear most likely to personally react or have a spouse/family member react to a lack of boundaries rather than enacting preventative work/life boundaries, (4) early career missionaries may be slightly more likely than advanced career healthcare missionaries to personally confront unresolved ethical conflicts related to patient care, and (5) practitioners from both ranges of field experience (more frequently advanced career practitioners) noted having conflict with authoritarian leadership dynamics specifically with expatriate, rather than national leaders. Conclusion: The relationship between moral distress themes across healthcare missionary careers is more complex than anticipated. This study identifies preliminary themes and insights that reflect possible moral distress in healthcare missions. These themes should be further researched to develop prevention and intervention methods addressing moral distress for healthcare missionaries and their patients.
Theisz et al. (Wed,) studied this question.