COVID-19 and Moral Distress: A Pediatric Critical Care Survey

Background Moral distress adversely affects the delivery of high-quality patient care and places health care professionals at risk for burnout, moral injury, and the loss of professional integrity. Objectives To investigate whether pediatric critical care professionals are experiencing moral distress during the COVID-19 pandemic and, if so, for what reasons. Methods An exploratory survey of pediatric critical care professionals was conducted via the Pediatric Acute Lung Injury and Sepsis Investigators Network from April to May 2020. The survey was derived from a framework integrating contemporary literature on moral distress, moral resilience, and expert consensus. Integration of descriptive statistics for quantitative data and thematic analysis for qualitative data yielded mixed insights. Results Overall, 85.8% of survey respondents reported moral distress. Nurses reported higher degrees of moral distress than other professional groups. Inducers of moral distress were related to challenges to professional integrity and lack of organizational support. Five themes were identified: (1) psychological safety, (2) expectations of leadership, (3) connectedness through a moral community, (4) professional identity challenges, and (5) professional versus social responsibility. Most respondents were confident in their ability to reason through ethical dilemmas (76.0%) and think clearly when confronting an ethical challenge even when pressured (78.9%). Conclusions During the COVID-19 pandemic, pediatric critical care professionals are experiencing moral distress due to various factors that challenge their professional integrity. Despite these challenges, they also exhibit attributes of moral resilience. Organizations have opportunities to cultivate a psychologically safe and healthy work environment to mitigate anticipatory, present, and lingering moral distress.

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Trends in Pediatric Palliative Care Research (TPPCR) 2021; Issue #3: Commentary on Guttmann et al and Dryden-Palmer et al.

10.31219/osf.io/54tky ◽

2021 ◽

Author(s):

Christina Vadeboncoeur ◽

TPPCR

Keyword(s):

Intensive Care Unit ◽

Palliative Care ◽

Critical Care ◽

Intensive Care ◽

Symptom Management ◽

Neonatal Intensive Care ◽

Moral Distress ◽

Pediatric Palliative Care ◽

Pediatric Critical Care ◽

Intensive Care Unit Staff

This TPPCR commentary discusses the 2021 paper by Guttmann et al and Dryden-Palmer et al., “Goals of Care Discussions and Moral Distress among Neonatal Intensive Care Unit Staff” published in the Journal of Pain and Symptom Management and the 2021 paper by Dryden-Palmer et al., “Moral Distress of Clinicians in Canadian Pediatric and Neonatal ICUs” published in Pediatric Critical Care Medicine.

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NURSE EXTENDERS IN THE PEDIATRIC CRITICAL CARE UNIT REDUCES NURSING TASKS WHILE MAINTAINING QUALITY PATIENT CARE

Critical Care Medicine ◽

10.1097/00003246-199401000-00302 ◽

1994 ◽

Vol 22 (1) ◽

pp. A158

Author(s):

Donna Kielma ◽

Mary Maciejewski ◽

Karen Blount ◽

Eileen Nahigian ◽

Michele Papo

Keyword(s):

Critical Care ◽

Patient Care ◽

Critical Care Unit ◽

Pediatric Critical Care ◽

Quality Patient Care

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Moral distress: Developing strategies from experience

Nursing Ethics ◽

10.1177/0969733020906593 ◽

2020 ◽

Vol 27 (4) ◽

pp. 1147-1156

Author(s):

Andrew Helmers ◽

Karen Dryden Palmer ◽

Rebecca A Greenberg

Keyword(s):

Critical Care ◽

Intensive Care ◽

Work Environment ◽

Moral Distress ◽

Healthcare Providers ◽

Pediatric Intensive Care ◽

Paediatric Intensive Care ◽

Care Providers ◽

Front Line ◽

Moral Resilience

Background Moral distress was first described by Jameton in 1984, and has been defined as distress experienced by an individual when they are unable to carry out what they believe to be the right course of action because of real or perceived constraints on that action. This complex phenomenon has been studied extensively among healthcare providers, and intensive care professionals in particular report high levels of moral distress. This distress has been associated with provider burnout and associated consequences such as job attrition, with potential impacts on patient and family care. There is a paucity of literature exploring how middle and late career healthcare providers experience and cope with moral distress. Objectives We explore the experience of moral distress and the strategies and resources invoked to mitigate that distress in mid- and late-career healthcare providers practicing in paediatric intensive care, in order to identify ways in which the work environment can build a culture of moral resilience. Research design An exploratory, qualitative quality improvement project utilizing focus group and semi-structured interviews with pediatric intensive care front-line providers. Participants Mid-and-later career (10 + years in practice) pediatric intensive care front line providers in a tertiary pediatric hospital. Research context This work focuses on paediatric intensive care providers in a single critical care unit, in order to explore the site-specific perspectives of health care providers in that context with respect to moral distress coping strategies. Ethical considerations The study was approved by the Quality Management Office at the institution; consent was obtained from participants, and no identifying data was included in this project. Findings Participants endorsed perspective-building and described strategies for positive adaptation including; active, reflective and structured supports. Participants articulated interest in enhanced and accessible formal supports. Discussion Findings in this study resonate with the current literature in healthcare provider moral distress, and exposed ways in which the work environment could support a culture of moral resilience. Avenues are described for the management and mitigation of moral distress in this setting. Conclusion This exploratory work lays the groundwork for interventions that facilitate personal growth and meaning in the midst of moral crises in critical care practice.

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Moral Resilience: A Capacity for Navigating Moral Distress in Critical Care

AACN Advanced Critical Care ◽

10.4037/aacnacc2016275 ◽

2016 ◽

Vol 27 (1) ◽

pp. 111-119 ◽

Cited By ~ 53

Author(s):

Cynda Hylton Rushton

Keyword(s):

Critical Care ◽

Moral Distress ◽

Moral Resilience

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Self-care Strategies to Combat Burnout Among Pediatric Critical Care Nurses and Physicians

Critical Care Nurse ◽

10.4037/ccn2020621 ◽

2020 ◽

Vol 40 (2) ◽

pp. 44-53 ◽

Cited By ~ 7

Author(s):

Holly Wei ◽

Hadley Kifner ◽

Melanie E. Dawes ◽

Trent L. Wei ◽

Jenny M. Boyd

Keyword(s):

Health Care ◽

Critical Care ◽

Health Care Professionals ◽

Self Care ◽

Well Being ◽

The United States ◽

Professional Burnout ◽

Pediatric Critical Care ◽

Qualitative Descriptive ◽

Nurses And Physicians

Background Professional burnout is a widespread phenomenon in health care. The health of patients and organizations begins with the well-being of health care professionals. Identifying and understanding self-care strategies that professionals perceive to be helpful is crucial to combat burnout. Objective To determine perceptions of self-care strategies to combat professional burnout among nurses and physicians in pediatric critical care settings. Methods This was a qualitative descriptive study with a phenomenological overtone. The study was conducted in a 20-bed pediatric intensive care unit and an 8-bed intermediate care unit of a children’s hospital in the United States. Information flyers and emails were used to introduce the study. A combination of convenience and purposive sampling methods was used to recruit participants who were full-time nurses and physicians in the 2 units. Information saturation was used to regulate sample sizes, resulting in 20 participants. Data were collected through a onetime face-to-face interview with each participant. A qualitative descriptive approach was used to analyze the data. The first author was the primary coder and discussed the codes with the coauthors throughout the coding process. Results Six major self-care strategies were identified: finding meaning in work, connecting with an energy source, nurturing interpersonal connections, developing an attitude of positivity, performing emotional hygiene, and recognizing one’s uniqueness and contributions at work. Conclusions Developing effective self-care strategies helps promote health care professionals’ physical and psychological well-being and reduce burnout. It is vital for health care professionals to care for themselves so that they can best care for others.

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Moral Distress in Critical Care Nurses: A Qualitative Study

International Journal of Studies in Nursing ◽

10.20849/ijsn.v4i4.659 ◽

2019 ◽

Vol 4 (4) ◽

pp. 35

Author(s):

Hawazen Rawas

Keyword(s):

Health Care ◽

Critical Care ◽

Health Care Professionals ◽

Moral Distress ◽

Critical Care Nurses ◽

Real Problem ◽

Research Paradigm ◽

Critical Care Units ◽

Medical City ◽

Depth Interviews

BackgroundHealth care professionals find themselves participating in insignificant events in human existence such as birth, pain, and death which is a privilege but also poses challenges as this participation involves decisions that can be life-changing and having an effect on everyone involved. The study aimed to explore moral distress within the context of Saudi Arabia.MethodologyA simple qualitative design was used with a research paradigm of constructivism. Data collection included in-depth interviews with five critical care nurses who were purposively sampled. The setting for the study was the critical care units at King Abdul- Aziz Medical City- Jeddah. Data analysis included content analysis. Principles of academic rigor were followed.FindingsTwo themes emerged from this study with various subthemes. Theme 1: Turning away from nursing obligations: hands are tied, the burden of workload, no voice, not honoring oath; Theme 2: Bad practice: hierarchy in practice and feeling guilty.ConclusionsThis study highlights that moral distress within critical care units is a real problem that impacts on critical care nurses' physical and psychological stress. Health care institutions should mobilize resources to reduce these effects on critical care nurses and other health care professionals.

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Study examines the relevance and applications of the Institute of Medicine's quality aims on pediatric critical care

PsycEXTRA Dataset ◽

10.1037/e556152006-008 ◽

2006 ◽

Keyword(s):

Critical Care ◽

Pediatric Critical Care

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The Association of Pediatric Critical Care Medicine Training Programs with Research Publication Productivity and Employment Outcomes of Their Graduates

Journal of Pediatric Intensive Care ◽

10.1055/s-0040-1721732 ◽

2020 ◽

Author(s):

Sonali Basu ◽

Robin Horak ◽

Murray M. Pollack

Keyword(s):

Critical Care ◽

Intensive Care ◽

Medical School ◽

Training Programs ◽

Fellowship Training ◽

Publication Productivity ◽

Research Publication ◽

Pediatric Critical Care ◽

Publication Success ◽

Fellowship Programs

AbstractOur objective was to associate characteristics of pediatric critical care medicine (PCCM) fellowship training programs with career outcomes of PCCM physicians, including research publication productivity and employment characteristics. This is a descriptive study using publicly available data from 2557 PCCM physicians from the National Provider Index registry. We analyzed data on a systematic sample of 690 PCCM physicians representing 62 fellowship programs. There was substantial diversity in the characteristics of fellowship training programs in terms of fellowship size, intensive care unit (ICU) bed numbers, age of program, location, research rank of affiliated medical school, and academic metrics based on publication productivity of their graduates standardized over time. The clinical and academic attributes of fellowship training programs were associated with publication success and characteristics of their graduates' employment hospital. Programs with greater publication rate per graduate had more ICU beds and were associated with higher ranked medical schools. At the physician level, training program attributes including larger size, older program, and higher academic metrics were associated with graduates with greater publication productivity. There were varied characteristics of current employment hospitals, with graduates from larger, more academic fellowship training programs more likely to work in larger pediatric intensive care units (24 [interquartile range, IQR: 16–35] vs. 19 [IQR: 12–24] beds; p < 0.001), freestanding children's hospitals (52.6 vs. 26.3%; p < 0.001), hospitals with fellowship programs (57.3 vs. 40.3%; p = 0.01), and higher affiliated medical school research ranks (35.5 [IQR: 14–72] vs. 62 [IQR: 32, unranked]; p < 0.001). Large programs with higher academic metrics train physicians with greater publication success (H index 3 [IQR: 1–7] vs. 2 [IQR: 0–6]; p < 0.001) and greater likelihood of working in large academic centers. These associations may guide prospective trainees as they choose training programs that may foster their career values.

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