Karen Dryden-Palmer, Gregory Moore1, Clare McNeil2, Charles Philip Larson3, George Tomlinson4,5, Nadia Roumeliotis, Annie Janvier6,7, Christopher S Parshuram8,9. 1. Division of Neonatology, CHEO, Ottawa, ON, Canada. 2. Centre for Safety Research, Child Health and Evaluation Sciences Program, The Research Institute, SickKids, Toronto, ON, Canada. 3. Department of Pediatrics, Division of Paediatric Critical Care Medicine, University of Alberta, Edmonton, AB, Canada. 4. Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, ON, Canada. 5. Department of Medicine, University Health Network and Mt Sinai Hospital, Toronto, ON, Canada. 6. Department of Pediatrics, Bureau de l'Éthique Clinique, Université de Montréal, Montréal, QC, Canada. 7. Division of Neonatology, Research Center, Clinical Ethics Unit, Palliative Care Unit, Unité de recherche en éthique clinique et partenariat famille, CHU Sainte-Justine, Montréal, QC, Canada. 8. Department of Pediatrics, University of Toronto, Toronto, ON, Canada. 9. Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada.
Abstract
OBJECTIVE: To quantify moral distress in neonatal ICU and PICU clinicians and to identify associated factors. DESIGN: A national cross-sectional survey of clinicians working in an neonatal ICU or PICU. Moral distress was assessed with the Moral Distress Scale-Revised and by self-rating. Depersonalization was assessed on the subscale of the Maslach Burnout Inventory. Respondents reported their attendance at each of six hospital supports that may serve to mitigate moral distress in frontline staff. Analyses compared outcomes across respondent characteristics and hierarchical linear regression evaluated individual, ICU, hospital, and regional effects. SETTING: Eligible ICUs were PICUs and level-3 neonatal ICUs in Canada. SUBJECTS: Eligible participants had worked in the participating ICU for more than 3 months. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: We identified 54 eligible ICUs from 31 hospitals. Forty-nine Canadian neonatal ICUs and PICUs (91%) contributed 2,852 complete responses for a 45.2% response rate. Most respondents were nurses (64.9%) or from a neonatal ICU (66.5%). The median and interquartile range Moral Distress Scale-Revised were 79 (52-113); 997 respondents (34.2%) had Moral Distress Scale-Revised scores greater than or equal to 100, and 234 respondents (8.3%) strongly agreed that work caused them significant moral distress. Nurses had a median (interquartile range) Moral Distress Scale-Revised score of 85 (57-121), 19 points higher than physicians and 8 points higher than respiratory therapists (p < 0.0001). Moral Distress Scale-Revised scores increased from 53 (35-79) for those working in ICU less than 1 year to 83 (54-120) in those working in ICU more than 30 years (p < 0.0001); 22.5% reported high degrees of depersonalization, which was associated with moral distress (p < 0.0001). Variability in Moral Distress Scale-Revised scores was explained by individual-level (92%), hospital-level (5%), and ICU-level effects (1%). Frequency of participation in potentially mitigating hospital supports had small effects (< 10 points) on mean Moral Distress Scale-Revised scores. CONCLUSIONS: Moral distress is common in clinicians working in ICUs for children. Addressing moral distress will require interventions tailored to individuals in higher-risk groups.
OBJECTIVE: To quantify moral distress in neonatal ICU and PICU clinicians and to identify associated factors. DESIGN: A national cross-sectional survey of clinicians working in an neonatal ICU or PICU. Moral distress was assessed with the Moral Distress Scale-Revised and by self-rating. Depersonalization was assessed on the subscale of the Maslach Burnout Inventory. Respondents reported their attendance at each of six hospital supports that may serve to mitigate moral distress in frontline staff. Analyses compared outcomes across respondent characteristics and hierarchical linear regression evaluated individual, ICU, hospital, and regional effects. SETTING: Eligible ICUs were PICUs and level-3 neonatal ICUs in Canada. SUBJECTS: Eligible participants had worked in the participating ICU for more than 3 months. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: We identified 54 eligible ICUs from 31 hospitals. Forty-nine Canadian neonatal ICUs and PICUs (91%) contributed 2,852 complete responses for a 45.2% response rate. Most respondents were nurses (64.9%) or from a neonatal ICU (66.5%). The median and interquartile range Moral Distress Scale-Revised were 79 (52-113); 997 respondents (34.2%) had Moral Distress Scale-Revised scores greater than or equal to 100, and 234 respondents (8.3%) strongly agreed that work caused them significant moral distress. Nurses had a median (interquartile range) Moral Distress Scale-Revised score of 85 (57-121), 19 points higher than physicians and 8 points higher than respiratory therapists (p < 0.0001). Moral Distress Scale-Revised scores increased from 53 (35-79) for those working in ICU less than 1 year to 83 (54-120) in those working in ICU more than 30 years (p < 0.0001); 22.5% reported high degrees of depersonalization, which was associated with moral distress (p < 0.0001). Variability in Moral Distress Scale-Revised scores was explained by individual-level (92%), hospital-level (5%), and ICU-level effects (1%). Frequency of participation in potentially mitigating hospital supports had small effects (< 10 points) on mean Moral Distress Scale-Revised scores. CONCLUSIONS: Moral distress is common in clinicians working in ICUs for children. Addressing moral distress will require interventions tailored to individuals in higher-risk groups.
Authors: Valerie Bailey; Dorothy M Beke; Jennifer M Snaman; Faraz Alizadeh; Sarah Goldberg; Melissa Smith-Parrish; Kimberlee Gauvreau; Elizabeth D Blume; Katie M Moynihan Journal: JAMA Netw Open Date: 2022-05-02
Authors: Naomi T Laventhal; Ratna B Basak; Mary Lynn Dell; Nanette Elster; Gina Geis; Robert C Macauley; Mark R Mercurio; Douglas J Opel; David I Shalowitz; Mindy B Statter; Douglas S Diekema Journal: J Pediatr Date: 2020-06-23 Impact factor: 4.406
Authors: Chiara Grasso; Davide Massidda; Karolina Zaneta Maslak; Cinzia Favara-Scacco; Francesco Antonio Grasso; Carmela Bencivenga; Valerio Confalone; Elisabetta Lampugnani; Andrea Moscatelli; Marta Somaini; Simonetta Tesoro; Giulia Lamiani; Marinella Astuto Journal: Int J Environ Res Public Health Date: 2022-03-24 Impact factor: 3.390