Background
Although use of mechanical circulatory support is increasing, it is unclear how providing such care affects clinicians’ moral distress.
Objective
To measure moral distress among intensive care unit clinicians who commonly care for patients receiving mechanical circulatory support.
Methods
In this prospective study, the Moral Distress Scale-Revised was administered to physicians, nurses, and advanced practice providers from 2 intensive care units in an academic medical center. Linear regression was used to assess whether moral distress was associated with clinician type, burnout, or desire to leave one’s job. Clinicians’ likelihood of reporting frequent moral distress when caring for patients receiving mechanical circulatory support vs other critically ill patients also was assessed.
Results
The sample comprised 102 clinicians who had a mean (SD) score of 100.5 (51.6) on the Moral Distress Scale- Revised. After adjustment for clinician characteristics, moral distress was significantly higher in registered nurses than physicians/advanced practice providers (115.9 vs 71.0, P < .001), clinicians reporting burnout vs those who did not (114.7 vs 83.1, P = .003), and those considering leaving vs those who were not (121.1 vs 89.2, P = .001). Clinicians were more likely to report experiencing frequent moral distress when caring for patients receiving mechanical circulatory support (26.5%) than when caring for patients needing routine care (10.8%; P = .004), but less likely than when caring for patients with either chronic critical illness (57.8%) or multisystem organ failure (56.9%; both P < .001).
Conclusion
Moral distress was high among clinicians who commonly care for patients receiving mechanical circulatory support, suggesting that use of this therapy may affect well-being among intensive care unit clinicians.
While this research is an observation of only one set of applicants to one residency program, if the findings are applicable to other programs and specialties, that suggests that medical schools and residency program directors should develop methods for increasing competency awareness among medical students.
There are many indications for the use of echocardiography in the critically ill and little consensus about how best to provide training for intensivists in its use. There are a profusion of opinions, courses and accreditation pathways available for training in the UK. The National Point of Care Ultrasound working group aims to facilitate learning and training in both echocardiography and ultrasound. In this article, an intermediate level of training suitable for most general UK-based intensivists, that provides more depth than focused resuscitation-based protocols but less depth than British Society of Echocardiography accreditation pathways, is proposed which, if endorsed by Royal Colleges and specialist societies, could be developed into a viable national training programme within five years.
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