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.

our journey, we have learned considerable lessons and often discovered that there were questions that we would have benefitted from asking earlier. CONCLUSIONS:This presentation will articulate some of these questions and invite participants to consider adding beautiful questions to wider planning conversations for new and sustainable PICU services and Child Critical Care training programmes

Objectives: Discharging a child home on long term ventilation (LTV) via tracheostomy is complex and involves multiple healthcare providers across healthcare sectors. To date, patient and family feedback of a newly developed LTV discharge pathway has been anecdotal. Our objective was to explore the perceptions of family caregivers (FCs) that have completed the LTV pathway to home with respect to their: (1) experience with transitions across the pathway (2) perceptions of competency attainment and, (3) viewed opportunities for improvement. Methods: We conducted 11 semi structured interviews with FCs. Interviews focused on FCs experience with the training process, perception of competency from a knowledge and skill perspective and opportunities for improvement. Interviews were audiotaped, transcribed verbatim, coded and analyzed using an inductive thematic analysis approach. Results: Eight mothers and 3 fathers of 10 children participated. Six primary themes were identified: 1) making an informed decision, 2) transitioning to rehabilitation, 3) building capacity for self-care, 4) coordinating case management, 5) readying for discharge home and, 6) experiencing home care. Conclusion: Overall, FCs felt that the preparation and transition support obtained through the application of a standardized LTV discharge pathway allowed successful attainment of new knowledge and skills necessary to care for their child with LTV at home.

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BACKGROUND AND AIM:To determine whether the intravenous administration of Thiamine, Vitamin C, and Vitamin B12 in patients with septic shock leads to a more rapid resolution of septic shock and reduces the mortality compared to standard care alone METHOD: Patients were randomised to the intervention group (n = 59), consisting of intravenous thiamine (100 mg every 12 hours), vitamin C (every 6 hours), Vitamin B12(every 24hours) and to the control group (n = 61), consisting of standard treatment alone till 3days. The primary trial outcome was ICU mortality and 28day vasopressor free days. 8 secondary outcomes were prespecified, including change in SOFA score and lactate on day3.RESULTS: Among 267 patients who were eligible for the study, 147 patients were excluded, and 120 patients were randomized. 28-day vasopressor-free days were a median of 27 days (IQR, 25-27 days) in the intervention group and 26 days (IQR, 0-27 days) in the control group, with a median difference of −1day (P =.85). ICU mortality was 16/69(27.1%) in intervention group and 22/61(36.1%) in control group value (p 0.292). Change in SOFA on Day 3 was 3 with IQR (1 to 4) in the intervention group and 2 with IQR (1 to 4) in control group (P 0.019). CONCLUSIONS:In children with severe sepsis and septic shock, treatment with intravenous Thiamine, vitamin C, and vitamin B12, compared with standard treatment alone, did not significantly improve the ICU mortality and 28day vasopressor free days.

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