An Overview of Moral Distress and the Paediatric Intensive Care Team

Abstract

A summary of the existing literature related to moral distress (MD) and the paediatric intensive care unit (PICU) reveals a high-tech, high-pressure environment in which effective teamwork can be compromised by MD arising from different situations related to: consent for treatment, futile care, end-of-life decision making, formal decision-making structures, training and experience by discipline, individual values and attitudes, and power and authority issues. Attempts to resolve MD in PICUs have included the use of administrative tools such as shift worksheets, the implementation of continuing education, and encouragement to report. The literature does not yet show these approaches to be effective in the resolution of MD. The need to acknowledge MD among PICU teams is discussed and an argument made that, to facilitate understanding among team members, practice stories need to be shared.

Moral Distress Amongst American Physician Trainees Regarding Futile Treatments at the End of Life: A Qualitative Study

“…12,13 Several qualitative studies on nurses have demonstrated that moral distress is associated with provision of treatments perceived to be overly aggressive and non-beneficial to patients. 10,14,15 While there have been theoretical discussions on moral distress experienced by physicians, there have only been a small number of empirical studies demonstrating moral distress in U.S. physicians, the majority of which have focused on physicians as members of larger interdisciplinary teams. 12,16,17 To our knowledge, there are no studies that describe the physician or physician trainee experience surrounding moral distress associated with end of life care in the United States.…”

Moral distress: challenges for an autonomous nursing professional practice

“…In general, most studies suggest that moral distress makes a big impact on the lives of the nursing professionals. Qualitatively, feelings of anger and sadness are the most cited ones in the literature as psychosocial effects caused by moral distress -introspection being the main characteristic (10) .…”

Recognizing and Alleviating Moral Distress Among Obstetrics and Gynecology Residents

“…1 Moral distress after clinical encounters, along with moral dilemmas, has been implicated in emotional distress, unsafe or poor-quality patient care, reduced job satisfaction, and attrition in nursing. [2][3][4][5][6] An extensive literature identifies the ''difficult'' patient and common characteristics and behaviors that compromise the therapeutic relationship, such as social class, occupation or employment status, appearance, age, cleanliness, and attire. [7][8][9][10][11] Previous studies confirm the characterizations of difficult patients and, more broadly, difficult clinical encounters.…”