Moral distress in the neonatal intensive care unit: an Italian study

Sannino, Patrizio; Gianni, M.C.; Re, Luca Giuseppe; Lusignani, Maura

doi:10.1038/jp.2014.182

Cited by 36 publications

(49 citation statements)

References 21 publications

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“…In common with the adult nursing literature, moral distress within NICUs and PICUs most commonly results from disproportionate interventions perceived to not be in the child's best interests,11 17 19 often within a negative ethical climate. With an increasing reliance on life-sustaining technology within intensive care, moral distress is a significant issue for healthcare professionals working in these environments.…”

Section: Discussionmentioning

confidence: 99%

Moral distress within neonatal and paediatric intensive care units: a systematic review

et al. 2016

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ObjectiveTo review the literature on moral distress experienced by nursing and medical professionals within neonatal intensive care units (NICUs) and paediatric intensive care units (PICUs).DesignPubmed, EBSCO (Academic Search Complete, CINAHL and Medline) and Scopus were searched using the terms neonat*, infant*, pediatric*, prematur* or preterm AND (moral distress OR moral responsibility OR moral dilemma OR conscience OR ethical confrontation) AND intensive care.Results13 studies on moral distress published between January 1985 and March 2015 met our inclusion criteria. Fewer than half of those studies (6) were multidisciplinary, with a predominance of nursing staff responses across all studies. The most common themes identified were overly ‘burdensome’ and disproportionate use of technology perceived not to be in a patient's best interest, and powerlessness to act. Concepts of moral distress are expressed differently within nursing and medical literature. In nursing literature, nurses are often portrayed as victims, with physicians seen as the perpetrators instigating ‘aggressive care’. Within medical literature moral distress is described in terms of dilemmas or ethical confrontations.ConclusionsMoral distress affects the care of patients in the NICU and PICU. Empirical data on multidisciplinary populations remain sparse, with inconsistent definitions and predominantly small sample sizes limiting generalisability of studies. Longitudinal data reflecting the views of all stakeholders, including parents, are required.

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Section: Discussionmentioning

confidence: 99%

Moral distress within neonatal and paediatric intensive care units: a systematic review

et al. 2016

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“…() reported high levels of moral distress in the former setting, whereas Sannino et al . () found relatively low levels in the latter.…”

Section: Introductionmentioning

confidence: 89%

Moral distress among nurses in medical, surgical and intensive-care units

Lusignani

Giannì

et al. 2016

J Nurs Manag

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“…In recent years, the concept of moral distress has rightly received a great deal of attention. [24][25][26][27][28] It occurs among caregivers who, without meaningful participation in the decisions to proceed, must execute the orders for aggressive, perhaps uncomfortable, expensive care for patients in whom they believe such care to be futile. As others have previously published, the consequences of moral distress are potentially devastating to the individual caregiver, but damage to the programme should not be underestimated.…”

Section: Discussionmentioning

confidence: 99%

Variabilities in the mortality-related resource utilisation for congenital heart disease

2016

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ObjectiveOur objective was to characterise the divergence of effort from outcome in congenital heart disease (CHD) care by measuring mortality-related resource utilisation fraction (MRRUF) for various CHD lesions across institutions of differing volumes.MethodsStudy design was observational analysis of an administrative database, the Pediatric Health Information System (PHIS). The setting was inpatient; 2004–2013. Patients were ≤21 years old with atrial septal defect (ASD), ventricular septal defect (VSD), tetralogy of Fallot (TOF), hypoplastic left heart syndrome (HLHS) or other single ventricle (SV). There were no interventions but diagnosis, institution (and volume), age, length of hospitalisation, billed charges and deaths were recorded. The main outcome measure was MRRUF, the ratio of investments during hospitalisations ending in fatality to investments during all hospitalisations.ResultsThere were 50 939 admissions, 1711 deaths, 703 383 inpatient days, and $10 182 000 000 billed charges. MRRUF varied widely by diagnosis: highest in HLHS (21%), but present in ASD (2%) and VSD (4%). Highest among the very young, MRRUF also increased in HLHS and SV during adolescence. MRRUF increased with hospitalisation duration. MRRUF had no relation to institutional volume, and was static over the decade studied.ConclusionsEven in the modern era we invest heavily in inpatient CHD care that does not produce the desired outcome. Although its magnitude varies by lesion and age, MRRUF is not limited to complex disease in the very young. MRRUF is not decreasing, and is not isolated to high or low volume institutions.

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Moral distress in the neonatal intensive care unit: an Italian study

Abstract: The present study provides further insight into the moral distress experienced by nurses working in Italian NICUs.

Cited by 36 publications

References 21 publications

Moral distress within neonatal and paediatric intensive care units: a systematic review

Moral distress within neonatal and paediatric intensive care units: a systematic review

Moral distress among nurses in medical, surgical and intensive-care units

Variabilities in the mortality-related resource utilisation for congenital heart disease

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