The Relationship Between Providing Neonatal Palliative Care and Nurses' Moral Distress

Cavinder, Christina

doi:10.1097/anc.0000000000000100

Cited by 39 publications

(21 citation statements)

References 4 publications

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“…Most were fairly satisfied with the care, probably because of the care and attention given to the baby and family. Less satisfaction with the care provided was reported by one third of the professionals and might be related to insufficient educational and/or emotional support, stress related to communication with parents16 or disagreement with the decision to withhold treatment, which could generate moral distress 41. Our results may serve as the starting point of a collaborative project aimed at improving the education and organisation of DR staff.…”

Section: Discussionmentioning

confidence: 74%

Delivery room deaths of extremely preterm babies: an observational study

Durrmeyer

Scholer-Lascourrèges

Boujenah

et al. 2016

Arch Dis Child Fetal Neonatal Ed

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Section: Discussionmentioning

confidence: 74%

Delivery room deaths of extremely preterm babies: an observational study

Durrmeyer

Scholer-Lascourrèges

Boujenah

et al. 2016

Arch Dis Child Fetal Neonatal Ed

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“…An integrative review examining moral distress in NICU nurses around palliative care found that experiences of moral distress were variable (56). Factors associated with a higher level of moral distress included conflicts among care providers, lack of continuity of care, perceived futile care, false hope, and fluctuation in patients' clinical status.…”

Section: Education and Communicationmentioning

confidence: 99%

Moral Distress in the Neonatal Intensive Care Unit: What Is It, Why It Happens, and How We Can Address It

Mills

Cortezzo

2020

Front. Pediatr.

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Moral distress is prevalent in the neonatal intensive care unit (NICU), where decisions regarding end-of-life care, periviable resuscitation, and medical futility are common. Due to its origins in the nursing literature, moral distress has primarily been reported among bedside nurses in relation to the hierarchy of the medical team. However, it is increasingly recognized that moral distress may exist in different forms than initially described and that healthcare professions outside of nursing experience it. Advances in medical technology have allowed the smallest, sickest neonates to survive. The treatment for critically ill infants is no longer simply limited by the capability of medical technology but also by moral and ethical boundaries of what is right for a given child and family. Shared decision-making and the zone of parental discretion can inform and challenge the medical team to balance the complexities of patient autonomy against harm and suffering. Limited ability to prognosticate and uncertainty in outcomes add to the challenges faced with ethical dilemmas. While this does not necessarily equate to moral distress, subjective views of quality of life and personal values in these situations can lead to moral distress if the plans of care and the validity of each path are not fully explored. Differences in opinions and approaches between members of the medical team can strain relationships and affect each individual differently. It is unclear how the various types of moral distress uniquely impact each profession and their role in the distinctively challenging decisions made in the NICU environment. The purpose of this review is to describe moral distress and the situations that give rise to it in the NICU, ways in which various members of the medical team experience it, how it impacts care delivery, and approaches to address it.

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“…The highest proportions were in the coronary ICU (71.4%) and neonatal ICU (70.6%), while the lowest were in the surgical-trauma-burn ICU (37.5%) and thoracic-cardiovascular ICU (46.2%). Additionally, 23.1% of respondents from the thoracic-cardiovascular ICU rated this domain as not important or only somewhat important.…”

Section: Resultsmentioning

confidence: 99%

Critical Care Nurses' Perceptions about Palliative Care and Moral Distress: Implications for Practice

Wolf

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Background: As the need for palliative care in the intensive care unit becomes increasingly recognized, it is unknown how gaps and variations in palliative care education and utilization are associated with the moral distress of critical care nurses. Purpose: To examine critical care nurses' perceived knowledge of palliative care, examine their recent experiences of moral distress, and explore how these variables may be related. Design: Quantitative, descriptive study design. Methods: Survey questionnaires were distributed to 517 critical care nurses across seven intensive care units at an academic medical center in central Virginia. Validated instruments were used to measure participants' perceptions, beliefs, and experiences with palliative care in their practice setting and their recent experiences of moral distress. Results: A total of 168 surveys were returned (response rate = 32.5%), of which 167 were analyzed. Each palliative care domain was rated highly important by a majority of respondents, but fewer than 40% of respondents reported being highly competent in any domain, with the lowest proportions rating themselves highly competent in knowledge of advance directives, assessing patient-family support and resources, and self-care. Most respondents reported little to no recent preparation in palliative care, with 38% reporting no palliative care education in the past two years. Most respondents reported some degree of moral distress during the study period, and there were significant differences in moral distress level based on perceived utilization of palliative care services (F = 3.02, p = .03). Respondents who reported palliative care services being more frequently utilized appropriately tended to experience lower levels of moral distress during the study period. A small, significant inverse correlation was found between moral distress levels and self-care, resilience, recognizing/managing stress, grief, and PALLIATIVE CARE AND MORAL DISTRESS 3 moral distress, indicating that respondents who felt less competent in this domain experienced greater moral distress during the study period. Conclusion: Palliative care knowledge gaps and moral distress remain highly prevalent in critical care nurses. Health system leaders and educators must improve and expand opportunities for nurses to become more competent in palliative care and how to cope with situations that may lead to moral distress, and empower nurses as leaders and advocates to reduce barriers to palliative care.

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The Relationship Between Providing Neonatal Palliative Care and Nurses' Moral Distress

Cited by 39 publications

References 4 publications

Delivery room deaths of extremely preterm babies: an observational study

Delivery room deaths of extremely preterm babies: an observational study

Moral Distress in the Neonatal Intensive Care Unit: What Is It, Why It Happens, and How We Can Address It

Critical Care Nurses' Perceptions about Palliative Care and Moral Distress: Implications for Practice

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The Relationship Between Providing Neonatal Palliative Care and Nurses' Moral Distress

Cited by 39 publications

References 4 publications

Delivery room deaths of extremely preterm babies: an observational study

Delivery room deaths of extremely preterm babies: an observational study

Moral Distress in the Neonatal Intensive Care Unit: What Is It, Why It Happens, and How We Can Address It

Critical Care Nurses&#39; Perceptions about Palliative Care and Moral Distress: Implications for Practice

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Critical Care Nurses' Perceptions about Palliative Care and Moral Distress: Implications for Practice