PICU clinicians report moral distress, ethical concerns

Nov. 3, 2021

A new study published in American Journal of Critical Care found high rates of moral distress among pediatric critical care professionals during initial surge of COVID-19 pandemic.

During the initial surge of COVID-19 in the United States, pediatric critical care professionals were already experiencing high rates of moral distress as they faced the rapid emergence of complex ethical challenges and the potential impact of COVID-19 on their young patients and their communities, according to a study published in the American Journal of Critical-Care.

“COVID-19 and Moral Distress: A Pediatric Critical Care Survey” reports the results of an exploratory survey of pediatric critical care professionals conducted in April and May 2020. The survey was sent to the Pediatric Acute Lung Injury and Sepsis Investigators (PALISI) research network of pediatric intensive care units (PICUs) in North America, and 337 participants responded. Nearly half were physicians and advanced practice providers, with nurses, respiratory therapists and other professionals constituting 26.4%, 15.7% and 8.9% respectively.

A total of 85.8% of respondents reported that they were experiencing varying degrees of moral distress. A similar number reported that after facing a challenging ethical situation, lingering distress continued to weigh them down.

Among the findings:

  • Although respondents were not confronting firsthand the same magnitude of morbidity and mortality as colleagues caring for adult patients, they were nonetheless experiencing direct or anticipatory moral distress.
  • Nurses had higher degrees of moral distress than other professional groups.
  • Challenges to their professional integrity during the pandemic was the main cause of moral distress for respondents.
  • Despite these challenges, healthcare professionals had the capacity to be morally resilient.

The qualitative data analysis revealed five key themes associated with moral distress, including psychological safety, expectations of leadership, connectedness through a moral community, professional identity challenges and professional versus social responsibility. The results illuminate how clinicians often struggled to maintain their professional identities, roles, expectations and collegial relationships during the initial surge of the pandemic.

The findings also support calls for organizations to foster healthy work environments and build a culture of psychological safety in which healthcare professionals can voice concerns without fear of retaliation or censure.

AACN press release

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