Goals of Care Discussions and Moral Distress Among Neonatal Intensive Care Unit Staff

Guttmann, Katherine; Flibotte, John; Seitz, Holli H.; Huber, Matthew; DeMauro, Sara B.

doi:10.1016/j.jpainsymman.2021.01.124

Cited by 15 publications

(13 citation statements)

References 16 publications

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“…and, therefore, the heterogeneity of the associated ethical issues. It is also crucial to consider other “individual” factors, such as those related to the emotional intelligence [ 84 ] and work–life balance of the professional [ 78 ], “contextual” factors (e.g., family perspectives) [ 85 ], and “organizational” factors. Such an approach would help to identify those individuals most at risk of developing MD and burnout [ 23 , 86 ] and to investigate the complex interplay between these variables.…”

Section: Discussionmentioning

confidence: 99%

Moral Distress and Burnout in Neonatal Intensive Care Unit Healthcare Providers: A Cross-Sectional Study in Italy

Carletto

Ariotti

Garelli³

et al. 2022

IJERPH

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Moral distress (MD) in healthcare providers is widely recognized as a serious issue in critical care contexts. It has the potential to have negative impacts on both personal and professional wellbeing, the quality of care provided and staff turnover. The aim of this study was to investigate the relationship between MD and burnout among neonatal intensive care unit (NICU) healthcare professionals and identify the possible factors associated with its occurrence. Participants were asked to complete an online survey, which covered sociodemographic and professional information and included two self-report questionnaires (Italian Moral Distress Scale-Revised and Maslach Burnout Inventory). The sample comprised 115 healthcare providers (nurses and physiotherapists: 66.1%; physicians: 30.4%; healthcare assistants: 3.5%) working in four NICUs located within the province of Turin, Italy. The results revealed overall low levels of MD, with no significant differences between nurses/physiotherapists and physicians. Nurses/physiotherapists showed a statistically significant higher percentage of personal accomplishment burnout (32.9%) compared with physicians (8.6%; p = 0.012). MD was associated with the emotional exhaustion dimension of burnout. Spirituality and/or religiousness was shown to be a moderating variable. Further research is needed to deepen our understanding of the correlation between MD and burnout and the role of spirituality and/or religiousness as moderators.

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Section: Discussionmentioning

confidence: 99%

Moral Distress and Burnout in Neonatal Intensive Care Unit Healthcare Providers: A Cross-Sectional Study in Italy

Carletto

Ariotti

Garelli³

et al. 2022

IJERPH

View full text Add to dashboard Cite

show abstract

“…Clinicians may struggle to discuss goals of care with parents in the Neonatal Intensive Care Unit (NICU) and may view key elements of such conversations differently. We previously described the relationship between components of goals‐of‐care discussions and change in moral distress following goals‐of‐care discussions 1 . With the analysis described here, we sought to determine how providers who participated in the same goals‐of‐care discussion viewed key discussion elements in comparison with other provider participants.…”

Section: Item From the Williams Instrument Per Cent Agreementmentioning

confidence: 99%

“…Understanding differences and concordance in perceptions may help to (1) understand the quality of goals-of-care discussions, (2) improve metrics of communication quality and (3) inform the development of targeted interventions to improve communication quality.…”

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confidence: 99%

Provider concordance regarding elements of goals‐of‐care discussions in neonatal intensive care

2021

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Clinicians may struggle to discuss goals of care with parents in the Neonatal Intensive Care Unit (NICU) and may view key elements of such conversations differently. We previously described the relationship between components of goals-of-care discussions and change in moral distress following goals-of-care discussions. 1 With the analysis described here, we sought to determine how providers who participated in the same goals-of-care discussion viewed key discussion elements in comparison with other provider participants.

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“…[7][8][9] Among clinicians caring for these complex patients, emotional and moral distress are well described. [10][11][12][13][14] Moral distress is the resultant emotional disturbance when a practitioner wishes to care for a patient in a certain way (i.e., "do the right thing") but cannot. 15 Moral distress can stem from varied reasons, including perceived futility, perceived poor patient care, and, in the case of children with prolonged ICU stays, from an inability to meet their needs for continuity of care, appropriate developmental stimulation, and chronic illness management due to the acute-care focus of PICU care.…”

Section: Introductionmentioning

confidence: 99%

Distress and the Long-Stay Pediatric Intensive Care Unit Admission: A Longitudinal Study of Parents and the Medical Team

Salant

Gangopadhyay

Jia

et al. 2021

J Pediatr Intensive Care

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Prolonged critical illness in children has emotional consequences for both parents and providers. In this observational cohort study, we longitudinally surveyed anxiety and depression in parents and moral distress in pediatric intensive care unit (PICU) providers (attendings, fellows, and bedside registered nurses) and explored their trajectories and relationships. Anxiety/depression and provider moral distress were measured using the Hospital Anxiety and Depression Scale and the Moral Distress Thermometer, respectively. The relationships of parental and provider distress were evaluated using Spearman's correlations, and their trajectories and potentially associated variables were explored using quadratic random slope and intercept models. Predetermined associated factors included demographic and clinical factors, including parent psychosocial risk and intubation status. We found parental anxiety and depression decreased over their child's admission, and parental psychosocial risk was significantly associated with anxiety (coefficient = 4.43, p < 0.001). Clinicians in different roles had different mean levels and trajectories of moral distress, with fellows reporting greater distress early in admissions and nurses later in admissions. Parental anxiety/depression and provider distress were significantly, though moderately, correlated. We conclude that anxiety and depression in parents of children with prolonged PICU admissions and the moral distress of their clinicians correlate and vary over time and by provider role.

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Goals of Care Discussions and Moral Distress Among Neonatal Intensive Care Unit Staff

Cited by 15 publications

References 16 publications

Moral Distress and Burnout in Neonatal Intensive Care Unit Healthcare Providers: A Cross-Sectional Study in Italy

Moral Distress and Burnout in Neonatal Intensive Care Unit Healthcare Providers: A Cross-Sectional Study in Italy

Provider concordance regarding elements of goals‐of‐care discussions in neonatal intensive care

Distress and the Long-Stay Pediatric Intensive Care Unit Admission: A Longitudinal Study of Parents and the Medical Team

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