Moral distress among neonatologists working in neonatal intensive care units in Greece: a qualitative study

Abstract

Background Working as a neonatologist in a neonatal intensive care unit (NICU) is stressful and involves ethically challenging situations. These situations may cause neonatologists to experience high levels of moral distress, especially in the context of caring for extremely premature infants (EPIs). In Greece, moral distress among neonatologists working in NICUs remains understudied and warrants further exploration. Methods This prospective qualitative study was conducted from March to August 2022. A combination of purposive and snowball sampling was used and data were collected by semi-structured interviews with twenty neonatologists. Data were classified and analyzed by thematic analysis approach. Results A variety of distinct themes and subthemes emerged from the analysis of the interview data. Neonatologists face moral uncertainty. Furthermore, they prioritize their traditional (Hippocratic) role as healers. Importantly, neonatologists seek third-party support for their decisions to reduce their decision uncertainty. In addition, based on the analysis of the interview data, multiple predisposing factors that foster and facilitate neonatologists’ moral distress emerged, as did multiple predisposing factors that are sometimes associated with neonatologists’ constraint distress and sometimes associated with their uncertainty distress. The predisposing factors that foster and facilitate neonatologists’ moral distress thus identified include the lack of previous experience on the part of neonatologists, the lack of clear and adequate clinical practice guidelines/recommendations/protocols, the scarcity of health care resources, the fact that in the context of neonatology, the infant’s best interest and quality of life are difficult to identify, and the need to make decisions in a short time frame. NICU directors, neonatologists’ colleagues working in the same NICU and parental wishes and attitudes were identified as predisposing factors that are sometimes associated with neonatologists’ constraint distress and sometimes associated with their uncertainty distress. Ultimately, neonatologists become more resistant to moral distress over time. Conclusions We concluded that neonatologists’ moral distress should be conceptualized in the broad sense of the term and is closely associated with multiple predisposing factors. Such distress is greatly affected by interpersonal relationships. A variety of distinct themes and subthemes were identified, which, for the most part, were consistent with the findings of previous research. However, we identified some nuances that are of practical importance. The results of this study may serve as a starting point for future research.

Extending the concept of moral distress to parents of infants hospitalized in the NICU: A Greek qualitative study

“…It is true that "parents are generally not informed about the evidence regarding the quality of life of surviving infants" [44]. Note, however, that the quality of life of a premature infant hospitalized in the NICU can hardly be conceived without vagueness [45]. Furthermore, Saigal et al concluded that "at young adulthood, health-related quality of life was not related to size at birth or to the presence of disability" [46].…”

Uncertainty and the NICU Experience: A Qualitative Evaluation of Family and Provider Perspectives

“…Provider uncertainty in the NICU is a prevalent aspect of the healthcare environment. Prognostic uncertainty emerged as a key factor associated with moral distress among neonatologists in a prospective qualitative study conducted to study moral distress among neonatologists working in a NICU [8]. By understanding the intricacies of uncertainty, researchers, healthcare providers, and support systems can develop tailored interventions, resources, and strategies to help individuals navigate uncertainty more effectively.…”

Correction: Moral distress among neonatologists working in neonatal intensive care units in Greece: a qualitative study

“…Following the publication of the original article [ 1 ], the authors omitted to include the funder in the Funding statement. The online version of this article has been updated to reflect the correct declarations.…”