Moral Distress in the Italian PICUs: The Role of Individual and Organizational Factors*

Abstract

Of 874 eligible clinicians, 635 responded to the survey (75% response rate), and 612 correctly completed the survey. Clinicians were 74% female; 66% nurses and 34% physicians; and 51% had between 6 and 20 years of experience from graduation. INTERVENTION: None. MEASUREMENTS AND MAIN RESULTS:Clinicians completed the "Italian Moral Distress Scale-Revised, " the "Connor-Davidson Resilience Scale, " and a sociodemographic questionnaire inquiring about sex, profession, years of experience, and spiritual/religious belief. PICU organizational characteristics were also collected (e.g., number of admissions, mortality rate, nurse-patient ratio, presence of parents in PICU, presence of parents during physical examination). To identify individual predictors of moral distress, we used stepwise linear regression. To determine the impact of organizational factors on moral distress, we used analysis of covariance, controlling for those individual factors that emerged as significant in the regression model. Moral distress was associated with being a nurse (B = -0.094; p < 0.05) and not having spiritual/religious belief (B = 0.130; p < 0.01), but not with resilience. Clinicians working in PICUs with a medium number of admissions per year (between 264 and 468), a lower nurse:patient ratio (1:3), and where parents' presence during physical examination were never allowed experienced higher moral distress even controlling for profession and spiritual/religious belief. CONCLUSIONS:Organizational factors (medium number of admissions, lower nurse:patient ratio, and parental exclusion from physical examination) played a stronger role than individual factors in increasing moral distress. To decrease moral distress, attention should be paid also to organizational aspects.

Moral distress and ethical climate in pediatric oncology care impact healthcare professionals' intentions to leave

“…It is important to identify and provide support to these individuals that risk negative consequences of moral distress. While these healthcare professionals could be found in any professional group, evidence from previous observations 29 and the present findings suggest that they most likely are female nurses that have been working in pediatric healthcare for several years. One possible explanation might be nurses' role as frontline providers of care.…”

“…[26][27][28] An Italian study linked moral distress with low nurse-to-patient ratios, suggesting fewer patients per nurse to alleviate the problem. 29 According to Lamiani 29 some organizational factors may impact moral distress more than individual factors. Dryden-Palmer et al 30 found that moral distress varied more between hospitals, than between individual intensive care units within the hospital.…”

“…An Italian study linked moral distress with low nurse‐to‐patient ratios, suggesting fewer patients per nurse to alleviate the problem 29 . According to Lamiani 29 some organizational factors may impact moral distress more than individual factors. Dryden‐Palmer et al 30 .…”

Editor’s Choice Articles for April

“…In 2021 and 2022 we published research in this domain from the United States and Italy. An idea of content can be gleaned from the titles like “Relationship distress at home and burnout among…PICU nurses” in a U.S. report (9), with an editorial entitled “Collateral damage” (10); and, “Moral distress in Italian PICUs: the role of individual and organizational factors” (11), with an editorial entitled “…are healthcare organizations listening?” (12).…”

Moral Distress in Italian PICUs—Are Healthcare Organizations Listening?*

“…Although a family-centered approach in pediatric critical care is consistently recommended by professional organizations, the study by Lamiani et al (7) adds empirical data to what many advocate for as the most compassionate way to care for patients and families (11,12). The findings by Lamiani et al (7) highlight that parental presence may be of benefit to the providers as well. Interestingly, the authors did not identify an association between resilience and moral distress, which is inconsistent with previous literature demonstrating that higher resilience is typically protective (13).…”