Moral distress in the neonatal intensive care unit: caregiver's experience

Abstract

Background: The Neonatal Intensive Care Unit (NICU) can be ethically charged, which can create challenges for health-care workers.Objective: To determine the frequency with which nurses and residents have experienced ethical confrontations and what factors are associated with increased frequency.Design/Methods: An anonymous questionnaire was distributed to nurses in a university center, a high-risk obstetric service, a maternity hospital NICU with 85% in-born patients and an outborn NICU, most of whose preterm admissions are those with surgical complications. Obstetric and pediatric residents in the four universities of the province also received the questionnaire, which included demographics, opinions regarding the gestational age threshold at which resuscitation of a premature infant with bradycardia was appropriate, knowledge of cerebral palsy (CP) outcomes (as an indicator of knowledge about long-term sequelae of prematurity) and questions about ethical confrontation in the NICU.Results: Two hundred and seventy-nine caregivers participated (115 full time nurses and 164 residents). All the distributed questionnaires were completed. Frequent ethical confrontation was reported by 35% of the nurses and 19% of the residents. Among the nurses, moral distress differed significantly between work environments. Nurses working in an out-born NICU and obstetric nurses were more likely to overestimate CP prevalence (P<0.05). Nurses who overestimated CP rates had higher thresholds for resuscitation and were more likely to experience ethical confrontations. Of the residents, 60% were pediatric and 40% obstetric. All groups of residents frequently overestimated the prevalence of CP, and knowledge differed significantly by residency program (P<0.05). The residents who overestimated CP rates had higher thresholds for resuscitation, had more incorrect answers regarding prematurity outcomes and were less likely to have ethical confrontations.Conclusions: A large proportion of nurses and residents report frequent ethical confrontations. Many residents and nurses have limited knowledge of outcomes and high threshold for resuscitation. Ethical confrontation is more common among nurses with poor knowledge about outcomes, and less common in residents with poor knowledge about outcomes.

Moral distress in the neonatal intensive care unit: an Italian study

“…[17][18][19] To our knowledge, studies investigating moral distress have mainly focused their attention on experiences of nurses working in acute adult inpatient settings, whereas only few studies, conducted on a relatively small number of subjects, have addressed this issue in the neonatal intensive care unit (NICU) area. 5,6,[20][21][22] Cavalieri et al 5 reported low-to-moderate mean scores of frequency, intensity and level of moral distress assessed in 94 nurses working in NICU. Yam et al 20 interviewed 10 nurses that reported ambivalent feelings when facing the step from the curative approach to palliative cares in NICU.…”

The challenge of integrating justice and care in neonatal nursing

“…10,11 A major aspect of nursing care is to promote confidence in the mothers for successfully taking over full responsibility of their infant's care. 12 Simultaneously, nurses may perceive themselves as the experts, 4 making the parents feel that the infant belongs to the hospital.…”

End-of-life care in a regional level IV neonatal intensive care unit after implementation of a palliative care initiative

“…Provider moral distress in the NICU is a welldescribed phenomenon. [35][36][37][38] Others have shown that palliative care educational interventions lead to an increase in nursing comfort levels in caring for dying infants in the NICU. 39 Also, lack of education has been identified as a barrier to the provision of end-of-life care in the NICU.…”