Abstract
Moral distress is ubiquitous in PICU settings, impacting team members from all different disciplines. Distress arises from the critical nature of the patient’s illness, with many children facing either death or living with life-long disability. Values used for decision making vary widely among patients’ families and multiple team members, leading to tension about “right” and “wrong”. Additionally, differences in experiences among parties contribute to difficulty arriving at conclusions along the same timeline. Although many know when they feel moral distress, it can be difficult to define. This chapter examines current thinking about moral distress, how it may arise from questions surrounding ethical permissibility of treatments and variations in values. Moral distress can impact clinical care and the well-being of healthcare professionals, leading to burnout. Strategies on mitigating moral distress are offered, although recognizing some degree of distress should be expected and may be beneficial.
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References
Burns, J.P., et al. 2014. Epidemiology of death in the PICU at five U.S. teaching hospitals. Critical Care Medicine 42 (9): 2101–2108.
Catlin, A., et al. 2008. Conscientious objection: A potential neonatal nursing response to care orders that cause suffering at the end of life? Study of a concept. Neonatal Network 27 (2): 101–108.
Crippen, D. 2016. Moral distress in medicine: Powerlessness by any other name. Journal of Critical Care 31 (1): 271–272.
Dewa, C.S., et al. 2017. The relationship between physician burnout and quality of healthcare in terms of safety and acceptability: A systematic review. British Medical Journal Open 7 (6): e015141.
Dzeng, E., and J.R. Curtis. 2018. Understanding ethical climate, moral distress, and burnout: A novel tool and a conceptual framework. BMJ Quality & Safety 27 (10): 766–770.
Epstein, E.G., and S. Delgado. 2010. Understanding and addressing moral distress. The Online Journal of Issues in Nursing 15(3).
Epstein, E.G., and A.B. Hamric. 2009. Moral distress, moral residue, and the crescendo effect. Journal of Clinical Ethics 20 (4): 330–342.
Field, D., J. Deeming, and L.K. Smith. 2016. Moral distress: An inevitable part of neonatal and paediatric intensive care? Archives of Disease in Childhood 101 (8): 686–687.
Freudenberger, H.J., and G. Richelson. 1980. Burn-out: The high cost of high achievement. 1st ed. xxii, 214 p. Garden City, N.Y.: Anchor Press.
Fumis, R.R.L., et al. 2017. Moral distress and its contribution to the development of burnout syndrome among critical care providers. Annals of Intensive Care 7 (1): 71.
Hartman, M.L., et al. 2016. Salivary biomarkers in pediatric metabolic disease research. Pediatric Endocrinology Reviews 13 (3): 602–611.
Hirschman, A.O. 1970. Exit, voice, and loyalty: Responses to decline in firms, organizations, and states. Cambridge: Harvard University Press.
Jameton, A. 1984. Nursing practice: The ethical issues. Englewood Cliffs, NJ: Prentice Hall.
Jameton, A. 1990. Culture, mortality, and ethics. Twirling the spindle. Critical Care Nursing Clinics of North America 2 (3): 443–451.
Kelly, B. 1998. Preserving moral integrity: A follow-up study with new graduate nurses. Journal of Advanced Nursing 28 (5): 1134–1145.
Larson, C.P., et al. 2017. Moral distress in PICU and neonatal ICU practitioners: A cross-sectional evaluation. Pediatric Critical Care Medicine 18 (8): e318–e326.
Maslach, C., and S.E. Jackson. 1986. Maslach burnout inventory: Manual. 2nd ed. v, 34 p. Palo Alto, Calif. (577 College Ave., Palo Alto 94306): Consulting Psychologists Press.
Maslach, C., S.E. Jackson, and M.P. Leiter. 1996. Maslach burnout inventory manual. 3rd ed. iv, 52 p. Palo Alto, Calif. (577 College Ave., Palo Alto 94306): Consulting Psychologists Press.
Peter, E. 2013. Advancing the concept of moral distress. Journal of Bioethical Inquiry 10 (3): 293–295.
Prentice, T., et al. 2016. Moral distress within neonatal and paediatric intensive care units: A systematic review. Archives of Disease in Childhood 101 (8): 701–708.
Schuklenk, U. 2015. Conscientious objection in medicine: Private ideological convictions must not supercede public service obligations. Bioethics 29 (5): ii–iii.
Shanafelt, T.D., et al. 2010. Burnout and medical errors among American surgeons. Annals of Surgery 251 (6): 995–1000.
Stahl, R.Y., and E.J. Emanuel. 2017. Physicians, not conscripts—Conscientious objection in health care. New England Journal of Medicine 376 (14): 1380–1385.
Thomas, T.A., et al. 2016. A qualitative study exploring moral distress among pediatric resuscitation team clinicians: Challenges to professional integrity. Pediatric Critical Care Medicine 17 (7): e303–e308.
Watson, R.S., et al. 2017. Epidemiology and outcomes of pediatric multiple organ dysfunction syndrome. Pediatric Critical Care Medicine 18 (3_suppl Suppl 1): S4–S16.
Wicclair, M. 2017. Conscientious objection in healthcare and moral integrity. Cambridge Quarterly of Healthcare Ethics 26 (1): 7–17.
Wocial, L., et al. 2017. Pediatric Ethics and Communication Excellence (PEACE) rounds: Decreasing moral distress and patient length of stay in the PICU. HEC Forum 29 (1): 75–91.
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Miller-Smith, L., Finnsdóttir Wagner, Á., Lantos, J.D. (2019). Moral Distress in the PICU. In: Bioethics in the Pediatric ICU: Ethical Dilemmas Encountered in the Care of Critically Ill Children. International Library of Ethics, Law, and the New Medicine, vol 77. Springer, Cham. https://doi.org/10.1007/978-3-030-00943-4_10
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DOI: https://doi.org/10.1007/978-3-030-00943-4_10
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