Originally published by 2 Minute Medicine® (view original article). Reused on AccessMedicine with permission.

1. Moral distress was experienced by clinicians on 15% of survey occasions, with 91% of neonates eliciting moral distress.

2. The most common reason for moral distress was due to baby-centered reasons (83%), such as disproportionate care and illness severity.

Evidence Rating Level: 3 (Average)

Study Rundown:

Moral distress may be experienced by clinicians who are asked to provide care they believe are not in the patient’s best interests. The neonatal intensive care unit (NICU) presents a challenging environment for clinicians due to the medical complexity and degree of illness of the patients. The aim of the current study was to evaluate longitudinal moral distress experienced by clinicians in the NICU caring for preterm infants while considering patient, team, and family factors. In this study, across 4593 surveys completed for 99 neonates, moral distress was experienced on 15% of occasions. The intensity of moral distress did not vary depending on the clinical time point of neonates, however the frequency of moral distress decreased across time points. The most common reason for moral distress was due to baby-centered reasons, such as illness severity, and the perception that the clinician was “doing too much.” Compared to residents and nurses, neonatologists reported less moral distress. The generalization of this study may be limited, as the study involved two hospitals and respondents were 91% female. However, this study demonstrates that longitudinal moral distress is highly individualized and dependent on the clinical course of each neonate, and although most neonates do generate some reports of moral distress, they are not sustained over time.

In-Depth [survey]:

Moral distress was evaluated at two tertiary NICUs in Melbourne, Australia for a period of 18 months. In total, 99 neonates born <28 weeks were followed until either discharge or death. Moral distress was surveyed on designated data collection days, with a total of 4593/5332 surveys (86%) completed across 525 clinicians (neonatologists, fellows, residents and nurses). Moral distress that was rated >6/10 prompted 50% of clinicians to explain the reasoning for indicating moral distress in open-text format. In total, the five main themes for moral distress included baby-centered reasons (83%), management plans (26%), family-centered reasons (19%), parental decision-making (16%) and provider-centered reasons (15%). Neonatologists reported fewer morally distressing experiences (6.4%), and fellows reported the highest number of experiences (19.6%). Across neonates, there was wide variation in the number of reports of moral distress, and 92% of neonates generated at least one report. There were few disagreements on preferred level of care across clinicians, as well as between clinicians and family.

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