Moral distress: Developing strategies from experience.
BACKGROUND
Moral distress was first described by Jameton in 1984, and has been defined as distress experienced by an individual when they are unable to carry out what they believe to be the right course of action because of real or perceived constraints on that action. This complex phenomenon has been studied extensively among healthcare providers, and intensive care professionals in particular report high levels of moral distress. This distress has been associated with provider burnout and associated consequences such as job attrition, with potential impacts on patient and family care. There is a paucity of literature exploring how middle and late career healthcare providers experience and cope with moral distress.


OBJECTIVES
We explore the experience of moral distress and the strategies and resources invoked to mitigate that distress in mid- and late-career healthcare providers practicing in paediatric intensive care, in order to identify ways in which the work environment can build a culture of moral resilience.


RESEARCH DESIGN
An exploratory, qualitative quality improvement project utilizing focus group and semi-structured interviews with pediatric intensive care front-line providers.


PARTICIPANTS
Mid-and-later career (10 + years in practice) pediatric intensive care front line providers in a tertiary pediatric hospital.


RESEARCH CONTEXT
This work focuses on paediatric intensive care providers in a single critical care unit, in order to explore the site-specific perspectives of health care providers in that context with respect to moral distress coping strategies.


ETHICAL CONSIDERATIONS
The study was approved by the Quality Management Office at the institution; consent was obtained from participants, and no identifying data was included in this project.


FINDINGS
Participants endorsed perspective-building and described strategies for positive adaptation including; active, reflective and structured supports. Participants articulated interest in enhanced and accessible formal supports.


DISCUSSION
Findings in this study resonate with the current literature in healthcare provider moral distress, and exposed ways in which the work environment could support a culture of moral resilience. Avenues are described for the management and mitigation of moral distress in this setting.


CONCLUSION
This exploratory work lays the groundwork for interventions that facilitate personal growth and meaning in the midst of moral crises in critical care practice.
['Helmers|Andrew|A|https://orcid.org/0000-0002-2935-9522', 'Palmer|Karen Dryden|KD|', 'Greenberg|Rebecca A|RA|']
D000223:Adaptation, Psychological D000328:Adult D002170:Canada D005260:Female D017144:Focus Groups D006282:Health Personnel D006801:Humans D015278:Intensive Care Units, Pediatric D008297:Male D008875:Middle Aged D009014:Morals D036301:Qualitative Research D055500:Resilience, Psychological D013315:Stress, Psychological
moral distress Intensive care resilience pediatric moral/ethical climate of organizations