Most PICU Clinicians Report Moral Distress During COVID-19 Pandemic
About 85% of pediatric critical care clinicians reported some degree of moral distress, according to a April to May 2020 survey of 337 pediatric critical care professionals.1
“At the start of the pandemic, the world’s attention was, rightfully so, on the adult ICUs caring for the critically ill adult patient populations,” says Tessy A. Thomas, DO, MBE, one of the study’s authors and an assistant professor of pediatrics and bioethics at the Center for Translational Bioethics and Health Care Policy.
Thomas and colleagues studied whether pediatric critical care clinicians were experiencing anticipatory active moral distress. “It would be only a matter of time before we would possibly be in the same distressing situations as they were,” says Thomas, pediatric intensivist in the division of critical care medicine at Janet Weis Children’s Hospital at Geisinger Medical Center in Danville, PA.
Were providers distressed out of anticipation of what might be coming during the pandemic, or was it because of known professional challenges that existed before? These challenges included scarce resources, inadequate staffing, supervisors asking staff to handle duties outside professional training, family or patient choices, institutional policies, conflicting opinions about care, miscommunication among team members, and power differentials. Many of these trying situations have existed for years.
“The acute pressure of the pandemic quickly brought to light numerous chronic vulnerabilities of our fragile healthcare systems and workforce,” Thomas notes.
The researchers also wanted to know if the pediatric critical care clinicians were preparing to remain resilient in the midst of these challenges. “Our findings indicate that despite the challenges, healthcare providers remain resilient,” Thomas reports.
Notably, about the same number of providers who reported moral distress indicated lingering distress continued to weigh them down after an ethically complex case.
“Moral distress is a universal phenomenon that is inherent within healthcare. We need to acknowledge that it is not a one-time phenomenon that simply goes away,” Thomas says. “Being afraid to discuss distress or feeling silenced is not the answer.”
Thomas suggests ethicists join rounds on various units, routinely conduct multiprofessional team debriefing sessions within departments and units, and offer educational workshops on ethical frameworks.
“Allow employees to be part of the solution and be participants in brainstorming ideas to address everyday problems at the bedside,” Thomas advises.
For example, engaging in frequent informal “check-ins” with staff helps ethicists develop strong relationships.
“To create flourishing professions, we have to equip bedside healthcare providers with the knowledge, skills, attitudes, voices, and moral characteristics needed to compassionately care for vulnerable populations within complex sociotechnical systems,” Thomas says.
- Thomas TA, Davis FD, Kumar S, et al. COVID-19 and moral distress: A pediatric critical care survey. Am J Crit Care 2021;30:e80-e98.
Ethicists should join rounds on various units, routinely conduct multiprofessional team debriefing sessions within departments and units, and offer educational workshops on ethical frameworks.
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