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Provider moral distress in caring for tracheostomy and ventilator dependent children: A single institution

Andrew J Redmann1,2, Catherine K Hart3,4, Matthew M Smith3,4

  • 1Children's Minnesota, Pediatric ENT and Facial Plastic Surgery, Minneapolis, Minnesota, USA.

Pediatric Pulmonology
|January 2, 2024
PubMed

Insights

Moral distress is high in pediatric units for patients needing tracheostomy/ventilator support. Advanced practice providers reported the highest distress levels, comparable to pediatric intensive care units.

Area of Science:

  • Pediatric Healthcare
  • Medical Ethics
  • Respiratory Care

Background:

  • Pediatric units caring for patients with tracheostomy/ventilator dependence face unique ethical challenges.
  • Moral distress is a significant concern for healthcare professionals in these specialized units.
  • Understanding the prevalence and sources of moral distress is crucial for supporting staff well-being.

Purpose of the Study:

  • To quantify the levels of moral distress experienced by healthcare professionals in a pediatric unit for tracheostomy/ventilator-dependent patients.
  • To compare moral distress levels across different professional groups within the unit.
  • To establish a baseline for interventions aimed at mitigating moral distress.

Main Methods:

  • The study utilized the Moral Distress Survey-Revised (MDS-R), a 21-question instrument.
  • The survey was anonymously distributed to medical doctors (MD/DOs), advanced practice practitioners (APPs), registered nurses (RNs), and respiratory therapists (RTs).
  • Descriptive statistics, bivariate, and multivariate analyses were performed to interpret the data.

Main Results:

  • A 48% response rate was achieved from 127 distributed surveys.
  • The mean MDS-R score was 83, indicating significant moral distress comparable to pediatric intensive care units.
  • Advanced practice practitioners reported the highest median moral distress scores (112), while medical doctors reported the lowest (49).

Conclusions:

  • Moral distress is prevalent and significant in pediatric units for long-term tracheostomy/ventilator-dependent patients.
  • Advanced practice practitioners experience higher levels of moral distress, potentially due to their primary provider role for complex cases.
  • These findings highlight the need for targeted support and interventions for healthcare professionals in these demanding clinical settings.
Abstract

Keywords:
burnoutmoral distresspediatrictracheostomyventilator dependent

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