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Moral Distress in Clinicians Caring for Critically Ill Patients Who Require Mechanical Circulatory Support

Year: 2021

Type: article

Abstract: BACKGROUND: Although use of mechanical circulatory support is increasing, it is unclear how providing such care affects clinicians' moral distress. OBJECTIVE: To measure moral distress among intensive care unit clinicians who commonly care for patients receiving mechanical circulatory support. METHODS: In this prospective study, the Moral Distress Scale-Revised was administered to physicians, nurses, and advanced practice providers from 2 intensive care units in an academic medical center. Linear regression was used to assess whether moral distress was associated with clinician type, burnout, or desire to leave one's job. Clinicians' likelihood of reporting frequent moral distress when caring for patients receiving mechanical circulatory support vs other critically ill patients also was assessed. RESULTS: The sample comprised 102 clinicians who had a mean (SD) score of 100.5 (51.6) on the Moral Distress Scale- Revised. After adjustment for clinician characteristics, moral distress was significantly higher in registered nurses than physicians/advanced practice providers (115.9 vs 71.0, P < .001), clinicians reporting burnout vs those who did not (114.7 vs 83.1, P = .003), and those considering leaving vs those who were not (121.1 vs 89.2, P = .001). Clinicians were more likely to report experiencing frequent moral distress when caring for patients receiving mechanical circulatory support (26.5%) than when caring for patients needing routine care (10.8%; P = .004), but less likely than when caring for patients with either chronic critical illness (57.8%) or multisystem organ failure (56.9%; both P < .001). CONCLUSION: Moral distress was high among clinicians who commonly care for patients receiving mechanical circulatory support, suggesting that use of this therapy may affect well-being among intensive care unit clinicians.

Source: American Journal of Critical Care

DOI: 10.4037/ajcc2021777

Authors: Artem Emple, Laura Fonseca, Shunichi Nakagawa, Gina Guevara, Cortessa Russell, May Hua

Institutions: Columbia University Irving Medical Center, NewYork–Presbyterian Hospital, Columbia University

Language: English

Topic: Ethics in medical practice

Subfield: General Health Professions

Field: Health Professions

Domain: Health Sciences

SDG: Good health and well-being

Open Access status: green

Funder: National Institute on Aging