Clinical Pearls

Abstract

Moral distress occurs when an individual faces constraints in doing the right thing, which challenges the ability to preserve integrity and can result in adverse outcomes such as burnout, diminished well-being, and poor quality patient care. During a pandemic, these constraints can be greatly increased, with health care staff experiencing greater moral distress.Thomas and colleagues conducted a survey with staff in a pediatric intensive care unit, including physicians/advanced practice providers, registered nurses, and respiratory therapists, to explore the extent and sources of moral distress during the COVID-19 pandemic. They found Although more research is needed, the authors suggest that moral resilience can be cultivated by organizations providing support and strategies to promote a healthy work environment.See Article, pp e80–e98Having a family member in the intensive care unit (ICU) can be a very stressful experience and can lead to the development of post–intensive care syndrome in families. Cognitive behavioral therapy (CBT) has been used to treat patients’ psychological distress both in-person and with mobile health apps. However, it is unknown if a CBT mobile app would be effective with family members.Petrinec and colleagues examined the feasibility of using a mobile app to deliver CBT to family members of adult ICU patients. They found Although a larger, randomized controlled trial is needed, the findings support the feasibility of using a mobile health app for family members of ICU patients.See Article, pp 451–458Microaspiration is the leaking of oral or gastric secretions into the lower airway that often occurs in patients receiving mechanical ventilation. Such leakage can result in ventilator-related complications such as ventilator-associated pneumonia. Pepsin A found in tracheal secretions is a biomarker of microaspiration of gastric secretions.Talbert and colleagues examined the association between pepsin A found in tracheal secretions and clinical outcomes in adult patients in the intensive care unit (ICU) who were expected to receive ventilation for at least 36 hours. They found Prevention bundles such as elevating the head of the bed 30º, management of endotracheal tube cuff pressure, and oropharyngeal suctioning were standard care during this study. Further research is needed to better understand the factors that affect microaspiration and ventilator-related events.See Article, pp 443–450Workplace turbulence is known to contribute to burnout and turnover in critical care nurses. Research shows that healthy work environments (HWEs) improve both nurse and patient outcomes. The American Association of Critical-Care Nurses (AACN) developed an HWE framework with 6 evidence-based standards to improve work settings—skilled communication, true collaboration, effective decision-making, appropriate staffing, meaningful recognition, and authentic leadership.Pena and colleagues implemented interventions using the AACN framework and evaluated the effect on nurse satisfaction and retention 2 years later. They found The findings reinforce the value of using an evidence-based framework to implement and evaluate strategies to improve workplace environments. The authors recommend further development of sustainable interventions to improve staff stability.See Article, pp 426–433