‘Distress at the bedside in the PICU: Nurses’ and respiratory therapists’ experiences in caring for children with complex medical or neurologic conditions’

Abstract

IntroductionIntensive care unit (ICU) care provided to children with complex chronic medical and neurological conditions is a frequent source of conflict and distress.ObjectiveTo quantify the extent to which pediatric ICU (PICU) nurses (RNs) and respiratory therapists (RTs) experience distress when caring for children with complex medical and developmental disabilities, and to explore which provider characteristics lessen or increase this distress.MethodsRNs and RTs at three pediatric hospitals completed an online scenario-based survey to assess their feelings toward a hypothetical patient with complex, chronic medical conditions, and neurological impairment. Twenty-four statements were created to capture features of moral distress, mismatch of expectations, and job dissatisfaction, and providers indicated degree of agreement with each statement. Responses were tabulated to create a Total Distress Score (TD) which was further subdivided into Moral Distress (MD), Mismatch of Expectations (ME), and Job Dissatisfaction (JD) sub-scores.ResultsOne hundred and fifty-five providers completed the survey. RNs and RTs expressed a wide variability of distress in relation to care provided to this hypothetical patient. No single demographic factor consistently accounted for the variability in distress levels. Providers who would have personally opted against aggressive treatment had a statistically significant increase in the level of distress. ME was strongly correlated with both MD and JD scores.ConclusionsProviding bedside care to children with complex chronic medical and neurological conditions is associated with wide variability in the level of distress for RNs and RTs. For a subset of providers, this distress can be substantial and highlights the importance of identifying and implementing strategies to mitigate this distress to create a more sustainable and effective work force.