Expanding Our Understanding of Moral Distress in the NICU.

Abstract

Moral distress is prevalent in many areas of medicine, including the NICU.1 Defined as “knowing the right thing do to, but feeling powerless to do it,” moral distress was initially thought to be experienced primarily by bedside nurses related to constraint from the medical team’s hierarchy.1 However, we now recognize that all health care team members experience moral distress, and the increasing complexity of health care delivery has increased the prevalence of moral distress.2,3 In this issue of Pediatrics, Prentice et al use a mixed-method study to assess moral distress in 525 neonatologists, trainees, and nurses in relation to 99 patients <28 weeks’ gestation over their NICU course. At any given time, moral distress was reported by 15%, with some variability across health care providers. Reasons for experiencing moral distress were infant-centered, such that the burden of intensive interventions outweighs the benefit, management plans, family-centered, parental decision-making, or provider-centered personal reasons, such as discomfort with uncertainty. Attending neonatologists were less likely to experience moral distress (6.4% of the time) than fellows (19.6%), residents (17.5%), or nurses (16.9%).4 This study highlights a potential paradigm shift in the source of constraint-type moral distress because it seems to … Address correspondence to Manisha Mills, MD, Cincinnati Children’s Hospital Medical Center, 3333 Burnet Ave, MLC 7009, Cincinnati, OH 45229. E-mail: manisha.mills{at}cchmc.org