Moral Distress and Burnout in Neonatal Intensive Care Unit Healthcare Providers: A Cross-Sectional Study in Italy

Overview

Journal Int J Environ Res Public Health

Publisher MDPI

Specialties Environmental Health
Public Health

Date 2022 Jul 27

PMID 35886379

Authors

Sara Carletto

Maria Chiara Ariotti

Giulia Garelli

Ludovica Di Noto

Paola Berchialla

Francesca Malandrone

Roberta Guardione

Floriana Boarino

Maria Francesca Campagnoli

Patrizia Savant Levet

Enrico Bertino

Luca Ostacoli

Alessandra Coscia

Affiliations

Soon will be listed here.

Abstract

Moral distress (MD) in healthcare providers is widely recognized as a serious issue in critical care contexts. It has the potential to have negative impacts on both personal and professional wellbeing, the quality of care provided and staff turnover. The aim of this study was to investigate the relationship between MD and burnout among neonatal intensive care unit (NICU) healthcare professionals and identify the possible factors associated with its occurrence. Participants were asked to complete an online survey, which covered sociodemographic and professional information and included two self-report questionnaires (Italian Moral Distress Scale-Revised and Maslach Burnout Inventory). The sample comprised 115 healthcare providers (nurses and physiotherapists: 66.1%; physicians: 30.4%; healthcare assistants: 3.5%) working in four NICUs located within the province of Turin, Italy. The results revealed overall low levels of MD, with no significant differences between nurses/physiotherapists and physicians. Nurses/physiotherapists showed a statistically significant higher percentage of personal accomplishment burnout (32.9%) compared with physicians (8.6%; = 0.012). MD was associated with the emotional exhaustion dimension of burnout. Spirituality and/or religiousness was shown to be a moderating variable. Further research is needed to deepen our understanding of the correlation between MD and burnout and the role of spirituality and/or religiousness as moderators.

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References

Lewis S . Emotional Intelligence in Neonatal Intensive Care Unit Nurses: Decreasing Moral Distress in End-of-Life Care and Laying a Foundation for Improved Outcomes: An Integrative Review. J Hosp Palliat Nurs. 2019; 21(4):250-256. DOI: 10.1097/NJH.0000000000000561. View

Lamiani G, Borghi L, Argentero P . When healthcare professionals cannot do the right thing: A systematic review of moral distress and its correlates. J Health Psychol. 2015; 22(1):51-67. DOI: 10.1177/1359105315595120. View

Johnson-Coyle L, Opgenorth D, Bellows M, Dhaliwal J, Richardson-Carr S, Bagshaw S . Moral distress and burnout among cardiovascular surgery intensive care unit healthcare professionals: A prospective cross-sectional survey. Can J Crit Care Nurs. 2018; 27(4):27-36. View

Larson C, Dryden-Palmer K, Gibbons C, Parshuram C . Moral Distress in PICU and Neonatal ICU Practitioners: A Cross-Sectional Evaluation. Pediatr Crit Care Med. 2017; 18(8):e318-e326. DOI: 10.1097/PCC.0000000000001219. View

Hamric A . Empirical research on moral distress: issues, challenges, and opportunities. HEC Forum. 2012; 24(1):39-49. DOI: 10.1007/s10730-012-9177-x. View

Lamiani G, Setti I, Barlascini L, Vegni E, Argentero P . Measuring Moral Distress Among Critical Care Clinicians: Validation and Psychometric Properties of the Italian Moral Distress Scale-Revised. Crit Care Med. 2016; 45(3):430-437. DOI: 10.1097/CCM.0000000000002187. View

Kok N, van Gurp J, van der Hoeven J, Fuchs M, Hoedemaekers C, Zegers M . Complex interplay between moral distress and other risk factors of burnout in ICU professionals: findings from a cross-sectional survey study. BMJ Qual Saf. 2021; 32(4):225-234. PMC: 10086276. DOI: 10.1136/bmjqs-2020-012239. View

Guttmann K, Flibotte J, Seitz H, Huber M, DeMauro S . Goals of Care Discussions and Moral Distress Among Neonatal Intensive Care Unit Staff. J Pain Symptom Manage. 2021; 62(3):529-536. DOI: 10.1016/j.jpainsymman.2021.01.124. View

McCarthy J, Deady R . Moral distress reconsidered. Nurs Ethics. 2008; 15(2):254-62. DOI: 10.1177/0969733007086023. View

10.

Sannino P, Gianni M, Carini M, Madeo M, Lusignani M, Bezze E . Moral Distress in the Pediatric Intensive Care Unit: An Italian Study. Front Pediatr. 2019; 7:338. PMC: 6700377. DOI: 10.3389/fped.2019.00338. View

11.

Profit J, Sharek P, Amspoker A, Kowalkowski M, Nisbet C, Thomas E . Burnout in the NICU setting and its relation to safety culture. BMJ Qual Saf. 2014; 23(10):806-13. PMC: 4167972. DOI: 10.1136/bmjqs-2014-002831. View

12.

Catlin E, Guillemin J, Thiel M, Hammond S, Wang M, ODonnell J . Spiritual and religious components of patient care in the neonatal intensive care unit: sacred themes in a secular setting. J Perinatol. 2002; 21(7):426-30. DOI: 10.1038/sj.jp.7210600. View

13.

Ozden D, Karagozoglu S, Yildirim G . Intensive care nurses' perception of futility: job satisfaction and burnout dimensions. Nurs Ethics. 2013; 20(4):436-47. DOI: 10.1177/0969733012466002. View

14.

Austin C, Saylor R, Finley P . Moral distress in physicians and nurses: Impact on professional quality of life and turnover. Psychol Trauma. 2016; 9(4):399-406. DOI: 10.1037/tra0000201. View

15.

Colville G, Smith J, Brierley J, Citron K, Nguru N, Shaunak P . Coping With Staff Burnout and Work-Related Posttraumatic Stress in Intensive Care. Pediatr Crit Care Med. 2017; 18(7):e267-e273. DOI: 10.1097/PCC.0000000000001179. View

16.

Delfrate F, Ferrara P, Spotti D, Terzoni S, Lamiani G, Canciani E . Moral Distress (MD) and burnout in mental health nurses: a multicenter survey. Med Lav. 2018; 109(2):97-109. PMC: 7682177. DOI: 10.23749/mdl.v109i2.6876. View

17.

Tajalli S, Rostamli S, Dezvaree N, Shariat M, Kadivar M . Moral distress among Iranian neonatal intensive care units' health care providers: a multi-center cross sectional study. J Med Ethics Hist Med. 2022; 14:12. PMC: 8696547. DOI: 10.18502/jmehm.v14i12.7667. View

18.

Kukora S, Boss R . Values-based shared decision-making in the antenatal period. Semin Fetal Neonatal Med. 2017; 23(1):17-24. DOI: 10.1016/j.siny.2017.09.003. View

19.

Mealer M, Moss M . Moral distress in ICU nurses. Intensive Care Med. 2016; 42(10):1615-1617. PMC: 5683387. DOI: 10.1007/s00134-016-4441-1. View

20.

McCarthy J, Gastmans C . Moral distress: a review of the argument-based nursing ethics literature. Nurs Ethics. 2014; 22(1):131-52. DOI: 10.1177/0969733014557139. View