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March 2021 List
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March 2021 List
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<a href="http://doi.org/10.1016/j.jpainsymman.2021.01.124" target="_blank" rel="noreferrer noopener">http://doi.org/10.1016/j.jpainsymman.2021.01.124</a>
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Title
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Goals of Care Discussions and Moral Distress among Neonatal Intensive Care Unit Staff
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Journal of Pain and Symptom Management
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2021
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Communication; Moral Distress; Ethics; Neonatal; End of Life
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Guttmann K; Flibotte J; Seitz H; Huber M; DeMauro SB
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CONTEXT: The relationship between quality of Goals of Care (GOC) conversations and moral distress among NICU providers is not known. OBJECTIVES: We sought: 1) to explore levels of moral distress in providers, 2) to evaluate how staff moral distress changes in relation to GOC discussions and 3) to identify elements of GOC discussions associated with change in moral distress. We hypothesized that staff moral distress would change after GOC discussions and that that change would vary with presence of key discussion elements. METHODS: Prospective cohort study in a level IV NICU in an urban teaching hospital. We administered validated instruments at baseline and following GOC discussions including the Moral Distress Thermometer (MDT) and Williams Instrument (a measure of end-of-life care) to physicians, nurses, and social workers. RESULTS: We collected data on 79 GOC conversations over a one-year period from 2018-2019. Most providers experienced an increase in moral distress following a GOC discussion. Providers experienced an average increase in moral distress, as measured by the MDT, of 0.84 (+/-3.15) (p=.002). Physicians experienced an average change in moral distress of 1.1 (+/-3.52) (p= 0.01) while nurses experienced an average change of .55 (+/-2.66) (p= 0.07). Several elements of discussions were associated with the degree of increase in moral distress after the conversation. CONCLUSION: Change in moral distress among providers may be a useful metric of quality of GOC discussions. There are identifiable elements of GOC conversations that are associated with high quality discussions. These elements warrant further study.
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<a href="http://doi.org/10.1016/j.jpainsymman.2021.01.124" target="_blank" rel="noreferrer noopener">10.1016/j.jpainsymman.2021.01.124</a>
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Article information provided for research and reference use only. PedPalASCNET does not hold any rights over the resource listed here. All rights are retained by the journal listed under publisher and/or the creator(s).
2021
Communication
DeMauro SB
End Of Life
Ethics
Flibotte J
Guttmann K
Huber M
Journal of Pain and Symptom Management
March 2021 List
Moral Distress
Neonatal
Seitz H