Moral distress, trauma and burnout in staff in relation to changes in picu outcomes, challenging cases and media involvement in disagreements about end-of-life care
burnout; emotional stress; morality; posttraumatic stress disorder; staff; terminal care; adult; awareness; child; conference abstract; controlled study; court; death; depersonalization; disability; human; life sustaining treatment; nurse; questionnaire; wellbeing
Background Technological advances have decreased PICU mortality but increased the number of children surviving with disability or technologically-dependent. Death in PICU most frequently follows withdrawal of life-sustaining therapy (LST), increasingly after prolonged admissions for invasive organ support. Disagreements with families about cessation of life-sustaining therapy (LST) can be protracted, distressing for everyone, harmful to the child and ultimately require court adjudication. Little is known about the impact of this, or of that of social/other media campaigns when families decides to involve the press, as is increasingly the case Method 50 staff (39 nurses; 9 doctors and 2 AHPs) were surveyed using the Moral Distress Scale-Revised (MD-R) ques-tionnaire; Trauma Screening Questionnaire (TSQ) and abbreviated Maslach Burnout Inventory (aMBI) together with several open-ended questions about their experiences and what they felt had been learned 3 months after the final court decision following one such high profile case. Results Mean moral distress score (MDS-R) was 96, consistent with recent Canadian multi-centre PICU study and higher than average Adult ICU scores (57-83 in the literature). Specifically, in relation to the recent high profile case 15% scored in the clinically significant range for post-traumatic stress symptoms (TSQ); a significant number reported a number of sub-clinical symptoms; 68% reported being 'upset by reminders of the event' and 53% reported 'heightened awareness of potential danger' to themselves and others at least twice in the previous week. Burnout symptoms (aMBI): 44% reported emotional exhaustion at a high level; 17% reported a high level of depersonalization. The 25% of staff considering leaving PICU reported higher burnout (emotional exhaustion) scores (p=0.001); higher post-traumatic stress scores (p=0.04) and were also less likely to feel supported in relation to moral distress (p=0.010). Conclusions These findings highlight the impact of changing PICU outcomes on staff, with increased survival of children with severe disability or technologically-dependent; and death following prolonged PICU admission sometimes after disagreements about cessation of LST, occasionally with public campaigns. They illustrate that the dimension of moral distress is one which needs to be acknowledged, along with burnout and post-traumatic stress² in a comprehensive assessment of staff well-being.
Colville G; Rutt M; Berger Z; Titman P; Brierley J
Archives of Disease in Childhood
2018
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).
<a href="http://doi.org/10.1136/archdischild-2018-rcpch.459" target="_blank" rel="noreferrer noopener">10.1136/archdischild-2018-rcpch.459</a>
Fifteen-minute consultation: How to communicate with parents who have a child on life support with no hope of recovery
child; psychology; ethics; human; consultation; article; palliative therapy; trust; child psychiatry; counter transference; court; motivational interviewing; transference
A child on life support with no hope of recovery is the worst nightmare for parents and for paediatricians. Unfortunately, some children have illnesses or injuries that are not compatible with life. Being in a vegetative state with no meaningful interaction does not safeguard children from feeling discomfort and pain. Letting nature take its course and allowing the child to die may well be the least worse option. However, this decision is fraught with difficulties for parents and for clinicians and can lead to unnecessary and painful conflict between them, even leading to court proceedings. In this paper, the impact of having a child on life support is discussed and recommendations are given in order to improve professional communication. It is hoped that an understanding of the impact on parents, cultural considerations, and the psychiatric concepts of 'denial', 'projection', the 'meta-level', 'transference', 'countertransference' and the techniques of 'motivational interviewing' will help clinicians prevent a breakdown of trust and improve doctor-parent relationships in these tragic cases. Copyright © Author(s) (or their employer(s)) 2022. No commercial re-use. See rights and permissions. Published by BMJ.
Swanepoel A
Archives of disease in childhood
2022
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).
<a href="http://doi.org/10.1136/archdischild-2021-322262" target="_blank" rel="noreferrer noopener">10.1136/archdischild-2021-322262</a>