Moral Distress in Pediatric Intensive Care Nurses: Experiences with the Death and Dying of Child Patients

• Author / Creator

  Gagnon, Michelle

• Background: Moral distress has been commonly understood in the literature to be when one
  knows the right thing to do but being unable to realize it. Research has indicated the consequences of such an experience can deeply affect the individual. Critical care areas are fraught with ethical issues and end-of-life care has been associated with numerous incidences of moral distress among nurses. One such area, where the dichotomy of life and death can seem to be at its sharpest, is in the pediatric intensive care unit (PICU).
  Purpose: The purpose of this dissertation was to understand nurses’ experiences of moral distress in Canadian PICUs where advanced life-sustaining interventions are offered for complex medical and surgical cases. The intention was to better understand the moral distress experiences of PICU nurses related to the death and dying of their patients.
  Methods: A content analysis was undertaken of seven transcripts from registered nurses from six PICUs across Canada. This secondary analysis uses data from a narrative inquiry reported in 2006 (Austin, Carnevale, Frank & Garros). The content analysis used open coding resulting in the emergence of nine dominant themes.
  Findings: The developed themes, with associated sub-themes, denote the outer state of nursing in the PICU, the inner state of the individual nurse, the relationship dynamics between the nurse and others, and differing perspectives among individuals to clearly depict the experiences of moral distress. The outer state includes the two themes PICU context and nurse positioning. The inner state includes the two themes of feelings around dying and death and greatest nursing concerns for dying patients. Relationship dynamics include four themes of decision-making power, communication and messaging, stated support for nurses, and recommendations for change. The final theme of differing opinions, perspectives, and perceptions emerged as having tendrils woven throughout the others.
  Discussion and Conclusions: Nurses are in a position to experience the burden of moral responsibilities intensely and with great effect to their inner state. This secondary analysis highlighted various feelings throughout the patient trajectory along with their reasonings; an additional notable contribution was the reimagination of distress related to decision-making in terms of the intention of treatment. Both of these findings have implications for practice in more precisely identifying reasons for moral distress and in tailoring prevention or intervention strategies. The findings of this secondary analysis show experiences of moral distress most often occur by being in some type of relation to others or to the environment. Indeed, this study demonstrates that a lack of communication is not simply a gap of exchanged knowledge; rather may indicate the underlying relationship health or status between the individuals. This indicates a need for interventions to be tailored less towards the sole individual but rather towards how relationships are being made and maintained with others and the organization.

• Subjects / Keywords

  • end-of-life
  • ethics
  • Moral distress
  • pediatric intensive care
  • death and dying

• Graduation date

  Fall 2020

• Type of Item

  Thesis

• Degree

  Master of Nursing

• DOI

  https://doi.org/10.7939/r3-1wnh-j326

• License

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