Moral distress in the neonatal intensive care unit: caregiver's experience

Background: The Neonatal Intensive Care Unit (NICU) can be ethically charged, which can create challenges for health-care workers. Objective: To detennine the frequency with which nurses and residents have experienced ethical confrontations and what factors are associated with increased frequency. Design/Methods: An anonymous questionnaire was distributed to nurses in a university center, a high-risk obstetric service, a maternity hospital NICU with 85% in-born patients and an outborn NICU, most of whose preterm admissions are those with surgical complications. Obstetric and pediatric residents in the four universities of the province also received the questionnaire, which induced demographics, opinions regarding the gestational age threshold at which resuscitation of a premature infant with bradycanlia was appropriate, knowledge of cerebral palsy (CP) outcomes (as an indicator of knowledge about long-tenn sequelae of prematurity) and questions about ethical confrontation in the NICU. Results: Two hundred and seventy-nine caregivers participated (115 full time nurses and 164 residents). All the distributed questionnaires were completed. Frequent ethical confrontation was reported by 35% of the nurses and 19% of the residents. Among, the nurses, moral distress differed significantly between work environments. Nurses working in an out-born NlCU and obstetric nurses were more likely to overestimate CP prevalence (P<0.05). Nurses who overestimated CP rates had higher thresholds for resuscitation and were more likely to experience ethical confrontations Of the residents, 60% were pediatric and 40% obstetric. All groups of residents frequently overestimated the prevalence of CP, and knowledge differed significantly by residency program (P<0.05). The residents who overestimated CP rates had higher thresholds for resuscitation, had more incorrect answers regarding prematurity outcomes and were less likely to have ethical confrontations. Couclusions: A large proportion of nurses and residents report frequent ethical confrontations. Many residents and nurses have timitel knowledge of outcomes and high threshold for resuscitation. Ethical confrontation is more common among nurses with poor knowledge about outcomes, and less common in residents with poor knowledge aheut outcomes.