Provider moral distress in caring for tracheostomy and ventilator dependent children: A single institution cross-sectional evaluation

Andrew J Redmann; Catherine K Hart; Matthew M Smith; Carrie Martin; Adrienne P Borschuk; DonnaMaria E Cortezzo; Dan Benscoter

doi:10.1002/ppul.26839

Provider moral distress in caring for tracheostomy and ventilator dependent children: A single institution cross-sectional evaluation

Pediatr Pulmonol. 2024 Apr;59(4):880-885. doi: 10.1002/ppul.26839. Epub 2024 Jan 2.

Authors

Andrew J Redmann^{1

2}, Catherine K Hart^{3

4}, Matthew M Smith^{3

4}, Carrie Martin⁵, Adrienne P Borschuk^{6

7}, DonnaMaria E Cortezzo^{6

8

9

10

11

12

13

14}, Dan Benscoter^{5

6}

Affiliations

¹ Children's Minnesota, Pediatric ENT and Facial Plastic Surgery, Minneapolis, Minnesota, USA.
² Department of Otolaryngology, University of Minnesota, Minneapolis, Minnesota, USA.
³ Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati, Cincinnati, Ohio, USA.
⁴ Division of Pediatric Otolaryngology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.
⁵ Division of Pulmonary Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.
⁶ Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA.
⁷ Department of Pediatrics, Division of Behavioral Medicine and Clinical Psychology, Cincinnati, Children's Hospital Medical Center, Cincinnati, Ohio, USA.
⁸ Division of Neonatal and Pulmonary Biology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.
⁹ Division of Pain and Palliative Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.
¹⁰ Department of Anesthesiology, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA.
¹¹ Department of Pediatrics, University of Connecticut School of Medicine, Farmington, Connecticut, USA.
¹² Division of Neonatology, Connecticut Children's Medical Center, Hartford, Connecticut, USA.
¹³ Division of Pain and Palliative Care, Connecticut Children's Medical Center, Hartford, Connecticut, USA.
¹⁴ Fetal Care Program, Connecticut Children's Medical Center, Hartford, Connecticut, USA.

PMID: 38165151
DOI: 10.1002/ppul.26839

Abstract

Objective: To determine levels of moral distress in a pediatric unit caring for patients with tracheostomy/ventilator dependence.

Hypothesis: Moral distress will be significant in a dedicated pediatric trach/vent unit.

Methods: The Moral Distress Survey-Revised (MDS-R) is a 21-question survey measuring moral distress in pediatrics. The MDS-R was anonymously distributed to medical degree/doctor of osteopathy (MD/DOs), advanced practice practitioners (APPs), registered nurses (RNs), and respiratory therapists (RTs) in a unit caring for tracheostomy/ventilator dependent patients. Descriptive statistics, bivariate and multivariate analysis were performed.

Results: Response rate was 48% (61/127). Mean MDS-R score was 83 (range 43-119), which is comparable to reported levels in the pediatric intensive care unit (ICU). APPs had the highest median rate of moral distress (112, interquartile range [IQR], 72-138), while MD/DOs had the lowest median score (49, IQR, 43-77). RNs and RTs had MDS-R scores between these two groups (medians of 91 and 84, respectively).

Conclusions: Moral distress levels in a unit caring for long term tracheostomy and ventilator dependent patients are high, comparable to levels in pediatric ICUs. APPs. APPs had higher levels of distress compared to other groups. This may be attributable to the constant stressors of being the primary provider for complex patients, especially in a high-volume inpatient setting.

Keywords: burnout; moral distress; pediatric; tracheostomy; ventilator dependent.

MeSH terms

Attitude of Health Personnel
Child
Cross-Sectional Studies
Humans
Morals*
Stress, Psychological
Surveys and Questionnaires
Tracheostomy*
Ventilators, Mechanical

Grants and funding

None