儿科重症监护病房和新生儿重症监护病房从业者的道德困扰：一项横断面评估。

Moral Distress in PICU and Neonatal ICU Practitioners: A Cross-Sectional Evaluation.

作者信息

Larson Charles Philip, Dryden-Palmer Karen D, Gibbons Cathy, Parshuram Christopher S

机构信息

1Department of Paediatric Intensive Care, The Royal Children's Hospital, Parkville, VIC, Australia. 2Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, ON, Canada. 3Department of Paediatric Intensive Care, Temple Street Children's University Hospital, Dublin, Ireland. 4Department of Critical Care Medicine, Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, ON, Canada. 5Department of Paediatrics, Institute of Health Policy, Management and Evaluation, Toronto, ON, Canada. 6Interdivisional Department of Critical Care Medicine, University of Toronto, Toronto, ON, Canada.

出版信息

Pediatr Crit Care Med. 2017 Aug;18(8):e318-e326. doi: 10.1097/PCC.0000000000001219.

DOI:10.1097/PCC.0000000000001219

PMID:28598947

Abstract

OBJECTIVES

To measure the level of moral distress in PICU and neonatal ICU health practitioners, and to describe the relationship of moral distress with demographic factors, burnout, and uncertainty.

DESIGN

Cross-sectional survey.

SETTING

A large pediatric tertiary care center.

SUBJECTS

Neonatal ICU and PICU health practitioners with at least 3 months of ICU experience.

INTERVENTIONS

A 41-item questionnaire examining moral distress, burnout, and uncertainty.

MEASUREMENTS AND MAIN RESULTS

The main outcome was moral distress measured with the Revised Moral Distress Scale. Secondary outcomes were frequency and intensity Revised Moral Distress Scale subscores, burnout measured with the Maslach Burnout Inventory depersonalization subscale, and uncertainty measured with questions adapted from Mishel's Parent Perception of Uncertainty Scale. Linear regression models were used to examine associations between participant characteristics and the measures of moral distress, burnout, and uncertainty. Two-hundred six analyzable surveys were returned. The median Revised Moral Distress Scale score was 96.5 (interquartile range, 69-133), and 58% of respondents reported significant work-related moral distress. Revised Moral Distress Scale items involving end-of-life care and communication scored highest. Moral distress was positively associated with burnout (r = 0.27; p < 0.001) and uncertainty (r = 0.04; p = 0.008) and inversely associated with perceived hospital supportiveness (r = 0.18; p < 0.001). Nurses reported higher moral distress intensity than physicians (Revised Moral Distress Scale intensity subscores: 57.3 vs 44.7; p = 0.002). In nurses only, moral distress was positively associated with increasing years of ICU experience (p = 0.02) and uncertainty about whether their care was of benefit (r = 0.11; p < 0.001) and inversely associated with uncertainty about a child's prognosis (r = 0.03; p = 0.03).

CONCLUSIONS

In this single-center, cross-sectional study, we found that moral distress is present in PICU and neonatal ICU health practitioners and is correlated with burnout, uncertainty, and feeling unsupported.

摘要

目的

测量儿科重症监护病房（PICU）和新生儿重症监护病房（NICU）医护人员的道德困扰水平，并描述道德困扰与人口统计学因素、职业倦怠和不确定性之间的关系。

设计

横断面调查。

地点

一家大型儿科三级护理中心。

研究对象

具有至少3个月重症监护病房工作经验的新生儿重症监护病房和儿科重症监护病房医护人员。

干预措施

一份包含41个条目的问卷，用于调查道德困扰、职业倦怠和不确定性。

测量指标及主要结果

主要结局指标是使用修订版道德困扰量表测量的道德困扰。次要结局指标是修订版道德困扰量表各子量表的频率和强度得分、使用马氏职业倦怠量表去个性化子量表测量的职业倦怠，以及使用改编自米舍尔父母不确定性感知量表的问题测量的不确定性。采用线性回归模型来检验参与者特征与道德困扰、职业倦怠和不确定性测量指标之间的关联。共收回206份可分析的调查问卷。修订版道德困扰量表的中位数得分为96.5（四分位间距，69 - 133），58%的受访者报告有与工作相关的显著道德困扰。涉及临终关怀和沟通的修订版道德困扰量表条目得分最高。道德困扰与职业倦怠呈正相关（r = 0.27；p < 0.001），与不确定性呈正相关（r = 0.04；p = 0.008），与感知到的医院支持度呈负相关（r = 0.18；p < 0.001）。护士报告的道德困扰强度高于医生（修订版道德困扰量表强度子量表得分：57.3对44.7；p = 0.002）。仅在护士中，道德困扰与重症监护病房工作年限的增加呈正相关（p = 0.02），与对自身护理是否有益的不确定性呈正相关（r = 0.11；p < 0.001），与对儿童预后的不确定性呈负相关（r = 0.03；p = 0.03）。