![\"The_Scream\"](\"https:\/\/stg-blogs.bmj.com\/adc\/files\/2015\/12\/The_Scream-150x150.jpg\")
The situation is clear. The child has an illness which is very likely to end their life – and soon – in days, not months or years. They may be hooked to a ventilator, drizzled with inotropes, or osmosed. The health care team is talking – once again – about the outcomes and what we can, should or will do.<\/p>\n
Do you recognise this?<\/p>\n
Do you recall how people spoke – not the ~mab, the pressor or the particular hospice name – but what the emotional and moral content of the discussions were?\u00a0Can you recall if that varied between professional groups &\u00a0experience of those folk? And if there were clashes between how people felt<\/em> the actions should flow, against how they were\u00a0made<\/em> to act?<\/p>\n This is the question that has been investigated by a new systematic review in the ADC<\/a>, drawing together original papers who have enquired about ‘moral distress’ in NICU \/ PICU<\/p>\n <\/p>\n The group undertook a complex, multilayered search (F<\/strong>ind<\/a>) to discover papers that might have been relevant, cut into them to see how well they were made using an appraisal system (A<\/strong>ppraise) and involved this in the summary. To cut to the chase, they found 13 studies, all relatively small, and only 5 multiprofessional. The way the s<\/strong>ynthesis took place was by a simple thematic analysis, the most basic form that can be used, though the analysis could potentially have been undertaken with a more complex approach.<\/p>\n Now I am aware that a key part of standard critical appraisal training is “don’t read the discussion” … but in quite a lot of papers, qualitative synthesis in particular, the discussion is actually part of the scholarship rather than part of the sales pitch. In this they summarise the t<\/strong>ransferability key messages:<\/p>\n [they tell us the] causes\u00a0of moral distress, relational dynamics between healthcare professionals within different settings or ethical climate and the impact of moral distress over time<\/em><\/p><\/blockquote>\n The causes of moral distress seem to be the clashes between interventions undertaken\u00a0and the benefits that could occur, potentially not in the best interest of the child, and a lack of ability to ‘do the right thing’. The relational dynamics that flow into this include the perception of medics as pressing on with life-saving treatments, and nurses caring deeply and personally for the child and family – but this is probably not really true – and reflects the way research has been undertaken, the way the instruments to judge ‘moral distress’ don’t work in medics, and the medical use of different language – “dilemma” and “confrontation” – despite the presence of an internal crash of ideas that is moral dilemma.<\/p>\n What do we know about what happens over time? Well moral distress may lead to burnout <\/a>& leaving jobs. Experience \/ age may reduce the experience of moral distress. Lots of may<\/em>. Not a lot of know<\/em>.<\/p>\n Does it matter? Is this a pointlessly academic – socialologically soused – barrel of work that does nothing in the world? I don’t think so – I think we under play the internal agonies we have at work – and we need to be aware of burnout <\/a>and keep safe those who are at risk. Understanding the mechanisms of these ‘pathologies’ should be considered as important as other pathologies, like bronchiolitis, COPD and psoriasis.<\/p>\n – Archi<\/p>\n","protected":false},"excerpt":{"rendered":" The situation is clear. The child has an illness which is very likely to end their life – and soon – in days, not months or years. They may be hooked to a ventilator, drizzled with inotropes, or osmosed. The health care team is talking – once again – about the outcomes and what we […]<\/p>\n