Moral distress among neonatologists working in neonatal intensive care units in Greece: a qualitative study
Abstract Background Working as a neonatologist in a neonatal intensive care unit (NICU) is stressful and involves ethically challenging situations. These situations may cause neonatologists to experience high levels of moral distress, especially in the context of caring for extremely premature infan...
| Main Authors: | , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2023-03-01
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| Series: | BMC Pediatrics |
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| Online Access: | https://doi.org/10.1186/s12887-023-03918-1 |
| _version_ | 1797863576107483136 |
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| author | Maria Deligianni Polychronis Voultsos Maria K. Tzitiridou-Chatzopoulou Vasiliki Drosou-Agakidou Vasileios Tarlatzis |
| author_facet | Maria Deligianni Polychronis Voultsos Maria K. Tzitiridou-Chatzopoulou Vasiliki Drosou-Agakidou Vasileios Tarlatzis |
| author_sort | Maria Deligianni |
| collection | DOAJ |
| description | Abstract Background Working as a neonatologist in a neonatal intensive care unit (NICU) is stressful and involves ethically challenging situations. These situations may cause neonatologists to experience high levels of moral distress, especially in the context of caring for extremely premature infants (EPIs). In Greece, moral distress among neonatologists working in NICUs remains understudied and warrants further exploration. Methods This prospective qualitative study was conducted from March to August 2022. A combination of purposive and snowball sampling was used and data were collected by semi-structured interviews with twenty neonatologists. Data were classified and analyzed by thematic analysis approach. Results A variety of distinct themes and subthemes emerged from the analysis of the interview data. Neonatologists face moral uncertainty. Furthermore, they prioritize their traditional (Hippocratic) role as healers. Importantly, neonatologists seek third-party support for their decisions to reduce their decision uncertainty. In addition, based on the analysis of the interview data, multiple predisposing factors that foster and facilitate neonatologists’ moral distress emerged, as did multiple predisposing factors that are sometimes associated with neonatologists’ constraint distress and sometimes associated with their uncertainty distress. The predisposing factors that foster and facilitate neonatologists’ moral distress thus identified include the lack of previous experience on the part of neonatologists, the lack of clear and adequate clinical practice guidelines/recommendations/protocols, the scarcity of health care resources, the fact that in the context of neonatology, the infant’s best interest and quality of life are difficult to identify, and the need to make decisions in a short time frame. NICU directors, neonatologists’ colleagues working in the same NICU and parental wishes and attitudes were identified as predisposing factors that are sometimes associated with neonatologists’ constraint distress and sometimes associated with their uncertainty distress. Ultimately, neonatologists become more resistant to moral distress over time. Conclusions We concluded that neonatologists’ moral distress should be conceptualized in the broad sense of the term and is closely associated with multiple predisposing factors. Such distress is greatly affected by interpersonal relationships. A variety of distinct themes and subthemes were identified, which, for the most part, were consistent with the findings of previous research. However, we identified some nuances that are of practical importance. The results of this study may serve as a starting point for future research. |
| first_indexed | 2024-04-09T22:37:43Z |
| format | Article |
| id | doaj.art-f5f3c5e1b94a4a1999380bdb70cc4a6e |
| institution | Directory Open Access Journal |
| issn | 1471-2431 |
| language | English |
| last_indexed | 2024-04-09T22:37:43Z |
| publishDate | 2023-03-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Pediatrics |
| spelling | doaj.art-f5f3c5e1b94a4a1999380bdb70cc4a6e2023-03-22T12:24:11ZengBMCBMC Pediatrics1471-24312023-03-0123111810.1186/s12887-023-03918-1Moral distress among neonatologists working in neonatal intensive care units in Greece: a qualitative studyMaria Deligianni0Polychronis Voultsos1Maria K. Tzitiridou-Chatzopoulou2Vasiliki Drosou-Agakidou3Vasileios Tarlatzis4Laboratory of Forensic Medicine & Toxicology (Division: Medical Law and Ethics), School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, University CampusLaboratory of Forensic Medicine & Toxicology (Division: Medical Law and Ethics), School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, University CampusMidwifery Department, School of Healthcare Sciences, University of Western Macedonia (Greece), Ikaron 3, GR 501001st Department of Neonatology, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, University Campus1st Department of Obstetrics and Gynaecology, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, University CampusAbstract Background Working as a neonatologist in a neonatal intensive care unit (NICU) is stressful and involves ethically challenging situations. These situations may cause neonatologists to experience high levels of moral distress, especially in the context of caring for extremely premature infants (EPIs). In Greece, moral distress among neonatologists working in NICUs remains understudied and warrants further exploration. Methods This prospective qualitative study was conducted from March to August 2022. A combination of purposive and snowball sampling was used and data were collected by semi-structured interviews with twenty neonatologists. Data were classified and analyzed by thematic analysis approach. Results A variety of distinct themes and subthemes emerged from the analysis of the interview data. Neonatologists face moral uncertainty. Furthermore, they prioritize their traditional (Hippocratic) role as healers. Importantly, neonatologists seek third-party support for their decisions to reduce their decision uncertainty. In addition, based on the analysis of the interview data, multiple predisposing factors that foster and facilitate neonatologists’ moral distress emerged, as did multiple predisposing factors that are sometimes associated with neonatologists’ constraint distress and sometimes associated with their uncertainty distress. The predisposing factors that foster and facilitate neonatologists’ moral distress thus identified include the lack of previous experience on the part of neonatologists, the lack of clear and adequate clinical practice guidelines/recommendations/protocols, the scarcity of health care resources, the fact that in the context of neonatology, the infant’s best interest and quality of life are difficult to identify, and the need to make decisions in a short time frame. NICU directors, neonatologists’ colleagues working in the same NICU and parental wishes and attitudes were identified as predisposing factors that are sometimes associated with neonatologists’ constraint distress and sometimes associated with their uncertainty distress. Ultimately, neonatologists become more resistant to moral distress over time. Conclusions We concluded that neonatologists’ moral distress should be conceptualized in the broad sense of the term and is closely associated with multiple predisposing factors. Such distress is greatly affected by interpersonal relationships. A variety of distinct themes and subthemes were identified, which, for the most part, were consistent with the findings of previous research. However, we identified some nuances that are of practical importance. The results of this study may serve as a starting point for future research.https://doi.org/10.1186/s12887-023-03918-1Moral distressConstraint distressUncertainty distressNeonatologistsNeonatal Intensive Care Units (NICUs)Extremely Premature Infants (EPIs) |
| spellingShingle | Maria Deligianni Polychronis Voultsos Maria K. Tzitiridou-Chatzopoulou Vasiliki Drosou-Agakidou Vasileios Tarlatzis Moral distress among neonatologists working in neonatal intensive care units in Greece: a qualitative study BMC Pediatrics Moral distress Constraint distress Uncertainty distress Neonatologists Neonatal Intensive Care Units (NICUs) Extremely Premature Infants (EPIs) |
| title | Moral distress among neonatologists working in neonatal intensive care units in Greece: a qualitative study |
| title_full | Moral distress among neonatologists working in neonatal intensive care units in Greece: a qualitative study |
| title_fullStr | Moral distress among neonatologists working in neonatal intensive care units in Greece: a qualitative study |
| title_full_unstemmed | Moral distress among neonatologists working in neonatal intensive care units in Greece: a qualitative study |
| title_short | Moral distress among neonatologists working in neonatal intensive care units in Greece: a qualitative study |
| title_sort | moral distress among neonatologists working in neonatal intensive care units in greece a qualitative study |
| topic | Moral distress Constraint distress Uncertainty distress Neonatologists Neonatal Intensive Care Units (NICUs) Extremely Premature Infants (EPIs) |
| url | https://doi.org/10.1186/s12887-023-03918-1 |
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