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• The challenges of communication to address Moral Distress
  Trisha Prentice
  Published on: 17 November 2016
• reflective staff meetings include attention to moral distress
  Sebastian KRAEMER
  Published on: 25 October 2016

• Published on: 17 November 2016

  The challenges of communication to address Moral Distress

  • Trisha Prentice, Neonatologist
  • Other Contributors:
    • Annie Janvier, Lynn, Gillam, Peter G Davis

  We thank Dr Kraemer for his constructive response and commend his initiative to facilitate weekly staff meetings within neonatal intensive care units. We concur that communication is an essential component of addressing not only moral distress but improving workplace culture.

  As Dr Kraemer notes, finding the best forum for such discussions continues to be challenging. In our various institutions we continue to...

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  We thank Dr Kraemer for his constructive response and commend his initiative to facilitate weekly staff meetings within neonatal intensive care units. We concur that communication is an essential component of addressing not only moral distress but improving workplace culture.

  As Dr Kraemer notes, finding the best forum for such discussions continues to be challenging. In our various institutions we continue to struggle to address a range of questions about when and how to communicate in ways that will be genuinely helpful. Some questions are about the nature of the discussion, such as: Do such meetings only really cater for those who are most vocal, or who have the ability to articulate their concerns? (And if so, what approaches will help those who struggle to be heard?) How do we bring the honesty and transparency of 'tea room' discussions to these more formal clinical meetings?

  Some questions are practical: How can such meetings meet the needs of both day and night time healthcare professionals? When the facilitator is the clinical lead, who will support and care for him/her as he/she seeks to support and highlight all other voices in the matter?

  Other questions are about attitudes and values: How do we turn the attitude that such discussions "don't change anything", into positive responses that both advance medicine and serve the patients and their families? At times our efforts to build trust, communicate openly and to walk a line of integrity still seem to fall short of what is needed or expected to maintain morale and a safe workplace environment.

  It is our hope that our current longitudinal study into moral distress will highlight the key time points where further interventions and debriefing meetings will be most effective in addressing healthcare professionals' valid concerns while providing a unified team that is equipped to care for the best interests of the patient and the family, no matter how challenging that may be.

  Conflict of Interest:

  None declared

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  Conflict of Interest:
  None declared.

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• Published on: 25 October 2016

  reflective staff meetings include attention to moral distress

  • Sebastian KRAEMER, retired consultant paediatric liaison psychiatrist

  The findings of this important paper should be used to promote regular staff development meetings in neonatal intensive care units. In my experience the reason these are not more widespread is lack of availability of suitably qualified staff to facilitate such groups. Clinicians may ask for support then find the meetings disappointing.

  Over many years in a district general hospital neonatal unit a colleague and...

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  The findings of this important paper should be used to promote regular staff development meetings in neonatal intensive care units. In my experience the reason these are not more widespread is lack of availability of suitably qualified staff to facilitate such groups. Clinicians may ask for support then find the meetings disappointing.

  Over many years in a district general hospital neonatal unit a colleague and I found that staff would attend our weekly work discussions because they knew and worked with us at other times; we were their colleagues. This reduced quite understandable resistance to 'mental health' that can put people off an invitation to reflect on ethical, emotional and practical aspects of their daily work. Caring for tiny, sick and helpless human beings and their shell-shocked parents is stressful (Fischer et al 2000) and disturbing (Cohen 2003). Like soldiers at the front line, staff often manage these strains heroically - not necessarily good for morale (Braithwaite 2008). Where senior managers can support work discussion by themselves attending and expecting staff to join them, a change of culture is possible in which thinking about difficult and apparently unresolvable questions is worthwhile. Though not widely used in medical settings staff groups are a part of the weekly timetable in many helping professions and follow a flexible tradition of curiosity and reflection (Hartley & Kennard 2009). There are of course fundamental ethical questions about the consequences of ever-progressing technical advances in neonatal medicine, but also expectable tensions between staff and parents and between staff themselves, aggravated by the harsh political climate that so often prevails in expensive health services. It is not all deeply serious. Provided there is good enough basic trust in the unit, clinicians who work closely together can laugh at the irony of it all, often leading to important points that might otherwise have been missed. And there are satisfactions as well as gripes to be aired.

  Work discussion goes against the grain of protocol-driven health services. It is potentially subversive in that staff may become more aware of how undermining their working environment is. Besides the more familiar "we are far too busy for that sort of thing" and "it doesn't change anything anyway" there are many seemingly good reasons for not having meetings with no agenda or agreed outcome (Kraemer 2015), yet with courage, foresight and skill there are even better ones for doing so.

  Fischer JE, Calame A, Dettling AC, Zeier H, Fanconi S. (2000) Experience and endocrine stress responses in neonatal and pediatric critical care nurses and physicians. Crit Care Med. 28(9):3281-8.

  Cohen, M. (2003) Sent Before My Time: A Child Psychotherapist's View of Life on a Neonatal Intensive Care Unit. London: Karnac.

  Braithwaite M.(2008) Nurse burnout and stress in the NICU. Adv Neonatal Care. 8(6):343-7.

  Hartley, P. & Kennard, D. (2009). Staff Support Groups in the Helping Professions. London: Routledge

  Kraemer, S. (2015) Anxiety at the front line. In D. Armstrong & M. Rustin (Eds.) Social Defences against Anxiety: Explorations in a Paradigm. London: Karnac http://bit.ly/29FH7zg

  Conflict of Interest:

  None declared

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  Conflict of Interest:
  None declared.

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