Background Technological advances have decreased PICU mortality but increased the number of children surviving with disability or technologically-dependent. Death in PICU most frequently follows withdrawal of life-sustaining therapy (LST), increasingly after prolonged admissions for invasive organ support. Disagreements with families about cessation of life-sustaining therapy (LST) can be protracted, distressing for everyone, harmful to the child and ultimately require court adjudication. Little is known about the impact of this, or of that of social/other media campaigns when families decides to involve the press, as is increasingly the case

Method 50 staff (39 nurses; 9 doctors and 2 AHPs) were surveyed using the Moral Distress Scale-Revised (MD-R) questionnaire¹; Trauma Screening Questionnaire (TSQ) and abbreviated Maslach Burnout Inventory (aMBI) together with several open-ended questions about their experiences and what they felt had been learned 3 months after the final court decision following one such high profile case.

Results Mean moral distress score (MDS-R) was 96, consistent with recent Canadian multi-centre PICU study and higher than average Adult ICU scores (57–83 in the literature). Specifically, in relation to the recent high profile case 15% scored in the clinically significant range for post- traumatic stress symptoms (TSQ); a significant number reported a number of sub-clinical symptoms; 68% reported being ‘upset by reminders of the event’ and 53% reported ‘heightened awareness of potential danger’ to themselves and others at least twice in the previous week. Burnout symptoms (aMBI): 44% reported emotional exhaustion at a high level; 17% reported a high level of depersonalization.

The 25% of staff considering leaving PICU reported higher burnout (emotional exhaustion) scores (p=0.001); higher post-traumatic stress scores (p=0.04) and were also less likely to feel supported in relation to moral distress (p=0.010).

Conclusions These findings highlight the impact of changing PICU outcomes on staff, with increased survival of children with severe disability or technologically-dependent; and death following prolonged PICU admission sometimes after disagreements about cessation of LST, occasionally with public campaigns. They illustrate that the dimension of moral distress is one which needs to be acknowledged, along with burnout and post-traumatic stress² in a comprehensive assessment of staff well-being.

References

1. . Hamric AB, Borchers CT, Epstein EG. Development and testing of an instrument to measure moral distress in healthcare professionals. AJOB Prim Res2012;3:1–9.

2. . Colville GA, Smith JG, Brierley J, et al.Coping with staff burnout and work-related posttraumatic stress in intensive care. Pediatr Crit Care Med2017;18:e267–e273.