When healthcare professionals feel constrained from acting in a patient’s best interests, moral distress ensues. The resulting negative sequelae of burnout, poor retention rates, and ultimately poor patient care are well recognized across healthcare providers. Yet an appreciation of how particular disciplines, including physicians, come to be “constrained” in their actions is still lacking. This paper will examine how the application of shared decision-making may contribute to the experience of moral distress for physicians and why such distress may go under-recognized. (...) Appreciation of these dynamics may assist in cross-discipline sensitivity, enabling more constructive dialogue and collaboration. (shrink)

The idea of “postponed withholding,” proposed by Syltern et al. (2022), is a provocative one, and like all good provocative ideas, provokes deeper thinking from fresh perspectives. Our attention wa...

That which constitutes a ‘good death’, or dying well, has long been of interest to philosophers and clinicians alike. While difficult to define due to its deeply personal nature and dependency on spiritual and cultural beliefs and past experiences, Wilkinson1 has drawn parallels from art and music to consider key ethical components. Few in clinical practice would dispute that a ‘good death’ is one that does not rob the person of a valuable life, is aligned with the preferences of the (...) patient and/or their family, where comfort and solace is provided, distress to family and caregivers is minimised or even that dying is not prolonged. However, what is more contentious is how tensions within the principles of a ‘good death’ should be managed or prioritised. In the context of caring for critically ill babies and children, the tension often takes the form of prolonging the dying process through providing life-sustaining interventions to meet the needs of, and to lessen the longer term distress of, the bereaved family, who must live with the decisions that are made. Though often justifiable, such interventions may result in considerable moral distress within caregivers—particularly, as often the case, when interventions are perceived by some clinicians to be of greater benefit to the family than the patient. Some clinicians may have difficulty …. (shrink)

Moral distress is prevalent within the neonatal intensive care unit (NICU) and can negatively affect clinicians. Studies have evaluated the causes of moral distress and interventions to mitigate it...

All research tools have limitations. Not all tools will be suited to every purpose. Understanding the limitations and accurately interpreting the output from any tool is essential to conducting mea...

Being a healthcare professional in both paediatric and adult hospitals will mean being exposed to human tragedies and stressful events involving conflict, misunderstanding, and moral distress. There are a number of different structured approaches to reflection and discussion designed to support healthcare professionals process and make sense of their feelings and experiences and to mitigate against direct and vicarious trauma. In this paper, we draw from our experience in a large children’s hospital and more broadly from the literature to identify (...) and analyse four established approaches to facilitated reflective discussions. Each of the four approaches seeks to acknowledge the stressful nature of health professional work and to support clinicians from all healthcare professions to develop sustainable skills so they continue to grow and thrive as health professionals. Each approach also has the potential to open up feelings of uncertainty, frustration, sorrow, anguish, and moral distress for participants. We argue, therefore, that in order to avoid unintentionally causing harm, a facilitator should have specific skills required to safely lead the discussion and be able to explain the nature, scope, safe application, and limits of each approach. With reference to a hypothetical but realistic clinical case scenario, we discuss the application and key features of each approach, including the goals, underpinning theory, and methods of facilitation. (shrink)