Assessment of Moral Distress Among Pediatric Respiratory Therapists and Extracorporeal Membrane Oxygenation Specialists

Abstract

Background:

The impact of moral distress, burn out, and compassion fatigue has been described in nurses and physicians, but limited data exist regarding respiratory therapists (RTs). We sought to investigate the prevalence of moral distress and burnout in pediatric RTs and extracorporeal membrane oxygenation (ECMO) specialists.

Methods:

IRB approval was obtained and an anonymous survey was electronically distributed to the Respiratory Care and ECMO departments at Boston Children’s Hospital. The survey was conducted from August 5 - September 20, 2020. Demographic variables were collected and participants were asked about familiarity with compassion fatigue, moral distress, burn out, and self-care. Measurement of Moral Distress for Healthcare Providers (MMD-HP) and a Single Item Assessment for Burnout were collected for each participant. Additional questions included whether or not they felt supported by the department and leadership during traumatic patient care experiences, day to day activities, and if they performed adequate self-care. Categorical variables were summarized using frequencies, percents, or proportions and compared using chi-square or Fisher’s exact test as appropriate. The Kruskal-Wallis test was used to compare MMD-HP between grouping variables. Spearmen correlation was used to assess the relationship between variables.

Results:

A total of 57 (67%) of the respondents completed all forms and were included for analysis. Staff characteristics are displayed in (Table 1). Median scores for MMD-HP and burnout were 92 IQR (68.5-133.5) and 2 (2-3) respectfully. Moderate inverse correlations were observed between MMD-HP and perceived support from the department (correlation coefficient -.273; P = .04), leadership (correlation coefficient -.279; P = .036), and reported levels of self-care (correlation coefficient -.314; P = .017).

Conclusions:

Pediatric RTs and ECMO Specialists reported moderate levels of moral distress and burnout. We identified that perceived lack of support from colleagues or department leadership and limited self-care practices may negatively influence moral distress. Further research evaluating the specific drivers of moral distress and the modification thereof are essential for designing interventions to mitigate the impact of moral distress within respiratory care departments.