The impact of interprofessional perspective-taking on moral distress in the pediatric intensive care unit

ABSTRACT

Moral distress arises when constraints outside of healthcare professionals’ control prohibit them from acting according to the ethically sound course of action. It can be triggered by poor communication and different perspectives between professionals. We examined whether and how taking the perspective of the other profession reduces moral distress among pediatric intensive care nurses and physicians. Using elements of a previously published scale, we created a Vignette-based Moral Distress Rating Scale (V-MDRS). Study participants from three sites included 105 nurses and 34 physicians who read a patient vignette with their own profession’s perspective, completed the V-MDRS, then received the other profession’s perspective and completed the V-MDRS again. We conducted semi-structured interviews with nine nurses and nine physicians who completed the V-MDRS to explore how interprofessional perspective-taking impacts moral distress. Nurses experienced higher baseline moral distress than physicians (mean ± standard deviation 31.1 ± 6.9 vs 26.4 ± 5, P < .001), and at two study sites nurses’ moral distress declined after reading the physician’s perspective. Findings from interviews suggest that physicians were already sensitized to nurses’ perspective and that perspective-taking may be particularly beneficial to cohesive teams with strong relationships. Thus, encouraging interprofessional perspective-taking may mitigate moral distress in healthcare professionals.

KEYWORDS:

• Moral distress
• perspective-taking
• ethics
• interprofessional care
• team-based care
• mixed methods

Acknowledgments

We thank Dr. Ann Hamric for granting permission to use items from the Moral Distress Scale – Revised for our rating scale, Dr. Martina Steurer-Muller for assistance with statistical analysis, Dr. Jennifer Plant and Ms. Hadley Sauers-Ford for assistance with data collection, and Alicia Bonella NP for her contributions to the vignette. We also are grateful to the nurses and physicians who participated in this study.

Declaration of interest

The authors report no conflicts of interest. The authors alone are responsible for the content and writing of this article.

Additional information

Notes on contributors

Katie Kowalek

Katie Kowalek is a pediatric intensivist at the University of Arizona with an interest in Interprofessional medical education.