Moral Distress in Paediatric Intensive Care Unit (PICU)Teams.

The Concept

Moral distress is the name given to the anguish that arises when one believes a moral situation to have gone awry. One has been unable, due to real or perceived constraints, to bring about the action judged to be the fitting response. 

Why Moral Distress in PICUs? Advances in technology within the modern ICUs are “pushing the envelope” in attempts to save the lives of seriously ill or injured children, where team members struggle daily to address issues of consent, futility, and quality of life. The risk of moral distress is high when team members disagree with one another or with children’s families over what is the right thing to do.

The Research

"The Experience and Resolution of Moral Distress in Paediatric Intensive Care Teams: A Canadian Perspective". 

In an effort to facilitate understanding of moral distress among Canadian PICU teams, a participatory action research project was designed in which stories where collected and a typology of paradigmatic stories developed. 

Why stories?

Stories are a way to convey experiences, raise questions, and search for answers. The sharing of stories supports learning to live together ethically: we learn about and from one another.   Stories are the basis for a form of research called "NARRATIVE INQUIRE".

The power of "narrative inquiry" to help PICU teams address their experiences of moral distress is demonstrated on this project, with health care professionals given personal recounts of situations leading to moral distress.

Over the course of the project, from 2007 to 2012, over 60 stories were collected from health care members who have worked or still work in 8 PICUs in Canada.  The PICUs involved were the ones with the capacity to provide the highest level of intensive treatment (i.e,  extra-corporeal life support -ECMO, organ transplantation and complex heart surgeries). The PICU team included dieticians, nurses, intensivists, medical residents/clinical fellows, respiratory therapists, and social workers. Five patterns of stories were identified (the typology!): Stories Bearing Witness, Stories of CollusionStories of Resistance, Untold Stories, and Stories of Legend. 

Based on these interviews and subsequent focus group research, it became clear that moral distress occurs for members of PICU teams when practitioners believe that they are not fulfilling their moral obligations and thus feel their integrity is in 

jeopardy. We know that Moral Distress arises when professionals feel they have participated in (or were unable to prevent) unethical actions. When their moral distress is unresolved, practitioners’ perceptions of their care and workplace are affected; many contemplate or do leave their job or their profession entirely. 

The research underscores the need for an end to a culture of silence around moral distress and for the creation of processes in which stories can be shared as a means of preventing and resolving it. That is why the film was created.

(for more information on the research findings, check http://www.picumoraldistress.ualberta.ca)

The Film

This film is based on a play created to disseminate the results of this CIHR (Canadian Institutes of Health Research) funded research project. It portrays some of the many stories told by PICU professionals, and their refections about their challenges in this environment.

It was directed by PETER CONRADI; Produced by "The Idea factory" (Edmonton, AB).

(see credits below)

What We Want to Achieve

Responses to moral distress arising from these ethical issues can include feeling frustration, anger, helplessness, despair, and/or betrayal. Unresolved moral distress can eventually drive health professionals out of their place of employment and even out of their discipline.

It is our aim that the dialogue fostered by this movie could help PICU professionals recognize potential situations in which moral distress can arise and help them develop strategies to identify, mitigate, and resolve it. The audience will not only obtain an understanding of moral distress (specifically within the PICU, as well as in health care, in general), but also will explore how one can maintain one’s moral compass within a morally plural environment while continuing to work towards a common goal ( the benefit of our patients).



Produced by - The Idea Factory 

Directed by - Peter Conradi ; Screenplay by - Timothy Anderson

Camera - Cory Gadke; 1st AD - Joses Martin; Sound - Jesse Luce ; Score by - Jeremy Wiebe

Editor - David Haas ; Locations Coordinator - Dr. Alf Conradi

Technical Advisor/ ICU Simulation  - Dr. Daniel Garros