• Giulia Lamiani, Luca Barlascini, Lidia Borghi, Alberto Giannini, and Open Doors in INtensive care (ODIN) Study Group 2.
• Department of Health Sciences, University of Milan, Milan, Italy.
• Pediatr Crit Care Me. 2022 Nov 1; 23 (11): 872880872-880.

ObjectivesTo assess the interplay between individual and organizational factors on moral distress in PICUs.DesignCross-sectional, article-based survey administered between June and August 2017.SettingTwenty-three Italian PICUs.SubjectsOf 874 eligible clinicians, 635 responded to the survey (75% response rate), and 612 correctly completed the survey. Clinicians were 74% female; 66% nurses and 34% physicians; and 51% had between 6 and 20 years of experience from graduation.InterventionNone.Measurements And Main ResultsClinicians completed the "Italian Moral Distress Scale-Revised," the "Connor-Davidson Resilience Scale," and a sociodemographic questionnaire inquiring about sex, profession, years of experience, and spiritual/religious belief. PICU organizational characteristics were also collected (e.g., number of admissions, mortality rate, nurse-patient ratio, presence of parents in PICU, presence of parents during physical examination). To identify individual predictors of moral distress, we used stepwise linear regression. To determine the impact of organizational factors on moral distress, we used analysis of covariance, controlling for those individual factors that emerged as significant in the regression model. Moral distress was associated with being a nurse (B = -0.094; p < 0.05) and not having spiritual/religious belief (B = 0.130; p < 0.01), but not with resilience. Clinicians working in PICUs with a medium number of admissions per year (between 264 and 468), a lower nurse:patient ratio (1:3), and where parents' presence during physical examination were never allowed experienced higher moral distress even controlling for profession and spiritual/religious belief.ConclusionsOrganizational factors (medium number of admissions, lower nurse:patient ratio, and parental exclusion from physical examination) played a stronger role than individual factors in increasing moral distress. To decrease moral distress, attention should be paid also to organizational aspects.Copyright © 2022 by the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies.

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