Introduction:
Moral distress is a phenomenon that often occurs in intensive care
settings and is defined as “when one knows the right thing to do, but
institutional constraints make it nearly impossible to pursue the right
course of action” (1). The concept has been described most
comprehensively in the pediatric nursing literature, as initial work
suggested nurses experienced high levels of moral distress due to their
proximity to patients and the hierarchy of decision-making leading
limited control of care decisions (2-6). However, recent data suggests
that moral distress also affects physicians and advanced practice
providers (APPs) caring for critically ill patients, indicating that it
is a broader issue than initially theorized (7-10).
While moral distress in critical care situations has been studied, there
is comparably scant information about the degree of moral distress
providers experience when caring for patients with chronic diseases
requiring long term care. Anecdotally, providers caring for children
requiring long term ventilatory support with tracheostomy dependence
express some degree of moral distress. It is known that families caring
for these children report some degree of distress (11), but little is
known about the impact on providers caring for this population. To this
end, we surveyed providers in an inpatient unit that specializes in the
long-term care of patients with tracheostomy and ventilator dependence
to determine the degree to which moral distress exists among these
providers.