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Always a burden? Healthcare providers’ perspectives on moral distress
  1. Trisha M Prentice1,2,3,4,
  2. Lynn Gillam4,5,
  3. Peter G Davis1,6,
  4. Annie Janvier7
  1. 1 Newborn Research, Royal Women’s Hospital, Melbourne, Victoria, Australia
  2. 2 Neonatal Medicine, Royal Children’s Hospital, Melbourne, Victoria, Australia
  3. 3 Murdoch Children’s Research Institute, Melbourne, Victoria, Australia
  4. 4 Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
  5. 5 Children’s Bioethics Centre, Royal Children’s Hospital, Melbourne, Victoria, Australia
  6. 6 Department of Obstetrics and Gynaecology, University of Melbourne, Melbourne, Victoria, Australia
  7. 7 Departement of Pediatrics, Division of Neonatology, Clinical Ethics Unit, Palliative Care Unit, Unité de Recherche en Éthique Clinique et Partenariat Famille, CHU Ste-Justine, Montreal, Quebec, Canada
  1. Correspondence to Dr Trisha M Prentice, Newborn Research, Royal Women’s Hospital, Parkville, Victoria 3052, Australia; trisha.prentice{at}


Background Current conceptualisations of moral distress largely portray a negative phenomenon that leads to burnout, reduced job satisfaction and poor patient care.

Objective To explore clinical experiences, perspectives and perceptions of moral distress in neonatology.

Design An anonymous questionnaire was distributed to medical and nursing providers within two tertiary level neonatal intensive care units (NICUs)—one surgical and one perinatal—seeking their understanding of the term and their experience of it. Open-ended questions were analysed using qualitative methodology.

Results A total of 345 healthcare providers from two NICUs participated (80% response rate): 286 nurses and 59 medical providers. Moral distress was correctly identified as constrained moral judgement resulting in distress by 93% of participants. However, in practice the term moral distress was also used as an umbrella term to articulate different forms of distress. Moral distress was experienced by 72% of providers at least once a month. Yet despite the negative sequelae of moral distress, few (8% medical, 21% nursing providers) thought that moral distress should be eliminated from the NICU. Open-ended responses revealed that while interventions were desired to decrease the negative impacts of moral distress, moral distress was also viewed as an essential component of the caring profession that prompts robust discussion and acts as an impetus for medical decision-making.

Conclusions Moral distress remains prevalent within NICUs. While the harmful aspects of moral distress need to be mitigated, moral distress may have a positive role in advocating for and promoting the interests of the neonatal population.

  • neonatology
  • prematurity
  • bioethics
  • clinical ethics
  • end-of-life
  • decision-making
  • moral distress

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  • Contributors TMP conceptualised and designed the study, carried out the initial analysis and drafted and approved the final manuscript. LG, AJ and PGD assisted in the design of the questionnaire, critically reviewed the manuscript and approved the final manuscript. LG and AJ additionally assisted in the thematic analysis of qualitative data.

  • Funding Australian Government Research Training Scholarship.

  • Competing interests None declared.

  • Ethics approval Royal Children’s Hospital, Melbourne, Australia.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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