Moral Distress and Burnout Among Healthcare Providers in a Cardiovascular Surgical Intensive Care
CCCF ePoster library. Bagshaw S. Oct 28, 2015; 117299; P106
Dr. Sean M Bagshaw
Dr. Sean M Bagshaw
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Abstract
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P106


Topic: Quality Assurance/Quality Improvement Project


Moral Distress and Burnout Among Healthcare Providers in a Cardiovascular Surgical Intensive Care



Sean M Bagshaw, M. Bellows, S. Richardson-Carr, L. Johnson-Coyle, S. Richardson-Carr, D. Opgenorth

Division of Critical Care Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada | Mazankowski Alberta Heart Institute,, University of Alberta, Edmonton, Canada | Cardiovascular Surgical Intensive Care Unit, Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Canada | Cardiovascular Surgical Intensive Care Unit, Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Canada | Cardiovascular Surgical Intensive Care Unit, Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Canada | Division of Critical Care Medicine, Faculty of Medicine and Dentistry,, University of Alberta, Edmonton, Canada

Introduction: The intensive care unit (ICU) is a busy, high stress, complex environment. ICU providers directly involved in patient care are susceptible to moral distress, compassion fatigue, and burnout. In recent months, the cardiovascular ICU (CVICU) at the Mazankowski Alberta Heart Institute (MAZ) has been characterized by high patient acuity and complexity, strained occupancy and challenging end-of-life care, raising concern health care providers are experiencing high levels of moral distress and burnout.

Objectives: To describe and compare the prevalence and contributing factors to moral distress and burnout across inter-disciplinary healthcare providers.

Methods: Web-based survey of providers (registered nurses [RN]/nurse practitioners [NP]; registered respiratory therapists [RRT]; allied health and physicians) working in a 24-bed CVICU at the MAZ between June 15–29, 2015. The survey captured demographic data and integrated the Moral Distress Scale-Revised and the Maslach Burnout Inventory™ instruments.

Results: One hundred sixty-nine providers completed the survey (response rate 88%). The majority of respondents were aged 26-34 years old (45%), female (79%), married or common law (50%), full time employed (78%) and had been working in the CVICU for > 5 years (46%). Moral distress was higher among RN/NPs (median [IQR] MDS-R score 80 [57-110]) and RRTs (85 [61-104]) compared with allied health (54 [39-66]) and physicians (66 [43-82], p=0.06). The highest ranking sources of moral distress among providers were: “Continue to participate in the care for a hopelessly ill person who is being sustained on a ventilator, when no one will make a decision to withdrawal support”; “follow a family’s wishes to continue life support even though I believe it is not in the best interest of the patient” and “witness healthcare providers giving “false hope” to a patient or family”. Fifty percent had considered leaving their position. This was highest among RN/NPs (52%) and RRTs (47%). Emotional exhaustion and depersonalization were more prevalent in RN/NPs (moderate-to-high: 70%; 69%) and RRTs (moderate-to-high: 80%; 80%), while high personal accomplishment was lowest (30%; 20%), when compared with allied health and physicians. Moral distress was positively correlated with emotional exhaustion (r = 0.41; p<0.01) and depersonalization (r = 0.27; p<0.01) and negatively correlated with workplace satisfaction, specifically with the perception of “recognition for good work” (r = -0.26; p<0.01) and “attention paid to suggestions” (r = -0.29; p<0.01).

Conclusion: Moral distress and burnout are common across providers in the CVICU; however, are most prevalent among nurses and respiratory therapists. Five themes emerged as contributing factors to moral distress and burnout including: care of complex patients, team communication, provision of non-beneficial therapy, end-of-life-care and capacity strain. These findings will aid in developing strategies to mitigate moral distress and burnout along with enhancing patient care and improving provider satisfaction.

References: None.
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