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Impact of a Pediatric Quality of Life Program on Providers' Moral Distress

Brandon, Debra PhD, RN, CCNS, FAAN; Ryan, Donna DNP, RN; Sloane, Richard MPH; Docherty, Sharron L. PhD, RN, CPNP-AC/PC, FAAN

MCN: The American Journal of Maternal/Child Nursing: May/June 2014 - Volume 39 - Issue 3 - p 189–197
doi: 10.1097/NMC.0000000000000025

Purpose: To evaluate the impact of the introduction of a new pediatric palliative care program on the pattern of moral distress in pediatric healthcare providers (HCPs).

Study Design and Methods: We used a before and after cross-sectional survey design to study the impact of the Pediatric Quality of Life (QoL) Program on the moral distress of pediatric HCPs at a single center. Moral distress is measured in both intensity and frequency. The sample came from lists of all pediatric providers (nurses, physicians, social workers, therapists, dieticians, chaplains, administrators) serving the inpatient and outpatient pediatric areas of a southeastern academic tertiary medical center.

Results: The intensity of moral distress from situations focused on “individual responsibility” and “not in the best interest of the patient” were similar before and after program implementation, but the intensity of distress related to “work quality of life” decreased after program implementation. Situations causing moral distress when the “care given was not in the patient's best interest” occurred less frequently after program implementation. Providers disagreed with statements that “work-related distress” impacted their personal or professional life. The number of providers who were considering leaving the institution within 6 months decreased following program implementation.

Clinical Implications: After implementation of the Pediatric QoL Program, nurses and other providers encountered morally distressing situations less often. Providers also answered that they had greater comfort with and competence in providing care focused on patients' quality of life after completing the program. As palliative care programs include many activities that reduce moral distress, nurses should actively take advantage of participation in debriefing sessions and staff education to maximize their work quality of life.

Nurses and other health care providers experience moral distress when they are asked to provide care that they don't agree with. These nurses gave their peers a special program on pediatric quality of life. Did they impact moral distress?

Debra Brandon is PhD and Postdoctoral Program Director, Duke University School of Nursing; Associate Professor, Duke University School of Nursing and School of Medicine, Durham, NC. The author can be reached via e-mail at

Donna Ryan is Clinical Instructor, Duke University School of Nursing, Durham, NC.

Richard Sloane is Biostatistician, Center for Aging, Duke University School of Medicine, Durham, NC.

Sharron L. Docherty is Associate Professor, School of Nursing; Associate Professor, Department of Pediatrics, School of Medicine; Co-Director, Adapt Center for Cognitive/Affective Symptom Science, Duke University School of Nursing, Durham, NC.

The authors have declared no conflicts of interest.

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