Objective

To explore how pediatric hospitalist attendings can recognize, prevent, and mitigate moral distress among pediatric residents.

Methods

We conducted a qualitative study, utilizing a deductive approach, from August 2019 to February 2020 at 4 university-affiliated, freestanding children's hospitals in the United States using semistructured, one-on-one interviews with pediatric residents and pediatric hospitalist attendings. All transcripts were coded by pairs of research team members. Using constant comparative analysis, codes were categorized into themes and subsequently grouped into domains. We then conceptualized the relationships between the domains.

Results

We interviewed 40 physicians (18 residents, 22 attendings) and identified specific strategies for attendings to help residents navigate moral distress, which were categorized into 4 proactive and 4 responsive themes. The proactive themes included strategies employed before morally distressing events to minimize impact: ensuring attendings’ awareness of residency factors influencing residents’ moral distress; knowing available support resources; creating a learning environment that lays the foundation for mitigating distress; and recognizing moral distress in residents. The responsive themes included strategies that help mitigate the impact of morally distressing situations after they occur: partnering with the senior resident to develop a team-specific plan; consideration of who will participate in, the timing of, and content of the debrief.

Conclusions

We present multiple strategies that attendings can implement to learn to recognize, prevent, and mitigate moral distress among residents. Our findings highlight the need for both proactive and reactive strategies and offer a possible roadmap for attending physicians to help their residents navigate moral distress.

中文翻译：

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出席如何帮助居民克服道德困境：一项定性研究

客观的

探讨儿科住院医师如何识别、预防和减轻儿科住院医师的道德困扰。

方法

2019 年 8 月至 2020 年 2 月，我们使用演绎法在美国 4 家附属大学的独立儿童医院进行了一项定性研究，对儿科住院医师和儿科住院医师进行了半结构化的一对一访谈。所有成绩单均由成对的研究团队成员编码。使用不断的比较分析，代码被分类到主题中，然后再分组到域中。然后我们将域之间的关系概念化。

结果

我们采访了 40 名医生（18 名住院医师，22 名主治医师）并确定了帮助住院医师应对道德困境的具体策略，这些策略分为 4 个主动主题和 4 个响应主题。积极主动的主题包括在道德困扰事件之前采用的策略，以尽量减少影响：确保参加者对影响居民道德困扰的居住因素的认识；了解可用的支持资源；创造一个学习环境，为减轻痛苦奠定基础；并认识到居民的道德困境。响应主题包括有助于减轻道德困境发生后影响的策略：与高级居民合作制定团队特定计划；考虑谁将参与、汇报的时间和内容。

结论

我们提出了多种策略，参与者可以实施这些策略来学习识别、预防和减轻居民的道德困扰。我们的研究结果强调了对主动和被动策略的需求，并为主治医生提供了一个可能的路线图，以帮助他们的居民渡过道德困境。