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Healthcare providers, Palliative care, Pediatrics, Psychological stress, Quality of life.



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


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.