Distress and moral imprint in pediatrics, concepts to recognize and manage

Abstract

Moral distress (MD) is the negative feeling experienced by professionals who are unable to act according to what they consider correct. This can be influenced by personal, relational, or institutional factors. It can generate emotions such as anger, guilt, and hopelessness, affecting the quality of life of professionals and their clinical practices. Since its initial description in nursing regarding therapeutic futility, its study has expanded through validated scales that identify its frequency, intensity, and contexts. MD is associated with job dissatisfaction, professional burnout, and even leaving the profession. In pediatrics, it is strongly expressed in intensive care, neonatal care, and oncology. Unlike ethical dilemmas –where there is deliberation– in MD, the professional acts against their moral judgment, causing harm by rupturing moral identity. In pediatrics, complexity increases when the wishes of family members are incorporated into the specifications of care, without being completely certain about what the child would have preferred. The lack of institutional tools and resources exacerbates its impact, which was most evident during the COVID-19 pandemic. This article explores some known sources, how professionals are affected, and the often overlooked impact of the moral injury or moral imprint. The objective of exploring this topic has been to bring visibility to the phenomenon and to foster a discussion that allows us to reflect on strategies and the need to promote moral resilience among pediatric care professionals.