Moral distress in pediatric complex care coordinators: a reflexive thematic analysis.
13 affiliations
- 1Alberta Children's Hospital Research Institute, University of Calgary, Calgary, AB, Canada.
- 2Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada.
- 3Department of Pediatrics, Cumming School of Medicine, University of Calgary Alberta Children's Hospital, 28 Oki Drive NW, Calgary, AB, T3B 6A8, Canada.
- 4School of Nursing and Midwifery, Mount Royal University, Calgary, AB, Canada.
- 5Alberta Health Services, Edmonton, Alberta, Canada.
- 6Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.
- 7Faculty of Nursing, University of Alberta, AB, Edmonton, Canada.
- 8Partnerships & Innovation, Acute Care Alberta, Calgary, AB, Canada.
- 9School of Public Policy, University of Calgary, Calgary, AB, Canada.
- 10Alberta Children's Hospital Research Institute, University of Calgary, Calgary, AB, Canada. [email protected].
- 11Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada. [email protected].
- 12Faculty of Nursing, University of Alberta, AB, Edmonton, Canada. [email protected].
- 13Department of Pediatrics, Cumming School of Medicine, University of Calgary Alberta Children's Hospital, 28 Oki Drive NW, Calgary, AB, T3B 6A8, Canada. [email protected].
Abstract
Background
Moral distress can occur in situations where one wants to follow a desired course of action but experiences restraints from internal and external barriers. Unaddressed moral distress is associated with negative outcomes (e.g., burnout). Due to the nature of their work with medically and neurodevelopmentally complex children and their families, pediatrics complex care coordinators are at risk of experiencing moral distress. However, there is limited understanding of moral distress in this professional population. Study objectives were to: (1) understand how pediatric complex care coordinators at a tertiary pediatric hospital defined moral distress; (2) explore factors that influence and modulate moral distress in these care coordinators; and (3) explore the impacts of moral distress on care coordinators.Methods
Semi-structured virtual interviews were conducted with twelve pediatric complex care coordinators from a pediatric tertiary care centre to explore experiences with moral distress. Interviews ranged from 25 to 60 min. Interview transcripts were examined by two researchers using inductive reflexive thematic analysis for each objective. The data were analyzed and coded and a 15-point checklist was utilized throughout each phase of the analysis process for consistency amongst coders.Results
All participants reported experiencing moral distress using the seminal definition of moral distress. Care coordinators added additional context and depth to this definition. Factors influencing and modulating moral distress in care coordinators were identified: (1) restrictiveness of their scope and capacity; (2) individual experiences; (3) availability of coping mechanisms; (4) the nature of their interactions; and (5) resolution. Four themes on the impact of moral distress were also identified: (1) changes in perspective; (2) impacts on well-being; (3) need for internal and external change; and (4) influence on interpersonal relationships.Conclusion
An expanded definition of moral distress was co-created with care coordinators and identified factors that influenced moral distress and impacts of moral distress. This work is an important first step to developing a better understanding of moral distress in care coordinators and could inform future interventions to address moral distress in this population.
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BibTeX
@article{chahal2026moral,
title = {{Moral distress in pediatric complex care coordinators: a reflexive thematic analysis.}},
author = {Simran Chahal and Genevieve Currie and Seong Eon Ha and Skanda Kaushik and Ishnoor Nahal and Myka Estes and Shannon Jaskela and Kiran Pohar Manhas and Julie Lauzon and Ian Mitchell and Stacey Page and Jennifer Zwicker and Deborah Dewey and W Ben Gibbard and Sarah J MacEachern},
journal = {BMC pediatrics},
year = {2026},
month = jul,
doi = {10.1186/s12887-026-07421-1},
url = {https://europepmc.org/article/MED/42928190},
note = {CC BY-NC-ND},
}
RIS
TY - JOUR
TI - Moral distress in pediatric complex care coordinators: a reflexive thematic analysis.
AU - Simran Chahal
AU - Genevieve Currie
AU - Seong Eon Ha
AU - Skanda Kaushik
AU - Ishnoor Nahal
AU - Myka Estes
AU - Shannon Jaskela
AU - Kiran Pohar Manhas
AU - Julie Lauzon
AU - Ian Mitchell
AU - Stacey Page
AU - Jennifer Zwicker
AU - Deborah Dewey
AU - W Ben Gibbard
AU - Sarah J MacEachern
PY - 2026
DA - 2026/07/01
JO - BMC pediatrics
DO - 10.1186/s12887-026-07421-1
UR - https://europepmc.org/article/MED/42928190
AB - Background Moral distress can occur in situations where one wants to follow a desired course of action but experiences restraints from internal and external barriers. Unaddressed moral distress is associated with negative outcomes (e.g., burnout). Due to the nature of their work with medically and neurodevelopmentally complex children and their families, pediatrics complex care coordinators are at risk of experiencing moral distress. However, there is limited understanding of moral distress in this professional population. Study objectives were to: (1) understand how pediatric complex care coordinators at a tertiary pediatric hospital defined moral distress; (2) explore factors that influence and modulate moral distress in these care coordinators; and (3) explore the impacts of moral distress on care coordinators.Methods Semi-structured virtual interviews were conducted with twelve pediatric complex care coordinators from a pediatric tertiary care centre to explore experiences with moral distress. Interviews ranged from 25 to 60 min. Interview transcripts were examined by two researchers using inductive reflexive thematic analysis for each objective. The data were analyzed and coded and a 15-point checklist was utilized throughout each phase of the analysis process for consistency amongst coders.Results All participants reported experiencing moral distress using the seminal definition of moral distress. Care coordinators added additional context and depth to this definition. Factors influencing and modulating moral distress in care coordinators were identified: (1) restrictiveness of their scope and capacity; (2) individual experiences; (3) availability of coping mechanisms; (4) the nature of their interactions; and (5) resolution. Four themes on the impact of moral distress were also identified: (1) changes in perspective; (2) impacts on well-being; (3) need for internal and external change; and (4) influence on interpersonal relationships.Conclusion An expanded definition of moral distress was co-created with care coordinators and identified factors that influenced moral distress and impacts of moral distress. This work is an important first step to developing a better understanding of moral distress in care coordinators and could inform future interventions to address moral distress in this population.
SN - 1471-2431
ER -