Purpose: Moral distress and compassion fatigue are known factors in the care delivery of patients in the Pediatric CICU.  The etiology is multi-factorial, but the care of patients with life-limiting diagnoses and increased risk of cardiac arrest requiring advanced cardiac therapies is a component of compassion fatigue amongst providers.  Often staff want to talk about their experience and listen to those who are experiencing these intense events at their place of work.  The CICU at Children’s National created a forum entitled VOICE to serve as a platform to facilitate these discussions.  VOICE stands for Validation, Openness, Integrity, Communication, and Engagement.  A VOICE session includes a patient based discussion where any part of the interprofessional team can join and talk about a difficult patient or topic for approximately 45 minutes followed by some coping and mindfulness techniques to help build resiliency.  

Project Design: VOICE sessions were scheduled bi-monthly and transitioned to monthly.  They were originally onsite near the unit and moved to a web-based discussion due to the COVID-19 pandemic.  Attendance was collected by discipline, not name.  Minutes were taken during the session and a summary email was distributed with no identifying information.  

Results: 22 discussions were held over 19 months.  In addition to patient-based sessions the VOICE team hosted four sessions on pressing social issues including COVID-19, Black Lives Matter, and Asian American Pacific Islander focused conversations.   In 2022, the VOICE project added nurse led bereavement sessions.  Attendance averaged around 14 participants ranging from 4 to 23.  When nurses (n=77) were surveyed about how often they read the summaries, 18% reported always, 27% reported usually, and 33% reported sometimes.  Of those same nurses that were surveyed, 60% reported that the summaries are important to very important to staff.  Feedback from staff less than 2 years of experience has been favorable as they enjoy having a safe space to talk about transition to practice with difficult patients and families.  Qualitative data will be shared during presentation. 

Conclusion: The VOICE sessions are an established meeting in the CICU.  The sessions are usually well attended, and people do enjoy the summary emails.  The meetings are true interprofessional discussions with representation from multiple disciplines.  The anecdotal feedback from staff has been positive as this has proven to be a desired opportunity to discuss hard topics in a safe forum.  Coincidentally it has a been a support to nurses starting to practice in the CICU.  Coping strategies are presented by the VOICE team and staff members share their own experience with working in the CICU and dealing with these emotionally charged cases.  Continued engagement in the nomination process and attendance demonstrates that this is a worthwhile offering in the CICU.  Future analysis will include correlation to staff satisfaction and moral distress scores.