Understanding the Moral Distress of Nurses Witnessing Medically Futile Care

Sofrimento moral e a dimensão ética no trabalho da enfermagem

Trabalhadores de enfermagem vivenciam problemas morais, dilemas morais e sofrimento moral, no seu cotidiano profissional. O sofrimento moral manifesta-se quando os trabalhadores apresentam dificuldades para executar situações moralmente adequadas, segundo suas consciências. O texto tem como objetivo enfocar o sofrimento moral dos trabalhadores de enfermagem e sua relação com problemas morais e dilemas morais, abordando conceitos, vivências de sofrimento moral e possíveis estratégias a serem adotadas para o seu enfrentamento. Enfocar o sofrimento moral provocado pelo enfrentamento de problemas e dilemas morais no trabalho da enfermagem parece fundamental, não apenas para desvelar um fenômeno ainda pouco conhecido, mesmo que vivenciado quase que diariamente, mas, também, para destacar a necessidade de problematização e valorização da dimensão ética do trabalho em saúde.

Medical futility: a paradigm as old as Hippocrates

Medical futility is a concept commonly used to describe medical therapy that has no known or anticipated immediate or long-term benefit for a patient. The concept of futility has existed since the time of Hippocrates and has become the predominant dilemma for many end-of-life situations. Today, clinicians grapple with ethical conflicts and concepts in their daily practice. Many healthcare providers use the concept of medical futility when they are talking with patients and families who are in a quandary about their loved one's care. This article provides an overview of medical futility.

The cardiovascular intensive care unit nurse's experience with end-of-life care: a qualitative descriptive study

PURPOSE

Nurses in the cardiovascular intensive care unit (CVICU) informally expressed moral angst when caring for patients who are approaching the end of life. The purpose of this study was to better understand CVICU nurses' perceptions about their roles and responsibilities in the decision-making process about change in intensity of care and end-of-life care for patients within the CVICU setting.

PARTICIPANTS AND METHODS

Nineteen nurses from one CVICU consented to being interviewed individually regarding their experiences caring for patients approaching the end of life, and specifically regarding the initiation of a change in code status. Investigators used a qualitative descriptive approach to collect and analyse the data. Transcript data were analysed and as concepts emerged they were compared with those from earlier interviews to establish similarities and differences. Investigators reached consensus about the major themes.

FINDINGS

Analysis revealed four major themes: (a) exhausting patient treatments; (b) promoting family presence; (c) acknowledging physician authority; and (d) walking a fine line.

CONCLUSIONS

This research adds to the limited body of knowledge concerning CVICU nurses' experiences with end-of-life care. Results of this study provide a basis for putting in place support systems for CVICU nurses.

Palliative care for people with Alzheimer's disease

The task of aligning the philosophical and clinical perspectives on ethics is a challenging one. Clinical practice informs philosophy, not merely by supplying cases, but through shaping and testing philosophical concepts in the reality of the clinical world. In this paper we explore several aspects of the relationship between the philosophical and the clinical within a framework of palliative care for people living with Alzheimer's disease. We suggest that health professionals have a moral obligation to question previous assumptions concerning the quality of life among people with Alzheimer's, and to address the question: does the concept of palliative care properly embrace people with severe dementia? We propose an ethic of palliative care for people with Alzheimer's that is based, not on the traditionally understood principle of autonomy, but on the need to listen to those living with the disease, acknowledging their profound loss of cognitive abilities, with a focus on preventing and relieving suffering, and improving the individual's quality of life.

Conscientious objection: a potential neonatal nursing response to care orders that cause suffering at the end of life? Study of a concept

This article is an exploratory effort meant to solicit and provoke dialog. Conscientious objection is proposed as a potential response to the moral distress experienced by neonatal nurses. The most commonly reported cause of distress for all nurses is following orders to support patients at the end of their lives with advanced technology when palliative or comfort care would be more humane. Nurses report that they feel they are harming patients or causing suffering when they could be comforting instead. We examined the literature on moral distress, futility, and the concept of conscientious objection from the perspective of the nurse's potential response to performing advanced technologic interventions for the dying patient. We created a small pilot study to engage in clinical verification of the use of our concept of conscientious objection. Data from 66 neonatal intensive care and pediatric intensive care unit nurses who responded in a one-month period are reported here. Interest in conscientious objection to care that causes harm or suffering was very high. This article reports the analysis of conscientious objection use in neonatal care.