A scale-development study: Exploration of intensive-care nurses' attitudes towards futile treatments

Individualized care perceptions and moral distress of intensive care nurses

BACKGROUND

Intensive care settings are characterized by their structure, which constantly changes in parallel with scientific and technological developments, the uncertainty of the lifeline between birth and death, the challenges in the fair distribution of limited resources, the participation of individuals in medical decisions, and witnessing the pain experienced by individuals. These characteristics also affect the level of moral distress, which can make it difficult for ICU nurses to provide the most appropriate individualized care for their patients.

AIMS

The purpose of this study was to determine the moral distress levels and individualized care perceptions of intensive care nurses.

STUDY DESIGN

This study employed a cross-sectional descriptive survey design.

METHODS

This descriptive study was conducted with 128 nurses working in the intensive care units of a university hospital in Turkey. Data were collected using an 'Information Form', 'the Moral Distress Scale', and 'the Individualized Care Scale-Nurse Version'.

RESULTS

78.9% of the nurses stated that there was staff shortage, and 36.0% stated that the physical conditions were not suitable for care in the intensive care units in which they worked. The mean score on the Moral Distress Scale was 79.2 ± 46.4. The mean total score on the Individualized Care Scale-Nurse Version was 3.5 ± 0.8.

CONCLUSION

This study revealed that the intensive care nurses had moderate levels of moral distress and good levels of individualized care perceptions although there was no significant relationship between their moral distress levels and individualized care perceptions. Also, the nurses adopted care behaviours supporting patients' feelings and autonomy.

RELEVANCE TO CLINICAL PRACTICE

In our study, the intensive care nurses did not reflect their moderate-level moral distress in the individualized care provided. It could be beneficial to measure intensive care nurses' moral distress and care levels at frequent intervals so that early precautions could be taken to prevent the accumulation of moral distress and care difficulties among intensive care nurses.

Relationship Between Physician's and Nurses' Attitudes Towards Futile Treatment and Their Approach to Death and Terminally Ill Patients

We aimed to determine the relationship between the attitudes of healthcare professionals towards futile treatment and their approach to death and terminally ill patients. We collected the data from nurses-physicians working in the intensive care unit, using the Nurses' Attitudes towards Futile Treatment Scale (NAFTS) and Approach to Death and Dying Patients Attitude Scale (ADDPAS). Avoidant attitudes displayed towards death and terminally ill patients increase as futile treatment is administered more. Health workers who work in the intensive care unit and witness futile treatment more frequently in the clinic are of the opinion that futile treatment should not be performed.

The moderating effect of spiritual beliefs on job dissatisfaction related to the futile care

Introduction

This study aimed to assess the experience of providing futile care among intensive care unit nurses and to examine the moderating effect of spiritual beliefs on job dissatisfaction related to the sense of futile care among nurses in Intensive Care Units.

Materials and methods

The study had two phases. The first phase was a qualitative study. Twenty-two semi-structured interviews were conducted. In the second phase, we employed a cross-sectional design. The data from 236 nurses were collected using nurses’ perceptions of futile care questionnaire, Minnesota Satisfaction Questionnaire, and Spirituality and Spiritual Care Rating Scale.

Results

The main theme of the qualitative phase was a feeling of self as a useful tool in God’s hand. Sub-themes were providing care while knowing it is futile, not knowing the patient destiny, having hope for care to be fruitful, experiences patient recovery, acting to be a part of God’s plan. Futile care and job experience were two predictors of low job satisfaction. Spiritual well-being had a moderating effect and increased job satisfaction.

Conclusions

Futile care can decrease job satisfaction, while spiritual well-being can reduce its negative effect. Supporting spiritual aspects of nursing care can decrease turn-over intention among nurses.