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

Relationship of intensive care unit nurses' attitudes towards futile treatment with compassion fatigue and turnover intention

BACKGROUND

Intensive care units (ICUs) are high-stress environments where nurses frequently encounter futile treatments. These experiences can lead to compassion fatigue (CF) and increase turnover intention (TI) among ICU nurses.

AIM

To examine the levels of attitudes towards futile treatment (ATFT), CF and TI among ICU nurses, to explore their relationship and identify the factors influencing ATFT.

STUDY DESIGN

This cross-sectional study involved 440 ICU nurses who were members of the Turkish Society of Critical Care Nurses. Data were collected via an online survey using the Attitudes Towards Futile Treatment Scale (ATFTS), Compassion Fatigue-Short Scale (CFS) and Turnover Intention Scale (TIS). Descriptive statistics, correlation analyses and hierarchical regression analyses were conducted to analyse the data.

RESULTS

The findings of the study indicated that ICU nurses' ATFTS, CFS and TIS scores were 43.18 ± 6.44, 74.25 ± 23.33 and 8.39 ± 3.03, respectively. There was a significant negative correlation between ATFTS and CFS (r = -0.428, p = .001) as well as TIS (r = -0.204, p = .029). In the final hierarchical regression model, the significant predictors of ATFTS included participation in patient-related decisions (β = -0.148, p = .001), performing futile treatment practices (β = 0.342, p = .001), work burnout (β = -0.165, p = .015), secondary trauma (β = -0.130, p = .011) and TI (β = -0.170, p = .039).

CONCLUSION

This study found that ICU nurses' ATFTs are negatively correlated with compassion fatigue and turnover intention. Enhancing ICU nurses' involvement in decision-making and providing psychological and emotional support to manage compassion fatigue and turnover intention may help improve their attitudes towards futile treatment.

RELEVANCE TO CLINICAL PRACTICE

The study highlights the critical need to address compassion fatigue and turnover intention among intensive care unit (ICU) nurses to mitigate their negative attitudes towards futile treatments. By improving emotional resilience and involving nurses more actively in ethical decision-making processes, health care institutions can enhance the quality of care provided in ICUs, reduce turnover rates and ultimately support the well-being of the nursing staff.

Medical futility at the end of life: the first qualitative study of ethical decision-making methods among Turkish doctors

BACKGROUND

The swift advancement of intensive care medicine, coupled with technological possibilities, has prompted numerous ethical inquiries regarding decision-making processes concerning the withholding or withdrawal of treatment due to medical futility. This study seeks to delineate the decision-making approaches employed by intensive care physicians in Türkiye when faced with medical futility at the end of life, along with an ethical evaluation of these practices.

METHODS

Grounded theory, a qualitative analysis method was employed, conducting semi-structured, in-depth interviews with eleven intensive care physicians in Türkiye. The subsequent text analysis was carried out using MAXQDA software.

RESULTS

Participants assert that the decisions made by Turkish physicians determine whether treatment is futile, rely on medical consensus, and lack a standardized decision-making process. The decisions are influenced by legal and social pressures, resource constraints, and occasional conflicts of interest. The significance of professional hierarchy is notable, with limited consideration given to the opinions of nurses and other staff. The unstructured medical consensus processes are shaped by normative concepts such as benefit, age, justice, and conscience. Furthermore, it was observed that the conscientious opinions of physicians carry more weight than adherence to ethical principles and guidelines.

CONCLUSION

To create optimal conditions for doctors to make ethically justifiable decisions, the dynamics within the treatment team should be improved, emphasizing the minimization of hierarchy, and ensuring the active participation of all team members in the decision-making process. Additionally, efforts should be directed toward narrowing the gap between the conscience of the individual doctor and established ethical principles. A potential solution lies in the nationwide implementation of clinical ethics committees and the establishing of clinical ethics guidelines, aiming to address, and overcome the identified challenges.

Nurses' attitude toward futile treatment and its relationship with missed care at the end of life

BACKGROUND

Avoiding futile treatment for patients at the end of life is among one of the care challenges of nurses in intensive care units (ICUs).

AIMS

This study aimed to determine the attitude of intensive care unit nurses toward futile treatment and its relationship with missed care for patients at the end of life.

METHOD

This cross-sectional study was conducted on 307 ICU nurses. Eleven teaching hospitals were selected from three Iranian provinces, Zanjan Province, East Azerbaijan and West Azerbaijan, in 2021. The data were collected using The Attitudes Toward Futile Treatment Scale (ATFTS) and The Missed Nursing Care Survey (MISSCARE Survey) as self-reports.

RESULTS

According to the obtained results, 94.8% of the nurses agreed that futile treatment should not be performed. However, 97.7% of the nurses reported that missed care occurs less for patients at the end of life. The correlation between the MISSCARE Survey's total scale and the ATFTS's total scale was positive and statistically significant (r =.11).

CONCLUSION

This research contributes to understanding nurses' attitudes toward futile treatment. Nurses oppose futile treatment, so obstacles to avoiding it should be eliminated. This attitude does not have a significant impact on nursing care quality or missed care for patients at the end of life, but it can lead to enduring distress for nurses. It is recommended to study the reasons for futile treatment, and its link to nurses' mental and physical health.

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.