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Accogli A, Vergano M. Managing the Labyrinth of Complex Ethical Issues in Anesthesia Practice: The Anesthesiologist's Ariadne's Thread. Anesthesiol Clin 2024; 42:357-366. [PMID: 39054012 DOI: 10.1016/j.anclin.2023.12.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/27/2024]
Abstract
Facing ethical dilemmas is challenging and sometimes becomes a real burden for anesthesiologists, particularly because they rarely have previous or long-standing patient relationships that help inform clinical decision-making. Although there is no ideal algorithm that can fit all clinical situations, some basic moral and ethical principles, which should be part of every clinician's armamentarium, can guide the decision-making process. Dealing with conflicting views among providers and/or patients can be distressing but can lead to meaningful professional and personal growth for each clinician.
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Affiliation(s)
- Agnese Accogli
- Department of Surgical Sciences, University of Turin, Corso Dogliotti 14, Turin, Italy
| | - Marco Vergano
- Department of Anesthesia and Intensive Care, San Giovanni Bosco Hospital, Torino, Italy.
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Kondo A, Oki T, Eckhardt AL. Factors related to resilience and attitudes towards care of the dying among critical care nurses. Nurs Crit Care 2024. [PMID: 39171433 DOI: 10.1111/nicc.13146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2023] [Revised: 07/26/2024] [Accepted: 07/26/2024] [Indexed: 08/23/2024]
Abstract
BACKGROUND Many critical care nurses provide care to patients who are injured or ill and are at the end-of-life. Therefore, they are at high risk for developing negative emotional responses due to exposure to patient suffering and death. AIM To determine the association between attitudes towards care of the dying, resilience, and Sense of Coherence. STUDY DESIGN A cross-sectional descriptive approach was used. Head nurses at 74 hospitals in Japan were sent a letter about the study; 29 head nurses agreed to send information to the critical care nurses in their hospital. Demographic factors, attitudes towards care of the dying, resilience, and Sense of Coherence were collected using Google Forms. Structural equation modelling was used to analyze the associations among the variables. RESULTS A total of 229 nurses completed the survey. The average years of clinical experience were 10.5 ± 8.4 years. Factors directly related to positive attitudes towards care of the dying were higher resilience, more years of clinical nursing experience, and having a Master's degree. Sense of Coherence was the strongest predictor of resilience. Other predictors for higher resilience included confidence in nursing skills, social support, and religious beliefs towards death. The main predictor for higher Sense of Coherence was workplace satisfaction. CONCLUSION Nurses with higher resilience had more positive attitudes about care of the dying. Individual factors, such as a Sense of Coherence, confidence in caring for patients, and religious beliefs were the most important factors related to resilience. RELEVANCE TO CLINICAL PRACTICE It is necessary to support newer nurses especially those with lower educational attainment, to increase workplace satisfaction, Sense of Coherence and resilience. It is necessary to develop educational programs focused on care of dying patients and to evaluate their effect so that critical care nurses have a positive response to caring for dying patients.
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Affiliation(s)
- Akiko Kondo
- International Nursing Development, Tokyo Medical and Dental University, Tokyo, Japan
| | - Tomomi Oki
- School of Nursing and Rehabilitation Sciences, Showa University, Yokohama-shi, Japan
| | - Ann L Eckhardt
- College of Nursing and Health Innovation, University Of Texas At Arlington, Arlington, Texas, USA
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Weill-Lotan D, Dekeyser-Ganz F, Benbenishty J. The relationship between departmental culture and resuscitation-related moral distress among inpatient medical departments physicians and nurses. Heart Lung 2024; 68:254-259. [PMID: 39098062 DOI: 10.1016/j.hrtlng.2024.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2023] [Revised: 07/07/2024] [Accepted: 07/08/2024] [Indexed: 08/06/2024]
Abstract
BACKGROUND While moral distress frequency and intensity have been reported among clinicians around the world, resuscitations have not been well documented as its source. OBJECTIVES to examine the relationship between intensity and frequency of resuscitation- related moral distress and departmental culture among nurses and physicians working in inpatient medical departments. METHODS This was a cross-sectional, prospective study of medical inpatient department staff from three hospitals. Questionnaires included a demographic and work characteristics questionnaire, the Resuscitation-Related Moral Distress Scale (a revised version of the Moral Distress Scale measuring frequency and intensity of moral distress), and a Departmental Culture Questionnaire. RESULTS 64 physicians and 201 nurses (response rate 64 %) participated, with a mean of 8.4 (SD = 5.1) resuscitations in the previous 6 months. Highest moral distress frequency scores were reported for items related to family demands or having no medical decision related to life- saving interventions for dying patients. Highest moral distress intensity scores were found when appropriate care for deteriorating patients was not given due poor staffing and when witnessing a resuscitation that could have been prevented had the staff identified the deterioration on time. Most participants strongly agreed (n = 228, 86.0 %) that their department medical director considers it important for staff to determine patients' end-of-life preferences and that quality of life is of the highest value. CONCLUSIONS Clinicians working in medical inpatient department suffer from moderate frequency and high intensity levels of resuscitation-related moral distress. There was a statistically significant association between intention to leave employment with resuscitation-related moral distress frequency and intensity.
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Affiliation(s)
- Dorit Weill-Lotan
- Nursing administration, Hadassah Hebrew University Medical Center, Israel; Dean, School of Nursing Science The Academic College Tel Aviv- Yaffo, Israel
| | - Freda Dekeyser-Ganz
- Hebrew University School of Medicine School of Nursing, Israel; Dean Jerusalem College of Technology, PO Box 12000, Jerusalem, Israel, 91120
| | - Julie Benbenishty
- Nursing administration, Hadassah Hebrew University Medical Center, Israel; Hebrew University School of Medicine School of Nursing, Israel.
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Rosa D, Villa G, Amigoni C, Rossetti AM, Guberti M, Ghirotto L, Manara DF. Role of emotions in the clinical decision-making process of the hospital nurse: A multicentre qualitative study. MethodsX 2024; 12:102590. [PMID: 38322133 PMCID: PMC10844854 DOI: 10.1016/j.mex.2024.102590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Accepted: 01/26/2024] [Indexed: 02/08/2024] Open
Abstract
While for a long-time emotional reaction and moral distress, have been primarily investigated for the possible outcomes of the nursing decision-making process rather than in terms of their role as antecedents of the final decision taken. The primary study's aim is to explore how inpatient nurses' decision-making takes place in different care settings, with a special focus on the role played by emotions during decision-making. The secondary aim is to explore the subjective experience of hospital nurses in relation to successful and unsuccessful decision-making situations. Multicentre qualitative study, consisting of three phases with different designs: participatory study, grounded theory study, and phenomenological study. Participants will be nurses and may be doctors with various levels of professional experience working in hospital, outpatient, or ward settings. Participants will be recruited through different sampling (purposive and convenience). Data will be collected through focus groups and in-depth interviews with nurses working in different hospital care settings. The researchers expect to find themes that will contribute to a better understanding of the role of emotions in decision-making. The results of this study have the potential of providing important implications to support nurses in the recognition and management of their emotions during the decision-making process.
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Affiliation(s)
- Debora Rosa
- Center for Nursing Research and Innovation, Giulia VILLA, Vita-Salute San Raffaele University, Milan, Italy
| | - Giulia Villa
- Center for Nursing Research and Innovation, Giulia VILLA, Vita-Salute San Raffaele University, Milan, Italy
| | | | | | - Monica Guberti
- Research and EBP Unit, Health Professions Department, Azienda USL-IRCCS Di Reggio Emilia, Reggio Emilia, Italy
| | - Luca Ghirotto
- Qualitative Research Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Duilio Fiorenzo Manara
- Center for Nursing Research and Innovation, Giulia VILLA, Vita-Salute San Raffaele University, Milan, Italy
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Hewitt J, Alsaba N, May K, Cartwright C, Willmott L, White BP, Marshall AP. The role of law in end-of-life decision-making in emergency departments and intensive care units: a retrospective review of current practice in a Queensland health service. AUST HEALTH REV 2024; 48:95-102. [PMID: 38081044 DOI: 10.1071/ah23160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Accepted: 11/17/2023] [Indexed: 02/02/2024]
Abstract
Objective There is limited evidence about how legal frameworks that underpin end-of-life decisions are applied in practice. This study aimed to identify how end-of-life decisions are made and documented in emergency departments and intensive care units. The secondary aim was to explore the extent to which the legal processes featured in these decisions. Methods A retrospective chart audit of 85 adult patients who died in the emergency departments and intensive care units of a Queensland health service was undertaken. Quantitative data were analysed and reported using descriptive statistics. Qualitative textual data were analysed using inductive content analysis. Results Nearly all admissions were unplanned (97.6%), and most patients (74.1%) were admitted from home. Only one patient had an advance health directive, although all had an eligible substitute decision-maker. The qualitative analysis revealed two main concepts - 'healthcare professionals choreograph the end of life' and 'patients and families are carried on an unplanned journey'. Conclusions There was limited documentation related to the application of the legal framework in these decisions. Healthcare professionals relied on their clinical judgment about what was in the best interest of the patient. It was common for there to be a substantial effort to achieve consensus in decision-making which coincidently complied with the law.
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Affiliation(s)
- Jayne Hewitt
- School of Nursing and Midwifery, Griffith University, Gold Coast Campus, Parklands Drive, Southport, Qld 4222, Australia; and Griffith University, Law Futures Centre, Gold Coast Campus, Parklands Drive, Southport, Qld 4222, Australia; and Gold Coast University Hospital, 1 Hospital Boulevard, Southport, Qld 4215, Australia
| | - Nemat Alsaba
- Gold Coast University Hospital, 1 Hospital Boulevard, Southport, Qld 4215, Australia; and Faculty of Health Science and Medicine, Bond University, 14 University Drive, Robina, Qld 4226, Australia
| | - Katya May
- School of Nursing and Midwifery, Griffith University, Gold Coast Campus, Parklands Drive, Southport, Qld 4222, Australia; and Gold Coast University Hospital, 1 Hospital Boulevard, Southport, Qld 4215, Australia
| | - Colleen Cartwright
- Faculty of Health, Southern Cross University, Southern Cross Drive, Bilinga, Qld 4225, Australia
| | - Lindy Willmott
- Faculty of Business and Law, Queensland University of Technology, Gardens Point campus, 2 George Street, Brisbane, Qld 4000, Australia
| | - Ben P White
- Faculty of Business and Law, Queensland University of Technology, Gardens Point campus, 2 George Street, Brisbane, Qld 4000, Australia
| | - Andrea P Marshall
- School of Nursing and Midwifery, Griffith University, Gold Coast Campus, Parklands Drive, Southport, Qld 4222, Australia; and Gold Coast University Hospital, 1 Hospital Boulevard, Southport, Qld 4215, Australia
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Heradstveit SH, Larsen MH, Solberg MT, Steindal SA. Critical care nurses' role in the decision-making process of withdrawal of life-sustaining treatment: A qualitative systematic review. J Clin Nurs 2023; 32:6012-6027. [PMID: 37082871 DOI: 10.1111/jocn.16728] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Revised: 03/21/2023] [Accepted: 03/23/2023] [Indexed: 04/22/2023]
Abstract
AIM To synthesise the qualitative evidence regarding the role of critical care nurses in the decision-making process of withdrawing life-sustaining treatment in critically ill adults. DESIGN Qualitative systematic review. REVIEW METHODS This qualitative systematic review employed the guidelines of Bettany-Saltikov and McSherry. The review was reported according to the ENTREQ checklist. Pairs of authors independently assessed eligibility, appraised methodological quality and extracted data. Data were synthesised using thematic synthesis. DATA SOURCES CINAHL, MEDLINE and EMBASE were searched for studies published between January 2001 and November 2021. RESULTS Twenty-three studies were included. Three analytical themes were synthesised: performing ethical decision-making to safeguard patients' needs rights, and wishes; tailoring a supporting role to guide the family's decision-making process; and taking on the role of the middleman by performing coordination. CONCLUSION The role of the critical care nurses in the decision-making process in withdrawal of life-sustaining treatment requires experience and the development of the clinical perspective of critical care nurses. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE Enhanced knowledge of the decision-making process of withdrawing life-sustaining treatment can prepare critical care nurses to be more equipped to master this role and enhance their ability to handle the emotional and moral stress associated with this part of the critical care unit. IMPACT The literature reveals the complex and challenging role of critical care nurses during the decision-making process of withdrawing life-sustaining treatment. Critical care nurses perform ethical decision-making to safeguard patients' concerns, guide the family's decision-making process and take on the role of the middleman. The findings have implications for critical nurses working in critical care units in hospitals and for educators and students in training in critical care nursing. PATIENT OR PUBLIC CONTRIBUTION No patient or public contribution was included.
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Affiliation(s)
- Siri Hammersland Heradstveit
- Department for Postgraduate Studies, Lovisenberg Diaconal University College, Oslo, Norway
- Division of Emergencies and Critical Care, Pediatric Intensive Care, Oslo University Hospital, Oslo, Norway
| | - Marie Hamilton Larsen
- Department for Postgraduate Studies, Lovisenberg Diaconal University College, Oslo, Norway
| | - Marianne Trygg Solberg
- Department for Postgraduate Studies, Lovisenberg Diaconal University College, Oslo, Norway
| | - Simen A Steindal
- Department for Postgraduate Studies, Lovisenberg Diaconal University College, Oslo, Norway
- Faculty of Health Studies, VID Specialized University, Oslo, Norway
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Kaplan A, Kaleem S, Huynh M. Quality Improvement in the Management of Subarachnoid Hemorrhage: Current State and Future Directions. Curr Pain Headache Rep 2023; 27:27-38. [PMID: 36881288 DOI: 10.1007/s11916-022-01097-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/02/2022] [Indexed: 03/08/2023]
Abstract
PURPOSE OF REVIEW Aneurysmal subarachnoid hemorrhage carries high mortality and morbidity. Quality improvement (QI) efforts in the management of this disease process are growing as the field of neurocritical care matures. This review provides updates in QI in subarachnoid hemorrhage (SAH) and discusses gaps and future directions. RECENT FINDINGS Literature published on the topic over the past 3 years were evaluated. An assessment of current QI practices pertaining to the acute care of SAH was conducted. These include processes surrounding acute pain management, inter-hospital coordination of care, complications during the initial hospital stay, role of palliative care, and quality metrics collection, reporting, and monitoring. SAH QI initiatives have shown promise by decreasing ICU and hospital lengths of stay, health care costs, and hospital complications. The review reveals substantial heterogeneity, variability, and limitations in SAH QI protocols, measures, and reporting. Uniformity in QI research, implementation, and monitoring will be crucial as disease-specific QI develops in neurological care.
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Affiliation(s)
- Aaron Kaplan
- Department of Neurology, New York-Presbyterian Hospital, Weill Cornell Medicine, 525 East 68th Street, NY, New York, USA
| | - Safa Kaleem
- Department of Neurology, New York-Presbyterian Hospital, Weill Cornell Medicine, 525 East 68th Street, NY, New York, USA
| | - Margaret Huynh
- Department of Neurology, New York-Presbyterian Hospital, Weill Cornell Medicine, 525 East 68th Street, NY, New York, USA.
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Decision Making Near End of Life: A Qualitative Exploration of the Lived Experiences of Jordanian Healthcare Providers. Cancer Nurs 2023; 46:152-158. [PMID: 35398869 DOI: 10.1097/ncc.0000000000001093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Discussions related to a patient's prognosis and interventions near end of life are challenging and stressful for healthcare providers. Many reported experiencing emotional distress and discomfort during the decision-making process. OBJECTIVES The aim of this study was to describe the lived experience of nurses and physicians who participate in decision making near the end of a patient's life. METHODS A descriptive, phenomenological approach was used with a purposive sample of 7 nurses and 6 physicians from 2 palliative and end-of-life care institutions in Jordan. Data derived from focus group discussions conducted online via the ZOOM video communication application, and analysis followed Colaizzi's qualitative methodology. RESULTS Three major themes emerged from the healthcare providers' experiences. Initially, the participants described how they "strive toward optimal decision-making near end of life," "the overwhelming experience of decision making near end of life," and finally, their struggle in sharing details about the end of life when patients ask and whether to tell or not to tell them as "the time for hard talk." CONCLUSIONS The healthcare providers' experiences revealed several issues of decision making near a patient's end of life, such as a lack of appropriate training and administrative support, emotional distress, fear of legal liability, and the burden of a hard talk with patients. These findings necessitate institutional support of setting appropriate policies and guidelines, staff counseling, and healthcare provider support. IMPLICATIONS FOR PRACTICE Institutions providing palliative and end-of-life care can use this study's findings to support their staff by setting appropriate practice guidelines and providing staff training and counseling.
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Prentice TM, Imbulana DI, Gillam L, Davis PG, Janvier A. Addressing Moral Distress: lessons Learnt from a Non-Interventional Longitudinal Study on Moral Distress. AJOB Empir Bioeth 2022; 13:226-236. [PMID: 35856901 DOI: 10.1080/23294515.2022.2093422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
BACKGROUND Moral distress is prevalent within the neonatal intensive care unit (NICU) and can negatively affect clinicians. Studies have evaluated the causes of moral distress and interventions to mitigate its harmful effects. However, the effects of participating in moral distress studies have not been evaluated. OBJECTIVE To evaluate the impact of participation in a longitudinal, non-intervention research project on moral distress in the NICU. DESIGN Clinicians who previously participated in an 18-month longitudinal research study on moral distress at two NICUs were invited to complete a questionnaire on the impact of participation. The original study required regular completion of surveys that sought predictions of death, disability and the intensity/nature of moral distress experienced by clinicians caring for extremely preterm babies. Individual and unit-wide effects were explored. Free-text responses to open-ended questions were analyzed using inductive content analysis. RESULTS A total of 249/463 (53%) eligible clinicians participated. Participation in the original 18-month study was perceived as having a positive impact by 58% of respondents. Clinicians found articulating their views therapeutic (76%) and useful in clarifying personal opinions about the babies (85%). Free-text responses revealed the research stimulated increased reflection, validated feelings and increased dialogue amongst clinicians. Respondents generally did not find participation distressing (70%). However, a small number of physicians felt the focus of discussion shifted from the baby to the clinicians. Intensity and prevalence of moral distress did not significantly change over the 18-month period. CONCLUSIONS Participating in moral distress research prompted regular reflection regarding attitudes toward fragile patients, improving ethical awareness. This is useful in clarifying personal views that may influence patient care. Participation also enhanced communication around difficult clinical scenarios and improved provider satisfaction. These factors are insufficient to significantly reduce moral distress in isolation.
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Affiliation(s)
- Trisha M Prentice
- Neonatal Medicine, Royal Children's Hospital, Melbourne, Victoria, Australia.,Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia
| | - Dilini I Imbulana
- Newborn Research, Royal Women's Hospital, Melbourne, Victoria, Australia
| | - Lynn Gillam
- Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia.,Children's Bioethics Centre, Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Peter G Davis
- Newborn Research, Royal Women's Hospital, Melbourne, Victoria, Australia.,Department of Obstetrics and Gynaecology, University of Melbourne, Melbourne, Victoria, Australia
| | - Annie Janvier
- Departement of Pediatrics, Division of Neonatology, Clinical Ethics Unit, Palliative Care Unit, Unité de Recherche en Éthique Clinique et Partenariat Famille, CHU Ste-Justine, University of Montreal, Montreal, Quebec, Canada
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10
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Emergency department staff perceptions of their roles in providing end of life care. Australas Emerg Care 2022:S2588-994X(22)00070-7. [DOI: 10.1016/j.auec.2022.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Revised: 08/31/2022] [Accepted: 09/01/2022] [Indexed: 11/18/2022]
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Elcelik UE, Ozcelik H, Muz G. The Effect on the Care Behaviors of Nurses Working in Intensive Care Clinics of Moral Distress Experienced During End of Life Patient Care. OMEGA-JOURNAL OF DEATH AND DYING 2022:302228221107195. [PMID: 35700116 DOI: 10.1177/00302228221107195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This research was conducted as a descriptive study in order to examine the effects of the moral problems experienced by nurses working in intensive care clinics on their end of life care behaviors. The data were collected using the Moral Distress Scale and Caring Behaviors Inventory. It was found that 74.5% of the nurses were women and their mean age was 32.60 ± 6.6 years. The frequency of moral distress in the nurses was 44.27 ± 16.25 and total score was 111.02 ± 63.85. There were significant differences in the scores of the concept the use of futile treatment by nurses, the decision not to begin life-support treatment being made only by physicians, and moral distress and discomfort felt by pediatric intensive care nurses (p < .05). A statistically significant relationship was found between total scores of discomfort on moral distress and assurance, knowledge and skills, connectedness, and being respectful on the end of life care behaviors (p < .05).
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Affiliation(s)
| | - Hanife Ozcelik
- Zubeyde Hanim School of Health, Nigde Omer Halisdemir University, Niğde Üniversitesi, Nigde, Turkey
| | - Gamze Muz
- Semra-Vefa Küçük School of HealthNevsehir Haci Bektas Veli Universitesi, Nevsehir, Turkey
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How nurses’ and physicians’ emotions, psychosocial factors, and professional roles influence the end-of-life decision making process: An interpretive description study. Intensive Crit Care Nurs 2022; 71:103249. [DOI: 10.1016/j.iccn.2022.103249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Revised: 03/07/2022] [Accepted: 03/18/2022] [Indexed: 11/19/2022]
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13
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Rego F, Sommovigo V, Setti I, Giardini A, Alves E, Morgado J, Maffoni M. How Supportive Ethical Relationships Are Negatively Related to Palliative Care Professionals' Negative Affectivity and Moral Distress: A Portuguese Sample. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:3863. [PMID: 35409546 PMCID: PMC8997490 DOI: 10.3390/ijerph19073863] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Revised: 03/21/2022] [Accepted: 03/22/2022] [Indexed: 01/27/2023]
Abstract
In the modern healthcare landscape, moral distress has become an increasingly common phenomenon among healthcare professionals. This condition is particularly prevalent among palliative care professionals who are confronted with bioethical issues in their daily practice. Although some studies described the effects of poor ethical climate and negative affectivity on moral distress, how these variables could be incorporated into a single model is still unclear. Thus, this study aims to investigate whether ethical relationships with the hospital could be related to the intensity and frequency of moral distress, both directly and as mediated by professionals' negative affectivity. Sixty-one Portuguese palliative care professionals completed web-based self-report questionnaires. After exploring descriptive statistics, mediation analyses were performed using the partial least squares method. The results indicated that the presence of positive relationships with the hospital reduced the professionals' negative affectivity levels. This, in turn, led palliative care professionals to experience a lower frequency and intensity of moral distress. Being a physician was positively associated with negative affectivity but not with the frequency of moral distress. Considering the protective role of ethical relationships with hospitals, health organizations could consider implementing interventions to improve hospitals' ethical climate and provide staff with ethics training programs.
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Affiliation(s)
- Francisca Rego
- Faculty of Medicine, University of Porto, 4200-319 Porto, Portugal; (F.R.); (E.A.)
| | - Valentina Sommovigo
- Department of Brain and Behavioural Sciences, Unit of Applied Psychology, University of Pavia, 27100 Pavia, Italy; (V.S.); (I.S.)
- Department of Management, University of Bologna-Rimini Campus, 47900 Rimini, Italy
| | - Ilaria Setti
- Department of Brain and Behavioural Sciences, Unit of Applied Psychology, University of Pavia, 27100 Pavia, Italy; (V.S.); (I.S.)
| | - Anna Giardini
- IT Department, Istituti Clinici Scientifici Maugeri IRCCS, 27100 Pavia, Italy;
| | - Elsa Alves
- Faculty of Medicine, University of Porto, 4200-319 Porto, Portugal; (F.R.); (E.A.)
| | - Julliana Morgado
- Institute of Philosophy and Human Sciences, Federal University of Pará, Belém 66075-110, Brazil;
| | - Marina Maffoni
- Psychology Unit of Montescano Institute, Istituti Clinici Scientifici Maugeri IRCCS, 27040 Montescano, Italy
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Chan NPX, Chia JL, Ho CY, Ngiam LXL, Kuek JTY, Ahmad Kamal NHB, Hanifah Marican Abdurrahman AB, Ong YT, Chiam M, Lee ASI, Chin AMC, Mason S, Radha Krishna LK. Extending the Ring Theory of Personhood to the Care of Dying Patients in Intensive Care Units. Asian Bioeth Rev 2022; 14:71-86. [PMID: 34691261 PMCID: PMC8526529 DOI: 10.1007/s41649-021-00192-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Revised: 09/17/2021] [Accepted: 09/23/2021] [Indexed: 11/29/2022] Open
Abstract
It is evident, in the face of the COVID-19 pandemic that has physicians confronting death and dying at unprecedented levels along with growing data suggesting that physicians who care for dying patients face complex emotional, psychological and behavioural effects, that there is a need for their better understanding and the implementation of supportive measures. Taking into account data positing that effects of caring for dying patients may impact a physician's concept of personhood, or "what makes you, 'you'", we adopt Radha Krishna's Ring Theory of Personhood (RToP) to scrutinise the experiences of physicians working in intensive care units (ICU) using a fictional scenario that was inspired by real events. The impact of death and dying, its catalysts, internal constituents, external factors, dyssynchrony, and buffers, specific to ICU physicians, were identified and explored. Such a framework allows for ramifications to be considered holistically and facilitates the curation of strategies for conflict resolution. This evaluation of the RToP acknowledges the experience and wide-ranging effects it has on ICU physicians. As such, our findings provide insight into their specific needs and highlight the importance of support on a personal and organisational level. Although further research needs to be conducted, the RToP could serve as the basis for a longitudinal assessment tool supported by the use of portfolios or mentorship due to their provision of personalised, appropriate, specific, timely, accessible and long-term support.
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Affiliation(s)
- Natalie Pei Xin Chan
- Yong Loo Lin School of Medicine , National University of Singapore, Singapore
- Division of Supportive and Palliative Care , National Cancer Centre Singapore, Singapore
| | - Jeng Long Chia
- Yong Loo Lin School of Medicine , National University of Singapore, Singapore
- Division of Supportive and Palliative Care , National Cancer Centre Singapore, Singapore
| | - Chong Yao Ho
- Yong Loo Lin School of Medicine , National University of Singapore, Singapore
- Division of Supportive and Palliative Care , National Cancer Centre Singapore, Singapore
| | - Lisa Xin Ling Ngiam
- Yong Loo Lin School of Medicine , National University of Singapore, Singapore
- Division of Supportive and Palliative Care , National Cancer Centre Singapore, Singapore
| | - Joshua Tze Yin Kuek
- Yong Loo Lin School of Medicine , National University of Singapore, Singapore
- Division of Supportive and Palliative Care , National Cancer Centre Singapore, Singapore
| | - Nur Haidah Binte Ahmad Kamal
- Yong Loo Lin School of Medicine , National University of Singapore, Singapore
- Division of Supportive and Palliative Care , National Cancer Centre Singapore, Singapore
| | - Ahmad Bin Hanifah Marican Abdurrahman
- Yong Loo Lin School of Medicine , National University of Singapore, Singapore
- Division of Supportive and Palliative Care , National Cancer Centre Singapore, Singapore
| | - Yun Ting Ong
- Yong Loo Lin School of Medicine , National University of Singapore, Singapore
- Division of Supportive and Palliative Care , National Cancer Centre Singapore, Singapore
| | - Min Chiam
- Division of Cancer Education , National Cancer Centre Singapore, Singapore
| | - Alexia Sze Inn Lee
- Division of Cancer Education , National Cancer Centre Singapore, Singapore
| | - Annelissa Mien Chew Chin
- Medical Library, National University of Singapore Libraries, National University of Singapore, Singapore
| | - Stephen Mason
- Palliative Care Institute Liverpool, Academic Palliative & End of Life Care Centre, University of Liverpool, Liverpool, UK
- Cancer Research Centre, University of Liverpool, Liverpool, UK
| | - Lalit Kumar Radha Krishna
- Yong Loo Lin School of Medicine , National University of Singapore, Singapore
- Division of Supportive and Palliative Care , National Cancer Centre Singapore, Singapore
- Division of Cancer Education , National Cancer Centre Singapore, Singapore
- Palliative Care Institute Liverpool, Academic Palliative & End of Life Care Centre, University of Liverpool, Liverpool, UK
- Cancer Research Centre, University of Liverpool, Liverpool, UK
- Palliative Care Centre for Excellence in Research and Education (PalC), Singapore
- Centre for Biomedical Ethics, National University of Singapore , Singapore
- Duke-NUS Graduate Medical School, Singapore
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Kmetec S, Fekonja Z, Škrbić S, Mlinar Reljić N. Doživljanje umiranja z vidika medicinskih sester. OBZORNIK ZDRAVSTVENE NEGE 2021. [DOI: 10.14528/snr.2021.55.4.3090] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Uvod: V enotah intenzivne terapije se medicinske sestrednevno soočajo z umiranjem. To jim predstavlja velike obremenitve, ki vodijo do stiske. Namen pregleda literature je ugotoviti, kaj doživljajo medicinske sestre ob umirajočih pacientih v enotah intenzivne terapije in kako se soočajo z umiranjem.Metode: Uporabljena je metoda pregleda literature. Iskanje je bilo izvedeno v bazah podatkov: PubMed, ScienceDirect, SAGE, Web of Science in CINAHL na osnovi vključitvenih in izključitvenih kriterijev. Proces iskanja literature je prikazan z diagramom PRISMA. Za analizo in sintezo podatkov je bila uporabljena metoda tematske analize.Rezultati: Od 1.886 zadetkov smo v končno analizo vključili 10 člankov. Na podlagi tematske analize smo oblikovali dve glavni temi: (1) doživljanje medicinskih sester ob hudo bolnih in umirajočih pacientih; (2) profesionalni odnos medicinskih sester.Diskusija in zaključek: Izvajanje zdravstvene nege v enotah intenzivne terapije je za medicinske sestre zelo stresno. Pri zdravstveni negi kritično bolnih pacientov se najpogosteje srečujejo s stalnimi fizičnimi obremenitvami, čustvenimi pretresi, pomanjkanjem čustvene podpore, žalostjo, izgorevanjem, depresijo, težavami v komunikaciji s pacientovimi sorodniki ter pomanjkljivim sodelovanjem in zagotavljanjem podpore v timu. Izpostavljene so številnim dejavnikom, ki prispevajo k doživljanju lastne stiske. Potrebni so ukrepi za zaščito, učinkovitejšo pomoč in podporo medicinskim sestram, ki se dnevno soočajo z umiranjem in zagotavljanjem podpore pacientovi družini oziroma svojcem.
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Intensive Care Unit Nurse: Could We Call a Palliative Care Consult? Intensive Care Unit Provider: It's Too Early. Palliative Care Integration in the Intensive Care Unit: The Struggle to Translate Evidence Into Practice. Dimens Crit Care Nurs 2021; 40:51-58. [PMID: 33560635 DOI: 10.1097/dcc.0000000000000451] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Despite evidence regarding the value of palliative care, there remains a translation-to-practice gap in the intensive care setting. The purpose of this article is to describe challenges and propose solutions to palliative care integration through the presentation and discussion of a critical care patient scenario. We also present recommendations for a collaborative palliative care practice framework that holds the potential to improve quality of life for patients and families. Collaborative palliative care is characterized by close working relationships with families, interprofessional intensive care unit healthcare teams, and palliative care specialists. The shortage of palliative care specialists has become a pressing policy and practice issue and highlights the importance of increasing primary palliative care delivery by the intensive care team. Underexplored aspects of collaborative palliative care delivery include the interprofessional communication required, identification of key skills, and expected outcomes. Increased recognition of intensive care unit palliative care as a process of engagement among nurses, providers, patients, and their family members heralds a vital culture shift toward collaborative palliative care. The interprofessional palliative specialist team has the expertise to support intensive care teams in developing their primary palliative skills and recognizing when specialist palliative care support is required. Promotion of strategic palliative care delivery through this collaborative framework has the potential to decrease suffering among patients and families and reduce moral distress among healthcare professionals.
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Taylan S, Özkan İ, Şahin G. Caring behaviors, moral sensitivity, and emotional intelligence in intensive care nurses: A descriptive study. Perspect Psychiatr Care 2021; 57:734-746. [PMID: 32885427 DOI: 10.1111/ppc.12608] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2019] [Revised: 07/16/2020] [Accepted: 08/07/2020] [Indexed: 12/13/2022] Open
Abstract
PURPOSE To evaluate the relationship of caring behaviors with moral sensitivity, emotional intelligence and descriptive characteristics in intensive care nurses. METHOD Descriptive study. The sample of this study consisted of 156 nurses. The data were collected using introductory information form, caring behaviors inventory, moral sensitivity questionnaire, and emotional intelligence scale. The factors affecting caring behavior were determined using stepwise multiple linear regression. FINDING It was determined that high education level, working in shifts, as well as appraisal of emotion subscale of emotional intelligence scale and also autonomy, expressing benevolence, and following praxis subscales of moral sensitivity questionnaire were high predictors for caring behaviors. PRACTICE IMPLICATIONS Descriptive characteristics, moral sensitivity, and emotional intelligence are related to high caring behavior in intensive care nurses.
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Affiliation(s)
- Seçil Taylan
- Kumluca Faculty of Health Sciences, Akdeniz University, Antalya, Turkey
| | - İlknur Özkan
- Kumluca Faculty of Health Sciences, Akdeniz University, Antalya, Turkey
| | - Günnaz Şahin
- Balcalı Hospital, Çukurova University, Adana, Turkey
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Espinoza Suarez NR, Urtecho M, Nyquist CA, Jaramillo C, Yeow ME, Thorsteinsdottir B, Wilson ME, Barwise AK. Consequences of suboptimal communication for patients with limited English proficiency in the intensive care unit and suggestions for a way forward: A qualitative study of healthcare team perceptions. J Crit Care 2021; 61:247-251. [PMID: 33221592 PMCID: PMC8423101 DOI: 10.1016/j.jcrc.2020.10.012] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Revised: 03/14/2020] [Accepted: 10/13/2020] [Indexed: 11/26/2022]
Abstract
PURPOSE To understand the healthcare team's perceptions of the negative consequences of suboptimal communication and their recommendations to improve communication with patients and families who have Limited English Proficiency (LEP) in the Intensive Care Unit (ICU). MATERIALS AND METHODS We performed a qualitative study using semi-structured interviews of physicians, nurses, and interpreters from 3 ICUs at Mayo Clinic Rochester, between November 2017 and April 2018. RESULTS We identified 5 consequences of suboptimal communication: 1) Suboptimal assessment and treatment of patient symptoms, 2) Unmet patient and family expectations, 3) Decreased patient autonomy, 4) Unmet end of life wishes and 5) Clinician Distress. Recommendations to improve communication include: 1) Education and training for patients,families, clinicians and interpreters, 4) Greater integration of interpreters into the ICU team 5) Standardized timeline for goals of care conversations with patients and families with LEP. CONCLUSIONS Patients with LEP are at risk of experiencing suboptimal communication with the healthcare team in the ICU. There are several educational and quality improvement strategies that ICUs and institutions can take to mitigate these issues.
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Affiliation(s)
- Nataly R Espinoza Suarez
- Knowledge and Evaluation Research Unit (KER), Mayo Clinic, Rochester, MN, United States of America.
| | - Meritxell Urtecho
- Knowledge and Evaluation Research Unit (KER), Mayo Clinic, Rochester, MN, United States of America.
| | - Christina A Nyquist
- Biomedical Ethics Research Program, Mayo Clinic, Rochester, MN, United States of America; University of Minnesota Medical School, Duluth Campus, MN, United States of America.
| | - Carolina Jaramillo
- Biomedical Ethics Research Program, Mayo Clinic, Rochester, MN, United States of America; Harvard Medical School, Boston, MA, United States of America
| | - Mei-Ean Yeow
- Division of Palliative Medicine, Mayo Clinic, Rochester, MN, United States of America.
| | - Bjorg Thorsteinsdottir
- Knowledge and Evaluation Research Unit (KER), Mayo Clinic, Rochester, MN, United States of America; Department of Primary Care Internal Medicine, Mayo Clinic, Rochester, MN, United States of America; Biomedical Ethics Research Program, Mayo Clinic, Rochester, MN, United States of America.
| | - Michael E Wilson
- Knowledge and Evaluation Research Unit (KER), Mayo Clinic, Rochester, MN, United States of America; Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN, United States of America.
| | - Amelia K Barwise
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN, United States of America; Biomedical Ethics Research Program, Mayo Clinic, Rochester, MN, United States of America.
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Kuek JTY, Ngiam LXL, Kamal NHA, Chia JL, Chan NPX, Abdurrahman ABHM, Ho CY, Tan LHE, Goh JL, Khoo MSQ, Ong YT, Chiam M, Chin AMC, Mason S, Krishna LKR. The impact of caring for dying patients in intensive care units on a physician's personhood: a systematic scoping review. Philos Ethics Humanit Med 2020; 15:12. [PMID: 33234133 PMCID: PMC7685911 DOI: 10.1186/s13010-020-00096-1] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Accepted: 10/11/2020] [Indexed: 05/07/2023] Open
Abstract
BACKGROUND Supporting physicians in Intensive Care Units (ICU)s as they face dying patients at unprecedented levels due to the COVID-19 pandemic is critical. Amidst a dearth of such data and guided by evidence that nurses in ICUs experience personal, professional and existential issues in similar conditions, a systematic scoping review (SSR) is proposed to evaluate prevailing accounts of physicians facing dying patients in ICUs through the lens of Personhood. Such data would enhance understanding and guide the provision of better support for ICU physicians. METHODS An SSR adopts the Systematic Evidenced Based Approach (SEBA) to map prevailing accounts of caring for dying patients in ICUs. To enhance the transparency and reproducibility of this process, concurrent and independent use of tabulated summaries, thematic analysis and directed content analysis (Split Approach) is adopted. RESULTS Eight thousand three hundred fifty-eight abstracts were reviewed from four databases, 474 full-text articles were evaluated, 58 articles were included, and the Split Approach revealed six categories/themes centered around the Innate, Individual, Relational and Societal Rings of Personhood, conflicts in providing end of life care and coping mechanisms employed. CONCLUSION This SSR suggests that caring for dying patients in ICU impacts how physicians view their personhood. To resolve conflicts within individual concepts of personhood, physicians use prioritization, reframing and rely on accessible, personalized support from colleagues to steer coping strategies. An adapted form of the Ring Theory of Personhood is proposed to direct timely personalized, appropriate and holistic support.
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Affiliation(s)
- Joshua Tze Yin Kuek
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, Singapore, Singapore
| | - Lisa Xin Ling Ngiam
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, Singapore, Singapore
| | - Nur Haidah Ahmad Kamal
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, Singapore, Singapore
| | - Jeng Long Chia
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, Singapore, Singapore
| | - Natalie Pei Xin Chan
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, Singapore, Singapore
| | - Ahmad Bin Hanifah Marican Abdurrahman
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, Singapore, Singapore
| | - Chong Yao Ho
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, Singapore, Singapore
| | - Lorraine Hui En Tan
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, Singapore, Singapore
| | - Jun Leng Goh
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, Singapore, Singapore
| | - Michelle Shi Qing Khoo
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, Singapore, Singapore
| | - Yun Ting Ong
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, Singapore, Singapore
| | - Min Chiam
- Division of Cancer Education, National Cancer Centre Singapore, Singapore, Singapore
| | - Annelissa Mien Chew Chin
- Medical Library, National University of Singapore Libraries, National University of Singapore, Singapore, Singapore
| | - Stephen Mason
- Palliative Care Institute Liverpool, Academic Palliative & End of Life Care Centre, Cancer Research Centre, University of Liverpool, 200 London Road, Liverpool, L3 9TA, UK
| | - Lalit Kumar Radha Krishna
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, Singapore, Singapore.
- Division of Cancer Education, National Cancer Centre Singapore, Singapore, Singapore.
- Palliative Care Institute Liverpool, Academic Palliative & End of Life Care Centre, Cancer Research Centre, University of Liverpool, 200 London Road, Liverpool, L3 9TA, UK.
- Duke-NUS Graduate Medical School, Singapore, Singapore.
- Centre for Biomedical Ethics, National University of Singapore, Singapore, Singapore.
- PalC, The Palliative Care Centre for Excellence in Research and Education, Singapore, Singapore.
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An Innovative Application of End-of-Life Nursing Education Consortium Curriculum to Increase Clinical Nurses' Palliative Care Knowledge. J Hosp Palliat Nurs 2020; 22:377-382. [PMID: 32826542 DOI: 10.1097/njh.0000000000000674] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Clinical nurses are in a crucial position to provide primary palliative care by advocating for patients and families at the end of life, collaborating with the health care team to optimize quality of life, and contributing to enhanced symptom management. Most clinical nurses, however, have not received the comprehensive palliative care education needed to provide high-quality palliative care. The End-of-Life Nursing Education Consortium curriculum can bridge this gap by providing nurses with the knowledge needed to promote palliative care. Following completion of an End-of-Life Education Consortium train-the-trainer program, 6 nurses from a large, metropolitan academic medical center designed and implemented a series of 20-minute educational sessions informed by a hospital-wide needs assessment and based on the End-of-Life Nursing Education Consortium curriculum. The educational sessions, Palliative Care Conversations, provide clinical nurses with the core palliative care knowledge and skills needed to advocate for and provide patient-/family-centered care throughout the serious illness trajectory and at end of life. This article describes the process, design, and content of the palliative care educational sessions.
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Abstract
BACKGROUND Ethical conflict and subsequent nurse moral distress and burnout are common in the intensive care unit. There is a gap in our understanding of nurses' perceptions of how organizational resources support them in addressing ethical conflict in the intensive care unit. RESEARCH QUESTION/OBJECTIVES/METHODS The aim of this qualitative, descriptive study was to explore how nurses experience ethical conflict and use organizational resources to support them as they address ethical conflict in their practice. PARTICIPANTS AND RESEARCH CONTEXT Responses to two open-ended questions were collected from critical care nurses working in five intensive care units at a large, academic medical center in the Midwestern region of the United States. ETHICAL CONSIDERATIONS This study was approved by the Institutional Review Board at the organization where the study took place. FINDINGS Three main interwoven themes emerged: nurses perceive (1) intensive care unit culture, practices, and organizational priorities contribute to patient suffering; (2) nurses are marginalized during ethical conflict in the intensive care unit; and (3) organizational resources have the potential to reduce nurse moral distress. Nurses identified ethics education, interprofessional dialogue, and greater involvement of nurses as important strategies to improve the management of ethical conflict. DISCUSSION Ethical conflict related to healthcare system challenges is intrinsic in the daily practice of critical care nurses. Nurses want to be engaged in discussions about their perspectives on ethical conflict and play an active role in addressing ethical conflict in their practice. Organizational resources that support nurses are vital to the resolution of ethical conflict. CONCLUSION These findings can inform the development of interventions that aim to proactively and comprehensively address ethical conflict in the intensive care unit to reduce nurse moral distress and improve the delivery of patient and family care.
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Affiliation(s)
- Natalie S McAndrew
- University of Wisconsin-Milwaukee, USA; Froedtert & the Medical College of Wisconsin, USA
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Intensive care nurses’ experiences of withdrawal of life-sustaining treatments in intensive care patients: A qualitative study. Intensive Crit Care Nurs 2020; 56:102768. [DOI: 10.1016/j.iccn.2019.102768] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Revised: 10/18/2019] [Accepted: 10/25/2019] [Indexed: 11/19/2022]
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Reignier J, Feral-Pierssens AL, Boulain T, Carpentier F, Le Borgne P, Del Nista D, Potel G, Dray S, Hugenschmitt D, Laurent A, Ricard-Hibon A, Vanderlinden T, Chouihed T. Withholding and withdrawing life-support in adults in emergency care: joint position paper from the French Intensive Care Society and French Society of Emergency Medicine. Ann Intensive Care 2019; 9:105. [PMID: 31549266 PMCID: PMC6757069 DOI: 10.1186/s13613-019-0579-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2019] [Accepted: 09/16/2019] [Indexed: 11/10/2022] Open
Abstract
For many patients, notably among elderly nursing home residents, no plans about end-of-life decisions and palliative care are made. Consequently, when these patients experience life-threatening events, decisions to withhold or withdraw life-support raise major challenges for emergency healthcare professionals. Emergency department premises are not designed for providing the psychological and technical components of end-of-life care. The continuous inflow of large numbers of patients leaves little time for detailed assessments, and emergency department staff often lack training in end-of-life issues. For prehospital medical teams (in France, the physician-staffed mobile emergency and intensive care units known as SMURs), implementing treatment withholding and withdrawal decisions that may have been made before the acute event is not the main focus. The challenge lies in circumventing the apparent contradiction between the need to make immediate decisions and the requirement to set up a complex treatment project that may lead to treatment withholding and/or withdrawal. Laws and recommendations are of little assistance for making treatment withholding and withdrawal decisions in the emergency setting. The French Intensive Care Society (Société de Réanimation de Langue Française, SRLF) and French Society of Emergency Medicine (Société Française de Médecine d'Urgence, SFMU) tasked a panel of emergency physicians and intensivists with developing a document to serve both as a position paper on life-support withholding and withdrawal in the emergency setting and as a guide for professionals providing emergency care. The task force based its work on the available legislation and recommendations and on a review of published studies.
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Affiliation(s)
- Jean Reignier
- Service de Médecine Intensive Réanimation, Centre Hospitalier Universitaire Hotel-Dieu, 30 Bd. Jean Monnet, 44093, Nantes Cedex 1, France. .,Université de Nantes, Nantes, France.
| | - Anne-Laure Feral-Pierssens
- Assistance Publique Hôpitaux de Paris, Service des Urgences, Hôpital Européen Georges Pompidou Paris, Paris, France
| | - Thierry Boulain
- Service de Réanimation Médicale Polyvalente, Centre Hospitalier Régional Orléans, Orléans, France
| | - Françoise Carpentier
- Pôle Urgences Médecine Aigüe, Hôpital Universitaire des Alpes, Grenoble, France.,Université de Grenoble, Grenoble, France
| | - Pierrick Le Borgne
- Service d'Accueil des Urgences, Hôpital de Hautepierre, CHRU Strasbourg, Strasbourg, France
| | | | - Gilles Potel
- Université de Nantes, Nantes, France.,Service des Urgences, CHU de Nantes, Nantes, France
| | - Sandrine Dray
- Service de Réanimation Médicale, Hôpital Nord, CHU de Marseille, Marseille, France
| | | | - Alexandra Laurent
- Laboratoire Psy-DREPI, Université de Bourgogne Franche-Comté, EA7458, Dijon, France
| | - Agnès Ricard-Hibon
- SAMU-SMUR 95- Service des Urgences, Centre Hospitalier René Dubos, Pontoise, France
| | - Thierry Vanderlinden
- Service de Réanimation Polyvalente, Groupe Hospitalier Institut Catholique de Lille/Faculté Libre de Médecine/Université Lille Nord de France, Lille, France
| | - Tahar Chouihed
- SAMU-SMUR-Service d'Urgences, Hôpital Central, CHRU Nancy, Vandoeuvre les Nancy, France.,INSERM U1116, Université de Lorraine, Vandoeuvre les Nancy, France
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Nia HS, Goudarzian AH, Shahrokhi A, Boyle C, Wilson MSJ, Hosseinigolafshani SZ. Psychometric properties of End-of-Life Caregiving Experience Appraisal Scale: Iranian critical care nurses. Nurs Crit Care 2019; 25:269-276. [PMID: 31046179 DOI: 10.1111/nicc.12427] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2018] [Revised: 12/24/2018] [Accepted: 02/26/2019] [Indexed: 11/28/2022]
Abstract
BACKGROUND Health care providers should be able to provide good quality end-of-life care. A tool to evaluate the positive and negative consequences of caring for dying patients is warranted. AIM The aim of this study was to evaluate the psychometric properties of the Persian version of the End-of-Life Caregiving Experience Appraisal Scale (EOLCAS). METHODS This research was conducted in two phases. Phase I: The World Health Organization Protocol of forward-backward translation and an expert panel in order to determine face and content validity. Phase II: Survey development with 310 nurses who worked in critical care units, construct validity (construct, convergent and divergent validity), internal consistency (average inter-item correlation, Cronbach's alpha and McDonald's omega) and construct reliability were evaluated. RESULTS The exploratory factor analysis showed that the present scale (Persian version) has four factors: Negative physical-emotional and social consequences, transcendental communication, information deficits and future rumination, which explained 83.92% of the overall extracted variance. Convergent and divergent validity were confirmed for all factors. The internal consistency and construct reliability were acceptable. CONCLUSION The scale has a multidimensional concept that is sufficiently reliable and the use of the scale would be helpful in measuring consequences of caring for dying patients. RELEVANCE TO CLINICAL PRACTICE This scale makes a significant contribution in that it helps in the recognition of positive and negative consequences of critical care nurses' caring for dying patients.
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Affiliation(s)
- Hamid S Nia
- School of Nursing and Midwifery Amol, Mazandaran University of Medical Sciences, Sari, Iran
| | - Amir H Goudarzian
- Student Research Committee, Mazandaran University of Medical Sciences, Sari, Iran
| | - Akram Shahrokhi
- Critical Care Nursing Department, Nursing & Midwifery School, Qazvin University of Medical Science, Qazvin, Iran
| | - Christopher Boyle
- Education and Psychology, Graduate School of Education, University of Exeter, Exeter, UK
| | - Michael S J Wilson
- Department of General Surgery, NHS Tayside, Ninewells Hospital, Dundee, UK
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Almansour I, Seymour JE, Aubeeluck A. Staff perception of obstacles and facilitators when providing end of life care in critical care units of two teaching hospitals: A survey design. Intensive Crit Care Nurs 2019; 53:8-14. [PMID: 31023516 DOI: 10.1016/j.iccn.2019.04.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2018] [Revised: 01/10/2019] [Accepted: 04/13/2019] [Indexed: 10/27/2022]
Abstract
OBJECTIVE To determine perceptions of Jordanian critical care staff about obstacles and facilitators to end-of-life care. RESEARCH METHODOLOGY The "National Survey of Critical Care Nurses' Perceptions of End-of-Life Care" was adapted and distributed to 143 critical care nurses (n = 110) and physicians (n = 33) in two Jordanian hospitals. Nurses and physicians completed items about perceived obstacles to end-of-life care. Nurses only completed items about facilitators to end-of-life care. RESULTS The overall response rate was 72.7% (n = 104/143). Seventy-six nurses (69.1%) and 28 physicians (84.5%) responded. Nurses and physicians agreed that the highest scoring obstacles were: 'family members who do not understand what life-saving measures mean' and the 'poor design of critical care units'. Other highly scoring obstacles related to clinicians' behaviours, characteristics and attitudes. Nurses perceived the highest scoring facilitator was 'family members who accepted that the patient was dying'. CONCLUSION There is a need to further explore the issues underlying perceptions about clinicians' behaviours, which were perceived to be key barriers to quality end-of-life care and to find acceptable solutions that fit with Islamic culture. It is the first time that the survey has been used to gather perceptions of doctors and nurses in a non-western culture.
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Affiliation(s)
- I Almansour
- School of Nursing, The University of Jordan, Amman, Jordan.
| | - J E Seymour
- School of Nursing and Midwifery, The University of Sheffield, Sheffield S10 2LA, UK
| | - A Aubeeluck
- School of Health Sciences, The University of Nottingham, Nottingham NG7 2HA, UK
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Maffoni M, Argentero P, Giorgi I, Hynes J, Giardini A. Healthcare professionals’ moral distress in adult palliative care: a systematic review. BMJ Support Palliat Care 2019; 9:245-254. [DOI: 10.1136/bmjspcare-2018-001674] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Revised: 12/01/2018] [Accepted: 12/19/2018] [Indexed: 01/08/2023]
Abstract
ObjectivesPalliative care providers may be exposed to numerous detrimental psychological and existential challenges. Ethical issues in the healthcare arena are subject to continual debate, being fuelled with ongoing medical, technological and legal advancements. This work aims to systematically review studies addressing the moral distress experienced by healthcare professionals who provide adult palliative care.MethodsA literature search was performed on PubMed, Scopus, Web of Science and PsycINFO databases, searching for the terms ‘moral distress’ AND ‘palliative care’. The review process has followed the international PRISMA statement guidelines.ResultsThe initial search identified 248 papers and 10 of them were considered eligible. Four main areas were identified: (1) personal factors, (2) patients and caregivers, (3) colleagues and superiors and (4) environment and organisation. Managing emotions of self and others, witnessing sufferance and disability, caring for highly demanding patients and caregivers, as well as poor communication were identified as distressing. Moreover, the relationship with colleagues and superiors, and organisational constraints often led to actions which contravened personal values invoking moral distress. The authors also summarised some supportive and preventive recommendations including self-empowerment, communication improvement, management of emotions and specific educational programmes for palliative care providers. A holistic model of moral distress in adult palliative care (integrating emotional, cognitive, behavioural and organisational factors) was also proposed.ConclusionsCognisance of risk and protective factors associated with the moral distress phenomenon may help reframe palliative healthcare systems, enabling effective and tailored actions that safeguard the well-being of providers, and consequently enhance patient care.
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Wiegand DL, Cheon J, Netzer G. Seeing the Patient and Family Through: Nurses and Physicians Experiences With Withdrawal of Life-Sustaining Therapy in the ICU. Am J Hosp Palliat Care 2018; 36:13-23. [DOI: 10.1177/1049909118801011] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Withdrawal of life-sustaining therapy at the end of life is a complex phenomenon. Intensive care nurses and physicians are faced with caring for patients and supporting families, as these difficult decisions are made. The purpose of this study was to explore and describe the experience of critical care nurses and physicians participating in the process of withdrawal of life-sustaining therapy. A hermeneutic phenomenological approach was used to guide this qualitative investigation. Interviews were conducted with critical care nurses and physicians from 2 medical centers. An inductive approach to data analysis was used to understand similarities between the nurses and the physicians’ experiences. Methodological rigor was established, and data saturation was achieved. The main categories that were inductively derived from the data analysis included from novice to expert, ensuring ethical care, uncertainty to certainty, facilitating the process, and preparing and supporting families. The categories aided in understanding the experiences of nurses and physicians, as they worked individually and together to see patients and families through the entire illness experience, withdrawal of life-sustaining therapy decision-making process and dying process. Understanding the perspectives of health-care providers involved in the withdrawal of life-sustaining therapy process will help other health-care providers who are striving to provide quality care to the dying and to their families.
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Affiliation(s)
| | - Jooyoung Cheon
- Department of Nursing Science, College of Nursing, Sungshin Women’s University, Seoul, South Korea
| | - Giora Netzer
- Division of Pulmonary and Critical Care Medicine, Department of Epidemiology and Public Health, School of Medicine, University of Maryland, Baltimore, MD, USA
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Feral-Pierssens AL, Boulain T, Carpentier F, Le Borgne P, Del Nista D, Potel G, Dray S, Hugenschmitt D, Laurent A, Ricard-Hibon A, Vanderlinden T, Chouihed T, Reignier J. Limitations et arrêts des traitements de suppléance vitale chez l’adulte dans le contexte de l’urgence. MEDECINE INTENSIVE REANIMATION 2018. [DOI: 10.3166/rea-2018-0047] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Feral-Pierssens AL, Boulain T, Carpentier F, Le Borgne P, Del Nista D, Potel G, Dray S, Hugenschmitt D, Laurent A, Ricard-Hibon A, Vanderlinden T, Chouihed T, Reignier J. Limitations et arrêts des traitements de suppléance vitale chez l’adulte dans le contexte de l’urgence. ANNALES FRANCAISES DE MEDECINE D URGENCE 2018. [DOI: 10.3166/afmu-2018-0058] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Lele A, Cheever C, Healey L, Hurley K, Kim LJ, Creutzfeldt CJ. Operationalization of the Transition to Comfort Measures Only in the Neurocritical Care Unit: A Quality Improvement Project. Am J Hosp Palliat Care 2018; 36:38-44. [PMID: 30041532 DOI: 10.1177/1049909118790069] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
INTRODUCTION: Transition to comfort measures only (CMO) is common in the neurocritical care unit, and close communication between interdisciplinary health-care teams is vital to a smooth transition. We developed and implemented a CMO huddle in an effort to reduce inconsistencies during the process of CMO transition. METHODS: The CMO huddle was a multiphase quality improvement project in a neurocritical care unit of a level-1 trauma and comprehensive stroke center. Interdisciplinary critical care clinicians engaged in a huddle during CMO processes and participated in a pre- and postimplementation survey to examine the impact of CMO huddle on communication, missed opportunities, and improvement in knowledge. RESULTS: Since the CMO implementation, a total of 131 patients underwent CMO transitions. After implementation of an interdisciplinary CMO huddle, 64.3% of neurocritical care nurses reported that they felt included and involved in CMO process compared to 28% before implementation ( P = .003); 87.9% of all neurocritical care clinicians reported that they felt comfortable participating in CMO discussions compared to 69.8% before ( P < .001); 57.4% of all neurocritical care clinicians reported that the CMO huddle improved communication among neurocritical care clinicians, 51.9% reported reduction in missed opportunities during CMO process, and 21.7% reported witnessing less-than-ideal CMO process compared to 80% before ( P < .001). CONCLUSIONS: Implementation of a multidisciplinary huddle in the neuro-intensive care unit before transition to CMO may improve clinician's experience of the end-of-life process through enhanced nursing inclusion and involvement and organized communication with the neurocritical care team.
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Affiliation(s)
- Abhijit Lele
- 1 Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, WA, USA
| | - Chong Cheever
- 2 Neurocritical Care Unit, Harborview Medical Center, Seattle, WA, USA
| | - Larry Healey
- 3 Neurocritical Care Service, Harborview Medical Center, Seattle, WA, USA
| | - Kellie Hurley
- 2 Neurocritical Care Unit, Harborview Medical Center, Seattle, WA, USA
| | - Louis J Kim
- 4 Department of Neurological Surgery, University of Washington, Seattle, WA, USA
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McAndrew NS. Nurses and physicians bring different perspectives to end-of-life decisions in intensive care units. Evid Based Nurs 2018; 21:85. [PMID: 29735723 DOI: 10.1136/eb-2018-102902] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/23/2018] [Indexed: 11/04/2022]
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End-of-Life Communication: Nurses Cocreating the Closing Composition With Patients and Families. ANS Adv Nurs Sci 2018; 41:2-17. [PMID: 29389725 DOI: 10.1097/ans.0000000000000186] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Communication is imperative for end-of-life decision-making; however, descriptions of key strategies used by nurses are missing. A phenomenological approach was used to interpret interviews from 10 hospice/palliative nurses. The overarching pattern is the closing composition. Key communication strategies/patterns include establishing context, acknowledging through attentive listening, making it safe for them to die, planning goals of care, and being honest. Essential is the awareness that nurse, patient, and family all hold expertise in the subject matter. It is imperative that pre-/postnursing licensure curriculum be expanded to include training in mutual influence communication practices and mentoring in the skill of orchestration.
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Kozlowski D, Hutchinson M, Hurley J, Rowley J, Sutherland J. The role of emotion in clinical decision making: an integrative literature review. BMC MEDICAL EDUCATION 2017; 17:255. [PMID: 29246213 PMCID: PMC5732402 DOI: 10.1186/s12909-017-1089-7] [Citation(s) in RCA: 104] [Impact Index Per Article: 14.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/10/2017] [Accepted: 11/29/2017] [Indexed: 05/18/2023]
Abstract
BACKGROUND Traditionally, clinical decision making has been perceived as a purely rational and cognitive process. Recently, a number of authors have linked emotional intelligence (EI) to clinical decision making (CDM) and calls have been made for an increased focus on EI skills for clinicians. The objective of this integrative literature review was to identify and synthesise the empirical evidence for a role of emotion in CDM. METHODS A systematic search of the bibliographic databases PubMed, PsychINFO, and CINAHL (EBSCO) was conducted to identify empirical studies of clinician populations. Search terms were focused to identify studies reporting clinician emotion OR clinician emotional intelligence OR emotional competence AND clinical decision making OR clinical reasoning. RESULTS Twenty three papers were retained for synthesis. These represented empirical work from qualitative, quantitative, and mixed-methods approaches and comprised work with a focus on experienced emotion and on skills associated with emotional intelligence. The studies examined nurses (10), physicians (7), occupational therapists (1), physiotherapists (1), mixed clinician samples (3), and unspecified infectious disease experts (1). We identified two main themes in the context of clinical decision making: the subjective experience of emotion; and, the application of emotion and cognition in CDM. Sub-themes under the subjective experience of emotion were: emotional response to contextual pressures; emotional responses to others; and, intentional exclusion of emotion from CDM. Under the application of emotion and cognition in CDM, sub-themes were: compassionate emotional labour - responsiveness to patient emotion within CDM; interdisciplinary tension regarding the significance and meaning of emotion in CDM; and, emotion and moral judgement. CONCLUSIONS Clinicians' experienced emotions can and do affect clinical decision making, although acknowledgement of that is far from universal. Importantly, this occurs in the in the absence of a clear theoretical framework and educational preparation may not reflect the importance of emotional competence to effective CDM.
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Affiliation(s)
- Desirée Kozlowski
- Discipline of Psychology, School of Health and Human Sciences, Southern Cross University, Hogbin Drive, Coffs Harbour, NSW Australia
| | - Marie Hutchinson
- School of Health and Human Sciences, Southern Cross University, Hogbin Drive, Coffs Harbour, NSW Australia
| | - John Hurley
- School of Health and Human Sciences, Southern Cross University, Hogbin Drive, Coffs Harbour, NSW Australia
| | - Joanne Rowley
- School of Health and Human Sciences, Southern Cross University, Hogbin Drive, Coffs Harbour, NSW Australia
| | - Joanna Sutherland
- School of Health and Human Sciences, Southern Cross University, Hogbin Drive, Coffs Harbour, NSW Australia
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Emotional Impact of End-of-Life Decisions on Professional Relationships in the ICU: An Obstacle to Collegiality? Crit Care Med 2017; 45:2023-2030. [PMID: 28938252 DOI: 10.1097/ccm.0000000000002710] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVES End-of-life decisions are not only common in the ICU but also frequently elicit strong feelings among health professionals. Even though we seek to develop more collegial interprofessional approaches to care and health decision-making, there are many barriers to successfully managing complex decisions. The aim of this study is to better understand how emotions influence the end-of-life decision-making process among professionals working in ICU. DESIGN Qualitative study with clinical interviews. All interviews were transcribed verbatim and analyzed thematically using interpretative phenomenological analysis. SETTING Two independent ICUs at the "Centre Hospitalier de l'Université de Montréal." SUBJECTS Ten physicians and 10 nurses. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS During the end-of-life decision-making process, families and patients restructure the decision-making frame by introducing a strong emotional dimension. This results in the emergence of new challenges quite different from the immediacy often associated with intensive care. In response to changes in decision frames, physicians rely on their relationship with the patient's family to assist with advanced care decisions. Nurses, however, draw on their relationship and proximity to the patient to denounce therapeutic obstinacy. CONCLUSIONS Our study suggests that during the end-of-life decision-making process, nurses' feelings toward their patients and physicians' feelings toward their patients' families influence the decisions they make. Although these emotional dimensions allow nurses and physicians to act in a manner that is consistent with their professional ethics, the professionals themselves seem to have a poor understanding of these dimensions and often overlook them, thus hindering collegial decisions.
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Elmore J, Wright DK, Paradis M. Nurses’ moral experiences of assisted death: A meta-synthesis of qualitative research. Nurs Ethics 2016; 25:955-972. [DOI: 10.1177/0969733016679468] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background: Legislative changes are resulting in assisted death as an option for people at the end of life. Although nurses’ experiences and perspectives are underrepresented within broader ethical discourses about assisted death, there is a small but significant body of literature examining nurses’ experiences of caring for people who request this option. Aim: To synthesize what has been learned about nurses’ experiences of caring for patients who request assisted death and to highlight what is morally at stake for nurses who undertake this type of care. Design: Qualitative meta-synthesis. Methods: Six databases were searched: CINAHL, Medline, EMBASE, Joanna Briggs Institute, PsycINFO, and Web of Science. The search was completed on 22 October 2014 and updated in February 2016. Of 879 articles identified from the database searches, 16 articles were deemed relevant based on inclusion criteria. Following quality appraisal, 14 studies were retained for analysis and synthesis. Results: The moral experience of the nurse is (1) defined by a profound sense of responsibility, (2) shaped by contextual forces that nurses navigate in everyday end-of-life care practice, and (3) sustained by intra-team moral and emotional support. Discussion: The findings of this synthesis support the view that nurses are moral agents who are deeply invested in the moral integrity of end-of-life care involving assisted death. The findings further demonstrate that to fully appreciate the ethics of assisted death from a nursing standpoint, it is necessary to understand the broader constraints on nurses’ moral agency that operate in everyday end-of-life care. Ethical considerations: Research ethics board approval was not required for this synthesis of previously published literature. Conclusion: In order to understand how to enact ethical practice in the area of assisted death, the moral experiences of nurses should be investigated and foregrounded.
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Affiliation(s)
- James Elmore
- St. Mary’s Research Centre, Canada; McGill University, Canada
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Watson AC, October TW. Clinical Nurse Participation at Family Conferences in the Pediatric Intensive Care Unit. Am J Crit Care 2016; 25:489-497. [PMID: 27802949 PMCID: PMC5751701 DOI: 10.4037/ajcc2016817] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
BACKGROUND Clinical nurses attend family conferences in the intensive care unit, but their role during these meetings is not yet fully understood. OBJECTIVES To assess perceived and observed contributions of the clinical nurse during family conferences. METHODS Prospective cross-sectional survey and review of 40 audio-recorded family conferences conducted in the 44-bed pediatric intensive care unit of an urban pediatric hospital. RESULTS Survey responses from 47 nurses were examined. Most nurses thought it important to attend family conferences, but identified workload as a barrier to attendance. They perceived their roles as gaining firsthand knowledge of the discussion and providing a unique perspective regarding patient care, emotional support, and advocacy. Audio recordings revealed that bedside nurses attended 20 (50%) of 40 family conferences and spoke in 5 (25%) of the 20. Nurses verbally contributed 4.6% to the overall speech at the family conference, mostly providing information on patient care. CONCLUSIONS The clinical nurse is often absent or silent during family conferences in the intensive care unit, despite the important roles they want to play in these settings. Strategies to improve both the physical and verbal participation of clinical nurses during the family conference are suggested, especially in the context of previous research demonstrating the need for more attention in family conferences to social-emotional support and patient advocacy.
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Affiliation(s)
- Anne C Watson
- Anne C. Watson is the research nurse coordinator for critical care medicine, Children's National Health Systems, Washington, DC. Tessie W. October is an attending physician in the pediatric intensive care unit at Children's National Health Systems, Washington, DC, and an assistant professor in the Department of Pediatrics, George Washington University, Washington, DC.
| | - Tessie W October
- Anne C. Watson is the research nurse coordinator for critical care medicine, Children's National Health Systems, Washington, DC. Tessie W. October is an attending physician in the pediatric intensive care unit at Children's National Health Systems, Washington, DC, and an assistant professor in the Department of Pediatrics, George Washington University, Washington, DC
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38
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Burdens Versus Benefits. J Hosp Palliat Nurs 2016. [DOI: 10.1097/njh.0000000000000270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Abstract
Background: Moral distress is a complex phenomenon frequently experienced by critical care nurses. Ethical conflicts in this practice area are related to technological advancement, high intensity work environments, and end-of-life decisions. Objectives: An exploration of contemporary moral distress literature was undertaken to determine measurement, contributing factors, impact, and interventions. Review Methods: This state of the science review focused on moral distress research in critical care nursing from 2009 to 2015, and included 12 qualitative, 24 quantitative, and 6 mixed methods studies. Results: Synthesis of the scientific literature revealed inconsistencies in measurement, conflicting findings of moral distress and nurse demographics, problems with the professional practice environment, difficulties with communication during end-of-life decisions, compromised nursing care as a consequence of moral distress, and few effective interventions. Conclusion: Providing compassionate care is a professional nursing value and an inability to meet this goal due to moral distress may have devastating effects on care quality. Further study of patient and family outcomes related to nurse moral distress is recommended.
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40
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Ho A, Jameson K, Pavlish C. An exploratory study of interprofessional collaboration in end-of-life decision-making beyond palliative care settings. J Interprof Care 2016; 30:795-803. [DOI: 10.1080/13561820.2016.1203765] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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Velarde-García JF, Luengo-González R, González-Hervias R, Cardenete-Reyes C, Alvarado-Zambrano G, Palacios-Ceña D. Facing death in the intensive care unit. A phenomenological study of nurses' experiences. Contemp Nurse 2016; 52:1-12. [PMID: 27225999 DOI: 10.1080/10376178.2016.1194725] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND Nurses may experience considerable emotional burden due to patient death, in part as they are generally the professionals who have the most contact with patients. OBJECTIVE To describe the lived experience of Spanish nurses working in intensive care units regarding how they face the death of their patients. METHODS A qualitative phenomenological study was performed. A purposeful sample was used. The data collection strategies used included in-depth unstructured and semi-structured interviews, field notes and personal documents. Afterwards, data were analyzed using the Giorgi proposal. RESULTS 22 nurses participated, with a mean age of 40.8 years and a mean work experience of 13.8 years. Three themes were identified: 1) dealing with expectations of recovery, 2) accepting the age of death, and 3) experiencing emotional attachment. CONCLUSIONS Nurses in intensive care units report a great emotional burden derived from patients death, Support programs for nurses should be organised within these units.
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Affiliation(s)
| | - Raquel Luengo-González
- a Department of Nursing , Spanish Red Cross , Avda. Reina Victoria n°28, Madrid 28003 , Spain
| | - Raquel González-Hervias
- a Department of Nursing , Spanish Red Cross , Avda. Reina Victoria n°28, Madrid 28003 , Spain
| | - César Cardenete-Reyes
- b Department of Nursing , Universidad Europea , Calle Tajo s/n, Villaviciosa de Odon, Madrid 28670 , Spain
| | - Gema Alvarado-Zambrano
- c Servicio Madrileño de Salud, Nursing Division , Hospital Universitario La Paz , Paseo de la Castellana, 261, Madrid 28046 , Spain
| | - Domingo Palacios-Ceña
- d Department of Physiotherapy, Occupational Therapy, Rehabilitation and Physical Medicine , Universidad Rey Juan Carlos , Avenida Atenas s/n. 28922. Alcorcn, Madrid . Spain
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Anderson WG, Puntillo K, Boyle D, Barbour S, Turner K, Cimino J, Moore E, Noort J, MacMillan J, Pearson D, Grywalski M, Liao S, Ferrell B, Meyer J, O'Neil-Page E, Cain J, Herman H, Mitchell W, Pantilat S. ICU Bedside Nurses' Involvement in Palliative Care Communication: A Multicenter Survey. J Pain Symptom Manage 2016; 51:589-596.e2. [PMID: 26596882 DOI: 10.1016/j.jpainsymman.2015.11.003] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2015] [Revised: 10/30/2015] [Accepted: 11/09/2015] [Indexed: 11/19/2022]
Abstract
CONTEXT Successful and sustained integration of palliative care into the intensive care unit (ICU) requires the active engagement of bedside nurses. OBJECTIVES To describe the perspectives of ICU bedside nurses on their involvement in palliative care communication. METHODS A survey was designed, based on prior work, to assess nurses' perspectives on palliative care communication, including the importance and frequency of their involvement, confidence, and barriers. The 46-item survey was distributed via e-mail in 2013 to bedside nurses working in ICUs across the five academic medical centers of the University of California, U.S. RESULTS The survey was sent to 1791 nurses; 598 (33%) responded. Most participants (88%) reported that their engagement in discussions of prognosis, goals of care, and palliative care was very important to the quality of patient care. A minority reported often discussing palliative care consultations with physicians (31%) or families (33%); 45% reported rarely or never participating in family meeting discussions. Participating nurses most frequently cited the following barriers to their involvement in palliative care communication: need for more training (66%), physicians not asking their perspective (60%), and the emotional toll of discussions (43%). CONCLUSION ICU bedside nurses see their involvement in discussions of prognosis, goals of care, and palliative care as a key element of overall quality of patient care. Based on the barriers participants identified regarding their engagement, interventions are needed to ensure that nurses have the education, opportunities, and support to actively participate in these discussions.
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Affiliation(s)
- Wendy G Anderson
- Division of Hospital Medicine and Palliative Care Program, University of California, San Francisco, California, USA.
| | - Kathleen Puntillo
- Department of Physiological Nursing, University of California San Francisco School of Nursing, San Francisco, California, USA
| | - Deborah Boyle
- University of California, Irvine Health, Orange, California, USA
| | - Susan Barbour
- University of California, San Francisco Medical Center, San Francisco, California, USA
| | - Kathleen Turner
- University of California, San Francisco Medical Center, San Francisco, California, USA
| | - Jenica Cimino
- Division of Hospital Medicine and Palliative Care Program, University of California, San Francisco, California, USA
| | - Eric Moore
- University of California, Davis Medical Center, Sacramento, California, USA
| | - Janice Noort
- University of California, Davis Medical Center, Sacramento, California, USA
| | - John MacMillan
- University of California, Davis Medical Center, Sacramento, California, USA
| | - Diana Pearson
- University of California, Davis Medical Center, Sacramento, California, USA
| | | | - Solomon Liao
- University of California, Irvine Health, Orange, California, USA
| | - Bruce Ferrell
- University of California, Los Angeles Medical Center, Los Angeles, California, USA
| | - Jeannette Meyer
- University of California, Los Angeles Medical Center, Los Angeles, California, USA
| | - Edith O'Neil-Page
- University of California, Los Angeles Medical Center, Los Angeles, California, USA
| | - Julia Cain
- University of California, San Diego Medical Center, San Diego, California, USA
| | - Heather Herman
- University of California, San Diego Medical Center, San Diego, California, USA
| | - William Mitchell
- University of California, San Diego Medical Center, San Diego, California, USA
| | - Steven Pantilat
- Division of Hospital Medicine and Palliative Care Program, University of California, San Francisco, California, USA
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Family Experiences During the Dying Process After Withdrawal of Life-Sustaining Therapy. Dimens Crit Care Nurs 2016; 35:160-6. [DOI: 10.1097/dcc.0000000000000174] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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