Nurses' ethical decision-making during end of life care in South Korea: a cross-sectional descriptive survey

Navigating end-of-life decision-making in nursing: a systematic review of ethical challenges and palliative care practices

OBJECTIVES

This systematic review aimed to synthesize evidence on the ethical dilemma's nurses encounter in end-of-life care and effective palliative care practices. The objectives were to understand key ethical issues, evaluate communication and decision-making strategies, and identify approaches to support nurses and patients.

METHODS

A comprehensive search of major databases was conducted according to the PRISMA guidelines. Studies directly relating to nursing ethics, challenges in end-of-life decision-making, and palliative care practices were included. The risk of bias was assessed using ROBVIS-II. Data on ethical issues, palliative interventions, and outcomes was extracted and analyzed thematically.

RESULTS

22 studies met the inclusion criteria. Key themes that emerged were: (1) Effective communication and involving patients in decision-making are essential but complex. (2) Nurses face dilemmas around balancing autonomy, beneficence and relational issues. (3) Integrating palliative care principles enhances symptom management and aligns care with patient values. (4) Education and organizational support are needed to equip nurses with skills and coping strategies.

CONCLUSION

Navigating end-of-life care requires addressing interconnected ethical, communication and support needs. While studies provided insights, further research is required on cultural competence training, standardized education programs and longitudinal evaluations.

Translation and psychometric testing of the Persian Version of nurses' ethical decision-making in End-of-Life Care Scale

BACKGROUND

Ethical decision-making in end-of-life care is one of the most challenging aspects of healthcare: providing ethical care to the society is one of the most important responsibilities of healthcare professionals. In order to assess nurses' ethical decision-making in end-of-life care, researchers need a specialized and comprehensive instrument which is sufficiently valid and reliable. The present study was conducted to translate and test the psychometric properties of the Persian version of Nurses' Ethical Decision-Making in End-of-Life Care Scale (NEDM-EOLCS).

METHODS

This is a cross-sectional, multi-centric study with a methodological design The participants were selected via convenience sampling from five hospitals located in Iran. In total, 1320 nurses (660 for exploratory factor analysis and 660 for confirmatory factor analysis) participated in the study. The original NEDM-EOLCS was translated into Persian and subsequently the psychometric properties of the scale were assessed according to COSMIN criteria.

RESULTS

Exploratory factor analysis (EFA) showed the factor loading of the 55 items to be between 0.62 and 0.88, all of which were significant. Also, exploratory factor analysis showed that 3 factors (perceived professional accountability, moral reasoning/moral agency and moral practice) explained 74.51% of the variance. Confirmatory factor analysis (CFA) results verified the good fit of the data (a chi-square of 21.74, df = 7, P = 0.001) RMSEA = 0.01, CFI = 0.96, NFI = 0.95, and TLI = 0.97). The reliability of the scale was measured in terms of its internal consistency and the Cronbach's alpha of the whole instrument was found to be 0.98.

CONCLUSION

The Persian version of NEDM-EOLCS for nurses is sufficiently valid and reliable. Thus, this instrument can be used to measure nurses' ethical decision-making in end-of-life care and identify the most effective strategies, e.g. educational interventions, to improve ethical decision-making skills in end-of-life care in these healthcare professionals as necessary.

Care of patients undergoing withdrawal of life-sustaining treatments: an ICU nurse perspective

BACKGROUND

Intensive care unit (ICU) nurses working in South Korea report experiencing uncertainty about how to care for patients undergoing withdrawal of life-sustaining treatments (WLT). A lack of consensus on care guidelines for patients with WLT contributes to uncertainty, ambiguity, and confusion on how to act appropriately within current law and social and ethical norms. To date, little has been discussed or described about how ICU nurses construct meaning about their roles in caring for dying patients in the context of wider social issues about end-of-life care and how this meaning interacts with the ICU system structure and national law. We aimed to better understand how ICU nurses view themselves professionally and how their perceived roles are enabled and/or limited by the current healthcare system in South Korea and by social and ethical norms.

METHODS

This qualitative descriptive study was conducted using in-depth, semi-structured interviews and discourse analysis using Gee's Tools of Inquiry. Purposive sampling was used to recruit ICU nurses (n = 20) who could provide the most insightful information on caring for patients undergoing WLT in the ICU. The interviews were conducted between December 2021 and February 2022 in three university hospitals in South Korea.

RESULTS

We identified four categories of discourses: (1) both "left hanging" or feeling abandoned ICU nurses and patients undergoing WLT; (2) socially underdeveloped conversations about death and dying management; (3) attitudes of legal guardians and physicians toward the dying process of patients with WLT; and (4) provision of end-of-life care according to individual nurses' beliefs in their nursing values.

CONCLUSION

ICU nurses reported having feelings of ambiguity and confusion about their professional roles and identities in caring for dying patients undergoing WLT. This uncertainty may limit their positive contributions to a dignified dying process. We suggest that one way to move forward is for ICU administrators and physicians to respond more sensitively to ICU nurses' discourses. Additionally, social policy and healthcare system leaders should focus on issues that enable and limit the dignified end-of-life processes of patients undergoing WLT. Doing so may improve nurses' understanding of their professional roles and identities as caretakers for dying patients.

A study on different types of moral courage and coping styles of clinical nurses: based on potential profile analysis

BACKGROUND

In professional ethics-related events, there are various unpleasant and complex ethical issues that require strong moral courage. Our aim is to identify and describe the potential categories of moral courage among nurses and to clarify the coping styles of nurses under different categories.

METHOD

A cross-sectional study was conducted using three data collection tools: a self-designed general information questionnaire, a Chinese version of the Moral Courage Scale, and a Trait Coping Style Questionnaire. Three hundred fourteen nurses from a tertiary hospital in Heilongjiang Province, China, were analysed using potential profile analysis, descriptive analysis, and Mann-Whitney U test data.

RESULT

The latent profile analysis (LPA) results indicate that the two-profile model is the most suitable and supports the existence of two different moral courage profiles: the low moral courage group (60.51%) and the high moral courage group (39.49%), with a high relative entropy value (0.922). The results point to a good profile solution, and there are significant differences between the two profiles. The Mann-Whitney U-test results showed that the positive coping scores of the high moral courage group were significantly higher than those of the low moral courage group, and the negative coping scores of the high moral courage group were significantly lower than those of the low moral courage group.

CONCLUSION

Our results reveal the heterogeneity of moral courage in the nurse sample and indicate that nurses in the high moral courage group tend to choose positive coping styles, while nurses in the low moral courage group are more likely to develop negative coping emotions. This provides important significance and reference value for nursing managers, who can propose customised management plans based on the types of moral courage of the nursing community and the coping styles under different categories.

Nurses' ethical leadership and related outcome variables: Systematic Review and Meta-analysis

AIM

To investigate the outcomes and the effect sizes of ethical leadership in nursing practice BACKGROUND: Many meta-analysis of ethical leadership have conducted in other fields, but there are none of the effects of ethical leadership of nurse leaders and should be investigated EVALUATION: For a systematic literature review, we searched PubMed, EMBASE, the Cochrane Library, CINAHL, OVID, Web of Science, and Korean databases for studies published in Korean or English. We used CMA 2.0 and R 3.6.2 for the meta-analysis KEY ISSUES: We divided the outcomes of ethical leadership into three categories and investigated the effect sizes: subordinates' perceptions of their leaders (ES = 0.65), subordinates' ethical behaviors (ES = 0.04), and job or organizational outcomes (ES = 0.45). In addition, we identified 14 outcome variables, and transformational leadership showed the greatest effect size (ES = 0.77) among them CONCLUSION: This study confirmed the positive effects of ethical nursing leadership on individual nurses' perceptions about their leaders, their jobs, and organizations IMPLICATIONS FOR NURSING MANAGEMENT: Nursing organizations and nurse administrators should make efforts to highlight ethical leadership of nurse leaders to improve outcomes of organizational performance including individual nurses' perceptions about their leaders, their jobs, and organizations.

Influence of empathy and professional values on ethical decision-making of emergency nurses: A cross sectional study

INTRODUCTION

Emergency nurses are likely to experience serious ethical dilemmas and conflicts because of the dangerous and unpredictable care situations. Nursing ethical decision-making ability is therefore a core competence. Empathy and professional values may be the important variables that influence ethical decision-making. However, for emergency nurses, there is a lack of empirical evidence to support presently. This study aimed to explore the influence of empathy and professional values on nursing ethical decision-making of emergency nurses.

METHODS

A convenience sample of 236 emergency nurses from 10 general hospitals in China were surveyed. Their ethical decision-making ability, empathy and professional values were measured using the Judgment About Nursing Decision scale, Jefferson Scale of Empathy-Health Professionals, and Nursing Professional Values Scale-Revised, respectively. Additionally, their sociodemographic data were collected. Univariate analysis, Pearson analysis, and multiple linear regression were performed.

RESULTS

The mean ethical decision-making score of emergency nurses was 295.06 ± 26.49, which was medium level. Their average ethical choice score was higher than that of ethical action (P < 0.001). The multiple linear regression results showed that professional values (Standardized coefficients (β) = 0.295, 95% confidence interval (CI): 0.618-1.618), empathy (β = 0.210, 95% CI: 0.620-1.613), job title (β = 0.253, 95% CI: 0.357-2.800) and number of forms of in-service training on ethical decision-making (β = 0.243, 95% CI: 0.254-3.942) were the independent factors significantly influencing the ethical decision-making ability. The multivariate linear regression model had an F statistic of 32.153 (P < 0.001) and an R² = 0.588.

CONCLUSIONS

Strengthening nurses' empathy and professional values can help nurses make ethical decisions. More clinical experience and in-service training on ethical decision-making can help emergency nurses better handle ethical dilemmas and conflicts.