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Tas Arslan F, Ozkan S, Bagcivan G. Nursing Students' Views about Do-Not-Resuscitate Orders: Quasi-Experimental Study. OMEGA-JOURNAL OF DEATH AND DYING 2024; 89:73-87. [PMID: 35045751 DOI: 10.1177/00302228211066690] [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: 11/16/2022]
Abstract
"Do Not Resuscitate" (DNR) order is one of the challenging issues encountered in end of life care. This study aimed to determine the effect of education about DNR on the views of senior nursing students. Students, who selected elective course of palliative care and received education about DNR formed the intervention group (n = 106) while the students who did not select the lesson were in the control group (n = 107). Data were collected using a questionnaire. It revealed that the students who had education about DNR agreed with the positive statements about DNR more than the control group. Also, intervention group students had a high agreement DNR should be a part of vocational training for health professionals. It is important and necessary to focus on the special role of nurses when a DNR order is given, and nursing education raised the awareness and views about DNR according to the data from this study.
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Affiliation(s)
| | - Sevil Ozkan
- Faculty of Nursing, Selcuk University, Konya, Turkey
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Ethical problems among nurses during pandemics: A study from Turkey. ETHICS, MEDICINE AND PUBLIC HEALTH 2022; 22:100796. [PMID: 35692247 PMCID: PMC9167429 DOI: 10.1016/j.jemep.2022.100796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/01/2021] [Accepted: 04/19/2022] [Indexed: 11/22/2022]
Abstract
Background Fighting Covid 19 at the forefront, increased the risk of infection and scarcity of resources have caused the ethical problems among nurses. It was planned to examine the ethical problems faced by nurses caring for Covid-19 patients and how they overcame the outcomes of these problems. Methodology This qualitative study was conducted with 20 nurses who caring Covid 19 patients in Turkey. Data were collected between January 24 and February 21, 2021. Purposive sampling was used in the study and a qualitative content analysis was performed. Results The research findings were discussed under two main themes as ethical problems and outcomes of ethical problems faced by nurses working in Covid-19 units. Then, 4 sub-categories for the theme of ethical problems (institutional problems, lack of knowledge and experience in nurses’ new place of duty, enforcing nurses to do doctors’ duties, problems encountered while caring for patients) and 2 sub-categories (emotions felt by nurses, coping strategies) for the theme of outcomes of ethical problems faced by nurses were defined. Conclusion The findings emphasize that nurses face ethical problems while giving care to Covid 19 problems. The nature of health services requires an ethical perspective to protect and improve human health, especially in uncertain, difficult and risky situations. Nurses should be supported to provide the ethical perspective in the best way.
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Aghakhani N, Habibzadeh H, Mohammadi F. Critical care nurses’ moral sensitivity during cardiopulmonary resuscitation: Qualitative perspectives. Nurs Ethics 2022; 29:938-951. [DOI: 10.1177/09697330221073998] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background Cardiopulmonary Resuscitation (CPR) is one of the areas in which moral issues are of great significance, especially with respect to the nursing profession, because CPR requires quick decision-making and prompt action and is associated with special complications due to the patients’ unconsciousness. In such circumstances, nurses’ ability in terms of moral sensitivity can be determinative in the success of the procedure. Identifying the components of moral sensitivity in nurses in this context can promote moral awareness and improve moral performance. Objective This study was conducted to explore and identify the experiences of critical care nurses about moral sensitivity components in CPR. Research design and methods This study was implemented with a qualitative approach. Data were collected via 22 in-depth semi-structured interviews held with 20 eligible participants with maximum variation. The data were then analyzed using the grounded theory approach. Participants and research context In total, thirteen clinical nurses, three head nurses, two educational supervisors, and two faculty members from different universities of Iran were interviewed. Ethical considerations This study was conducted with the ethical approval (IR.UMSU.REC.1399.337) of the Ethics Committee of Urmia University of Medical Sciences. Findings Four themes and 12 sub-themes were extracted from the analysis of the data, including “Consciously and compassionate attention to resuscitate the patient,” “Awareness of families’ anxiety,” “Understanding the teamwork and interactive guidance of the CPR process,” and “Compulsory violation of moral principles.” Discussion It is anticipated that this discussion will prompt further debate, raise awareness and help clarify the dimensions of moral sensitivity in unconscious patients especially during CPR, so that it can be more clearly named and defended as a moral authority in CPR. Conclusion identifying the components of moral sensitivity in nurses, facilitates their encounter with moral issues and can improve their moral performance and encourage right decisions.
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Affiliation(s)
- Nader Aghakhani
- School of Nursing and Midwifery, Urmia University of Medical Sciences, Urmia, Iran
| | - Hossein Habibzadeh
- School of Nursing and Midwifery, Urmia University of Medical Sciences, Urmia, Iran
| | - Farshad Mohammadi
- School of Nursing and Midwifery, Urmia University of Medical Sciences, Urmia, Iran
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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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5
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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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Gül Ş, Bağcivan G, Aksu M. Nurses' Opinions on Do-Not-Resuscitate Orders. OMEGA-JOURNAL OF DEATH AND DYING 2020; 86:271-283. [PMID: 33095667 DOI: 10.1177/0030222820969317] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The aim of this study was to determine nurses' opinions on Do Not Resuscitate (DNR) orders. This is a descriptive study. A total of 1250 nurses participated in this study. The mean age of participants was 34.5 ± 7.7 years; 92.6% were women; 56.4% had bachelor's degrees, and 28.8% were intensive care, oncology, or palliative care nurses. Most participants (94.3%) agreed that healthcare professionals involved in DNR decision-making processes should have ethical competence, while they were mostly undecided (43%) about the statement whether or not DNR should be legal. More than half the participants (60.2%) disagreed with the idea that DNR implementation causes an ethical dilemma. Participants' opinions on DNR decisions significantly differed according to the number of years of employment and unit of duty. The results showed that most of the nurses had positive attitudes towards DNR orders despite it being illegal. Future studies are needed to better understand family members' and decision makers' perceptions of DNR orders for patients.
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Affiliation(s)
- Şenay Gül
- Faculty of Nursing, Hacettepe University, Ankara, Turkey
| | | | - Miray Aksu
- Gulhane Training and Research Hospital, Ankara, Turkey
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ÖNDAŞ AYBAR D, Parlar Kılıç S. Bir Üniversite Hastanesinde Çalışan Yoğun Bakım Hemşirelerinin Karşılaştıkları Etik Sorunlar Ve Stres Düzeylerine Etkisi. DÜZCE ÜNIVERSITESI SAĞLIK BILIMLERI ENSTITÜSÜ DERGISI 2020. [DOI: 10.33631/duzcesbed.512205] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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8
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Abstract
This article reports results from a descriptive study involving nurses working in intensive care units of hospitals in the province of Erzurum, eastern Turkey. A total of 110 nurses agreed to participate in the study. The Moral Sensitivity Questionnaire and a personal information form, which was developed by researchers in accordance with the relevant literature, were used for data collection. The results indicated that intensive care nurses face frequent ethical problem and that moral sensitivity is required to assist in coping with the issues. Researchers report that nurses who were highly satisfied with their work possessed a heightened sensitivity about ethical issues when compared with those who were dissatisfied with their profession.
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deSante-Bertkau JE, McGowan ML, Matheny Antommaria AH. Systematic Review of Typologies Used to Characterize Clinical Ethics Consultations. THE JOURNAL OF CLINICAL ETHICS 2018. [DOI: 10.1086/jce2018294291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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10
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Birtan D, Arslantas MK, Dincer PC, Altun GT, Bilgili B, Ucar FB, Bozoklar CA, Ayanoglu HO. Effect of Interviews Done by Intensive Care Physicians on Organ Donation. Transplant Proc 2017; 49:396-398. [PMID: 28340798 DOI: 10.1016/j.transproceed.2017.01.030] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
In this study, we examined the correspondence between intensive care unit physicians and the relatives of potential brain-dead donors regarding the decision to donate or the reasons for refusing organ donation. A total of 12 consecutive cases of potential brain-dead patients treated in intensive care units of Marmara University Pendik Education and Research Hospital in 2013 were evaluated. For each of the cases, the Potential Donor Questionnaire, and Family Notification, Brain Death Criteria Fulfilment and Organ Donation Conversation Questionnaires were used to collect the required data. Statistically, descriptive analyses were performed. We concluded that honestly, regularly, and sufficiently informed relatives of the potential brain-dead donor more readily donate organs, with a positive contribution from the intensive care physician.
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Affiliation(s)
- D Birtan
- Transplantation Coordination Unit, Marmara University Pendik Research and Training Hospital, Istanbul, Turkey
| | - M K Arslantas
- Anesthesiology and Reanimation Department, Marmara University Pendik Research and Training Hospital, Istanbul, Turkey
| | - P C Dincer
- Anesthesiology and Reanimation Department, Marmara University, School of Medicine, Istanbul, Turkey
| | - G T Altun
- Anesthesiology and Reanimation Department, Marmara University Pendik Research and Training Hospital, Istanbul, Turkey
| | - B Bilgili
- Anesthesiology and Reanimation Department, Marmara University, School of Medicine, Istanbul, Turkey
| | - F B Ucar
- Transplantation Coordination Unit, Marmara University Pendik Research and Training Hospital, Istanbul, Turkey
| | - C A Bozoklar
- Department of General Surgery, Istanbul Bilim University, School of Medicine, Istanbul, Turkey
| | - H O Ayanoglu
- Anesthesiology and Reanimation Department, Marmara University, School of Medicine, Istanbul, Turkey.
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11
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Kälvemark Sporrong S, Arnetz B, Hansson MG, Westerholm P, Höglund AT. Developing Ethical Competence in Health Care Organizations. Nurs Ethics 2016; 14:825-37. [PMID: 17901191 DOI: 10.1177/0969733007082142] [Citation(s) in RCA: 78] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Increased work complexity and financial strain in the health care sector have led to higher demands on staff to handle ethical issues. These demands can elicit stress reactions, that is, moral distress. One way to support professionals in handling ethical dilemmas is education and training in ethics. This article reports on a controlled prospective study evaluating a structured education and training program in ethics concerning its effects on moral distress. The results show that the participants were positive about the training program. Moral distress did not change significantly. This could be interpreted as competence development, with no effects on moral distress. Alternatively, the result could be attributed to shortcomings of the training program, or that it was too short, or it could be due to the evaluation instrument used. Organizational factors such as management involvement are also crucial. There is a need to design and evaluate ethics competence programs concerning their efficacy.
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12
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Scholtz S, Nel EW, Poggenpoel M, Myburgh CPH. The Culture of Nurses in a Critical Care Unit. Glob Qual Nurs Res 2016; 3:2333393615625996. [PMID: 28462324 PMCID: PMC5342286 DOI: 10.1177/2333393615625996] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2015] [Revised: 12/01/2015] [Accepted: 12/07/2015] [Indexed: 01/12/2023] Open
Abstract
Critical care nurses have to adapt to a fast-paced and stressful environment by functioning within their own culture. The objective of this study was to explore and describe the culture of critical care nurses with the purpose of facilitating recognition of wholeness in critical care nurses. The study had a qualitative, exploratory, descriptive, and contextual design. The ethnographic study included data triangulation of field notes written during 12 months of ethnographic observations, 13 interviews from registered nurses, and three completed diaries. Coding and analysis of data revealed patterns of behavior and interaction. The culture of critical care nurses was identified through patterns of patient adoption, armor display, despondency because of the demands to adjust, sibling-like teamwork, and non-support from management and medical doctors. An understanding of the complexity of these patterns of behavior and interaction within the critical care nursing culture is essential for transformation in the practice of critical care nursing.
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Affiliation(s)
| | - Elsabe W. Nel
- University of Johannesburg, Johannesburg, South Africa
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Badır A, Topçu İ, Türkmen E, Göktepe N, Miral M, Ersoy N, Akın E. Turkish critical care nurses' views on end-of-life decision making and practices. Nurs Crit Care 2015; 21:334-342. [PMID: 25943254 DOI: 10.1111/nicc.12157] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2014] [Revised: 12/04/2014] [Accepted: 12/18/2014] [Indexed: 11/27/2022]
Abstract
BACKGROUND Life-sustaining treatments are increasingly used in intensive care units (ICUs) for EOL care, but the decision to use these may cause ethical issues. AIMS AND OBJECTIVES The aim of this study was to investigate the views and practices of critical care nurses in Turkey on the end-of-life (EOL) care. DESIGN This was a cross-sectional study. METHODS The research was conducted in 32 second- and third-level ICUs of 19 Ministry of Health research hospitals in Turkey. The Views of European Nurses in Intensive Care on EOL Care tool was used for data collection. RESULTS The total sample size was 602. While half of the nurses stated that the withholding and withdrawal of life support were ethically different decisions, 40% felt both decisions were unethical. The expected quality of life as viewed by the patient, the medical team, the family and the nursing team (90·4%, 85·4%, and 83·4%, respectively) was an important factor in EOL decision making. The majority of the nurses (75·7%) were not directly involved in the EOL decision making and 78·4% of nurses were committed to family involvement in EOL decisions. When withdrawing treatment, 87·2% of ICU nurses agreed that the patient and family members should perform their final religious and spiritual duties. Further results showed that after withdrawing treatment, a majority of nurses (86%) agreed to continue pressure sore prevention, effective pain relief (85·5%), nutritional support (77·6%) and hydration (64·8%). Almost half (48·2%) indicated that keeping the patients in the ICU was unnecessary. CONCLUSION ICU nurses expressed a range of experiences and practices regarding EOL care. ICU nurses should be more involved in the decision-making process about EOL care. RELEVANCE TO CLINICAL PRACTICE Due to their unique relationship with patients, nurses should be involved in EOL care decision making; however, patients, families or nurses are not often involved in the decision-making process in Turkey.
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Affiliation(s)
- Aysel Badır
- Koc University School of Nursing, Istanbul, Turkey
| | - İbrahim Topçu
- Bezmialem Foundation University, School of Medicine, Department of Medical History and Ethics, Istanbul, Turkey
| | | | | | - Mukaddes Miral
- Department of Education & Human Resources, Health Directorate of Istanbul, Istanbul, Turkey
| | - Nermin Ersoy
- Kocaeli University School of Medicine, Department of Medical History and Ethics, Kocaeli, Turkey
| | - Esra Akın
- İzmir Katip Çelebi University, Health Sciences Faculty, Izmir, Turkey
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Park DW, Moon JY, Ku EY, Kim SJ, Koo YM, Kim OJ, Lee SH, Jo MW, Lim CM, Armstrong JD, Koh Y. Ethical issues recognized by critical care nurses in the intensive care units of a tertiary hospital during two separate periods. J Korean Med Sci 2015; 30:495-501. [PMID: 25829820 PMCID: PMC4366973 DOI: 10.3346/jkms.2015.30.4.495] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2014] [Accepted: 11/12/2014] [Indexed: 11/20/2022] Open
Abstract
This research aimed to investigate the changes in ethical issues in everyday clinical practice recognized by critical care nurses during two observation periods. We conducted a retrospective analysis of data obtained by prospective questionnaire surveys of nurses in the intensive care units (ICU) of a tertiary university-affiliated hospital in Seoul, Korea. Data were collected prospectively during two different periods, February 2002-January 2003 (Period 1) and August 2011-July 2012 (Period 2). Significantly fewer cases with ethical issues were reported in Period 2 than in Period 1 (89 cases [2.1%] of 4,291 ICU admissions vs. 51 [0.5%] of 9,302 ICU admissions, respectively; P < 0.001). The highest incidence of cases with identified ethical issues in both Periods occurred in MICU. The major source of ethical issues in Periods 1 and 2 was behavior-related. Among behaviorrelated issues, inappropriate healthcare professional behavior was predominant in both periods and mainly involved resident physicians. Ethical issue numbers regarding end-oflife (EOL) care significantly decreased in the proportion with respect to ethical issues during Period 2 (P = 0.044). In conclusion, the decreased incidence of cases with identified ethical issues in Period 2 might be associated with ethical enhancement related with EOL and improvements in the ICU care environment of the studied hospital. However, behaviorrelated issues involving resident physicians represent a considerable proportion of ethical issues encountered by critical care nurses. A systemic approach to solve behavior-related issues of resident physicians seems to be required to enhance an ethical environment in the studied ICU.
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Affiliation(s)
- Dong Won Park
- Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea
| | - Jae Young Moon
- Department of Internal Medicine, Chungnam National University College of Medicine. Daejeon, Korea
| | - Eun Yong Ku
- Department of Nursing, College of Medicine, Konkuk University, Seoul, Korea
| | - Sun Jong Kim
- Department of Internal Medicine, College of Medicine, Konkuk University, Seoul, Korea
| | - Young-Mo Koo
- Department of Medical Humanities and Social Sciences, University of Ulsan College of Medicine, Seoul, Korea
| | - Ock-Joo Kim
- Department of Medical History and Medical Humanities, Seoul National University College of Medicine, Seoul, Korea
| | - Soon Haeng Lee
- Department of Nursing, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Min-Woo Jo
- Department of Preventive Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Chae-Man Lim
- Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | | | - Younsuck Koh
- Department of Medical Humanities and Social Sciences, University of Ulsan College of Medicine, Seoul, Korea
- Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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Manea T. Medical Bribery and the Ethics of Trust: The Romanian Case. THE JOURNAL OF MEDICINE AND PHILOSOPHY 2014; 40:26-43. [DOI: 10.1093/jmp/jhu049] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Shoorideh FA, Ashktorab T, Yaghmaei F, Alavi Majd H. Relationship between ICU nurses’ moral distress with burnout and anticipated turnover. Nurs Ethics 2014; 22:64-76. [DOI: 10.1177/0969733014534874] [Citation(s) in RCA: 88] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background: Moral distress is one of intensive care unit nurses’ major problems, which may happen due to various reasons, and has several consequences. Due to various moral distress outcomes in intensive care unit nurses, and their impact on nurses’ personal and professional practice, recognizing moral distress is very important. Research objective: The aim of this study was to determine correlation between moral distress with burnout and anticipated turnover in intensive care unit nurses. Research design: This study is a descriptive-correlation research. Participants and research context: A total of 159 intensive care unit nurses were selected from medical sciences universities in Iran. Data collection instruments included “demographic questionnaire,” “ICU Nurses’ Moral Distress Scale,” “Copenhagen Burnout Inventory” and “Hinshaw and Atwood Turnover Scale.” Data analysis was done by using SPSS19. Ethical considerations: Informed consent from samples and research approval was obtained from Shahid Beheshti Medical Sciences University Research Ethics Board in Tehran. Findings: The findings showed intensive care unit nurses’ moral distress and anticipated turnover was high, but burnout was moderate. The results revealed that there was a positive statistical correlation between intensive care unit nurses’ age, their work experience and the fraction of nurses’ number to number of intensive care unit beds with their moral distress and burnout. However, there were no correlation between gender, marriage status, educational degree and work shift and moral distress. Discussion: Some of the findings of this research are consistent with other studies and some of them are inconsistent. Conclusion: Similarly, moral distress with burnout and anticipated turnover did not have statistical correlation. However, a positive correlation was found between burnout and anticipated turnover. The results showed that increase in the recruitment of young nurses, and nursing personnel, and diminishing intensive care unit nurses’ moral distress, burnout and their turnover intention are essential.
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McAndrew NS, Leske JS. A Balancing Act: Experiences of Nurses and Physicians When Making End-of-Life Decisions in Intensive Care Units. Clin Nurs Res 2014; 24:357-74. [PMID: 24864319 DOI: 10.1177/1054773814533791] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The purpose of this qualitative, descriptive study was to describe end-of-life decision-making experiences as understood by critical care nurses and physicians in intensive care units (ICUs). A purposive sample of seven nurses and four physicians from a large teaching hospital were interviewed. Grounded theory analysis revealed the core category of "end-of-life decision making as a balancing act." Three interacting subthemes were identified: emotional responsiveness, professional roles and responsibilities, and intentional communication and collaboration. Balancing factors included a team approach, shared goals, understanding the perspectives of those involved, and knowing your own beliefs. In contrast, feeling powerless, difficult family dynamics, and recognition of suffering caused an imbalance. When balance was achieved during end-of-life decision making, nurses and physicians described positive end-of-life experiences. The consequence of an imbalance during an end-of-life decision-making experience was moral distress. Practice recommendations include development of support interventions for nurses and physicians involved in end-of-life decision making and further research to test interventions aimed at improving communication and collaboration.
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Teixeira C, Ribeiro O, Fonseca AM, Carvalho AS. Ethical decision making in intensive care units: a burnout risk factor? Results from a multicentre study conducted with physicians and nurses. JOURNAL OF MEDICAL ETHICS 2014; 40:97-103. [PMID: 23408707 DOI: 10.1136/medethics-2012-100619] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
BACKGROUND Ethical decision making in intensive care is a demanding task. The need to proceed to ethical decision is considered to be a stress factor that may lead to burnout. The aim of this study is to explore the ethical problems that may increase burnout levels among physicians and nurses working in Portuguese intensive care units (ICUs). A quantitative, multicentre, correlational study was conducted among 300 professionals. RESULTS The most crucial ethical decisions made by professionals working in ICU were related to communication, withholding or withdrawing treatments and terminal sedation. A positive relation was found between ethical decision making and burnout in nurses, namely, between burnout and the need to withdraw treatments (p=0.032), to withhold treatments (p=0.002) and to proceed to terminal sedation (p=0.005). This did not apply to physicians. Emotional exhaustion was the burnout subdimension most affected by the ethical decision. The nurses' lack of involvement in ethical decision making was identified as a risk factor. Nevertheless, in comparison with nurses (6%), it was the physicians (34%) who more keenly felt the need to proceed to ethical decisions in ICU. CONCLUSIONS Ethical problems were reported at different levels by physicians and nurses. The type of ethical decisions made by nurses working in Portuguese ICUs had an impact on burnout levels. This did not apply to physicians. This study highlights the need for education in the field of ethics in ICUs and the need to foster inter-disciplinary discussion so as to encourage ethical team deliberation in order to prevent burnout.
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Affiliation(s)
- Carla Teixeira
- Santo António Hospital, Hospital Center of Porto, , Department of Anaesthesia, Intensive Care and Emergency, Porto, Portugal
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Park M, Jeon SH, Hong HJ, Cho SH. A comparison of ethical issues in nursing practice across nursing units. Nurs Ethics 2014; 21:594-607. [PMID: 24449700 DOI: 10.1177/0969733013513212] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND The complexity and variety of ethical issues in nursing is always increasing, and those issues lead to special concerns for nurses because they have critical impacts on nursing practice. RESEARCH OBJECTIVES The purpose of this study was to gather comprehensive information about ethical issues in nursing practice, comparing the issues in different types of nursing units including general units, oncology units, intensive care units, operating rooms, and outpatient departments. RESEARCH DESIGN The study used a descriptive research design. Ethics/human rights issues encountered by nurses in their daily nursing practice were identified by using the Ethical Issues Scale. PARTICIPANTS The study sample included 993 staff nurses working in a university hospital in South Korea. ETHICAL CONSIDERATIONS This study was approved by the University Institutional Review Board. Completed questionnaires were returned sealed with signed informed consent. FINDINGS The most frequently and disturbingly encountered issues across nursing units were "conflicts in the nurse-physician relationship," "providing care with a possible risk to your health," and "staffing patterns that limit patient access to nursing care." The findings of this study showed that nurses from different nursing units experienced differences in the types or frequency of ethical issues. In particular, intensive care units had the greatest means of all the units in all three component scales including end-of-life treatment issues, patient care issues, and human rights issues. DISCUSSION Nurses experienced various ethical challenges in their daily practice. Of the ethical issues, some were distinctively and frequently experienced by nurses in a specific unit. CONCLUSION This study suggested that identifying and understanding specific ethical issues faced by nurses in their own areas may be an effective educational approach to motivate nurses and to facilitate nurses' reflection on their experiences.
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Affiliation(s)
- Mihyun Park
- Seoul National University, Republic of Korea
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de Graaff FM, Mistiaen P, Devillé WL, Francke AL. Perspectives on care and communication involving incurably ill Turkish and Moroccan patients, relatives and professionals: a systematic literature review. BMC Palliat Care 2012; 11:17. [PMID: 22985103 PMCID: PMC3517329 DOI: 10.1186/1472-684x-11-17] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2012] [Accepted: 09/13/2012] [Indexed: 11/10/2022] Open
Abstract
Background Our aim was to obtain a clearer picture of the relevant care experiences and care perceptions of incurably ill Turkish and Moroccan patients, their relatives and professional care providers, as well as of communication and decision-making patterns at the end of life. The ultimate objective is to improve palliative care for Turkish and Moroccan immigrants in the Netherlands, by taking account of socio-cultural factors in the guidelines for palliative care. Methods A systematic literature review was undertaken. The data sources were seventeen national and international literature databases, four Dutch journals dedicated to palliative care and 37 websites of relevant national and international organizations. All the references found were checked to see whether they met the structured inclusion criteria. Inclusion was limited to publications dealing with primary empirical research on the relationship between socio-cultural factors and the health or care situation of Turkish or Moroccan patients with an oncological or incurable disease. The selection was made by first reading the titles and abstracts and subsequently the full texts. The process of deciding which studies to include was carried out by two reviewers independently. A generic appraisal instrument was applied to assess the methodological quality. Results Fifty-seven studies were found that reported findings for the countries of origin (mainly Turkey) and the immigrant host countries (mainly the Netherlands). The central themes were experiences and perceptions of family care, professional care, end-of-life care and communication. Family care is considered a duty, even when such care becomes a severe burden for the main female family caregiver in particular. Professional hospital care is preferred by many of the patients and relatives because they are looking for a cure and security. End-of-life care is strongly influenced by the continuing hope for recovery. Relatives are often quite influential in end-of-life decisions, such as the decision to withdraw or withhold treatments. The diagnosis, prognosis and end-of-life decisions are seldom discussed with the patient, and communication about pain and mental problems is often limited. Language barriers and the dominance of the family may exacerbate communication problems. Conclusions This review confirms the view that family members of patients with a Turkish or Moroccan background have a central role in care, communication and decision making at the end of life. This, in combination with their continuing hope for the patient’s recovery may inhibit open communication between patients, relatives and professionals as partners in palliative care. This implies that organizations and professionals involved in palliative care should take patients’ socio-cultural characteristics into account and incorporate cultural sensitivity into care standards and care practices.
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Affiliation(s)
- Fuusje M de Graaff
- NIVEL (Netherlands Institute for Health Services Research), PB 1568, 3500, BN, Utrecht, the Netherlands.
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21
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Fernandes MID, Moreira IMPB. Ethical issues experienced by intensive care unit nurses in everyday practice. Nurs Ethics 2012; 20:72-82. [PMID: 22918059 DOI: 10.1177/0969733012452683] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This research aims to identify the ethical issues perceived by intensive care nurses in their everyday practice. It also aims to understand why these situations were considered an ethical issue and what interventions/strategies have been or are expected to be developed so as to minimize them. Data were collected using a semi-structured interview with 15 nurses working at polyvalent intensive care units in 4 Portuguese hospitals, who were selected by the homogenization of multiple samples. The qualitative content analysis identified end-of-life decisions, privacy, interaction, team work, and health-care access as emerging ethical issues. Personal, team, and institutional aspects emerge as reasons behind the experience of these issues. Personal and team resources are used in and for solving these issues. Moral development and training are the most significant strategies.
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Affiliation(s)
- Maria I D Fernandes
- Department of Medical-Surgical Nursing, Nursing School of Coimbra, Portugal.
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Shorideh FA, Ashktorab T, Yaghmaei F. Iranian intensive care unit nurses’ moral distress. Nurs Ethics 2012; 19:464-78. [DOI: 10.1177/0969733012437988] [Citation(s) in RCA: 78] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Researchers have identified the phenomena of moral distress through many studies in Western countries. This research reports the first study of moral distress in Iran. Because of the differences in cultural values and nursing education, nurses working in intensive care units may experience moral distress differently than reported in previous studies. This research used a qualitative method involving semistructured and in-depth interviews of a purposive sample of 31 (28 clinical nurses and 3 nurse educators) individuals to identify the types of moral distress among clinical nurses and nurse educators working in 12 cities in Iran. A content analysis of the data produced four themes to describe the nurses’ moral distress. The four themes were as follows: (a) institutional barriers and constraints; (b) communication problems; (c) futile actions, malpractice, and medical/care errors; (d) inappropriate responsibilities, resources, and competencies. The results demonstrate that moral distress for intensive care unit nurses is different and that the nursing leaders must reduce moral distress among nursing in intensive care.
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Abstract
This descriptive study was conducted to determine nursing students' observation of ethical problems encountered in their clinical practice. Data were collected through a questionnaire from 153 volunteer nursing students at a university-based nursing school in Ankara, Turkey. The students reported that some patients are either physically or psychologically mistreated by doctors and nurses; they were not given appropriate information; they were subjected to discrimination according to their socio-economic situation; and their privacy was ignored. The findings reveal that nurses' own unethical behaviors contribute to a rise in ethical problems. It is argued that nurses should internalize their professional and ethical roles in order to provide safe and ethical care and be good role models for students.
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Benson A, Cribb A, Barber N. Understanding pharmacists' values: A qualitative study of ideals and dilemmas in UK pharmacy practice. Soc Sci Med 2009; 68:2223-30. [DOI: 10.1016/j.socscimed.2009.03.012] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2007] [Indexed: 10/20/2022]
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Abstract
This study was conducted to gain opinions about euthanasia from nurses who work in intensive care units. The research was planned as a descriptive study and conducted with 186 nurses who worked in intensive care units in a university hospital, a public hospital, and a private not-for-profit hospital in Adana, Turkey, and who agreed to complete a questionnaire. Euthanasia is not legal in Turkey. One third (33.9%) of the nurses supported the legalization of euthanasia, whereas 39.8% did not. In some specific circumstances, 44.1% of the nurses thought that euthanasia was being practiced in our country. The most significant finding was that these Turkish intensive care unit nurses did not overwhelmingly support the legalization of euthanasia. Those who did support it were inclined to agree with passive rather than active euthanasia (P = 0.011).
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MESH Headings
- Adult
- Analysis of Variance
- Attitude of Health Personnel
- Chi-Square Distribution
- Critical Care/ethics
- Critical Care/organization & administration
- Euthanasia/ethics
- Euthanasia/legislation & jurisprudence
- Euthanasia/psychology
- Health Knowledge, Attitudes, Practice
- Health Policy/legislation & jurisprudence
- Health Services Needs and Demand
- Hospitals, Public
- Hospitals, University
- Hospitals, Voluntary
- Humans
- Intensive Care Units/ethics
- Intensive Care Units/organization & administration
- Nurse's Role/psychology
- Nursing Methodology Research
- Nursing Staff, Hospital/education
- Nursing Staff, Hospital/ethics
- Nursing Staff, Hospital/organization & administration
- Nursing Staff, Hospital/psychology
- Organizational Policy
- Patient Rights/ethics
- Patient Rights/legislation & jurisprudence
- Social Support
- Statistics, Nonparametric
- Surveys and Questionnaires
- Turkey
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Affiliation(s)
- Gülşah Kumaş
- Cukurova University, Adana Health Sciences School, Nursing Division, Adana, Turkey
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Abstract
AIM The aim was to describe critical care nurses' experiences of close relatives within intensive care. BACKGROUND There is a lack of research describing critical care nurses' experiences of the significance of close relatives in intensive care. Knowledge in this area will support critical care nurses to develop good nursing care for the critically ill person and their close relatives. DESIGN AND METHOD The design of the study was qualitative. Data collection was carried out through focus group discussions with 24 critical care nurses in four focus groups during spring 2004. The data were subjected to qualitative thematic content analysis. RESULTS The focus groups discussions showed that the presence of close relatives was taken for granted by critical care nurses and it was frustrating if the critically ill person did not have any. Information from close relatives made it possible for critical care nurses to create individual care for the critically ill person. They supported close relatives by giving them information, being near and trying to establish good relations with them. Close relatives were important. Critical care nurses lacked forums for reflection and discussion about the care given. RELEVANCE TO CLINICAL PRACTICE This study indicates that close relatives are a prerequisite for critical care nurses to give good nursing care to meet the needs of the critically ill person. A communication based on mutual understanding is necessary if critical care nurses are to be able to support close relatives. Dealing constantly with situations that were ethically difficult without any chance to reflect was an obstacle for critical care nurses to improve their work with close relatives.
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Affiliation(s)
- Asa Engström
- Division of Nursing, Department of Health Science, Luleå University of Technology, Luleå, Sweden.
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