Concordance of Nurses and Physicians on Whether Critical Care Patients are Receiving Futile Treatment

Neville, Thanh; Wiley, Joshua F.; Yamamoto, Myrtle; Flitcraft, Mark; Anderson, Barbara A.; Curtis, J. Randall; Wenger, Neil S.

doi:10.4037/ajcc2015476

Cited by 32 publications

(33 citation statements)

References 25 publications

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“…This result was not unexpected given that nurses have repeatedly identified distress in this context. 9,[26][27][28] Consistent with research conducted by McAndrew et al, 21 the highest frequency of moral distress occurred from "continuing to participate in care for a hopelessly ill person" (mean score, 3.74 on a Likert scale of 1 to 5).…”

Section: Discussionsupporting

confidence: 71%

Predictors of Moral Distress in a US Sample of Critical Care Nurses

Hiler

Hickman

Reimer

et al. 2018

American Journal of Critical Care

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59Background Moral distress in registered nurses causes decreased job satisfaction, turnover in staffing, burnout, and heightened states of psychological distress. To date, investigation of modifiable factors, such as perceptions of the practice environment and patient safety, among a diverse sample of critical care nurses has been limited. Objective To explore the relationships among the severity of moral distress, the practice environment, and patient safety in a national sample of critical care nurses. Methods Critical care nurses experienced in working with adults (> 1 year of intensive care unit experience) and who were subscribers to the American Association of Critical-Care Nurses' e-mail listserv and social media sites anonymously participated in this descriptive study. Participants completed a demographic questionnaire, the Moral Distress Scale-Revised, and the Practice Environment Scale of the Nursing Work Index. Descriptive statistics, bivariate correlation coefficients, and a hierarchical regression analysis were used to describe the sample characteristics and to assess relationships among the study variables.Results Of a national sample of 328 critical care nurses, 56% had less than 20 years of experience as a registered nurse. Moral distress was modestly associated with negative perceptions of the practice environment and patient safety. Job satisfaction, practice environment, and the participant's age were statistically significant predictors of moral distress in this sample. Conclusions Modifications of organizational factors such as the development of healthy work environments that promote collegial relationships could reduce moral distress among critical care nurses.

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Section: Discussionsupporting

confidence: 71%

Predictors of Moral Distress in a US Sample of Critical Care Nurses

Hiler

Hickman

Reimer

et al. 2018

American Journal of Critical Care

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“…As PEC by a clinician alone was only moderately predictive of the patient’s combined outcome compared to no PEC across all climates (ESM 2), and previous publications have highlighted the importance of concordance between two clinicians [15–18], we compared the probability of attaining the combined endpoint for patients with PECs by at least two clinicians between the ethical climates. For practical reasons, “PECs by at least two clinicians” is referred to as “concordant PECs” throughout the manuscript.…”

Section: Methodsmentioning

confidence: 99%

Outcome in patients perceived as receiving excessive care across different ethical climates: a prospective study in 68 intensive care units in Europe and the USA

et al. 2018

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PurposeWhether the quality of the ethical climate in the intensive care unit (ICU) improves the identification of patients receiving excessive care and affects patient outcomes is unknown.MethodsIn this prospective observational study, perceptions of excessive care (PECs) by clinicians working in 68 ICUs in Europe and the USA were collected daily during a 28-day period. The quality of the ethical climate in the ICUs was assessed via a validated questionnaire. We compared the combined endpoint (death, not at home or poor quality of life at 1 year) of patients with PECs and the time from PECs until written treatment-limitation decisions (TLDs) and death across the four climates defined via cluster analysis.ResultsOf the 4747 eligible clinicians, 2992 (63%) evaluated the ethical climate in their ICU. Of the 321 and 623 patients not admitted for monitoring only in ICUs with a good (n = 12, 18%) and poor (n = 24, 35%) climate, 36 (11%) and 74 (12%), respectively were identified with PECs by at least two clinicians. Of the 35 and 71 identified patients with an available combined endpoint, 100% (95% CI 90.0–1.00) and 85.9% (75.4–92.0) (P = 0.02) attained that endpoint. The risk of death (HR 1.88, 95% CI 1.20–2.92) or receiving a written TLD (HR 2.32, CI 1.11–4.85) in patients with PECs by at least two clinicians was higher in ICUs with a good climate than in those with a poor one. The differences between ICUs with an average climate, with (n = 12, 18%) or without (n = 20, 29%) nursing involvement at the end of life, and ICUs with a poor climate were less obvious but still in favour of the former.ConclusionEnhancing the quality of the ethical climate in the ICU may improve both the identification of patients receiving excessive care and the decision-making process at the end of life.Electronic supplementary materialThe online version of this article (10.1007/s00134-018-5231-8) contains supplementary material, which is available to authorized users.

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“…Studies on nurse and physician concordance in other domains have had mixed findings. 9–11 The high discordance rate found in our study points to the highly subjective nature of suspicion of infection.…”

Section: Discussionmentioning

confidence: 56%

Detecting Sepsis: Are Two Opinions Better Than One?

Bhattacharjee

Churpek

Snyder

et al. 2017

Journal of Hospital Medicine

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The diagnosis of sepsis requires that objective criteria be met with a corresponding subjective suspicion of infection. We conducted a study to characterize the agreement between different providers’ suspicion of infection and the correlation with patient outcomes using prospective data from a general medicine ward. Registered nurse (RN) suspicion of infection was collected every 12 hours and compared with medical doctor or advanced practice professional (MD/APP) suspicion, defined as an existing order for antibiotics or a new order for blood or urine cultures within the 12 hours before nursing screen time. During the study period, 1386 patients yielded 11,489 screens, 3744 (32.6%) of which met at least 2 systemic inflammatory response syndrome (SIRS) criteria. Infection was suspected by RN and MD/APP in 5.8% of cases, by RN only in 22.2%, by MD/APP only in 7.2%, and by neither provider in 64.7%. Overall agreement rate was 80.7% for suspicion of infection (κ = 0.11, P < 0.001). Progression to severe sepsis or shock was highest when both providers suspected infection in a SIRS-positive patient (17.7%), was substantially reduced with single-provider suspicion (6.0%), and was lowest when neither provider suspected infection (1.5%) (P < 0.001). Provider disagreement regarding suspected infection is common, with RNs suspecting infection more often, suggesting that a collaborative model for sepsis detection may improve timing and accuracy.

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Concordance of Nurses and Physicians on Whether Critical Care Patients are Receiving Futile Treatment

Cited by 32 publications

References 25 publications

Predictors of Moral Distress in a US Sample of Critical Care Nurses

Predictors of Moral Distress in a US Sample of Critical Care Nurses

Outcome in patients perceived as receiving excessive care across different ethical climates: a prospective study in 68 intensive care units in Europe and the USA

Detecting Sepsis: Are Two Opinions Better Than One?

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