Ethical conflicts experienced by intensive care unit health professionals in a regional hospital, Limpopo province, South Africa

Abstract

Background: Conflicts arise when healthcare providers disagree about providing optimal care to critically ill patients where resources and services are constrained.Aim: This study investigated ethical conflicts experienced by intensive care unit (ICU) healthcare professionals working in a regional hospital, Limpopo province of South Africa. Setting:The study was conducted at a rural public regional hospital in Vhembe district, Limpopo Province. Communities served by the hospital are poor and medically uninsured.Methods: This study adopted a qualitative, exploratory and descriptive design. The target population comprised Health care professionals working in an ICU of the regional hospital. Purposive sample was selected and 17 unstructured interviews were conducted. Tesch's method of data analysis was used. Ethical considerations were adhered to.Results: Patients' care needs were compromised because of the unavailability of beds and high-technology equipment, such as well-functioning ventilators. Doctors were not having the necessary skills required in the ICU as the majority were on community service/internship and nurses acted beyond their scope of practice because of a lack of adequately trained intensive care specialists. Infection control practices were overlooked and 'use once' pieces of equipment were reused. Conflicting values between nurses, patients and family of patients exist. Conclusion:Lack of resources compromises provision of optimal and intensive care. Patients were prone to infections and their safety might have been compromised.

Conflict Sources and Management in the ICU Setting before and during COVID-19: A Scoping Review of the Literature

“…From 2015-2020 period, 8 met the inclusion criteria; 3 of them described ethical conflicts perceived by nurses. 3 groups of researchers used the Ethical Conflict in Nursing Questionnaire-Critical Care Version [18][19][20], while the other 2 conducted interviews [21,22], 1 used the original questionnaire [23], 1 used the technique of observation and in-depth interview [24], and 1 open-ended questions [25].…”

“…Healthcare workers who participated in the researched studies included nurses [18][19][20]25] and physicians [21][22][23]. Other investigators studied patients' families [24] and auxiliary personnel (social workers, chaplains, case managers) [21].…”

“…Conflicts within an ICU involve the process of taking care of a patient, emotional commitment, providing information or making decisions concerning futile medical care [23]. Differences in opinions, experience or expectations frequently lead to moral distress [18,[21][22][23][24][25].…”

COVID-19 in South Africa: outbreak despite interventions

“…Regulatory decision against COVID-19 cannot only take care of short-term economic constraints 17 . A large-scale outbreak and massive ICU overload may have drastic consequences for the country as a whole, including societal and economic but also psychological, and ethical issues (compare 30 ). Thinking of economic constraints should also imply of long-term implications, for both economy and society.…”

COVID-19 in Africa: outbreak despite interventions?

“…Therefore, regulatory decision against COVID-19 cannot only keep in mind short-term economic constraints. 17 A large-scale outbreak and massive ICU overload may have drastic consequences for the country as a whole, including societal and economic but also psychological, and ethical issues (compare 27 ). Thinking of economic constraints should also imply thinking of long-term implications, for both economy and society.…”