Giving nurses a voice during ethical conflict in the Intensive Care Unit

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.

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]. Nurses and physicians may not share the same view on the aims of the therapy, and the former try to advocate in the best interests of their patients, take holistic care over them and can more easily perceive extra-medical aspects which relate to the well-being of their patients [19,20,34] The latter issue is analysed particularly in nurses [19][20][21][22]25].…”

“…Differences in opinions, experience or expectations frequently lead to moral distress [18,[21][22][23][24][25]. Nurses and physicians may not share the same view on the aims of the therapy, and the former try to advocate in the best interests of their patients, take holistic care over them and can more easily perceive extra-medical aspects which relate to the well-being of their patients [19,20,34] The latter issue is analysed particularly in nurses [19][20][21][22]25]. Ethical conflicts m occur when there is a conflict concerning moral principles, values and beliefs betw nurses and the patients or their families [35].…”

Medical Futility or Persistent Therapy? A Dispute over the Terms and Definitions in the Polish Context

“…Second, it seems important to solve all conflicts between the patient and the physician through dialogue (Quill, Holloway, 2012;Burkle, Benson, 2012;Brody, 1997, p. 14). Building a warm relationship based on openness and trust between the doctor (or medical personnel) and the patient (or family or representative) may prove to be a key issue in making a decision on discontinuing therapy (McAndrew, Hardin, 2020;Andersen, Abrahams, Borasio, Carvalho de, Chio, Damme Van, Weber, 2012). Third, palliative care as an alternative to aggressive treatment still seems to be mentioned too rarely in the discussion on persistent therapy and medical futility (Courtwright, 2012).…”