Nurse-physician perspectives on the care of dying patients in intensive care units: Collaboration, moral distress, and ethical climate*

Abstract

Registered nurses experienced more moral distress and lower collaboration than physicians, they perceived their ethical environment as more negative, and they were less satisfied with the quality of care provided on their units than were physicians. Provider assessments of quality of care were strongly related to perception of collaboration. Improving the ethical climate in ICUs through explicit discussions of moral distress, recognition of differences in nurse/physician values, and improving collaboration may mitigate frustration arising from differences in perspective.

Efficacy beliefs predict collaborative practice among intensive care unit nurses

“…More recently conducted studies among ICU staff also lend support to the focal role of collaborative practice for ICU functioning. For instance, in a study among staff members of 14 ICUs in two different US hospitals, Hamric and Blackhall (2007) found that the quality of nurse-physician collaboration was significantly related to care providers' satisfaction with care, moral distress, and ICU ethical climate. Manojlovic and DeCicco (2007) surveyed a sample of 866 US ICU nurses, and showed that nurse-physician communication was predictive of nurse-assessed medication errors.…”

“…Therefore, it is not surprising that, compared to physicians, ICU-nurses perceive lower levels of collaboration and are less satisfied with that collaboration (Hamric and Blackhall, 2007;Miller, 2001;Thomas, Sexton & Helmreich, 2003). In a qualitative study among German ICU nurses, Knoll & Lendner (2008) described the culture of ICUcommunication as being highly physician dominated, resulting in a considerable adverse effect on the flow of patient information between nurses and physicians, and in barriers for nurses to participate actively with their knowledge and professional competence in the process of decision making.…”

Implementing a palliative approach in the intensive care unit: an oxymoron or a realistic possibility?

“…While physicians take responsibility for managing treatment and negotiating "Not-For-Resuscitation" orders where indicated, nurses are responsible for upholding these orders and providing quality end-of-life care. Inter-professional ethical conflict between members of the ICU team can arise during the decision-making process to withdraw life-sustaining treatment (Truog et al, 2008); or if members of the team perceive that ICU patients and/or their families are being pressured to endure aggressive therapy that they are unlikely to benefit from (Hamric and Blackhall, 2007). A combination of inconsistent and inadequate communication and meetings between clinicians and patients or family members and/or unrealistic goals and expectations of patients, family members and clinicians adds to the complexity of initiating a palliative approach to care for many older ICU patients (Papadimos et al, 2011).…”

“…A combination of inconsistent and inadequate communication and meetings between clinicians and patients or family members and/or unrealistic goals and expectations of patients, family members and clinicians adds to the complexity of initiating a palliative approach to care for many older ICU patients (Papadimos et al, 2011). Moral distress is a well-known hazard for ICU nurses, especially when they are providing care that they perceive to be futile (Hamric and Blackhall, 2007). These ICU ethical dilemmas can be avoided through frequent open communication and shared decision-making among physicians, nurses and the older patient's family.…”

Pediatric Ethics and Communication Excellence (PEACE) Rounds: Decreasing Moral Distress and Patient Length of Stay in the PICU

“…MoD is often associated with what providers perceive as futile or inappropriate treatment (Mobley et al, 2007: Piers et al, 2011Wilson et al, 2013) and poor physician nurse collaboration (Hamric and Blackhall, 2007: Kalvemark et al, 2004: McAndrew et al 2011: Papathanassoglou et al, 2012.…”