Beyond technology, drips, and machines: Moral distress in PICU nurses caring for end‐of‐life patients

Gagnon, Michelle; Kunyk, Diane

doi:10.1111/nin.12437

Cited by 12 publications

(15 citation statements)

References 68 publications

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“…For example, in a qualitative study exploring nurses' experiences of MD in the ICU, a nurse described feeling MD when the care team was instructed by the patient's family to intubate and insert a feeding tube for a critically ill patient. The nurse describes explaining to the family that medical intervention would prolong the patient's suffering; however, it was “clear that they just wanted everything done.” 25 It has been proposed that hierarchies within medicine, in which physicians and institutions dictate the course of treatment delivered, contribute to a nurse's perceived lack of power 27–30 . Nurses described themselves as powerless and hopeless when they are unable to elicit change or act on their moral agency 20,21,23,24,28,29 .…”

Section: Resultsmentioning

confidence: 99%

“…The nurse describes explaining to the family that medical intervention would prolong the patient's suffering; however, it was “clear that they just wanted everything done.” 25 It has been proposed that hierarchies within medicine, in which physicians and institutions dictate the course of treatment delivered, contribute to a nurse's perceived lack of power 27–30 . Nurses described themselves as powerless and hopeless when they are unable to elicit change or act on their moral agency 20,21,23,24,28,29 . The pandemic has exacerbated conditions contributing to nurses' perceived powerlessness and experiences of MD 28 .…”

Section: Resultsmentioning

confidence: 99%

“…[27][28][29][30] Nurses described themselves as powerless and hopeless when they are unable to elicit change or act on their moral agency. 20,21,23,24,28,29 The pandemic has exacerbated conditions contributing to nurses' perceived powerlessness and experiences of MD. 28 For example, in a study exploring the experiences of healthcare professionals working in the intensive care unit during the pandemic, a nurse stated that they felt powerlessness and experienced MD when required to "beg" for visitor restrictions to be eased to allow families to say goodbye to their loved ones.…”

Section: Attributesmentioning

confidence: 99%

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Moral distress in critical care nursing practice: A concept analysis

2022

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Aim To provide a critical analysis of the concept of moral distress (MD) in critical care (CC) nursing. Background Despite extensive inquiry pertaining to the legitimacy of MD within nursing discourse, some authors still question its relevancy to the profession. However, amid the global COVID‐19 pandemic, MD is generating a significant amount of discussion anew, warranting the further exploration of the concept within CC nursing to provide clarity and expand on the definition. Design Rodger's Evolutionary Concept Analysis method was used to guide this analysis. Methods Related terms, attributes, antecedents, and consequences of MD were identified using current literature. Results The results of this analysis demonstrate strong congruence between the attributes, antecedents, and negative consequences pertaining to MD. However, a new theme has emerged from this review of the contemporary literature, highlighting the potential unexpected positive outcomes perceived by nurses who experience MD, including the provision of better care, increased levels of empathy, and enhanced opportunities for ethical reflection.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Attributesmentioning

confidence: 99%

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Moral distress in critical care nursing practice: A concept analysis

2022

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“…Namely, dying and death are not being valued in healthcare contexts 1 . Various reasons exist for this, including an over-reliance on health systems to provide curative care when palliative care should be the focus 13 . Discussion about dying and death has also receded across many societies, rooted in fear and avoidance of the reality of dying 1 .…”

Section: Global Pediatric Palliative Care Access Gapmentioning

confidence: 99%

Dying, dependency and death: Exploring palliative care access gaps for children

Lamb

2024

Wellcome Open Res

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Death has become a medicalized event. As such, end-of-life care has become entrenched in an over-reliance on individual patient autonomy to guide ethical decision making. Subsequently, the process of dying and the event of death are not primarily valued as life events – that is, as life-affirming phases of living. Rather, dying and death are viewed through the lens of medical options of when and how to die versus why dying and death are meaningful. This presents a problem for addressing the pediatric palliative care access gap and the Global Common Good. Specifically, in the context of important life events, one of which is death, we need space to be dependent on our inter-personal relationships to make crucial life decisions that affect our well-being. Recognizing dependency and inter-personalism is particularly important for pediatric populations. Children are uniquely placed to draw on their families and caregivers to make affirming life decisions in end-of-life care. This is particularly challenging to do in the Canadian context when Specialized Pediatric Palliative Care is not equitably available but options such as assisted death may soon be. Importantly, the meaning of death and dying is largely unexplored for this population. To advance ethical care at the end-of-life, more emphasis needs to be placed on the meaning that end of life events hold for Canadian children. In this paper I will outline the relevance of dependency and inter-personalism to attend to dying and death as meaningful phases of living for Canadian children and in relation to the pediatric palliative care access gap, the Global Common Good and Global Health Bioethics.

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“…At times, authentic death talk needs to happen on behalf of children who are unable to speak for themselves. Such conversations require skilled, ethical consideration and respect for the need to protect children's dignity in response to their increased dependency relative to their clinical and holistic care needs [29].…”

Section: Theme 3: Authentic Death Talkmentioning

confidence: 99%

The meaning of dying and death for children, their carers, and families: a scoping review

Lamb,

Ramer,

Amodu

et al. 2023

BMC Palliat Care

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Background The meaning of dying and death are underexplored concepts for Canadian children. Subsequently, it is unclear how children and stakeholders make meaning of children’s holistic health needs at the end of life. Methods A scoping review of the international scholarly literature was conducted. Thirteen data sources were searched to search the scholarly literature without date limits until January 2022. Studies were included on the basis of population: children (aged 0–19 years), families and caregivers; setting (in Canada and end-of-life or dying phases of living) and concepts of interest (dying and death). Results Of the 7377 studies identified, 12 were included for data extraction and content thematic analysis. The themes and subthemes include: 1) valuing the whole person; 2) living while dying; 3) authentic death talk; 4) a supportive approach (with lack and presence of support as subthemes); and, 5) a personalist approach. Conclusions There is a pressing need for research into the meaning of dying and death for children, their carers and families in Canada. Lack of holistic care, authentic death talk, specialized pediatric palliative care providers, a personalist approach and communities of support present major gaps in care for Canadian children. Research is urgently needed to address these knowledge gaps to generate policy and support practice for dying children in Canada.

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Beyond technology, drips, and machines: Moral distress in PICU nurses caring for end‐of‐life patients

Cited by 12 publications

References 68 publications

Moral distress in critical care nursing practice: A concept analysis

Moral distress in critical care nursing practice: A concept analysis

Dying, dependency and death: Exploring palliative care access gaps for children

The meaning of dying and death for children, their carers, and families: a scoping review

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