End-of-life decisions in the Intensive Care Unit (ICU) – Exploring the experiences of ICU nurses and doctors – A critical literature review

Flannery, Liz; Ramjan, Lucie M.; Peters, Kathleen

doi:10.1016/j.aucc.2015.07.004

Cited by 138 publications

(129 citation statements)

References 17 publications

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“…It is important to point out that our results agree with those of other studies, showing that terminal care can be one of the most important drivers of burnout and moral distress [5, 8, 29–32]. …”

Section: Discussionsupporting

confidence: 91%

Moral distress and its contribution to the development of burnout syndrome among critical care providers

Fumis

Amarante

Nascimento

et al. 2017

Ann. Intensive Care

226

181

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BackgroundBurnout appears to be common among critical care providers. It is characterized by three components: emotional exhaustion, depersonalization and personal accomplishment. Moral distress is the inability of a moral agent to act according to his or her core values and perceived obligations due to internal and external constraints. We aimed to estimate the correlation between moral distress and burnout among all intensive care unit (ICU) and the step-down unit (SDU) providers (physicians, nurses, nurse technicians and respiratory therapists).MethodsA survey was conducted from August to September 2015. For data collection, a self-administered questionnaire for each critical care provider was used including basic demographic data, the Maslach Burnout Inventory (MBI) and the Moral Distress Scale-Revised (MDS-R). Correlation analysis between MBI domains and moral distress score and regression analysis to assess independent variables associated with burnout were performed.ResultsA total of 283 out of 389 (72.7%) critical care providers agreed to participate. The same team of physicians attended both ICU and SDU, and severe burnout was identified in 18.2% of them. Considering all others critical care providers of both units, we identified that overall 23.1% (95% CI 18.0–28.8%) presented severe burnout, and it did not differ between professional categories. The mean MDS-R rate for all ICU and SDU respondents was 111.5 and 104.5, respectively, p = 0.446. Many questions from MDS-R questionnaire were significantly associated with burnout, and those respondents with high MDS-R score (>100 points) were more likely to suffer from burnout (28.9 vs 14.4%, p = 0.010). After regression analysis, moral distress was independently associated with burnout (OR 2.4, CI 1.19–4.82, p = 0.014).ConclusionsMoral distress, resulting from therapeutic obstinacy and the provision of futile care, is an important issue among critical care providers’ team, and it was significantly associated with severe burnout.Electronic supplementary materialThe online version of this article (doi:10.1186/s13613-017-0293-2) contains supplementary material, which is available to authorized users.

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Section: Discussionsupporting

confidence: 91%

Moral distress and its contribution to the development of burnout syndrome among critical care providers

Fumis

Amarante

Nascimento

et al. 2017

Ann. Intensive Care

226

181

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“…Seven databases and editorial portals (Medline via Pubmed; PsycInfo and Psychology, and behavioral science collection via EBSCOhost; Elsevier's ScienceDirect, SpringerLink, Sage Journals, and Wiley Online Library) were screened using the following terms in the title, the abstract, or the keywords: (intensive OR critical) AND care AND (professional OR job OR work OR occupational) AND (stress OR stressors OR burnout). The references of 10 literature review articles (Dunser et al, 2006;Embriaco et al, 2007b;Fassier and Azoulay, 2010;Adriaenssens et al, 2015;Karanikola et al, 2015;Van Mol et al, 2015;Chuang et al, 2016;Flannery et al, 2016) were manually screened to identify other relevant studies that had not been initially retrieved.…”

Section: Search Strategy and Study Eligibilitymentioning

confidence: 99%

“…This often requires a considerable level of coordination of human resources. Furthermore, end-oflife decisions are frequent and contribute to an intense emotional charge (Teixeira et al, 2014;Flannery et al, 2016). The ICU is thus fertile ground for the emergence of professional stressors (Donchin and Seagull, 2002;Embriaco et al, 2007a).…”

Section: Introductionmentioning

confidence: 99%

Scales Used to Measure Job Stressors in Intensive Care Units: Are They Relevant and Reliable? A Systematic Review

et al. 2020

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Background: Many studies have been conducted in intensive care units (ICUs) to identify the stress factors involved in the health of professionals and the quality and safety of care. The objectives are to identify the psychometric scales used in these studies to measure stressors and to assess their relevance and validity/reliability. Methods: All peer-reviewed full-text articles published in English between 1997 and 2016 and focusing on an empirical quantitative study of job stressors were identified through searches on seven databases and editorial portals. Results: From the 102 studies analyzed, we identified 59 different scales: 17 "all settings scales" (16 validated scales), 20 "healthcare settings scales" (13 validated scales), and 22 "ICU settings scales" (two validated scales). All these scales used measured stressors from at least one of the following eight broad categories: High job demands, Problematic relationships with other professionals, Lack of control over work situations and career, Lack of organizational resources, Problematic situations with users and relatives, Dealing with ethical-and moral-related situations, Risk management issues, and Disadvantages in comparison to other occupational situations. The "all settings scales" and "healthcare settings scales," the most often validated, did not measure, or only slightly measured, the stressors most specific to ICUs. Where these were taken into account, the authors were forced to develop their own tools or modify existing scales without testing the validity of the tool used. Conclusions: This review highlights the lack of a tool that meets both the criteria of validity and relevance with regard to the specificity of work in ICUs. Future research must focus on developing reliable/valid tools covering all types of relevant stressors to ensure the quality of the studies carried out in this field.

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“…It is noteworthy that it is only upon reflection that some nurses reconsider how events such as death could have been managed better, for example by moving the patient to a private room during the dying process (Rocker et al., ). At the same time, these are complex ethical decisions in the ICU and are often a source of moral distress for nursing and medical staff (Flannery, Ramjan, & Peters, ) that can exacerbate and delay the dying process. However, Latour and Albarran (:109) are fervent in their belief that this issue “can no longer be ignored as privacy is inextricably linked with the provision of patient‐centered dignified care.”…”

Section: Discussionmentioning

confidence: 99%

Privacy at end of life in ICU: A review of the literature

Timmins

Parissopoulos

Plakas

et al. 2018

Journal of Clinical Nursing

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End-of-life decisions in the Intensive Care Unit (ICU) – Exploring the experiences of ICU nurses and doctors – A critical literature review

Cited by 138 publications

References 17 publications

Moral distress and its contribution to the development of burnout syndrome among critical care providers

Moral distress and its contribution to the development of burnout syndrome among critical care providers

Scales Used to Measure Job Stressors in Intensive Care Units: Are They Relevant and Reliable? A Systematic Review

Privacy at end of life in ICU: A review of the literature

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