Moral distress in end‐of‐life care in the intensive care unit

Ledger, Una St; Begley, Ann; Reid, Joanne; Prior, Lindsay; McAuley, Daniel F.; Blackwood, Bronagh

doi:10.1111/jan.12053

Cited by 58 publications

(49 citation statements)

References 50 publications

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“…13,14 Similarly, the emotional pressures described by NZ nurses during EOL care resonate strongly with the literature on moral distress in this area. 15 In reviewing survey results from European 11 and NZ nurses, similar attitudes were held about EOL care. However, the view of NZ nurses, that withholding life support treatment was ethically more acceptable than withdrawal, was not held by European nurses.…”

Section: Discussionmentioning

confidence: 62%

Certainty and uncertainty about end of life care nursing practices in New Zealand Intensive Care Units: A mixed methods study

Coombs

Fulbrook

Donovan

et al. 2015

Australian Critical Care

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Keywords:56 57Death and dying, end of life care, intensive care, intensive care nurse, treatment withdrawal, been undertaken to explore EOL care in the context of New Zealand (NZ) intensive care nursing. 10 11Objective: To investigate NZ intensive care nurses' experiences of, and attitudes towards EOL 12 13 care. 15 16Design: Sequential mixed methods study using cross sectional survey with follow-on focus groups. 18 19Methods: NZ intensive care nurses (N=465) across four large tertiary intensive care units (ICUs) 20 21 were contacted to complete a 43-item web-based survey. A follow-on focus group was conducted 22 23 24 in each of the sites to explore specific aspects of the survey findings. 26 27Results: 203 fully completed surveys were returned (response rate 44%) from the four ICUs. Over was ethically more acceptable than withdrawing it. Whilst nurses generally supported reducing 35 36 inspired oxygen to air for ventilated patients at EOL (71%, n=139) this was also an area that 37 38 demonstrated one of the highest levels of uncertainty (21%, n=41 piloted on 14 ICU nurses from a non-tertiary ICU in NZ to determine cultural relevance to NZ. 21Minor amendments were made to clarify clinical phrases commonly used. In preparation for data collection, the study was presented to staff in each of the four study sites Results from Phase I were reviewed by MC and PF and areas of similarity and difference in 1 2 experiences and attitudes towards EOL between European and NZ ICU nurses were identified. 4Based on this, a focus group guide was developed and used in Phase 2.In Phase Two, follow-on focus groups were undertaken using a developed focus group guide to 11 12 13 explore: EOL in ICU, use of fluids, nutritional support and passive limb exercises during EOL care. 15Participants were drawn from participants in Phase One. Consent was gained prior to focus group were considered to be much less important (63%, n = 128 and 44%, n = 90; respectively). 32Most respondents indicated that the patient's (68%, n = 138) and family's (55%, n = 111) the religious views of medical or nursing staff to be as important (see Table 2.) Most 37 38important was considered to be the medical and nursing teams' assessment that the The majority of nurses who had been directly involved in EOL care of a patient had also actively 4 5 participated in decision-making about withholding or withdrawing treatment (70%, n = 137). 7Furthermore, there was a significant association between active involvement in EOL-decision- EOL decision-making process. Focus group participants held varying views on the use of intravenous fluids and nutrition at EOL. 50Some identified that there was confusion around their purpose and that 'dehydration was a Although results of this study cannot be generalised, the survey response rate suggests that Phase 22One results can reasonably be assumed to broadly represent the views of tertiary New Zealand specific aspects of nursing care at EOL is required.

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Section: Discussionmentioning

confidence: 62%

Certainty and uncertainty about end of life care nursing practices in New Zealand Intensive Care Units: A mixed methods study

Coombs

Fulbrook

Donovan

et al. 2015

Australian Critical Care

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“…How healthcare professionals respond to disparate groups of patients is a challenge, as well as how they deal with the contradictory needs of being empathic clinicians and dealing with the emotional burden of patients’ suffering, complications, or death [2]. Providing patient-centered and family-focused care implies more challenging medical and clinical decisions and the risk for unsatisfactory patient outcomes is greater, thereby generating strong negative emotions among healthcare professionals, such as ‘stress of consciences’ [3], moral distress [4], or feelings of loss of control [5]. …”

Section: Introductionmentioning

confidence: 99%

Validation of the German version of two scales (RIS, RCS-HCP) for measuring regret associated with providing healthcare

Richner

Cullati

Cheval

et al. 2017

Health Qual Life Outcomes

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BackgroundThe regret intensity scale (RIS) and the regret coping scale for healthcare professionals (RCS-HCP) working in hospitals assess the experience of care-related regrets and how healthcare professional deal with these negative events. The aim of this study was to validate a German version of the RIS and the RCS-HCP.MethodsThe RIS and RCS-HCP in German were first translated into German (forward- and backward translations) and then pretested with 16 German-speaking healthcare professionals. Finally, two surveys (test and 1-month retest) administered the scales to a large sample of healthcare professionals from two different hospitals.ResultsOf the 2142 eligible healthcare professionals, 494 (23.1%) individuals (108 physicians) completed the cross-sectional web based survey and 244 completed the retest questionnaire. Participants (n = 165, 33.4% of the total sample) who reported not having experienced a regret in the last 5 years, had significantly more days of sick leave during the last 6 months. These participants were excluded from the subsequent analyses. The structure of the scales was similar to the French version with a single dimension for the regret intensity scale (Cronbach’s alpha: 0.88) and three types of coping strategies for the regret coping scale (alphas: 0.69 for problem-focused strategies, 0.67 for adaptive strategies and 0.86 for the maladaptive strategies). Construct validity was good and reproduced the findings of the French study, namely that higher regret intensity was associated with situations that entailed more consequences for the patients. Furthermore, higher regret intensity and more frequent use of maladaptive strategies were associated with more sleep difficulties and less work satisfaction.ConclusionsThe German RIS and RCS-HCP scales were found valid for measuring regret intensity and regret coping in a population of healthcare professionals working in a hospital. Reporting no regret, which corresponds to the coping strategy of suppression, seems to be a maladaptive strategy because it was associated with more frequent sick day leaves.Electronic supplementary materialThe online version of this article (doi:10.1186/s12955-017-0630-z) contains supplementary material, which is available to authorized users.

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“…The scientific literature documents that some of the main factors causing work-related stress are the lack of support from the managers, the psychological pressure of managers and the duty to submit to a hierarchy (5,19). In addition, the lack of encouragement and support from colleagues are a significant source of stress too (33); while, the measures for the management and the communication and collaboration between colleagues, are preventive strategies to reduce the occurrence of physical and emotional tension at work (34).…”

Section: Discussionmentioning

confidence: 99%

“…This result encourages to maintain a work environment characterized by collaboration and dialogue (5,34).…”

Section: Discussionmentioning

confidence: 99%

Work-related stress: volunteer and employee drivers/rescuers

Tomei¹

2017

PER

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Introduction: In the health field, volunteer staff, unpaid and not moved by economic reasons, support more often the workers, sharing the same stressful factors. The study aims to assess subjective stress by comparing 119 volunteer drivers/rescuers and 119 employee drivers/rescuers, belonging to a big Italian healthcare company. Materials and methods: Stress was evaluated through the "questionnaire-indicating tool" validated by HSE (Health and Safety Executive). The research was conducted on a working population of 119 employee rescuers/drivers made comparable as for sex and age (p = 0.8831) to 119 volunteer rescuers/drivers. Results: Our study showed a critical situation in the fields "Demand", "Control" and "Relationship" for the employee rescuers drivers and in the fields

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Moral distress in end‐of‐life care in the intensive care unit

Cited by 58 publications

References 50 publications

Certainty and uncertainty about end of life care nursing practices in New Zealand Intensive Care Units: A mixed methods study

Certainty and uncertainty about end of life care nursing practices in New Zealand Intensive Care Units: A mixed methods study

Validation of the German version of two scales (RIS, RCS-HCP) for measuring regret associated with providing healthcare

Work-related stress: volunteer and employee drivers/rescuers

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