Nurses’ Experience of Ethical Dilemma at the End-Of-Life Care in the Intensive Care Unit

Abstract

One of the aims of the care service in the Intensive Care Unit (ICU) is to prepare patients in end-of-life conditions to die in a dignified manner. This can be challenging due to decision-making problems and result in a dilemma. Therefore, this study explores the ethical dilemmas experienced by nurses that provide end-of-life care in the ICU. The qualitative phenomenological methodology was used to describe the ethical dilemmas nurses face during these conditions. The data were collected through in-depth interviews and were analyzed using Colaizzi. Purposive sampling was used to select a total of eight participants, i.e., ICU nurses, who have treated end-of-life patients. Four themes were obtained from this study, namely, “the dilemma between the family’s decisions and continuing care”, “patient’s life expectancy and the family’s hope”, “DNR decisions and the nurse’s confidence”, and “the family’s understanding of the information provided”. This study recommends that the assessment of end-of-life status in critical care areas, especially the ICU, should be conducted as soon as possible to have a clearer purpose for the care provided.

Evaluating ICU nurses’ education, practice, and competence in palliative and end-of-life care in Saudi Arabia: A cross-sectional study

“…In settings where stress levels are naturally high, such as the ICU, where physicians are at the helm of decision-making and communication roles, Sexton et al (2018) propose that there is always an urgent need for nurses to be empowered. Several studies support this view and note the challenges faced by nurses as they engage with families when important decisions are made (Alshammari et al, 2023 ; Alshehri et al, 2022 ; Griffiths, 2019 ; Jung & Matthews, 2021 ; Meilando et al, 2022 ). When nurses are trusted to make decisions, their perceived expertise and efficacy in PEOL care can be boosted.…”

“…For instance, one of the worrying trends is the dearth of knowledge, coupled with negative attitudes among nursing staff. Such factors present considerable impediments to the achievement of the gold standard in caring for patients during the end-of-life stage (Alshammari et al, 2022 ; Carvajal et al, 2019 ; Griffiths, 2019 ; Hussin et al, 2018 ; Mani & Ibrahim, 2017 ; Meilando et al, 2022 ). Another impediment noted by numerous studies is the challenge associated with nurses managing their own emotions and meeting the emotional demands linked to the provision of PEOL care (Carvajal et al, 2019 ; Griffiths, 2019 ; Hafez et al, 2022 ; Jung & Matthews, 2021 ).…”

“…In countries such as Saudi Arabia, this challenge can be more acute for expatriate nurses, with significant language and culture challenges (Alenezi et al, 2022 ; Mani & Ibrahim, 2017 ; Oakley et al, 2019 ). Family members take an active role in decision-making within the ICU environment, usually accommodating unconscious patients (Meilando et al, 2022 ). Yet, navigating this realm is not without its complexities.…”

“…Yet, navigating this realm is not without its complexities. Nurses frequently encounter challenges in facilitating and managing family participation in these crucial decisions (Alshammari et al, 2023 ; Alshehri et al, 2022 ; Griffiths, 2019 ; Jung & Matthews, 2021 ; Meilando et al, 2022 ).…”

Ethical Dilemma Do Not Ressuscitation (DNR) in Nursing Practice

“…To clarify the purpose of care provided, the assessment of end-of-life status in critical care areas, particularly the ICU, should be conducted promptly [11]. Implementation of DNR instructions contributed to the moral stress experienced by ICU nurses [12] and led to burnout, which is directly linked to depression and work stress.…”