Respecting the Wishes of Patients in Intensive Care Units

Abstract

This study examined why intensive care unit (ICU) nurses experience difficulties in respecting the wishes of patients in end-of-life care in Japan. A questionnaire survey was conducted with ICU nurses working in Japanese university hospitals. The content of their narratives was analyzed concerning the reasons why the nurses believed that patients' wishes were not respected. The most commonly stated reason was that patients' wishes were impossible to realize, followed by the fact that decision making was performed by others, regardless of whether the patients' wishes were known, if the death was sudden, and time constraints. Many nurses wanted to respect the wishes of dying patients, but they questioned how patients die in ICUs and were therefore faced with ethical dilemmas. However, at the same time, many of the nurses realized that respecting patients' wishes about end-of-life care in an ICU would be difficult and that being unable to respect these wishes would often be unavoidable. The results thus suggest that there has been insufficient discussion about respecting the wishes of patients undergoing intensive care.

The unexpected force of acute stroke leading to patients’ sudden death as described by nurses

“…This could lead to ethical conflicts because the nurses might have to act against what they think is in the patient’s best interest. This is similar to the findings of previous studies on hospital care (35, 38, 39). Making decisions together with relatives is one way for nurses to avoid ethical dilemmas (2).…”

Ethical dilemmas in nursing: An integrative review

“…(), Ferrell et al. (), Kinoshita (). Other level three studies with smaller samples are Ahern and McDonald (), Barlem et al.…”

“…A few researchers specifically discussed the distressing appearance of the dying patient related to changes in skin or fluid shifts. Descriptors such as “rotting” and “already dead” were verbalised in these qualitative studies (Harris, ; Kinoshita, ; Melia, ), where the physical decay of patients was a key element in nurses’ ethical distress and further evidence of the ethical dilemma the nurses faced when providing end‐of‐life care. A common theme for nurses was that they generally accepted the dying process before physicians, who may consider palliation or hospice care a failure on their part (Blasszauer & Palfi, ; Chaves & Massarollo, ; Chiu et al., 209; Eriksson et al., ; Jackson et al., ; Pavlish et al., ; Wadensten et al., ).…”

“…Related to end of life, the issue of patient appearance emerged (Harris, ; Kinoshita, ) and generated the following question: Are patients’ deteriorating appearances a factor in nursing's determination of futility? Futile care is a common source of ethical dilemmas for nurses who want to ease end‐of‐life suffering.…”

Who needs rights? … Reflections on Hellenic critical care patients

“…As yet, no empirical evidence exists on how critically ill patients’ rights are realized in Greece. Moreover, international data are scarce, although some evidence indicates that this may be a problematic area for nursing (Kendrick and Cubbin, 1996; Söderberg et al , 1997; Miracle, 2004; Kinoshita, 2007). Most research has focused on decision‐making, end‐of‐life care and resource allocation (Vincent, 1990), whereas results on issues that may affect patients’ sense of control and lived experience of critical care, such as privacy, autonomy and information delivery, are scant.…”