Nurses’ Response to Ethical Dilemmas on Patient Care Issues in the Critical Care Set Up
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Background:
Ethical issues have emerged in the recent years as a major component of health care for the critically ill patients, who are vulnerable and totally depended on nursing care provider. The study sought to establish the perception and magnitude of ethical dilemmas faced by nurses working in critical care unit of Kenyatta National Hospital (KNH) as well as the ways they respond to them. The common patient care issues which posed a dilemma as identified during the study included: unsafe nurse- patient ratios, allocation of scarce medical resources, breach of patient’s confidentiality, ignoring patient’s autonomy, dealing with impaired colleague, discriminatory treatment of patients and patients/relatives uninformed about the prognosis of the patient.
Methods:
An exploratory survey was conducted on 123 nurses working in three critical care areas of the Kenyatta National Hospital (Kenya). These were the intensive care unit, the renal and the burns units. The research aimed to identify the ethical dilemmas experienced by nurses working in Critical Care Units of the Kenyatta National Hospital in their everyday practice. It also aimed to explore what actions the nurses take to deal with the issues and what factors influence the decisions. Data were collected using questionnaires which were distributed to 123 nurses working in the critical care areas. The participants were selected using stratified random sampling method. Data was cleaned and analyzed using SPSS. Chi square test was used to assess the relationship between variables.
Results:
The study identified various ethical dilemmas relating to patient care issues to include: unsafe nurse- patient ratios, allocation of scarce medical resources, breaches of patients’ privacy, ignoring patients’ autonomy, dealing with incompetent colleagues, discriminatory treatment of patients, and uninformed patient/ relatives about the patient’s prognosis. Other dilemmas reported were and Human rights issues and End-of-life decisions. Nurses reported to have adopted various strategies to address the dilemmas touching on patient care issues among others.
Conclusion and recommendations
This study shows that ethical dilemmas are an issue of concern among the nurses working in the critical care units of the KNH. Nurses have adopted various strategies to deal with these dilemmas which affect them almost on a day to day basis.
Allison H. (1990). Kant’s theory of freedom, Cambridge University press, New York.
American nurses Association. (1985). Code for nurses with interpretive statements, Lippincott Williams, Missouri.
Basavanthappa B.T.( 2007). Nursing research 2nd edition, Jaypee Brothers medical publishers, New Delhi.
Betty F. et al (2000). Dignity in dying – how we are meeting end- of –life issues, Journal of Nursing management , 31(9), 52.
Breen, C. M.et al. (2004). Conflict Associated with Decisions to Limit Life-Sustaining Treatment in Intensive Care Units, Journal of General Internal Medicine, (16), 283–289.
(http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1495214, available in May 2010, Viewed on 1st march 2012).
Chadwick R. (1992). Ethics and nursing practice a case study approach, Macmillan, London.
Dominic L.F. (1991). Advance directives, Journal of nursing administration, 21 (11),16- 19.
Ellis R.J. (1988). Nursing in today’s world – challenges, issues and trends, Lippincott publishers, Philadelphia.
Erlen and Sereika. (1997). Critical care nurses, Ethical decision making and stress, Journal of advanced nursing 26 (5), 953- 961.(http://www.ncbi.nlm.nih.gov/pubmed/9372400, available in November 1997, viewed on 1st march 2012).
Errickson et al. (2010). Journal of healthcare analysis. Ethical dilemmas and ethical competence in the daily work of research Nurses. September 2010, Volume 18, Issue 3, pp 239–251.
Ferrand E. et. al (2003). Discrepancies between perceptions by physicians and nursing staff of ICU end- of – life decisions, American journal of respiratory critical care medicine, 167, 1310- 1315.
Friedman Y. (2001). Ethical issues in the critically ill patient, current Opinions on Critical care, 7 (6), 475- 479.
(http://www.ncbi.nlm.nih.gov/pubmed/11805555, available in December 2001, viewed on 2nd March 2012).
Fry T.S. (2002). Ethics in nursing practice, a guide to ethical decision making, Blacwell publishing, Oxford.
Fry T.S.(2001) the development and psychometric evaluation of the ethical issues scale, Journal of nursing scholarships 33(3), 273- 277.
http://www.ncbi.nlm.nih.gov/pubmed/11552555, available in 2001, viewed on 2nd March 2012.
Gantt H.L. (1974). Work, wages and profits, Hive publishing company, Pennsylvania.
George J. B. (2002). Nursing theories the base for Professional Nursing Practice ,Prentice hall, Carlifonia.
Hicks F.T.(2003). Critical thinking and clinical decision making in critical care, Heart and lung Journal of acute and critical care. 32 (3), 169- 180.
(http://www.ncbi.nlm.nih.gov/pubmed/12827102, available in may 2003, viewed on 3rd March 2012).
International Council of nurses (2006). International code of ethics for nurses , Illinois Institute of technology, Geneva.
Jaya K. (2006). Essentials of critical care nursing, Jaypee brothers publishers, new Dheli.
Joan M.R. (2002) Nurse executives response to ethical conflicts and choice in the workplace, Nursing Ethics Network, Boston.
Johansen, Mary L. PhD, RN, NE-BC. Nursing Management: Keeping the peace: Conflict management strategies for nurse managers. February 2012 - Volume 43 - Issue 2 - p 50–54
doi:10.1097/01.NUMA.0000410920.90831.96
Johnstone M. 2004. Leadership ethics in nursing and health care domains. Churchill Livingstone, Sydney.
Keffer. (2001). Attitudinal patterns determining decision making in severely ill elderly patients, International journal of nursing studies, 38 (4), 381- 388.( http://www.springerlink.com/content/be8yerqb9ee1rc7x/, available on 3rd may 2001, viewed on 16th January 2012).
Kirchhoff et al. (2000). Intensive care nurses experiences with end– of–life care, American Journal of critical Care, 9 (1), 36- 42. (obtained from
http://ajcc.aacnjournals.org/content 9/1/36.abstract , available on 1st, Feb 2000, viewed on 23rd February 2012).
Laura M. (2005), Helping the terminally ill to a good death, American nursing journal of hospice and palliative nursing, 7(2),113- 116. (abstract).
Lyndsay S. (2007). Ethical decision making: How to Make Ethical Decisions in 5 Steps." Mftrou.com.
(http://www.mftrou.com/ethical-decision-making.html, obtained on 21 February 2010, viewed on 3rd March 2012).
Marcia S.D.B.(2005). Nurse executive’s legal primer: Jona’s healthcare law, ethics and regulation, Journal of nursing administration,7(1),10-12. (http://journals.lww.com/jonalaw/Citation/2005/01000/Nurse_Executive_s_Legal_Primer.5.aspx , available in March 2005, viewed on 29th january, 2012).
Maren E.J. 2004. Ethical issues in the Intensive Care Unit, pulmonary disease board review manual, 11(3), 3- 11. (http://www.turnerwhite.com/pdf/brm_PD_pre11_3.pdf, available in 2004, viewed on 5th February, 2012).
Megan J.J. (2010). Registered and enrolled nurses experiences of ethical issues in nursing practice, Australian journal of advanced nursing. 22(1), 24-30. http://dro.deakin.edu.au/view/DU:30025953, available on 29th march 2010, viewed on 1st February 2012).
Mugenda and Mugenda O.M.(1999). Research methods, qualitative and quantitative approaches, African Centre for Technological Studies press, Nairobi.
Nancy B.(2001). The practice of nursing research conduct, critique and utilization, W.B. Saunders Company, Philadelphia.
Nermin E.(2001). Turkish nurses decision on distribution of ICU beds, Journal of nursing ethics, 17 (87), 85- 98. http://nej.sagepub.com/content/17/1/87, available in January 2010, viewed on 7th December 2011).
Nesrin C. (2004). A qualitative analysis of ethical problems experienced by physicians and nurses in intensive care units, Journal of nursing ethics, 5 (11), 444–458. http://nej.sagepub.com/content/11/5/444, available in September 2004, viewed on 7th December 2011).
Oberlek and Hughes. (2001).Doctors and nurses perception of ethical problems in end- of –life decisions, Advanced nursing journal, 33(6), 707- 715. http://www.ncbi.nlm.nih.gov/pubmed/11298208, available in march 2001, viewed on 6th, February 2012.
Procaccino J.R., (2012), Legal and ethical dilemmas in healthcare decision making. Acma Maryland chapter conference, September 15, 2012.
Rebecca F.C. (2005). Nurse executive’s legal primer, Journal of nursing administration, Jona’s healthcare law, ethics and regulation, 7 (1), 10 -12. http://journals.lww.com/jonalaw/Citation/2005/01000/Nurse_Executive_s_Legal_Primer.5.aspx, available in may 2005, viewed on 17th January, 2012).
Redman B.K. (2006). Clinical ethics, Review of measurement instruments in clinical and research ethics, Journal of Medical Ethics, 32 (3),153-156. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2564469/, available on 29th June, 2005.
Rumbold G. (1993). Ethics in nursing practice, BailliereTindal, London.
Sivy M. (2012) Facing up to the Ethical Dilemmas in the Healthcare Debate. UNICAF University. USA.
Sorta Iva (2011). Journal of Nursing Ethics. How nurses and physicians face Ethical Dilemmas.Vol 18, Issue 3, 2011.
Stewart, R. S. (2007). Withholding and Withdrawing Life Support: Moral Dilemmas, Moral Distress, and Moral Residue. Online Journal of Health Ethics, 4(2). http://dx.doi.org/1018785/ojhe.0402.04
Thompson I.E. (2000). Nursing ethics, Churchill Livingstone, London.
Ulrich et al (2013). Ethical issues and stress in nursing practice. Available as J Adv Nurs. 2013. Published as: J Adv Nurs. 2010 Nov; 66(11): 10.1111/j.1365-2648.2010.05425.x.
Wayne W.D.(2010). Biostatistics- basic concepts and methodology for the health science. Wiley Inc. New Dheli.
Westphal M. Stephanie A. (2009). End of care decision making in the intensive care unit: physicians and nurses perspective, American journal of medical quality, American journal of medical quality, 24(3), 222- 240.
(http://ajm.sagepub.com/content/24/3/222.full.pdf , available on may 20th 2009, viewed on 11th April 2012).
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