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Ethical Decision-Making Practice of Nursing Students in Intensive Care Units

Study on ethical decision-making practices of nursing students in ICU settings focusing on end-of-life care dilemmas. Investigates ethical concepts, decision-making levels, and implications for patient care.

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Ethical Decision-Making Practice of Nursing Students in Intensive Care Units

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  1. Ethical Decision-Making Practice of Nursing Students in Intensive Care Units Gönül KURT (RN, PhD) GulhaneMilitaryMedicalAcademy School of Nursing, Turkey

  2. PROBLEM STATEMENTS Intensive Care Units (ICUs) provide increasingly sophisticated treatments to those who are critically ill. The primary goals of intensive care medicine are to help patients survive acute threats to their lives while preserving and restoring the quality of those lives. These goals are frequently achieved, with approximately 75% to 90% of patients admitted to an intensive care unit surviving to discharge .

  3. PROBLEM STATEMENTS • Unfortunately, this goal is not always obtained and despite great improvements in the care of critical patients, death is frequent in the Intensive Care Units. • The mortality rate reported in international studies ranges between 7% and 20%.

  4. PROBLEM STATEMENTS • A high percentage of patients die in the Intensive Care Units, often after a prolonged period of illness and being unable to make decisions for themselves. • Timely communication about life expectancy and end-of-life care is crucial for ensuring good patient quality-of-life at the end of life and a good quality of death in IntensiveCareUnits. • For these reasons, ethical problems in ICUs are common, especially when caring for patients at the end of life.

  5. PROBLEM STATEMENTS • Thus, medical professionals who work in intensive care units must have the ability to analyze, evaluate and make decisions in ethical issues that are relevant to their duties, making use of ethical theories and principles. • It is necessary that they should have an ability tounderstand ethical concepts such as rights, justice, freedom and autonomy, andto analyze and understand ethical reasoning based on ethical theory. Analyze Evaluate Making decision Ethical principles

  6. PROBLEM STATEMENTS In particular, professional nurses need to make special efforts to enable them to cope effectively with practical situations presenting ethical dilemmas. Because given their proximity to patients and families, nurses working in ICU have an important role in end of life decision-making. These decisions are ethical in nature as they relate to quality and sanctity of life and to balancing ethical principles such as respect for autonomy, do well, minimize harm and treat people justly.

  7. PROBLEM STATEMENTS • Nurses have a pivotal role in a person’ s end of life and nurses’ knowledge, skills and attitude towards death and dying and end-of-life care affect the care that they provide for these patients. • Therefore, it is imperative that nurses receive education about end-of-life care in their prelicensure curriculum so that they are prepared to care for dying patients.

  8. PURPOSE The aim of this study to determine the ethical decision-making practice of nursing students about end-of-life care in Intensive Care Units.

  9. MATERIAL & METHODS StudyLocation: Intensive Care Units of an University Hospital StudyType: Descriptive study Study Time: January-June 2015 StudySample The study sample consisted of a total of 87 student nurseswho work with dying patients in ICU.

  10. MATERIAL & METHODS • Measures: • A “Data CollectionForm” and “Nursing Dilemma Test (NDT)to measure nursing students' responses to nursing dilemmas and to determine the ethical decision-making level of the students was used • for data collection. • The Data Collection Form wasdeveloped by the present investigatorafter evaluation of the relevant literature. Thequestionnaireconsisted of 10 questions. • NDT wasdevelopedbyCrisham in 1981 to measure nurses' responses to nursing dilemmas and the importance given to moral issues and practical considerations.

  11. MATERIAL & METHODS • Measures: • Crisham (1981) developedthe NDT based on experienses of the 130 staffnurses. Theinstrumentcontainssixvignettesaddressingtheethicalissues of “decidingrighttoknowanddeterminingrighttodecide, definingandpromotingquality of life, maintainingprofessionalandinstitutionalstandards, anddistributingnursingresources”. • Thesixvignettesdealwiththefollowingproblems: Newbornwithanomalies, ForcingMedication, Adult’sRequesttoDie, New NurseOrientation, MedicationError, UninformedTerminallyillAdult. • The NDT examineswillingnesstoact, familiaritywiththe dilemma presented, importance of practicalconsiderations, andlevel of moral reasoning, which is madeup of nursing –principleditemsforeach of thesixnursingdilemmas.

  12. MATERIAL & METHODS • Data Collection: • The hospital Institutional Review Board approved this study. • Participating nursing students provided verbal consent after the aim and method of the study were explained. • Students independently completed the forms in their classrooms under the supervision of researchers.

  13. MATERIAL & METHODS • Data Analyses: • The SPSS 15.0 software packagewasusedforstatisticalanalysis. • Categorical variables wereexpressed as counts and percentages. • Continuous variables were summarized with means and standard deviation. • Conformity the normal distribution of data wasassessed by One-Sample Kolmogorov-Smirnov test. • According to the conformity the normal distribution of data, the independent sample t test was used for statistical comparison between two groups, as appropriate. • A p value less than 0.05 will accepted as statistically significant.

  14. RESULTS

  15. RESULTS Most of the students (58.6%) think that the aim of end-of-life care is relieved pain of dying patients and 40.2% of students think that it improved quality of life. The students (64.4%) think that it should be given care the dying patients at home but 29.8% of students think that it should be given care the dying patients at hospital by health care providers.

  16. The Nursing Principled Thinking levelwas above average, while Practical Considerations • levelwas nearly at the level of average. These findings showed that students notice to decide • taking into account the ethical principles if there is any ethical issues and students who decide • ethical issues take into account environmental factors, relatively. • It was found that nurses were familiar to the similar nursing dilemmas. • A significant relationship between Practical Considerations level and have experiencedthe • death of a person from the family was found (t=2.899; p<0.05). • While deciding about ethical issues, the students who have experienced the death of a person • from the family had significantly lower take into account environmental factors than the others.

  17. CONCLUSIONS • We found that nursing students notice to decide taking into account the • ethical principles and environmental factors while decide any ethical • issues. • In the health care environment nurses encounter ethical issues daily. • These issues are seldom the major ethical dilemmas, but minor issues • that nurses face in their every-day contact with patients. To solve these • issues, nurses need skills in ethical decision-making. • Therefore nurses should be capable of making autonomous ethical • decisions. For this reason, the content of nursing education for students • should include the procedures necessary for applying universaltheories • to real situations, by means of case studies and practical training in • the analysis of ethical dilemmas.

  18. CONCLUSIONS • Nurses have a pivotal role in a person’ s end of life and nurses’ knowledge, skills and attitude towards death and dying and end-of-life care affect the care that they provide for these patients. • Therefore, it is imperative that nurses receive education about end-of-life care in their prelicensure curriculum so that they are prepared to care for dying patients.

  19. THANK YOU FOR YOUR ATTENTION...

  20. REFERENCES • Han S.S., Ahn S.H. An Analysis And Evaluation ofStudent Nurses’ Participation InEthical Decision Making, Nursing Ethics , 2000; 7 (2):113-123. • Crisham P. Measuring moral judgement in nursing dilemmas. Nursing Research ,1981; 30 (2):104-110. • Truog R.D. Et. all. Recommendations for end-of-life care in the intensive careunit: A consensus statement by the American College ofCritical Care Medicine. Crit Care Med., 2008; 36 (3): 953-963. • Campbell ML, Guzman JA. A proactive approach to improve end-of-life care in a medical intensive care unit for patients withterminal dementia. Crit Care Med., 2004; 32:1839–1843. • International Nurses’ End-of-Life Decision-Making in Intensive Care Research Group. Negotiated reorienting: A grounded theory of nurses’ end-of-life ecisionmaking in the intensive care unit. 1-19. • Papadimos T.J. et al.. An overview of end-of-life issues in theintensive care unit. International Journal of Critical Illness and Injury Science, 2011;1(2): 138-146.

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