Ethical conflict in critical care nursing

Abstract

Background:

Ethical conflicts in nursing have generally been studied in terms of temporal frequency and the degree of conflict. This study presents a new perspective for examining ethical conflict in terms of the degree of exposure to conflict and its typology.

Objectives:

The aim was to examine the level of exposure to ethical conflict for professional nurses in critical care units and to analyze the relation between this level and the types of ethical conflict and moral states.

Research design:

This was a descriptive correlational study. Central and dispersion, normality tests, and analysis of variance were carried out.

Participants and research context:

A total of 203 nurses were from two third-level teaching hospitals in Spain. Both centers are part of the University of Barcelona Health Network. Participants filled out the Ethical Conflict in Nursing Questionnaire–Critical Care Version.

Ethical considerations:

This investigation received the approval of the ethical committees for clinical investigation of the two participating hospitals. Participants were informed of the authorship and aims of the study.

Findings:

The index of exposure to ethical conflict was $\overset{ˉ}{x} = 182.35$ . The situations involving analgesic treatment and end-of-life care were shown to be frequent sources of conflict. The types of ethical conflict and moral states generally arranged themselves from lesser to greater levels of index of exposure to ethical conflict.

Discussion:

The moderate level of exposure to ethical conflict was consistent with other international studies. However, the situations related with family are infrequent, and this presents differences with previous research. The results suggest that there is a logical relationship between types of conflict and levels of exposure to ethical conflict.

Conclusion:

The types of ethical conflict and moral states were related with the levels of exposure to ethical conflict. The new perspective was shown to be useful for analyzing the phenomenon of ethical conflict in the nurse.

Keywords

Critical care nursing ethical conflict model moral distress types of ethical conflict

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References

Breslin

MacRae

Bell

. University of Toronto Joint Center for Bioethics Clinical Ethics Group. Top 10 health care ethics challenges facing the public: views of Toronto bioethicists. BMC Med Ethics 2005; 6: 5.

Dierckx de Caterlé

Izumi

Godfrey

. Nurses’ responses to ethical dilemmas I nursing practice: meta-analysis. J Adv Nurs 2008; 63 (6): 540–549.

Johnstone

. Bioethics: a nursing perspective. 5th ed. Chatswood, NSW, Australia: Churchill Livingstone Elsevier, 2009.

Rittenmeyer

Huffman

. How professional nurses working in hospital environments experience moral distress: a systematic review. JBI Library Systematic Reviews 2009; 7 (28): 1260–1317.

Cavaliere

Dowling

. Moral distress in neonatal intensive care unit RNs. Adv Neonatal Care 2010; 10 (3): 145–156.

Falcó-Pegueroles

. Análisis de la conflictividad ética en los profesionales de enfermería de las unidades de cuidados intensivos [Analysis of ethical conflicts in professional nursing in critical care units]. PhD Thesis, Department of Fundamental Care and Medical-Surgical Nursing, University of Barcelona, Spain, 2012, http://www.tdx.cat/handle/10803/84082

Wilkinson

. Moral distress in nursing practice: experience and effect. Nurs Forum 1988; 23 (1): 16–29.

Raines

ML.

Ethical decision making in nurses. Relationships among moral reasoning, coping style, and ethics stress. JONAS Healthc Law Ethics Regul 2000; 2 (1): 29–41.

McCaffree

. Moral distress and the intensive care unit. Crit Care Med 2006; 34 (12): 3049–3050.

10.

Rushton

. Defining and addressing moral distress: tools for critical care nursing leaders. AACN Adv Crit Care 2006; 17 (2): 161–168.

11.

Hamric

Blackhall

. Nurse-physician perspectives on the care of dying patients in intensive care units: collaboration, moral distress and ethical climate. Crit Care Med 2007; 35 (2): 422–429.

12.

Burkhardt

Nathaniel

Walton

. Ethics and issues in contemporary nursing. Scarborough, ON, Canada: Nelson Education, 2010.

13.

American Association of Critical-Care Nurses (AACN). The 4A’s to rise above moral distress. 2005, AACN, http://www.aacn.org/WD/Practice/Docs/4As_to_Rise_Above_Moral_Distress.pdf

14.

Jameton

. Dilemmas of moral distress: moral responsibility and nursing practice. AWHONNS Clin Issues Perinat Womens Health Nurs 1993; 4: 542–551.

15.

Corley

. Moral distress of critical care nurses. Am J Crit Care 1995; 4 (4): 280–285.

16.

Zuzelo

. Exploring the moral distress of registered nurses. Nurs Ethics 2007; 14 (3): 344–359.

17.

Fogel

. The relationships of moral distress, ethical climate and intent to turnover among critical care nurses. PhD Thesis, University of Chicago, Chicago, IL, 2007.

18.

Pauly

Varcoe

Storch

. Registered nurses’ perceptions of moral distress and ethical climate. Nurs Ethics 2009; 16 (5): 561–573.

19.

De Veer

Francke

Struijs

. Determinants of moral distress in daily nursing practice: a cross sectional correlational questionnaire survey. Int J Nurs Stud 2013; 50: 100–108.

20.

Severinsson

. Moral stress and burnout: qualitative content analysis. Nurs Health Sci 2003; 5: 59–66.

21.

Glasberg

Eriksson

Norberg

. Burnout and “stress of conscience” among healthcare personnel. J Adv Nurs 2007; 57 (4): 392–403.

22.

Juthberg

Eriksson

Sundin

. Stress of conscience and perceptions of conscience in relation to burnout among care-providers in older people. J Clin Nurs 2008; 17: 1897–1906.

23.

Jameton

. Nursing practice: the ethical issues. London: Prentice Hall, 1984.

24.

Canadian Nurses Association. Ethical distress in health care environments: ethics in practice for registered nurses. No. 1480-9990, http://www.cnaaiic.ca/cna/documents/pdf/publications/ethics_pract_ethical_distress_oct_2003_e.pdf (2003, accessed 2 December 2013).

25.

Kälvemark

Höglund

Arnetz

. Measuring moral distress in pharmacy and clinical practice. Nurs Ethics 2006; 13 (4): 417–427.

26.

Corley

. Nurse moral distress: a proposed theory and research agenda. Nurs Ethics 2002; 9(6): 636–650.

27.

Corley

Elswick

Gorman

. Development and evaluation of a moral distress scale. J Adv Nurs 2001; 33 (2): 250–256.

28.

Gutiérrez

. Critical care nurses’ perceptions of and responses to moral distress. Dimens Crit Care Nurs 2005; 24 (5): 229–241.

29.

Schwenzer

Wang

. Assessing moral distress in respiratory care practitioners. Crit Care Med 2006; 34 (12): 2967–2973.

30.

Eizenberg

Desivilya

Hirschfled

. Moral distress questionnaire for clinical nurses: instrument development. J Adv Nurs 2009; 65 (4): 885–892.

31.

Elpern

Covert

Kleinpell

. Moral distress of staff nurses in a medical intensive care unit. Am J Crit Care 2005; 14 (6): 523–530.

32.

Meltzer

Huckabay

. Critical care nurses’ perceptions of futile care and its effect on burnout. Am J Crit Care 2004; 13 (3): 202–208.

33.

Mobley

Rady

Verheijde

. The relationship between moral distress and perception of futile care in the critical care unit. Intensive Crit Care Nurs 2007; 23: 256–263.

34.

Forde

Aasland

. Moral distress among Norwegian doctors. J Med Ethics 2008; 34: 521–525.

35.

Glasberg

. Stress of conscience and burnout in healthcare: the danger of deadening one’s conscience. PhD Thesis, Umea University, Umea, 2007.

36.

Glasberg

Eriksson

Dahlqvist

. Development and initial validations of the stress of conscience questionnaire. Nurs Ethics 2006; 13 (6): 633–648.

37.

Juthberg

Eriksson

Norberg

. Perceptions of conscience in relation to stress of conscience. Nurs Ethics 2007; 14 (3): 329–343.

38.

Gustafsson

Eriksson

Strandberg

. Burnout and perceptions of conscience among health care personnel: a pilot study. Nurs Ethics 2010; 17 (1): 23–38.

39.

Corley

Minick

Elswick

. Nurse moral distress and ethical work environment. Nurs Ethics 2005; 12 (4): 381–390.

40.

Falcó-Pegueroles

Lluch-Canut

Guàrdia-Olmos

. Development process and initial validation of the Ethical Conflict in Nursing Questionnaire–Critical Care Version. BMC Med Ethics 2013; 14: 22.

41.

Bond

Kearns

Mason

. Exploring the relationships between housing, neighbourhoods and mental wellbeing for residents of deprived areas. BMC Public Health 2012; 12: 48.