Page 120 - ACCCN's Critical Care Nursing

Ethical Issues in Critical Care 97

Case study, Continued
insensitive in convincing the family to forgo life sustaining ICU nurse manager
therapies. ● diverse responsibilities to colleagues, patient, family and hos-
pital require an understanding of ethics and the law, profes-
The ethical impact of Mary’s stay is summarised in key perspectives
of those involved in her care. sional codes of practice, and sensitivity to both staff and
patient needs.
Nurses: The hospital’s clinical ethicist and clinical ethics committee was
● reported to be physically and mentally drained consulted and all options were discussed with the family, with
● ethical dilemmas complicated by differing personal beliefs sensitivity to their religious views. It was decided that all current
● patient allocation difficulties treatments would be continued, no new treatments would com-
● stressed, frustrated, burnout mence and ‘nature would take its course’.
● each describing how they were affected in different ways
● needed to be sensitive to family’s views A staff debriefing was conducted by independent external coun-
● debriefing should have been considered earlier and sellors and was positively received by all staff. Staff comments
regularly reflected their personal ethical and professional struggles that they
● were they advocating for the patient’s best interest or the openly shared in this confidential forum.
family’s? What lessons can be learnt from this case study? Culturally-
● what were the patient’s best interests?
challenging patients and families can significantly affect many
Doctors: resources, and most crucially the patient and staff. They also
● varied opinions, mild dissent, communication challenges at present many ethical and clinical challenges. These families may
times discussing the advantages and disadvantages of extend- have a feeling of isolation and lack of support from the medical
ing ’futile’ care and nursing team. The teams may feel overwhelming difficulties
● communication barrier between themselves, nursing team when dealing with a family that desire measures not advised
and the family. by them.
Family: Staff described variable rewards and/or stress levels, ranging from
● physical and emotional exhaustion negligible to great. Increased focus on clinical and personal
● insistence on full treatment support for staff, including an awareness of the diverse sensitivi-
● children traumatised ties, is essential when caring for culturally-challenging critical care
● receiving support for their decisions from a spiritual source patients. Staff require consistent support personally and profes-
rather than from the medical team sionally. Awareness of sensitivities regarding nursing allocation to
● felt anger and aggression from medical team. patient care including fair rotations is important, in addition to
provision of education for nurses regarding ethical principles,
Patient ethical conduct, and their obligations as critical care nurses. Patient
● does she feel that she has suffered enough? advocacy is also paramount, as is the establishment of early forma-
● is she waiting for a miracle? tive and open communication with patients and their loved ones.

Research vignette

Benbenishty J. DeKeyser Ganz F, Lippert A, Bulow FH, Wennberg E, Setting
Henderson B, Svantesson M, Baras M, Phelan D, Maia P, Sprung CL, The study took place in 37 intensive care units in 17 European
Nurse Involvement in end-of-life decision making: the ETHICUS countries. Patients and participants: Physician investigators
Study. Intensive Care Medicine 2006 32: 129–32. reported data related to patients from 37 centres in 17 European
countries. Interventions: None.
Abstract
Objective Measurements and results
The purpose was to investigate physicians’ perceptions of the role Physicians perceived nurses as involved in 2412 (78.3%) of the 3086
of European intensive care nurses in end-of-life decision making. end-of-life decisions (EOLD) made. Nurses were thought to initiate
Design: This study was part of a larger study sponsored by the the discussion in 66 cases (2.1%), while ICU physicians were cited
Ethics Section of the European Society of Intensive Care Medicine, in 2,438 cases (79.3%), the primary physician in 328 cases (10.7%),
the ETHICUS Study. Physicians described whether they thought the consulting physician in 105 cases (3.4%), the family in 119 cases
nurses were involved in such decisions, whether nurses initiated (3.9%) and the patient in 19 cases (0.6%). In only 20 responses
such a discussion and whether there was agreement between phy- (0.6%) did physicians report disagreement between physicians and
sicians and nurses. The items were analysed and comparisons were nurses related to EOLD. A significant association was found
made between different regions within Europe. between the region and responses to the items related to nursing.