Gönül KURT (RN, PhD)Gönül KURT (RN, PhD)

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Intensive Care Units (ICUs) provide increasingly sophisticated treatments to

those who are critically ill.

PROBLEM STATEMENTSPROBLEM STATEMENTS

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 .

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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%.

PROBLEM STATEMENTSPROBLEM 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.

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PROBLEM STATEMENTSPROBLEM STATEMENTS

• 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 Intensive Care Units.

• For these reasons, ethical problems in ICUs are common, especially when caring for patients at the end of life.

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 to understand ethical concepts such as rights, justice, freedom and autonomy, and to analyze and understand ethical reasoning based on ethical theory.

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PROBLEM STATEMENTSPROBLEM STATEMENTS

AnalyzeAnalyze EvaluateEvaluate

MakMakinging decisiondecision

EthicalEthical principlesprinciples

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PROBLEM STATEMENTSPROBLEM 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.

• 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.

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PROBLEM STATEMENTSPROBLEM STATEMENTS

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The aim of this study to determine the ethical

decision-making practice of nursing students about end-of-life care in Intensive Care

Units.

PURPOSEPURPOSE

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MATERIAL & METHODSMATERIAL & METHODS

Study Time:Study Time: January-June 2015

Study Type:Study Type: Descriptive study

Study Location:Study Location: Intensive Care Units of an University Hospital

Study Sample Study Sample The study sample consisted of a total of 87 student nurses who work with

dying patients in ICU.

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MATERIAL & METHODSMATERIAL & METHODS

Measures:Measures:

A “Data Collection Form” 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 was developed by the present investigator after evaluation of the relevant literature. The questionnaire consisted of 10 questions.

NDT was developed by Crisham in 1981 to measure nurses' responses to nursing dilemmas and the importance given to moral issues and practical considerations.

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MATERIAL & METHODSMATERIAL & METHODS

Measures:Measures: Crisham (1981) developed the NDT based on experienses of the 130 staff nurses. The instrument contains six vignettes addressing the ethical issues of “deciding right to know and determining right to decide, defining and promoting quality of life, maintaining professional and institutional standards, and distributing nursing resources”.

The six vignettes deal with the following problems: Newborn with anomalies, Forcing Medication, Adult’s Request to Die, New Nurse Orientation, Medication Error, Uninformed Terminally ill Adult.

The NDT examines willingness to act, familiarity with the dilemma presented, importance of practical considerations, and level of moral reasoning, which is made up of nursing –principled items for each of the six nursing dilemmas.

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MATERIAL & METHODSMATERIAL & METHODS

Data CollectiData Collectioon:n:

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.

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MATERIAL & METHODSMATERIAL & METHODS

Data Analyses:Data Analyses:

The SPSS 15.0 software package was used for statistical analysis.

Categorical variables were expressed as counts and percentages.

Continuous variables were summarized with means and standard

deviation.

Conformity the normal distribution of data was assessed 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.

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RESULTSRESULTS

Face with the dying patient and felt emotions of students

n=87

Encounter with dying patient n %

No 5 5.7

Yes 82 94.3

Felt emotions while caring the dying patient

Sadness 75 86.2

Feelings of helplessness 47 54.0

47.1 Fear 41

Inadequacy 47 54.0

Feel like crying 24 27.6

Desperation 13 14.9

Grief 9 10.3

X ± SD

Age of students 21.98 ± 0.28

X

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RESULTSRESULTS

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.

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The Nursing Principled Thinking level was above average, while Practical Considerations level was 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 experienced the 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.

Mean scores of students in Nursing Dilemma Test (n=87)

Sub-scale of Nursing Dilemma Test X±SD

Nursing Principled Thinking 48.57±5.66

Practical Consideration 16.78±3.03

Familiarity 16.79±2.25

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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 universal theories to real situations, by means of case studies and practical training in the analysis of ethical dilemmas.

CONCLUSIONSCONCLUSIONS

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CONCLUSIONSCONCLUSIONS

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.

THANK YOU FOR YOUR THANK YOU FOR YOUR ATTENTION...ATTENTION...

REFERENCESREFERENCES1. Han S.S., Ahn S.H. An Analysis And Evaluation of Student Nurses’ Participation In Ethical Decision Making,

Nursing Ethics , 2000; 7 (2):113-123.

2. Crisham P. Measuring moral judgement in nursing dilemmas. Nursing Research ,1981; 30 (2):104-110.

3. Truog R.D. Et. all. Recommendations for end-of-life care in the intensive care unit: A consensus statement by the American College of Critical Care Medicine. Crit Care Med., 2008; 36 (3): 953-963.

4. Campbell ML, Guzman JA. A proactive approach to improve end-of-life care in a medical intensive care unit for patients with terminal dementia. Crit Care Med., 2004; 32: 1839–1843.

5. 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.

6. 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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