Ethical Decision-Making Level of Intensive Care Nurses

Abstract

Aim: A crucial skill for nurses is the understanding of ethics and ethical dilemmas, which enables them to make ethical decisions. This study aimed to assess the ethical decision-making abilities of intensive care nurses employed at a university hospital. Materials and Methods: In this descriptive study, the population comprised 265 nurses employed in the hospital's intensive care units. The sample for the study, on the other hand, consisted of 56 intensive care nurses. Data were collected using a “Nurse Information Form” and the “Nursing Dilemma Test”. Results: It was found that the average scores of intensive care nurses in Principled Thinking (29.95±10.34) and Practical Thinking (17.79±4.73) were at medium levels. The study indicated that these nurses were acquainted with dilemmas similar to those in the Nursing Dilemma Test (15.71±4.47). Conclusion: The most common ethical dilemmas faced by intensive care nurses included the conflict between true procedures that should be done and the physician's request, the decision not to perform cardiopulmonary resuscitation, and telling the truth to the patient. It was concluded that intensive care nurses tried to take ethical principles into account when making decisions about ethical dilemmas, but that they did not make use of ethical principles adequately and were affected by environmental factors.

Keywords

• Ethical decision-making
• ethical dilemma
• intensive care
• nurse
• nursing

Yoğun Bakım Hemşirelerinin Etik Karar Verme Düzeyleri

Abstract

Amaç: Etik ve etik ikilemlerin bilinmesi, hemşirelerin etik kararlar alabilmesi için temel bir gerekliliktir. Bu çalışma, bir üniversite hastanesinde çalışan yoğun bakım hemşirelerinin etik karar verme düzeylerini belirlemek amacıyla yapılmıştır. Gereç ve Yöntem: Tanımlayıcı tipteki bu araştırmanın evrenini bir hastanenin yoğun bakım ünitelerinde görev yapan 265 hemşire, örneklemini ise 56 yoğun bakım hemşiresi oluşturmuştur. Araştırmanın verileri “Hemşire Bilgi Formu” ve “Hemşirelik İkilem Testi” kullanılarak toplanmıştır. Bulgular: Voğun bakım hemşirelerinin ilkesel düşünme (29.95±10.34) ve pratik düşünme (17.79±4.73) puan ortalamalarının orta düzeyde olduğu bulunmuştur. Araştırmada yer alan yoğun bakım hemşirelerinin Hemşirelik İkilem Testindeki ikilemlere benzer durumlara aşina oldukları belirlenmiştir (15.71±4.47). Sonuç: Yoğun bakım hemşirelerinin en sık karşılaştıkları etik ikilemler arasında yapılması gereken doğruların çatışması, kardiyopulmoner resüsitasyon yapmama kararı ve hastaya gerçeğin söylenmemesi yer almaktadır. Yoğun bakım hemşirelerinin etik ikilemlerle ilgili karar verirken etik ilkeleri dikkate almaya çalıştıkları ancak etik ilkelerden yeterince yararlanmadıkları ve çevresel faktörlerden etkilendikleri sonucuna varılmıştır.

Keywords

• Etik karar verme
• etik ikilem
• yoğun bakım
• hemşire
• hemşirelik

References

1. Arslantas H. Ethical issues, codes, and standards in mental health and psychiatric nursing. Journal of Psychiatric Nursing 2015; 6(1): 47-56.
2. Torun S. A Group of master degree students assessment of ethical dilemmas and their familiarity status. The Interdisciplinary Journal of Law and Forensic Sciences 2016; 1(1): 81-92.
3. Cerit B. A study of validity and reliability of nursing dilemma test and nurses’ level of ethical decision-making. Hacettepe University Faculty of Health Sciences Nursing Journal 2010: 47–67.
4. Akfert SK. Ethical dilemmas experienced by psychological counsellors working at different institutions and their attitudes and behaviours as a response to these dilemmas. Educational Sciences: Theory & Practice 2012; 12(3): 1791-1812.
5. Basak T, Uzun Ş, Arslan F. Investigation of the moral sensibility of intensive care nurses. Gülhane Tıp Dergisi 2010; 52: 76-81.
6. Eser I, Khorshid L, Demir Y. A survey of the factors effecting the critical thinking dispositions of intensive care nurses. C.Ü. Hemşirelik Yüksekokulu Dergisi 2007; 11: 13-22.
7. Dickert N. Focusing on the big picture to ımprove ethical decision-making in ICUs*. Critical Care Medicine 2019; 47(12): 1804–1805.
8. Buyukkocak Ü, Cakirca M. Ethical subjects related to anaesthesia and intensive care: review. Turkiye Klinikleri J Anest Reanim. 2007; 5: 19-30.

9. Erkekol FO, Numanoglu N, Gurkan OU, Kaya A. Yoğun bakım ünitelerine ilişkin etik konular. Toraks Dergisi 2002; 3: 307-316.
10. Kirsan M, Yıldırım D, Ceylan B, Korhan EA, Uyar M. Yoğun bakım ünitelerinde etik sorunlar: sistematik derleme. Turkiye Klinikleri J Med Ethics 2018; 26(2): 57-65.
11. Jamshidian F, Shahriari M, Aderyani MR. Effects of an ethical empowerment program on critical care nurses ethical decision-making. Nurs Ethics 2019; 26(4): 1256-1264.
12. Pekcan HS. The ethics sensitivity of the doctors and nurses working in Yalova and its region summary. [Master Thesis]. İstanbul, Marmara University Institute of Health Sciences; 2007.
13. Park M, Jeon, SH, Hong HJ, Cho SH. A comparison of ethical issues in nursing practice across nursing units. Nurs Ethics 2014; 21(5): 594-607.
14. Ibrahimoğlu O. Ethical problems and ethical approach of the end of life patients in intensive care. Sağlık Akademisyenleri Dergisi 2017; 4(3): 216-220.
15. Tel H. Ethical problems frequently encountered in the intensive care units. Cumhuriyet Nurs J. 2012; 1(1): 30-38.
16. Kälvemark S, Höglund AT, Hansson MG, Westerholm P, Arnetz B. Living with conflicts-ethical dilemmas and moral distress in the health care system. Social Science & Medicine 2004; 58(6): 1075-1084.
17. Falco ́ -Pegueroles A, Lluch-Canut MT, Martınez-Estalella G, Zabalegui-Yarnoz A, Delgado-Hito P, Via-Clavero G, et al. Levels of exposure to ethical conflict in the ICU: Correlation between sociodemographic variables and the clinical environment. Intensive Crit Care Nurs. 2016; 33:12–20.
18. Pishgooie AH, Barkhordari-Sharifabad M, Atashzadeh-Shoorideh F, Falcó-Pegueroles A. Ethical conflict among nurses working in the intensive care units. Nursing Ethics 2019; 26(7-8): 2225–2238.
19. Azoulay E, Timsit JF, Sprung CL, Soares M, Rusinová K, Lafabrie A, et al. Prevalence and factors of intensive care unit conflicts: the conflicus study. Am J Respir Crit Care Med 2009; 180(9): 853-860.
20. Cerit B, Ozturk E. Determination of the relationship between intensive care nurses' moral sensitivity and ethical decision making level. DEUHFED 2021; 14(2):116-123.
21. Pinch W. Ethical dilemmas in nursing: the role of the nurse and perceptions of autonomy. J Nurs Educ 1985; 24: 372–376.
22. Sabancıogulları S, Kol EU, Arslantas AT, Togantemuz F, Ulker F. Examination of the relationship between ethical decision making levels and professional self-concepts of nurses’. DEUHFED 2018; 11 (2): 105-112.
23. McLennon SM, Uhrich M, Lasiter S, Chamness AR, Helft PR. Oncology nurses’ narratives about ethical dilemmas and prognosis-related communication in advanced cancer patients. Cancer Nurs 2013; 36(2): 114–121.
24. Baysal E, Sari D, Erdem H. Ethical decision-making levels of oncology nurses. Nurs Ethics 2019; 26(7-8): 2204-2212.
25. Cerit B, Dinc L. Ethical decision-making and professional behaviour among nurses: A correlational study. Nurs Ethics 2013; 20(2): 200-212.
26. Rizalar S, Baltaci N. Ethical decision-making levels of nurses and it’s affecting factors. Int J Caring Sci 2020; 13(1): 42-52.
27. Yurttas A, Kara Kasikci M, Agacdiken S, Kavuran E, Sirin M. Comparison of levels of nurses and nursing students' ethical decision making. Türkiye Klinikleri J Med Ethics 2014; 22(1):1-8.
28. Demirsoy N, Yılmaz AT, Şaylıgil Ö. Nurses' approaches to ethical dilemmas: An example of a public hospital. Journal of Human Sciences 2018; 15(3): 1568-1583.
29. Koohi A, Khaghanizade M, Ebadi A. The relationship between ethical reasoning and demographic characteristics of nurses. IJME [online]. 2016; 9(1): 26-36.
30. Dinc L, Görgülü RS. Teaching ethics in nursing. Nurs Ethics 2002; 9(3): 259–268.
31. Keller AC, Smith KT, Smith LM. Do gender, educational level, religiosity, and work experience affect the ethical decision-ma¬king of u.s. accountants? Crit Perspect Account 2007; 18: 299-314.
32. Roxas ML, Stoneback JY. An investigation of the ethical deci¬sion-making process across varying cultures. Int J Account 1997; 32: 503- 535.
33. Crisham P. Measuring moral judgment in nursing dilemmas. Nurs Res 1981; 30(2): 104–110.