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Opinions of intensive care professionals about futile treatment

Year 2013, Volume: 15 Issue: 3, 42 - 55, 01.12.2013

Abstract

Objective: The study was conducted to determine the views of nurses and physicians working at intensive care units on the concept of futile treatment. Methods: The sample of the descriptive study included 176 individuals. The data were obtained with the futile treatment questionnaire developed by the researchers. The research data were evaluated with the percentage calculation and chi-square significance test. Results: Based on the statistical analysis of the findings, it was determined that 55.1% of the nurses and physicians said that futile treatment was provided for some patients in the intensive care units and 67.6% were knowledgeable about the futile treatment concept. Of the health professionals, 61.4% stated that futile treatment should not be administered in intensive care units, 58.0% stated that physicians played an important role in making decisions to provide futile treatment, and 60.8% experienced ethical dilemmas in futile treatment practices. Conclusions: A great majority of the nurses and physicians stated that some patients received futile treatment in intensive care units but futile treatment should not be provided in intensive care units. It is suggested that institutional and legal policies should be established on the administration of futile treatment in clinical settings in Turkey

References

  • Başak T, Uzun Ş, Arslan F. Examination of the ethical sensitivity of intensive care nurses. Gulhane Med J2010; 52: 76-81.
  • Aydın E, Ersoy N.The principle of justice in medical ethics. Turkiye Klinikleri J MedEthics 1994; 2(2): 61-63.
  • Faber-Langendoen K, Lanken PN. Dying patients in the intensive care unit: forgoing treatment, maintaining care. Ann Intern Med 2000; 133(11): 886-892.
  • Mobley MS, Rady MY, Verheijde J, Patel B, Larson JS. The relationship between moral distress and perception of futility in the critical care unit. ICCN 2007; 23: 256-263.
  • Cosgrove JF, Nesbitt ID, Bartley C. Futility and the critically ill adult patient: A framework. Curr Anaesth Crit Care 2006; 17: 255-262.
  • Gampel E.Does Professional autonomy protect medical futility judgments? Bioethics 2006; 20(2): 92-104.
  • Mohammed S, Peter E. Rituals, death and the moral practice of medical futility. Nurs Ethics 2009; 16(3): 292-302.
  • Turkish Medical Association. Turkish Medical Association Declaration of Ethics regarding the end of life. Ankara: Turkish Medical Association publications-Hermes, 2010: 27-30.
  • Kasman DL. When is medical treatment futility? J Gen Intern Med 2004;19(10): 1053-1056.
  • Meltzer LS and Huckabay LM. Critical care nurses’ perceptions of futility and its effect on burnout. AJCC 2004; 13(3): 202- 208.
  • PaldaVA, Bowmn KW, Mclean RF, Chapman MG. “Futile” care: do we provide it? Why? A semi structured, Canada-Wide survey of intensive care unit doctors and nurses. J Crit Care 2005; 20: 207-213.
  • Sibbald R, Downar J, Hawryluck L. Perceptions of “futile care” among caregivers in intensive care units. CMAJ 2007; 177(10): 1201-1208.
  • Trotter G. Mediating disputes about medical futility. Camb Q Healthc Ethics 1999; 8(4): 527-537.
  • Akpınar A, Senses M, Er RA.Attitudes to end-of life decisions in paediatric intensive care. Nurs Ethics 2009; 16(1): 83-91.
  • Senses MÖ, Ersoy N. New-born ıntensıve care doctors and nurses’ ideas and preferences on futile treatment. In: Congress Book of 2. International Congress On Medical Ethics And Medical Law Life Maintenance Treatments At The Beginnings Of The 21 St Century From The Point of Medical Ethics And Medical Law. Ankara: Nobel, 2009: 332-341.
  • Ferrell BR. Understanding the moral distress of nurses witnessing medically futility. OncolNursForum2006; 33(5): 922-930.
  • Fleming DA. Futility: revisiting a concept of shared moral Judgment. HEC FORUM 2005; 17(4): 260-275.
  • Lawson AD. Futility. CurrAnaesthCritCare2004; 15(3): 219-223.
  • Pellegrino DE. Futility in medical decisions: the word and the concept. HEC FORUM 2005; 17(4): 308-318.
  • Vincent JL. Forgoing life support in western European intensive care units: The results of an ethical questionnaire. Crit Care Med 1999; 27(8): 1626-1633.
  • Buken NO. Truth-telling information and communication with cancer patients in Turkey. J Int Soc History Islamic Med 2003; 2(4): 31-37.
  • Yildirim G, Kadioglu S, Sumer H. The concept of “Medical Ethics” according to doctors and nurses and their demands from Ethicists in Turkey. Pak J Med Sci 2011; 27(1): 28-32.
  • Hot I, Gurgan M. The end of life decisions belonging to the views of the intensive care physicians. In: Congress Book of 2. International Congress On Medical Ethics And Medical Law Life Maintenance Treatments At The Beginnings of The 21 St Century From The Point of Medical Ethics And Medical Law. Ankara: Nobel, 2009; 515-521.
  • Bailey S.The concept of futility in health care decision-making. Nurs Ethics 2004; 11(1): 77-83.
  • Akpinar A. Patient admission and discharge decisions for intensive care unit in the view of distributive justice. Turkish Journal of Anesthesiology and Reanimation 2007; 35(2): 102-110.
  • Carvalho KK, Lunardi VL. Therapeutic futility as an ethical issue: intensive care unit nurses. Rev Latino-am Enfermagem 2009; 17(3): 308-313.
  • Löfmark R, Nilstu T. Conditions and consequences of medical futility- from a literature review to a clinical model. J Med Ethics 2002; 28: 115-119.
  • American Medical Association. AMA code of medical ethics. 2007. [Online]. Available from: http://www.ama- assn.org/ama/pub/physician-resources/medical-ethics/code-medical-ethics.page?(Accessed 2007 June 29). 29. British Medical Association. End-of-life decisions.
  • [Online].Available from
  • http://bmaopac.hosted.exlibrisgroup.com/exlibris/aleph/a21_1/apache_media/VITJEQ4TGE1SQBYYUCDDQ2T93SAHVT.pdf.
  • (Accessed 2013 December 14).
  • Ersoy N. Ethical issues related to the end of life. Eds: Aksoy S, Demirhan Erdemir A, Öncel O. Modern Medical Ethics. Istanbul: Nobel, 2003; 328-357.
  • FerrandE, Robert R, Ingrand P, Lemaire F. Withholding and withdrawal of life support in intensive care units in France: a prospective survey. The Lancet 2001; 357(6): 9-14.
  • Robichaux CM, Clark AP.At the end of life practice of expert critical care nurses in situations of prognostic conflict. Am J Crit Care 2006; 15(5): 480-491.
  • Schneiderman LJ, Jecker NS, Jonsen AR. Medical futility: response to critiques. Ann Intern Med 1996; 125: 669-674.
  • Hansen L, Goodell T, DeHaven J, Smith M. Improvement nurses' perceptions of end-of-life care after multiple interventions for improvement. Am J Crit Care 2009; 18(3): 263-271.
  • Jecker NS. Medical futility and care of dying patients, in caring for patients at the end of life. West J Med 1995; 163(3): 287-291.
  • Sjökvist P, Nistun T, Svantesson M, Berggren M. Withdrawal of life support who should decide? Intensive Care Med 1999; 25(9): 949-954.
  • Ahrens T, Yancey V,Kollef M.Length of stay in the intensive care unit and resource use improving family communications at the end of life: implications forlength of stay in the intensive care unit and resource use. Am J Crit Care 2003; 12(4): 317-324.
  • HalvorsenK, Fİrde R, Nortvedt P. Value choices and considerations when limiting intensive care treatment: a qualitative study. Acta Anaesthesiol Scand 2009; 53(1): 10–17.
  • Joseph R. Hospital policy on medical futility — does it help in conflict resolution and ensuring good end-of-life care? Ann Acad Med Singapore 2011; 40(1): 19-25.

Yoğun bakım çalışanlarının nafile tedaviye ilişkin görüşleri

Year 2013, Volume: 15 Issue: 3, 42 - 55, 01.12.2013

Abstract

Amaç: Bu çalışma, yoğun bakım ünitesinde çalışan hemşirelerin ve hekimlerin nafile/boşuna tedavi kavramına yönelik görüşlerini belirlemek amacıyla yapılmıştır. Yöntem: Bu tanımlayıcı araştırmanın örneklemini 176 birey oluşturmuştur. Veriler araştırmacılar tarafından geliştirilen nafile tedavi anketi ile elde edilmiştir. Araştırma verileri, yüzde hesaplama ve ki-kare önemlilik testi ile değerlendirilmiştir. Bulgular: Bulguların istatistiksel değerlendirmesi sonucu hemşire ve hekimlerin %55,1’ine göre yoğun bakım ortamında bazı hastalara nafile tedavi uygulandığı, %67,6’sının nafile tedavi kavramını bildikleri belirlendi. Sağlık profesyonellerinin %61,4’ünün yoğun bakım ortamlarında nafile tedavinin uygulanmaması gerektiğini belirttikleri, %58,0’inde nafile tedaviyi uygulama kararında hekimin önemli rol oynadığı ve sağlık çalışanlarının %60,8’inin nafile tedavi uygulamalarında etik ikilem yaşadıkları belirlenmiştir. Sonuç: Hemşire ve hekimlerin büyük çoğunluğu yoğun bakım ortamında bazı hastalara nafile tedavi uygulandığını, yoğun bakım ortamlarında nafile tedavinin yapılmaması gerektiğini belirtmiştir. Bu bağlamda ülkemizde klinik ortamlarda nafile tedavinin uygulanmasına ilişkin kurumsal ve yasal politikaların oluşturulması önerilir

References

  • Başak T, Uzun Ş, Arslan F. Examination of the ethical sensitivity of intensive care nurses. Gulhane Med J2010; 52: 76-81.
  • Aydın E, Ersoy N.The principle of justice in medical ethics. Turkiye Klinikleri J MedEthics 1994; 2(2): 61-63.
  • Faber-Langendoen K, Lanken PN. Dying patients in the intensive care unit: forgoing treatment, maintaining care. Ann Intern Med 2000; 133(11): 886-892.
  • Mobley MS, Rady MY, Verheijde J, Patel B, Larson JS. The relationship between moral distress and perception of futility in the critical care unit. ICCN 2007; 23: 256-263.
  • Cosgrove JF, Nesbitt ID, Bartley C. Futility and the critically ill adult patient: A framework. Curr Anaesth Crit Care 2006; 17: 255-262.
  • Gampel E.Does Professional autonomy protect medical futility judgments? Bioethics 2006; 20(2): 92-104.
  • Mohammed S, Peter E. Rituals, death and the moral practice of medical futility. Nurs Ethics 2009; 16(3): 292-302.
  • Turkish Medical Association. Turkish Medical Association Declaration of Ethics regarding the end of life. Ankara: Turkish Medical Association publications-Hermes, 2010: 27-30.
  • Kasman DL. When is medical treatment futility? J Gen Intern Med 2004;19(10): 1053-1056.
  • Meltzer LS and Huckabay LM. Critical care nurses’ perceptions of futility and its effect on burnout. AJCC 2004; 13(3): 202- 208.
  • PaldaVA, Bowmn KW, Mclean RF, Chapman MG. “Futile” care: do we provide it? Why? A semi structured, Canada-Wide survey of intensive care unit doctors and nurses. J Crit Care 2005; 20: 207-213.
  • Sibbald R, Downar J, Hawryluck L. Perceptions of “futile care” among caregivers in intensive care units. CMAJ 2007; 177(10): 1201-1208.
  • Trotter G. Mediating disputes about medical futility. Camb Q Healthc Ethics 1999; 8(4): 527-537.
  • Akpınar A, Senses M, Er RA.Attitudes to end-of life decisions in paediatric intensive care. Nurs Ethics 2009; 16(1): 83-91.
  • Senses MÖ, Ersoy N. New-born ıntensıve care doctors and nurses’ ideas and preferences on futile treatment. In: Congress Book of 2. International Congress On Medical Ethics And Medical Law Life Maintenance Treatments At The Beginnings Of The 21 St Century From The Point of Medical Ethics And Medical Law. Ankara: Nobel, 2009: 332-341.
  • Ferrell BR. Understanding the moral distress of nurses witnessing medically futility. OncolNursForum2006; 33(5): 922-930.
  • Fleming DA. Futility: revisiting a concept of shared moral Judgment. HEC FORUM 2005; 17(4): 260-275.
  • Lawson AD. Futility. CurrAnaesthCritCare2004; 15(3): 219-223.
  • Pellegrino DE. Futility in medical decisions: the word and the concept. HEC FORUM 2005; 17(4): 308-318.
  • Vincent JL. Forgoing life support in western European intensive care units: The results of an ethical questionnaire. Crit Care Med 1999; 27(8): 1626-1633.
  • Buken NO. Truth-telling information and communication with cancer patients in Turkey. J Int Soc History Islamic Med 2003; 2(4): 31-37.
  • Yildirim G, Kadioglu S, Sumer H. The concept of “Medical Ethics” according to doctors and nurses and their demands from Ethicists in Turkey. Pak J Med Sci 2011; 27(1): 28-32.
  • Hot I, Gurgan M. The end of life decisions belonging to the views of the intensive care physicians. In: Congress Book of 2. International Congress On Medical Ethics And Medical Law Life Maintenance Treatments At The Beginnings of The 21 St Century From The Point of Medical Ethics And Medical Law. Ankara: Nobel, 2009; 515-521.
  • Bailey S.The concept of futility in health care decision-making. Nurs Ethics 2004; 11(1): 77-83.
  • Akpinar A. Patient admission and discharge decisions for intensive care unit in the view of distributive justice. Turkish Journal of Anesthesiology and Reanimation 2007; 35(2): 102-110.
  • Carvalho KK, Lunardi VL. Therapeutic futility as an ethical issue: intensive care unit nurses. Rev Latino-am Enfermagem 2009; 17(3): 308-313.
  • Löfmark R, Nilstu T. Conditions and consequences of medical futility- from a literature review to a clinical model. J Med Ethics 2002; 28: 115-119.
  • American Medical Association. AMA code of medical ethics. 2007. [Online]. Available from: http://www.ama- assn.org/ama/pub/physician-resources/medical-ethics/code-medical-ethics.page?(Accessed 2007 June 29). 29. British Medical Association. End-of-life decisions.
  • [Online].Available from
  • http://bmaopac.hosted.exlibrisgroup.com/exlibris/aleph/a21_1/apache_media/VITJEQ4TGE1SQBYYUCDDQ2T93SAHVT.pdf.
  • (Accessed 2013 December 14).
  • Ersoy N. Ethical issues related to the end of life. Eds: Aksoy S, Demirhan Erdemir A, Öncel O. Modern Medical Ethics. Istanbul: Nobel, 2003; 328-357.
  • FerrandE, Robert R, Ingrand P, Lemaire F. Withholding and withdrawal of life support in intensive care units in France: a prospective survey. The Lancet 2001; 357(6): 9-14.
  • Robichaux CM, Clark AP.At the end of life practice of expert critical care nurses in situations of prognostic conflict. Am J Crit Care 2006; 15(5): 480-491.
  • Schneiderman LJ, Jecker NS, Jonsen AR. Medical futility: response to critiques. Ann Intern Med 1996; 125: 669-674.
  • Hansen L, Goodell T, DeHaven J, Smith M. Improvement nurses' perceptions of end-of-life care after multiple interventions for improvement. Am J Crit Care 2009; 18(3): 263-271.
  • Jecker NS. Medical futility and care of dying patients, in caring for patients at the end of life. West J Med 1995; 163(3): 287-291.
  • Sjökvist P, Nistun T, Svantesson M, Berggren M. Withdrawal of life support who should decide? Intensive Care Med 1999; 25(9): 949-954.
  • Ahrens T, Yancey V,Kollef M.Length of stay in the intensive care unit and resource use improving family communications at the end of life: implications forlength of stay in the intensive care unit and resource use. Am J Crit Care 2003; 12(4): 317-324.
  • HalvorsenK, Fİrde R, Nortvedt P. Value choices and considerations when limiting intensive care treatment: a qualitative study. Acta Anaesthesiol Scand 2009; 53(1): 10–17.
  • Joseph R. Hospital policy on medical futility — does it help in conflict resolution and ensuring good end-of-life care? Ann Acad Med Singapore 2011; 40(1): 19-25.
There are 41 citations in total.

Details

Primary Language Turkish
Journal Section Research Article
Authors

Dilek Özden This is me

Serife Karagözoğlu This is me

Gülay Yıldırım This is me

Eda Tabak This is me

Publication Date December 1, 2013
Published in Issue Year 2013 Volume: 15 Issue: 3

Cite

APA Özden, D., Karagözoğlu, S., Yıldırım, G., Tabak, E. (2013). Yoğun bakım çalışanlarının nafile tedaviye ilişkin görüşleri. Hemşirelikte Araştırma Geliştirme Dergisi, 15(3), 42-55.