Hanne Irene Jensen1,2, Stine Hebsgaard3,4, Tina Charlotte Bitsch Hansen5, Rikke Frank Aagaard Johnsen2, Christiane S Hartog6,7, Ioanna Soultati8,9, Orsolya Szucs10, Michael E Wilson11, Bo van den Bulcke12, Dominique D Benoit12, Ruth Piers13. 1. Institute of Regional Health Research, University of Southern Denmark, Odense, Denmark. 2. Department of Anaesthesiology and Intensive Care, Lillebaelt Hospital, University Hospital of Southern Denmark, Kolding, Vejle and Middelfart, Denmark. 3. Department of Anaesthesiology and Intensive Care, Kolding Hospital, Kolding, Denmark. 4. Department of Anaesthesiology and Intensive Medicine, Odense University Hospital, Odense, Denmark. 5. Department of Anaesthesiology and Intensive Care, Holbæk Hospital, Holbæk, Denmark. 6. Department of Anesthesiology and Intensive Care Medicine, Charité Universitätsmedizin Berlin, Berlin, Germany. 7. Klinik Bavaria Kreischa, Kreischa, Germany. 8. ICU "M.E.TH.A" University General Hospital of Thessaloniki, Thessaloniki, Greece. 9. ICU Department of Anaesthesiology and Intensive Care Clinic of Aristotele University of Thessaloniki, Thessaloniki, Greece. 10. Semmelweis University, 1st Department of Surgery, Budapest, Hungary. 11. Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN. 12. Department of Intensive Care Medicine, Ghent University Hospital and Ghent University, Ghent, Belgium. 13. Department of Geriatrics, Ghent University Hospital and Ghent University, Ghent, Belgium.
Abstract
OBJECTIVES: To examine perceptions of nurses and physicians in regard to ethical decision-making climate in the ICU and to test the hypothesis that the worse the ethical decision-making climate, the greater the discordance between nurses' and physicians' rating of ethical decision-making climate with physicians hypothesized to rate the climate better than the nurses. DESIGN: Prospective observational study. SETTING: A total of 68 adult ICUs in 13 European countries and the United States. SUBJECTS: ICU physicians and nurses. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Perceptions of ethical decision-making climate among clinicians were measured in April-May 2014, using a 35-items self-assessment questionnaire that evaluated seven factors (empowering leadership by physicians, interdisciplinary reflection, not avoiding end-of-life decisions, mutual respect within the interdisciplinary team, involvement of nurses in end-of-life care and decision-making, active decision-making by physicians, and ethical awareness). A total of 2,275 nurses and 717 physicians participated (response rate of 63%). Using cluster analysis, ICUs were categorized according to four ethical decision-making climates: good, average with nurses' involvement at end-of-life, average without nurses' involvement at end-of-life, and poor. Overall, physicians rated ethical decision-making climate more positively than nurses (p < 0.001 for all seven factors). Physicians had more positive perceptions of ethical decision-making climate than nurses in all 13 participating countries and in each individual participating ICU. Compared to ICUs with good or average ethical decision-making climates, ICUs with poor ethical decision-making climates had the greatest discordance between physicians and nurses. Although nurse/physician differences were found in all seven factors of ethical decision-making climate measurement, the factors with greatest discordance were regarding physician leadership, interdisciplinary reflection, and not avoiding end-of-life decisions. CONCLUSIONS: Physicians consistently perceived ICU ethical decision-making climate more positively than nurses. ICUs with poor ethical decision-making climates had the largest discrepancies.
OBJECTIVES: To examine perceptions of nurses and physicians in regard to ethical decision-making climate in the ICU and to test the hypothesis that the worse the ethical decision-making climate, the greater the discordance between nurses' and physicians' rating of ethical decision-making climate with physicians hypothesized to rate the climate better than the nurses. DESIGN: Prospective observational study. SETTING: A total of 68 adult ICUs in 13 European countries and the United States. SUBJECTS: ICU physicians and nurses. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Perceptions of ethical decision-making climate among clinicians were measured in April-May 2014, using a 35-items self-assessment questionnaire that evaluated seven factors (empowering leadership by physicians, interdisciplinary reflection, not avoiding end-of-life decisions, mutual respect within the interdisciplinary team, involvement of nurses in end-of-life care and decision-making, active decision-making by physicians, and ethical awareness). A total of 2,275 nurses and 717 physicians participated (response rate of 63%). Using cluster analysis, ICUs were categorized according to four ethical decision-making climates: good, average with nurses' involvement at end-of-life, average without nurses' involvement at end-of-life, and poor. Overall, physicians rated ethical decision-making climate more positively than nurses (p < 0.001 for all seven factors). Physicians had more positive perceptions of ethical decision-making climate than nurses in all 13 participating countries and in each individual participating ICU. Compared to ICUs with good or average ethical decision-making climates, ICUs with poor ethical decision-making climates had the greatest discordance between physicians and nurses. Although nurse/physician differences were found in all seven factors of ethical decision-making climate measurement, the factors with greatest discordance were regarding physician leadership, interdisciplinary reflection, and not avoiding end-of-life decisions. CONCLUSIONS: Physicians consistently perceived ICU ethical decision-making climate more positively than nurses. ICUs with poor ethical decision-making climates had the largest discrepancies.
Authors: Bo Van den Bulcke; Victoria Metaxa; Anna K Reyners; Katerina Rusinova; Hanne I Jensen; J Malmgren; Michael Darmon; Daniel Talmor; Anne-Pascale Meert; Laura Cancelliere; László Zubek; Paulo Maia; Andrej Michalsen; Erwin J O Kompanje; Peter Vlerick; Jolien Roels; Stijn Vansteelandt; Johan Decruyenaere; Elie Azoulay; Stijn Vanheule; Ruth Piers; Dominique Benoit Journal: Intensive Care Med Date: 2019-11-05 Impact factor: 17.440