Ethical dilemmas of end-of-life care in intensive care unit: a literature review

Albertus Budi Arianto; Yanny Trisyani; Etika Emiliyawati

doi:10.17509/jpki.v4i2.101

Abstract

The end-of-life (EOL) care is the progressive terminal illness, leading to death; that in the situation the nurse have significant role in decision making. In decision making, temporarily, the nurse will experiences the ethical dilemmas, including in intensive care unit (ICU) with any factors resulting in problem in medical decision making. The literature review intends to analyze the description of ethical dilemmas occurred in intensive care unit, especially to the EOL care. A method used is critical review full text of 2007-2018 periods in English langguage. The multiple databases used is PubMed, Proquest and Google Scholar with keyword “End of Life Care” and “Nursing Ethic in critical care” and “issue End-of-life critical care”, and “Dilemmas Ethic in ICU.” The articles selected gradually by using of Appraisal tool of PRISMA and obtained 21 articles. The literature study obtaining 4 themes related to description of the ethical dilemmas in ICU including (1) the ethical principle involved in EOL care at ICU, (2) resource of ethical conflict in ICU, (3) impact of ethical conflict in ICU, and (4) response of nurse in dealing with ethical dilemmas. The discussion of literature review related to the perception of nurse on EOL care; that nurse have important role in medical decision making involving ethical principle in the implementation. it is required further research on exploration of nurse experience on implementation of ethical principle in case of EOL care.

Abstrak

Perawatan end of life (EOL) merupakan suatu perawatan pada penyakit terminal yang bersifat progresif, yang akan berujung dengan kematian, pada kondisi ini perawat mempunyai peran dalam pengambilan keputusan perawatan. Terkadang dalam pengambilan keputusan ini perawat akan mengalami kondisi dilema etik, tak terkecuali di ruangan intensive care unit dimana diruangan tersebut banyak faktor yang mengakibatkan kesulitan dalam pengambilan keputusan medis. Literature reviews ini bertujuan untuk menganalisia gambaran dilema etik yang terjadi di area intensive khususnya pada kasus end of life care. Metode yang digunakan adalah critical review full text dengan rentang tahun 2007-2018 dalam Bahasa Inggris. Multiple database yang digunakan adalah PubMed, Proquest dan Google Scholar merupakan database yang digunakan, dengan kata kunci “End Of Life Care” and “Nursing Ethic in critical care” and “issue End-of-life in critical care”, and“Dilema Ethic in ICU”. Artikel diseleksi bertahap menggunakan Appraisal tool PRISMA dan didapatkan 21 artikel. Studi literatur diperoleh 4 tema terkait gambaran dilema etik di ruang ICU diantaranya (1) Prinsip etik yang terlibat dalam end of life care di ICU, (2) Sumber konflik etik di ICU, (3) Dampak konflik etik di ICU, dan (4) Respon perawat dalam menghadapi dilema etik. Pembahasan telaah literatur ini terkait persepsi perawat mengenai perawatan end of life, dimana perawat mempunyai peran penting dalam pengambilan keputusan medis yang melibatkan prinsip etik dalam pelaksanaannya. Diperlukan penelitian lebih lanjut mengenai eksplorasi pengalaman perawat terhadap implementasi prinsip etik pada kasus perawatan menjelang ajal.

Keywords:

End-of-life-care ethical dilemmas in ICU issue end of-life in critical care nursing ethic in critical care

References

Advanced Illness & End-Of-Life Care. (2017). Advanced illness & end-of-life care. Health Affairs, 36(7), 1168–1169. https://doi.org/10.1377/hlthaff.2017.0544.

Alligood, M. R. (2014). Nursing Theorists and Their Work (8th edn)Alligood, M. R. (2014). Nursing Theorists and Their Work (8th edn). Nursing Theorists and Their Work (8th edn). http://doi.org/10.5172/conu.2007.24.1.106a. Nursing Theorists and Their Work (8th Edn), 746. https://doi.org/10.5172/conu.2007.24.1.106a.

Azoulay, É., Timsit, J. F., Sprung, C. L., Soares, M., Rusinová, K., Lafabrie, A., … Schlemmer, B. (2009). Prevalence and factors of intensive care unit conflicts: The conflicus study. American Journal of Respiratory and Critical Care Medicine. https://doi.org/10.1164/rccm.200810-1614OC

Crump, S. K., Schaffer, M. a, & Schulte, E. (2010). Critical care nurses’ perceptions of obstacles, supports, and knowledge needed in providing quality end-of-life care. Dimensions of Critical Care Nursing : DCCN, 29(6), 297–306. https://doi.org/10.1097/DCC.0b013e3181f0c43c

De Casterlé, B. D., Izumi, S., Godfrey, N. S., & Denhaerynck, K. (2008). Nurses’ responses to ethical dilemmas in nursing practice: Meta-analysis. Journal of Advanced Nursing, 63(6), 540–549. https://doi.org/10.1111/j.1365-2648.2008.04702.x

Del Mar Rivero, M. (2012). Ethical dilemas in the ICU: An everyday issue. Critical Care and Shock, 15(3), 64. Retrieved from http://www.embase.com/search/results?subaction=viewrecord%7B&%7Dfrom=export%7B&%7Did=L71527471%5Cnhttp://limo.libis.be/resolver?%7B&%7Dsid=EMBASE%7B&%7Dissn=14107767%7B&%7Did=doi:%7B&%7Datitle=Ethical+dilemas+in+the+ICU:+An+everyday+issue%7B&%7Dstitle=Cri

Efstathiou, N., & Walker, W. (2014). Intensive care nurses’ experiences of providing end-of-life care after treatment withdrawal: A qualitative study. Journal of Clinical Nursing, 23(21–22), 3188–3196. https://doi.org/10.1111/jocn.12565

Erdil, F., & Korkmaz, F. (2009). Ethical problems observed By student nurses. Nursing Ethics. https://doi.org/10.1177/0969733009106651

Falcó-Pegueroles, A., Lluch-Canut, T., Roldan-Merino, J., Goberna-Tricas, J., & Guàrdia-Olmos, J. (2015). Ethical conflict in critical care nursing: Correlation between exposure and types. Nursing Ethics, 22(5), 594–607. https://doi.org/10.1177/0969733014549883

Fernandes, M. I., & Moreira, I. M. (2012). Ethical issues experienced by intensive care unit nurses in everyday practice. Nursing Ethics, 20(1), 72–82. https://doi.org/10.1177/0969733012452683

Ferrell, B. R., Virani, R., Paice, J. A., Malloy, P., & Dahlin, C. (2010). Statewide efforts to improve palliative care in critical care settings. Critical Care Nurse, 30(6), 40–45. https://doi.org/10.4037/ccn2010248

Fridh, I., Forsberg, A., & Bergbom, I. (2009). Doing one’s utmost: Nurses’ descriptions of caring for dying patients in an intensive care environment. Intensive and Critical Care Nursing, 25(5), 233–241. https://doi.org/10.1016/j.iccn.2009.06.007

Hamric, A. B., & Blackhall, L. J. (2007). Nurse-physician perspectives on the care of dying patients in intensive care units: Collaboration, moral distress, and ethical climate. Critical Care Medicine, 35(2), 422–429. https://doi.org/10.1097/01.CCM.0000254722.50608.2D

Holt, J. (2017). Ethical Issues at the end of Life. Key Concepts and Issues in Nursing Ethics, 101(10), 129–143. https://doi.org/10.1007/978-3-319-49250-6_10

Jamshidian, F., Shahriari, M., & Aderyani, M. R. (2018). Effects of an ethical empowerment program on critical care nurses’ ethical decision-making. Nursing Ethics. https://doi.org/10.1177/0969733018759830

McAndrew, N. S., Leske, J. S., & Garcia, A. (2011). Influence of moral distress on the professional practice environment during prognostic conflict in critical care. Journal of Trauma Nursing : The Official Journal of the Society of Trauma Nurses. https://doi.org/10.1097/JTN.0b013e31823a4a12

Moon, J. Y., & Kim, J.-O. (2015). Ethics in the Intensive Care Unit. Tuberculosis and Respiratory Diseases, 78(3), 175. https://doi.org/10.4046/trd.2015.78.3.175

Oerlemans, A. J. M., Van Sluisveld, N., Van Leeuwen, E. S. J., Wollersheim, H., Dekkers, W. J. M., & Zegers, M. (2015). Ethical problems in intensive care unit admission and discharge decisions: A qualitative study among physicians and nurses in the Netherlands. BMC Medical Ethics. https://doi.org/10.1186/s12910-015-0001-4

Park, Dong Won., & Moon, Jae Young., & Ku, Eun Yong., & Kim, Sun Jong., & Koo, Young-Mo., & Kim, Ock-Joo., & Lee, Soom Haeng., & Jo, Min-Woo., & Lim, Chae-Man., & Armstrong II , John David., & Koh, Y. (2015). Ethical issues recognized by critical care nurses in the intensive care union of a Tertiary hospital during two separate periods. Journal of Korean Medical Science, 30, 495–501. https://doi.org/10.3346/jkms.2015.30.4.495

Pavlish, C., Brown-Saltzman, K., Hersh, M., Shirk, M., & Rounkle, A. M. (2011a). Nursing priorities, actions, and regrets for ethical situations in clinical practice. Journal of Nursing Scholarship. https://doi.org/10.1111/j.1547-5069.2011.01422.x

Romano, M. E., Wahlander, S. B., Lang, B. H., Li, G., & Prager, K. M. (2009). Mandatory ethics consultation policy. Mayo Clinic Proceedings. https://doi.org/10.4065/84.7.581

Santiago, C., & Abdool, S. (2011). Conversations about challenging end-of-life cases: ethics debriefing in the medical surgical intensive care unit. Dynamics (Pembroke, Ont.).

Sorta-Bilajac, I., Baždarić, K., Brkljačić Žagrović, M., Jančić, E., Brozović, B., Čengić, T., … Agich, G. J. (2011). How Nurses and physicians face ethical dilemmas — the Croatian experience. Nursing Ethics, 18(3), 341–355. https://doi.org/10.1177/0969733011398095

Tapper, E. B., Vercler, C. J., Cruze, D., & Sexson, W. (2010). Ethics consultation at a large urban public teaching hospital. Mayo Clinic Proceedings. https://doi.org/10.4065/mcp.2009.0324

Vanderspank-Wright, B., Fothergill-Bourbonnais, F., Brajtman, S., & Gagnon, P. (2011). Caring for patients and families at end of life: The experiences of nurses during withdrawal of life-sustaining treatment. Dynamics, 22(4), 31–5. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/22282952

Wiegand, D. L., & Funk, M. (2012). Consequences of clinical situations that cause critical care nurses to experience moral distress. Nursing Ethics. https://doi.org/10.1177/0969733011429342

Zeitzer, M. B. (2009). Ethical issues and decision making related to resuscitation of severely injured patients: Perceptions of emergency department nurses. ProQuest Dissertations and Theses. Retrieved from http://search.proquest.com/docview/304979280?accountid=14553%5Cnhttp://openurl.library.uiuc.edu/sfxlcl3?url_ver=Z39.88-2004&rft_val_fmt=info:ofi/fmt:kev:mtx:dissertation&genre=dissertations+&+theses&sid=ProQ:ProQuest+Dissertations+&+Theses+Full+Text&atitl