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Moral distress in end-of-life care in the intensive care unit

Authors

  • Una St Ledger MSc RNT RGN,

    Research & Development Doctoral Fellowship Student
    1. Centre for Infection and Immunity, School of Medicine, Dentistry and Biomedical Sciences, Queen's University of Belfast, Belfast, UK
    2. Nursing Development Lead for Adult Critical Care, Resuscitation, and Pain Services, Belfast Health and Social Care Trust, Belfast, UK
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  • Ann Begley PhD FFNMRCSI RGN,

    Lecturer in Ethics
    1. The Virtual University of Uganda, Kampala, Uganda
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  • Joanne Reid PhD RNT RGN,

    Lecturer in Nursing
    1. The School of Nursing & Midwifery, Queen's University of Belfast, Belfast, UK
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  • Lindsay Prior BSc MA PhD,

    Professor of Sociology
    1. The School of Sociology, Social Policy and Social Work, and Centre of Excellence in Public Health, Queen's University of Belfast, Belfast, UK
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  • Danny McAuley MD FRCP FFICM,

    Consultant and Professor in Intensive Care Medicine
    1. Centre for Infection and Immunity, School of Medicine, Dentistry and Biomedical Sciences, Queen's University of Belfast, Belfast, UK
    2. Regional Intensive Care Unit, The Royal Hospitals, Belfast Health and Social Care Trust, Belfast, UK
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  • Bronagh Blackwood PhD RNT RGN

    Senior Lecturer, Corresponding author
    • Centre for Infection and Immunity, School of Medicine, Dentistry and Biomedical Sciences, Queen's University of Belfast, Belfast, UK
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Correspondence to U. St Ledger:

e-mail: ustledger01@qub.ac.uk

Abstract

Aim

To explore moral distress in relatives doctors and nurses, in end-of-life care decision-making, in the adult intensive care unit.

Background

Many deaths in intensive care involve decisions about withholding and withdrawing therapy, potentially triggering moral distress. Moral distress occurs when individuals feel constrained from acting in accordance with moral choice, or act against moral judgement, generating painful, unresolved emotions, and problems that continue long after an event. Prior research has focused mainly on nurses; less is known about doctors' experiences and occurrence and impact on relatives is unknown.

Design

A narrative inquiry case study approach, funded by a Northern Ireland Health and Social Care Doctorate Fellowship Award (April 2011).

Methods

In-depth digitally recorded interviews will be conducted with relatives, doctors, and nurses involved in end-of-life cases comprising: (1) withdrawal of therapy, including circulatory death organ donation; (2) non-escalation of therapy; and (3) brain stem death with a request for organ donation. Relatives will be offered the opportunity to share their experiences on ‘Healthtalkonline’ by copyrighting audio-visual interviews to the Health Experiences Research Group, Oxford University. Research Ethics Committee approval was obtained (April 2012).

Discussion

This is the first time that moral distress is explored, in a case approach, among relatives, doctors, and nurses intimately involved in end-of-life decisions in intensive care. Dissemination of findings will make a large contribution to international knowledge and understanding in this area and alert healthcare professionals and relatives to an otherwise under-recognized, but potentially detrimental, experience. Findings will inform education, practice, and policy.

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