Respecting the wishes of patients in intensive care units.
This study examined why intensive care unit (ICU) nurses experience difficulties in respecting the wishes of patients in end-of-life care in Japan. A questionnaire survey was conducted with ICU nurses working in Japanese university hospitals. The content of their narratives was analyzed concerning the reasons why the nurses believed that patients' wishes were not respected. The most commonly stated reason was that patients' wishes were impossible to realize, followed by the fact that decision making was performed by others, regardless of whether the patients' wishes were known, if the death was sudden, and time constraints. Many nurses wanted to respect the wishes of dying patients, but they questioned how patients die in ICUs and were therefore faced with ethical dilemmas. However, at the same time, many of the nurses realized that respecting patients' wishes about end-of-life care in an ICU would be difficult and that being unable to respect these wishes would often be unavoidable. The results thus suggest that there has been insufficient discussion about respecting the wishes of patients undergoing intensive care.
Kinoshita
Satomi
S
Kanagawa University of Human Services, Faculty of Health & Social Work, School of Nursing, Yokosuka Kanagawa. kinoshita-s@kuhs.ac.jp
D000328:Adult; D024362:Advance Directive Adherence / Q000941:ethics / Q000458:organization & administration / Q000523:psychology*; D016223:Advance Directives / Q000941:ethics / Q000523:psychology; D001291:Attitude of Health Personnel; D001293:Attitude to Death; D003220:Conflict, Psychological; D003422:Critical Care / Q000941:ethics / Q000458:organization & administration / Q000523:psychology*; D003657:Decision Making / Q000941:ethics; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006785:Hospitals, University; D006801:Humans; D007564:Japan; D008297:Male; D008875:Middle Aged; D009042:Motivation; D015404:Nursing Methodology Research; D009741:Nursing Staff, Hospital / Q000941:ethics / Q000458:organization & administration / Q000523:psychology*; D010344:Patient Advocacy / Q000941:ethics / Q000523:psychology; D012297:Right to Die / Q000941:ethics; D011795:Surveys and Questionnaires; D013727:Terminal Care / Q000941:ethics / Q000458:organization & administration / Q000523:psychology*; D028761:Withholding Treatment / Q000941:ethics