title: Ethical issues recognized by critical care nurses in the intensive care units of a tertiary hospital during two separate periods.
abstract: This research aimed to investigate the changes in ethical issues in everyday clinical practice recognized by critical care nurses during two observation periods. We conducted a retrospective analysis of data obtained by prospective questionnaire surveys of nurses in the intensive care units (ICU) of a tertiary university-affiliated hospital in Seoul, Korea. Data were collected prospectively during two different periods, February 2002-January 2003 (Period 1) and August 2011-July 2012 (Period 2). Significantly fewer cases with ethical issues were reported in Period 2 than in Period 1 (89 cases [2.1%] of 4,291 ICU admissions vs. 51 [0.5%] of 9,302 ICU admissions, respectively; P < 0.001). The highest incidence of cases with identified ethical issues in both Periods occurred in MICU. The major source of ethical issues in Periods 1 and 2 was behavior-related. Among behaviorrelated issues, inappropriate healthcare professional behavior was predominant in both periods and mainly involved resident physicians. Ethical issue numbers regarding end-oflife (EOL) care significantly decreased in the proportion with respect to ethical issues during Period 2 (P = 0.044). In conclusion, the decreased incidence of cases with identified ethical issues in Period 2 might be associated with ethical enhancement related with EOL and improvements in the ICU care environment of the studied hospital. However, behaviorrelated issues involving resident physicians represent a considerable proportion of ethical issues encountered by critical care nurses. A systemic approach to solve behavior-related issues of resident physicians seems to be required to enhance an ethical environment in the studied ICU.
authors.affiliation: Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea.
authors.forename: Dong Won
authors.identifier: 0000-0002-4538-6045
authors.initials: DW
authors.lastname: Park
authors.affiliation: Department of Internal Medicine, Chungnam National University College of Medicine. Daejeon, Korea.
authors.forename: Jae Young
authors.identifier: 0000-0001-8724-6289
authors.initials: JY
authors.lastname: Moon
authors.affiliation: Department of Nursing, College of Medicine, Konkuk University, Seoul, Korea.
authors.forename: Eun Yong
authors.initials: EY
authors.lastname: Ku
authors.affiliation: Department of Internal Medicine, College of Medicine, Konkuk University, Seoul, Korea.
authors.forename: Sun Jong
authors.identifier: 0000-0003-3237-4499
authors.initials: SJ
authors.lastname: Kim
authors.affiliation: Department of Medical Humanities and Social Sciences, University of Ulsan College of Medicine, Seoul, Korea.
authors.forename: Young-Mo
authors.identifier: 0000-0002-3736-5797
authors.initials: YM
authors.lastname: Koo
authors.affiliation: Department of Medical History and Medical Humanities, Seoul National University College of Medicine, Seoul, Korea.
authors.forename: Ock-Joo
authors.identifier: 0000-0003-4095-4768
authors.initials: OJ
authors.lastname: Kim
authors.affiliation: Department of Nursing, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
authors.forename: Soon Haeng
authors.initials: SH
authors.lastname: Lee
authors.affiliation: Department of Preventive Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
authors.forename: Min-Woo
authors.identifier: 0000-0002-4574-1318
authors.initials: MW
authors.lastname: Jo
authors.affiliation: Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
authors.forename: Chae-Man
authors.identifier: 0000-0001-5400-6588
authors.initials: CM
authors.lastname: Lim
authors.affiliation: National Jewish Health, Denver, Colorado, USA.
authors.forename: John David
authors.initials: JD
authors.lastname: Armstrong
authors.affiliation: Department of Medical Humanities and Social Sciences, University of Ulsan College of Medicine, Seoul, Korea. ; Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
authors.forename: Younsuck
authors.identifier: 0000-0001-5066-2027
authors.initials: Y
authors.lastname: Koh
mesh_terms: D064648:Critical Care Nursing / Q000941:ethics*; D006801:Humans; D007362:Intensive Care Units; D009726:Nurses; D012189:Retrospective Studies; D013727:Terminal Care; D062606:Tertiary Care Centers
keywords: Behavior; Critical Care; Ethics; Intensive Care Units; Nurses; Questionnaires
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