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Title: Moral distress in end-of-life care decisions in the intensive care unit
Author: St.Ledger, Una
ISNI:       0000 0004 6061 6747
Awarding Body: Queen's University Belfast
Current Institution: Queen's University Belfast
Date of Award: 2016
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Background: Moral distress is a poorly recognised and understood phenomenon and little is known of the triggering factors in ICU end-of-life decisions. Prior research focused largely on nurses, less was known about doctors’ experiences, and moral distress in relatives was under-investigated. Aim: To identify the triggers and constraints generating moral distress in end-of-life decisions in ICU and the consequences of moral distress for the clinical staff and relatives involved. Methods: A qualitative narrative thematic analysis of in-depth interviews with 20 bereaved relatives and 45 nurses and doctors closely involved in 21 patient cases of non-escalation and withdrawal of therapy, and organ donation following brain-stem death and circulatory death. The study was conducted in a large ICU in Northern Ireland (August 2012- November 2013) and funded by the Research and Development Office of the Public Health Agency. Key Findings: ICU staff and relatives experienced considerable moral distress in end-of-life care decisions. Bedside nurses and junior medical trainees with perceived lower levels of knowledge, experience and influence in end-of-life decisions experienced more moral distress than consultants and senior nurses. At least half of relatives experienced moral distress at some point along the ICU end-of-life care trajectory. Triggers specific to all three participant groups included breaches in the consistency and continuity of care delivery and end-of-life decisions and insensitive and lengthy organ retrieval procedures. In particular, failure to ensure ‘The Good Death’ left a powerful sense of failed obligation. Some relatives continued to experience the aftermath of moral distress several months after the death. Conclusions: Findings have important implications for (a) educational preparation of new ICU nurses and doctors to prepare them for the complexities of the ethically challenging ICU environment: (b) the support of relatives in ICU with follow-up after the death; and (c) improvement in organ retrieval services in Northern Ireland.
Supervisor: Not available Sponsor: Not available
Qualification Name: Thesis (M.D.) Qualification Level: Doctoral
EThOS ID:  DOI: Not available