Perceptions of Ethical Decision-Making Climate among Clinicians Working in European and U.S. ICUs: Differences between Nurses and Physicians∗

Hanne Irene Jensen, Stine Hebsgaard, Tina Charlotte Bitsch Hansen, Rikke Frank Aagaard Johnsen, Christiane S. Hartog, Ioanna Soultati, Orsolya Szucs, Michael E. Wilson, Bo Van Den Bulcke, Dominique D. Benoit, Ruth Piers

Research output: Contribution to journalArticle

2 Scopus citations

Abstract

Objectives: To examine perceptions of nurses and physicians in regard to ethical decision-making climate in the ICU and to test the hypothesis that the worse the ethical decision-making climate, the greater the discordance between nurses' and physicians' rating of ethical decision-making climate with physicians hypothesized to rate the climate better than the nurses. Design: Prospective observational study. Setting: A total of 68 adult ICUs in 13 European countries and the United States. Subjects: ICU physicians and nurses. Interventions: None. Measurements and Main Results: Perceptions of ethical decision-making climate among clinicians were measured in April-May 2014, using a 35-items self-assessment questionnaire that evaluated seven factors (empowering leadership by physicians, interdisciplinary reflection, not avoiding end-of-life decisions, mutual respect within the interdisciplinary team, involvement of nurses in end-of-life care and decision-making, active decision-making by physicians, and ethical awareness). A total of 2,275 nurses and 717 physicians participated (response rate of 63%). Using cluster analysis, ICUs were categorized according to four ethical decision-making climates: good, average with nurses' involvement at end-of-life, average without nurses' involvement at end-of-life, and poor. Overall, physicians rated ethical decision-making climate more positively than nurses (p < 0.001 for all seven factors). Physicians had more positive perceptions of ethical decision-making climate than nurses in all 13 participating countries and in each individual participating ICU. Compared to ICUs with good or average ethical decision-making climates, ICUs with poor ethical decision-making climates had the greatest discordance between physicians and nurses. Although nurse/physician differences were found in all seven factors of ethical decision-making climate measurement, the factors with greatest discordance were regarding physician leadership, interdisciplinary reflection, and not avoiding end-of-life decisions. Conclusions: Physicians consistently perceived ICU ethical decision-making climate more positively than nurses. ICUs with poor ethical decision-making climates had the largest discrepancies.

Original languageEnglish (US)
Pages (from-to)1716-1723
Number of pages8
JournalCritical care medicine
Volume47
Issue number12
DOIs
StatePublished - Dec 1 2019

Keywords

  • conflicts
  • decision-making
  • end-of-life
  • ethical climate
  • intensive care unit
  • interprofessional collaboration

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine

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    Jensen, H. I., Hebsgaard, S., Hansen, T. C. B., Johnsen, R. F. A., Hartog, C. S., Soultati, I., Szucs, O., Wilson, M. E., Van Den Bulcke, B., Benoit, D. D., & Piers, R. (2019). Perceptions of Ethical Decision-Making Climate among Clinicians Working in European and U.S. ICUs: Differences between Nurses and Physicians∗. Critical care medicine, 47(12), 1716-1723. https://doi.org/10.1097/CCM.0000000000004017