"It Kills Your Soul": A Mixed Methods Study of Ethical Sensitivity of Critical Care Nurses.

BACKGROUND: Critically ill patients often experience distressful and impactful symptoms and conditions that include pain, agitation/sedation, delirium, immobility, and sleep disturbances (PADIS). The presence of PADIS can affect recovery and long-term patient outcomes. An integral part of critical care nursing is PADIS prevention, assessment, and management. Ethical sensitivity of everyday nursing practice related to PADIS is an imperative part of implementing evidence-based care for patients. OBJECTIVE: The first 2 aims of this study were to determine the measured level of ethical awareness as an attribute of ethical sensitivity among the critical care nurse participants and to explore the ethical sensitivity of critical care nurses related to the implementation of PADIS care. The third aim was to examine how the measured level of ethical awareness and ethical sensitivity exploration results converge, diverge, and/or relate to each other to produce a more complete understanding of PADIS ethical sensitivity by critical care nurses. METHODS: This was a convergent parallel mixed methods study (QUAL + quant). Ethical sensitivity was explored by conducting an ethnography of critical care nurses. The participants were 19 critical care nurses who were observed during patient care, interviewed individually, participated in a focus group (QUAL), and were administered the Ethical Awareness Scale (quant). FINDINGS: Despite high levels of individual ethical awareness among nurses, themes of ambiguous beneficence, heedless autonomy, and moral distress were found to be related to PADIS care. CONCLUSIONS: More effort is needed to establish moral community, ethical leadership, and individual ethical guidance for nurses to establish patient-centered decision-making and PADIS care.

The integration of care ethics and nursing workload: A qualitative systematic review.

AIM: The aim of this review was to explore literature from January 2017 to December 2021 for specific aspects of care ethics related to nursing workload in the acute care setting. BACKGROUND: High nursing workload is associated with adverse outcomes for nurses as well as patients. Nursing workload goes beyond patient-to-nurse ratios and encompasses patient, nurse and organizational factors. EVALUATION: This qualitative systematic review was conducted according to the Joanna Briggs Institute Manual for Evidence Synthesis. The four features of care ethics related to nursing workload guided the review of qualitative studies in MEDLINE, CINAHL and PsycINFO, and synthesized findings were presented in the four phases of caring. KEY ISSUES: Key issues include ethical dilemmas, time pressure, shared moral burden and managerial support. CONCLUSION: To reduce nursing workload, a care ethics perspective can provide solutions through fortifying interprofessional relationships and enhancing empathetic actions. IMPLICATIONS FOR NURSING MANAGEMENT: Situational, individual and team approaches to management allows for incorporation of personal values and ethics of care to support patient-centred care. Leadership initiating conversations and being proactive about workload can lead to an improved work environment for both the nurse and the nurse manager.

Use of PADIS Assessment Tools by Critical Care Nurses: An Integrative Review.

The purpose of this integrative review was to evaluate the literature from January 2013 to April 2020 and to explore critical care nurses' perspectives of and intent to use recommended Pain, Agitation/Sedation, Delirium, Immobility, and Sleep Disruption (PADIS) patient assessment tools in adult critical care units. A literature search was performed with a total of 47 studies included in the final analysis for this review. The studies' data were organized and further reduced based on The Reasoned Action Approach behavioral theory to reflect the extent to which a nurse plans to use a PADIS assessment tool. Extracted themes were related to behavioral beliefs in patient-centered care and critical thinking; normative beliefs about communication and prioritization; and control beliefs concerning autonomy and confidence. Contextualizing the international phenomenon of variation in PADIS assessment tool use by critical care nurses provides a deeper understanding of its complexity for use in the clinical setting.