Ethical issues recognized by critical care nurses in the intensive care units of a tertiary hospital during two separate periods.

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.

Perspectives on practicing procedures on the newly dead.

UNLABELLED: Invasive procedures are commonly practiced and taught on newly deceased patients (the newly dead) in emergency and critical care settings. Justified by the claim of necessity for professional competence to provide lifesaving care, these procedures, commonly hidden from public and professional scrutiny, are frequently performed on the newly dead without consent from family or interested parties. OBJECTIVE: To describe older adults' beliefs about practicing and teaching lifesaving procedures on the newly dead and their belief about the requirement for consent for these procedures. METHODS: An exploratory, descriptive design used a seven-item Likert-type instrument with open-ended questions to gather data from a convenience sample of 100 adults in two metropolitan cities. RESULTS: The typical respondent was 74.5 years old (mean; range of 55-95 years), female (71%), and married (44.8%) or widowed (36.5%). Most respondents were high school graduates (94%), and 63% had some level of college education. The majority of the sample was white (75%), they were predominately Protestant (40%), and 72% reported their health as good to excellent. Most study participants believed that practicing or teaching lifesaving skills on a newly dead body is acceptable (54%), and that provision for consent is necessary (80%). Planning to donate organs and preferring an autopsy were associated with agreeing that using the newly dead body for skill practice was acceptable; preferring cremation was related to believing that consent for skill practice on the newly dead was not necessary. CONCLUSIONS: The participants in this study value the use of the newly dead to practice and teach lifesaving skills, and believe that consent for this practice is necessary.