“It Is Difficult to Always Be an Antagonist”: Ethical, Professional, and Moral Dilemmas as Potentially Psychologically Traumatic Events among Nurses in Canada
Abstract
:1. Introduction
2. Background
Social Relations of Nursing: Hierarchy, Interaction, Moral Injury
3. The Study
3.1. Aims
3.2. Design
3.3. Sample
3.4. Data Collection
3.5. Ethical Considerations
3.6. Data Analysis
3.7. Validity and Reliability
4. Results
4.1. Ethical, Professional, and Moral Dilemmas
4.2. Disregarded Assessments and Lack of Agency in the Context of Medical Power
The patient had surgery to remove gall stones and returned. Overnight the patient’s developed requirements increased and troponin was elevated. Doctor was made aware three times overnight and did nothing. Said it was sepsis. By 10am the following morning the patient died (P2220).
Doctors not responding to assessments and patients dying because of it (P2973).
Part of a breach birth that had a negative outcome that was avoidable if the physician would have listened to nursing concerns. It makes it very difficult to work with that physician. It causes flashbacks of the incident and anxiety in myself (P3011).
There have been decisions that physicians have made that have not been supported by nurses (i.e., changing meds not being in the best interest of the patient). I’ve had a patient who was very quick to deteriorate with med adjustments… It was difficult to not feel like we had created that situation and indirectly caused the outcome for someone who had been doing well, and was only following doctors recommendations (P1203).
I was so busy tending to the patient and completing physician orders and barely meeting strict goals that in a 12 h shift I couldn’t take a mere 10 min to just be with the obviously devastated family, who were sobbing at his bedside. Instead of letting this man die peacefully surrounded by his family we took him away to IR, CT, etc., leaving fewer moments for them to be with the patient. Looking back, I’m angry and saddened about how aggressive our care was for a man that could not be saved. It robbed him of his dignity and his family’s ability to mourn his approaching death. The patient passed 2 h after I reported off to the day nurse.
It is difficult to watch how we currently extend the life of our palliative patients through medical intervention. I see daily a lot of prolonged suffering where nurses are often questioning the orders as we know there is no hope (P2919).
Being forced to give prescribed dose of medication knowing it will kill your terminally ill patient (P2373).
4.3. Witnessing, but Rarely Curbing, Physicians’ Behaviours
Client’s right to informed consent is not always respected, and fear tactics are sometimes used. This is really upsetting to me, but it is difficult to always be an antagonist with people I have to have a working relationship with (P2835).
Emergency vaginal/Forcep deliveries for women to deliver their babies alive when pain medication is not able to be given timely/pain medication isn’t effective at all. Feels like an assault when the women are screaming and yelling. I’ve also seen doctors pulling on and stretching women’s perineum during pushing—assault and women who are having their first baby think it’s normal. Doctors/residents who will do a cervical exam by putting their whole hand inside the woman’s vagina—should never be more than 2 fingers unless the woman is bleeding to death and needs a manual removal of her placenta (consented to by patient) (P2319).
4.4. Inadequate Resources and Life Changing Decision Making
Working in a specialized geriatric unit that is constantly understaffed and over capacity I see situations that are stressful every day where patients are not taken care of in a priority manner and they end up passing away due to lack of priority due to their age (P3908).
Feeling like you can’t provide quality care in hospital due to circumstances beyond your control (P3097).
Death of patients due to overcrowding, cuts, lack of adequate equipment or staff (P2249).
4.5. Enacting the Wishes of Family to Prolong Life
Moral distress—torturing a patient with “care” and procedures desired by the family that only cause harm and suffering. There is a desperation from the families to prolong an unprolongable life (P2258).
Torturing someone with invasive life support measures that only the family deem to be appropriate, despite a mountain of medical evidence to the contrary… We who treat suffering patients feel unable to speak up in advocacy of a patient whose family knows them best, and feels they know what their prior wishes would have been (P2317).
Keeping a patient alive when the patient is incompatible with life only to discontinue care 70 some days later once family is on board (P2338).
So many times in my career I am forced to give care that is futile, painful and won’t save or give my patient a good quality of life … family prolonging dying man’s life through artificial means and being extremely controlling and unreasonable, they were there 24/7 for close to 2 years (P2643).
It was a patient who was nearing the end of her life and her family demanded and expected unreasonable efforts made. They were also rude & confrontational with Staff. I feel it was unethical what was being done (P3173).
4.6. Professional Error
Patient died from error after I referred…Totally preventable (P1169).
Patient(s) dies or had serious injuries due to (what I think) me not doing my job optimally (P2663).
I was working ICU, and gave the wrong blood to a patient. That patient almost died. Only time in my life I considered suicide (P1162).
Witnessing loss of life of patients that I felt could have been saved by medical intervention (P844).
Responded to a trauma code the patient was unresponsive and posturing and remains with severe brain damage (May still be in a coma). There was only one other nurse who did questionable treatments and disagreed with me and took over moving the patient without following spinal precautions etc. (P2714).
A surgeon that caused injury and death for years at our hospital…It was a horrible time in my career. Very hard to care for his post surgical patients and watch them suffer. Also very hard to not warn the innocent public but if you did your entire career was in jeopardy (P2534).
The patient had been in unimaginable pain for HOURS and had deteriorating vital signs for a long time until the doctor on the unit actually decided to transfer her. The patient’s family were traumatized from the event and upset nothing had been investigated earlier. This was extremely upsetting to see as my patient suffered a great injury, and my co-worker let her down. It made me feel guilty for weeks as I wondered if there was anything I could have done differently. I visited her in CCU frequently and had insomnia for many nights due to this patient harm (P2026).
4.7. Not Adhering to Patient’s Wishes
Pt had made self DNR but family rescinded it when patient not capable anymore, so they got attached and lived on a ventilator for 9 months begging to be allowed to die. Family never visited.
Watching my patients suffer because their family is not realistic about goals of care. Continuing full medical interventions when patients tell me they don’t want to or ask me to stop but unable because the family or decision maker has decided to continue (P2262).
The person involved was deemed unable to make decisions for their own health care, but was alert and vocal (P1827).
Very difficult to lose any patient, it is emotionally and ethically challenging when family change patient’s wishes of DNR to full code post patient losing consciousness (P3842).
5. Discussion
Limitations
6. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
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Participant Responses | Percent | |
---|---|---|
Sample | 120 | 100 |
Gender | ||
Male | 3 | 2.5 |
Female | 117 | 97.5 |
Age Group | ||
19–29 | 18 | 15 |
30–39 | 29 | 24.2 |
40–49 | 15 | 12.5 |
50–59 | 18 | 15 |
60+ | 10 | 8.3 |
Unassigned | 30 | 25 |
Job Length | ||
Under 1 year | 3 | 2.5 |
1 to under 5 years | 26 | 21.7 |
5 to under 10 years | 26 | 21.7 |
10 to under 20 years | 28 | 23.3 |
20+ years | 37 | 30.8 |
Nursing License | ||
Registered Psychiatric Nurse | 3 | 2.5 |
Registered Nurse | 108 | 90 |
Nurse Practitioner | 2 | 1.7 |
Licensed or Registered Practical Nurse | 5 | 4.2 |
Other | 2 | 1.7 |
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Ricciardelli, R.; Johnston, M.S.; Bennett, B.; Stelnicki, A.M.; Carleton, R.N. “It Is Difficult to Always Be an Antagonist”: Ethical, Professional, and Moral Dilemmas as Potentially Psychologically Traumatic Events among Nurses in Canada. Int. J. Environ. Res. Public Health 2022, 19, 1454. https://doi.org/10.3390/ijerph19031454
Ricciardelli R, Johnston MS, Bennett B, Stelnicki AM, Carleton RN. “It Is Difficult to Always Be an Antagonist”: Ethical, Professional, and Moral Dilemmas as Potentially Psychologically Traumatic Events among Nurses in Canada. International Journal of Environmental Research and Public Health. 2022; 19(3):1454. https://doi.org/10.3390/ijerph19031454
Chicago/Turabian StyleRicciardelli, Rosemary, Matthew S. Johnston, Brittany Bennett, Andrea M. Stelnicki, and R. Nicholas Carleton. 2022. "“It Is Difficult to Always Be an Antagonist”: Ethical, Professional, and Moral Dilemmas as Potentially Psychologically Traumatic Events among Nurses in Canada" International Journal of Environmental Research and Public Health 19, no. 3: 1454. https://doi.org/10.3390/ijerph19031454