The Relationship between Moral Sensitivity and Nurses' Perception of Futile Care in Patients with Covid-19
akhlāq-i pizishkī i.e., Medical Ethics,
Vol. 14 No. 45 (1399),
30 March 2020
,
Page 1-16
https://doi.org/10.22037/mej.v14i45.32999
Abstract
Background and Aim: Nurses' perceptions and attitudes about futility can sometimes lead to the cessation of valuable treatments or the refusal to provide care to patients. On the other hand, having moral sensitivity can change the perspective of nurses in the face of ethical challenges in caring for patients with Covid-19 and may be effective improve nurses’ perception of futile care and the quality of care. The aim of this study was to determine the relationship between moral sensitivity and nurses' perception of futile care in patients with Covid-19 in hospitals affiliated to Hamadan University of Medical Sciences in 2020.
Materials and Methods: The present study is a descriptive-correlational study that was performed on 150 nurses working in selected hospitals in Hamadan province in 2020. Participants were selected by convenience sampling. Tools of data collection are used in a research study included a three-part questionnaire of demographic information, Lutzen's moral sensitivity and perception of futile care designed based on Corley's moral distress scale and review of related texts, which was distributed as a physical presence in the hospital and an electronic version. Data analysis was performed using SPSS software version 26 and descriptive statistics (frequency, mean and standard deviation) and analytical statistics (Independent T-test, ANOVA, Pearson correlation coefficient and differential correlation).
Findings: Although there no significant relationship was seen between moral sensitivity and intensity of perception of futile care (r=0.277, p=0.06) and frequency (r=0.213, p=0.15) but is a significant positive relationship between some subclasses of moral sensitivity and perception of futile care. The mean score of nurses' moral sensitivity was low (36.12±3.46) and most of the participants had a moderate perception of the intensity (47.12±8.22) and frequency of futile care (32.43±5.76). Also between moral sensitivity and work experience (r=0.324, p=0.03) and age (r=0.279, p=0.04) and work nurses’ experience with intensive care futile (r=0.311, p=0.04) and its frequency (r=0.235, p=0.02) showed a significant relationship.
Ethical Considerations: This research has been approved by the ethics committee of Hamadan University of Medical Sciences (IR.UMSHA.REC.1399.572). After obtaining informed consent from the participants, the researcher assured them that all their information would be confidential.
Conclusion: Several factors are involved in the level of moral sensitivity and perception of nurses' futile care in the care of Covid-19 patients. No significant correlation between moral sensitivity and the perception of futile care in this study was in a situation where nurses faced the peak of the Covid-19 pandemic and were under high organizational and psychological pressures. Therefore, for better conclusions, it is suggested that this study be conducted with further sample size and in the Covid-19 and non-Covid-19 wards.
Cite this article as: Hajiloo P, Torabi M. The Relationship between Moral Sensitivity and Nurses' Perception of Futile Care in Patients with Covid-19. Faṣlnāmah-i akhlāq-i pizishkī i.e., Quarterly Journal of Medical Ethics. 2020; 14(45): e27.
- Futile Care; Moral Sensitivity; Nurse; Covid-19
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References
Goethals S, Gastmans C, De Casterlé BD. Nurses’ ethical reasoning and behaviour: A literature review. International Journal of Nursing Studies 2010; 47(5): 635-650.
Kim YS, Park JW, You MA, Seo YS, Han SS. Sensitivity to ethical issues confronted by Korean hospital staff nurses. Nursing Ethics 2005; 12(6): 595-605.
Borhani F, Abbas Zadeh A, Kohan M, Fazayel M. Comparison of ethical reasoning abilities in dealing with ethical dilemmas in nurses and nursing students of Kerman University of Medical Sciences. Med Ethics Hist 2010; 3(4): 71-81.
Schroeter K. Ethics in perioperative practice patient advocacy. AORN Journal 2002; 75(5): 941-944.
Cavinder C. The relationship between providing neonatal palliative care and nurses' moral distress: An integrative review. Advances in Neonatal Care 2014; 14(5): 322-328.
Weaver K. Ethical sensitivity: State of knowledge and needs for further research. Nursing Ethics 2007; 14(2): 141-155.
Beidler SM. Ethical considerations for nurse-managed health centers. Nursing Clinics 2005; 40(4): 759-770.
Butts D, Janie B. Nursing ethics: Across the curriculum and into practice book review. Online Journal of Health Ethics 2005; 2(2): 2.
Abdou H, Baddar F, Alkorashy H. The relationship between work environment and moral sensitivity among nursing faculty assistants. World Applied Sciences Journal 2010; 11(11): 1375-1387.
Hunt G. Moral crisis, professionals and ethical education. Nursing Ethics 1997; 4(1): 29-38.
Hasanpour M, Hosseini M. Fallahi khoshknab M, Abaszadeh M. The effect of nursing ethics, ethical decision-making on sensitive social security hospitals in Kerman, 2010. Journal of Medical Ethics and History of Medicine 2011; 4(5): 58-64.
Heshmatifar N, Mohsenpour M, Rakhshani MH. Barriers to moral sensitivity from the perspective of nurses in Sabzevar teaching hospitals. Ethics and History of Medicine 2014; 7(1): 34-42. [Persian]
Dehghani A, Pak D, Gharib M. Barriers to professional ethics standards in clinical care from the perspective of nurses. Iranian Journal of Medical Education 2013; 13(5): 421-430. [Persian]
Lützén K, Dahlqvist V, Eriksson S, Norberg A. Developing the concept of moral sensitivity in health care practice. Nursing Ethics 2006; 13(2): 187-196.
Borhani F, Abbaszadeh A, Mohsenpour M. Nursing students’ understanding of factors influencing ethical sensitivity: a qualitative study. Iranian Journal of Nursing and Midwifery Research 2013; 18(4): 310.
Baykara ZG, Demir SG, Yaman S. The effect of ethics training on students recognizing ethical violations and developing moral sensitivity. Nursing Ethics 2015; 22(6): 661-675.
Schluter J, Winch S, Holzhauser K, Henderson A. Nurses' moral sensitivity and hospital ethical climate: A literature review. Nurs Ethics 2008; 15(3): 304-321.
Azodi F, Sharif F, Azodi P, Shirazi ZH, Khalili A, Jahanpour F. The reasons of tendency toward hookah smoking among teens and youth in Iran-A qualitative study. Journal of Pharmaceutical Sciences and Research 2017; 9(9): 1642-1646.
Weaver K, Morse JM. Pragmatic utility: Using analytical questions to explore the concept of ethical sensitivity. Research and Theory for Nursing Practice 2006; 20(3): 191-214.
Bischko D. The art of nursing: the client-nurse relationship as a therapeutic tool. Nursing Case Management: Managing the Process of Patient Care 1998; 3(4): 148-150.
John ME, Mgbekem MA, Nsemo AD, Maxwell GI. Missed nursing care, patient outcomes and care outcomes in selected hospitals in Southern Nigeria. Nursing 2016; 5(4): 1-5.
McGuire AL, Aulisio MP, Davis FD, Erwin C, Harter TD, Jagsi R, et al. Ethical Challenges Arising in the COVID-19 Pandemic: An Overview from the Association of Bioethics Program Directors (ABPD) Task Force. Am J Bioeth 2020; 20(7): 15-27.
Turale S, Meechamnan C, Kunaviktikul W. Challenging times: Ethics, nursing and the COVID-19 pandemic. Int Nurs Rev 2020; 67(2): 164-167.
Biddison ELD, Gwon HS, Schoch-Spana M, Regenberg AC, Juliano C, Faden RR, et al. Scarce Resource Allocation During Disasters: A Mixed-Method Community Engagement Study. Chest 2018; 153(1): 187-195.
Emanuel EJ, Persad G, Upshur R, Thome B, Parker M, Glickman A, et al. Fair Allocation of Scarce Medical Resources in the Time of Covid-19. N Engl J Med 2020; 382(21): 2049-2055.
Gulia A, Salins N. Ethics-based decision-making in a COVID-19 pandemic crisis. Indian J Med Sci 2020; 72(2): 39-40.
Shah P, Smith H, Olarewaju A, Jani Y, Cobb A, Owens J, et al. Is Cardiopulmonary Resuscitation Futile in Coronavirus Disease 2019 Patients Experiencing In-Hospital Cardiac Arrest? Crit Care Med 2021; 49(2): 201-208.
Wilson D, Savulescu J. Knowing when to stop: Futility in the intensive care unit. Curr Opin Anaesthesiol 2011; 24(2): 160-165.
Meltzer LS, Huckabay LM. Critical care nurses’ perceptions of futile care and its effect on burnout. American Journal of Critical Care 2004; 13(3): 202-208.
Mobley MJ, Rady MY, Verheijde JL, Patel B, Larson JS. The relationship between moral distress and perception of futile care in the critical care unit. Intensive Crit Care Nurs 2007; 23(5): 256-263.
Gabbay E, Calvo-Broce J, Meyer KB, Trikalinos TA, Cohen J, Kent DM. The empirical basis for determinations of medical futility. Journal of General Internal Medicine 2010; 25(10): 1083-1089.
Palda VA, Bowman KW, McLean RF, Chapman MG. "Futile" care: Do we provide it? Why? A semistructured, Canada-wide survey of intensive care unit doctors and nurses. Journal of Critical Care 2005; 20(3): 207-213.
McCabe MS, Storm C. When doctors and patients disagree about medical futility. Journal of Oncology Practice 2008; 4(4): 207.
Rostami S, Esmaeali R, Jafari H, Cherati JY. Perception of futile care and caring behaviors of nurses in intensive care units. Nurs Ethics 2019; 26(1): 248-255.
Moaddaby S, Adib M, Ashrafi S, Kazemnezhad Leili E. Perception of the Futile Care and its Relationship With Moral Distress in Nurses of Intensive Care Units. Journal of Holistic Nursing and Midwifery 2021; 31(2): 85-92.
Schneiderman LJ. Defining Medical Futility and Improving Medical Care. J Bioeth Inq 2011; 8(2): 123-131.
Niederman MS, Berger JT. The delivery of futile care is harmful to other patients. Crit Care Med 2010; 38(10 Suppl): S518-522.
Davis JK. Futility, conscientious refusal and who gets to decide. J Med Philos 2008; 33(4): 356-373.
Utkualp N. Ethical issues and dilemmas encountered in nursing practice in Turkey. International Journal of Caring Sciences 2015; 8(3): 830.
Araç B, Doğan R, Sarıtaş S. Determining the Moral Sensitivity of Intensive Care Nurses. International Journal of Medical Investigation 2018; 7(1): 88-97.
Borhani F, Alhani F, Mohammadi I, Abbaszadeh A. Professional nursing ethics: It's development and challenges. Medical Ethics and History of Medicine 2009; 2(3): 27-38.
Martínez-Sellés D, Martínez-Sellés H, Martinez-Sellés M. Ethical Issues in Decision-making Regarding the Elderly Affected by Coronavirus Disease 2019: An Expert Opinion. Eur Cardiol 2020; 15: e48.
Cai H, Tu B, Ma J, Chen L, Fu L, Jiang Y. Psychological impact and coping strategies of frontline medical staff in Hunan between January and March 2020 during the outbreak of Coronavirus Disease 2019 (COVID-19) in Hubei, China. Med Sci Monit 2020; 26: e924171.
Findlay M, Loke JY, Remolina N, Tham B. Ethics, AI, Mass Data and Pandemic Challenges: Responsible Data Use and Infrastructure Application for Surveillance and Pre-emptive Tracing Post-crisis. Paper Forthcoming. Singapore: SMU Centre for AI & Data Governance Research; 2020. p.1-51.
Bridges J, Nicholson C, Maben J, Pope C, Flatley M, Wilkinson C, et al. Capacity for care: meta‐ethnography of acute care nurses' experiences of the nurse‐patient relationship. Journal of Advanced Nursing 2013; 69(4): 760-772.
Godlee F. Paying the ultimate price. British Medical Journal Publishing Group 2020; 369: m1605.
Saberi Isfeedvajani M, Fares F, Ismaili Shahroudi Moqaddam Z. Ethical Issues in COVID-19 Pandemic. Hospital Practices and Research 2020; 5(4): 126-133.
Robert R, Kentish-Barnes N, Boyer A, Laurent A, Azoulay E, Reignier J. Ethical dilemmas due to the Covid-19 pandemic. Ann Intensive Care 2020; 10(1): 84.
Amiri E, Ebrahimi H, Vahidi M, Asghari Jafarabadi M, Namdar Areshtanab H. Relationship between nurses' moral sensitivity and the quality of care. Nurs Ethics 2019; 26(4): 1265-1273.
Hassanpoor M, Hosseini M, Fallahi Khoshknab M, Abbaszadeh A. The effect of teaching the principles of nursing ethics on moral sensitivity in the decision making of nurses in social security hospitals in Kerman province. Iranian Journal of Medical Ethics and History 2010; 4(5): 58-64. [Persian]
Izadi A, Imani H, Noughabi F, Hajizadeh N, Naghizadeh F. Moral sensitivity of critical care nurses in clinical decision making and its correlation with their caring behavior in teaching hospitals of Bandar Abbas in 2012. Iranian Journal of Medical Ethics and History of Medicine 2013; 6(2): 43-56.
Borhani F, Keshtgar M, Abbaszadeh A. Moral self-concept and moral sensitivity in Iranian nurses. Journal of Medical Ethics and History of Medicine 2015; 8: 4.
Lützén K, Nordin C, Brolin G. Conceptualization and instrumentation of nurses' moral sensitivity in psychiatric practice. International Journal of Methods in Psychiatric Research 1994; 4(4): 241-248.
Amiri E, Ebrahimi H, Vahidi M, Asghari Jafarabadi M, Namdar Areshtanab H. Moral sensitivity and its relationship with demographic and professional characteristics of nurses working in medical wards of hospitals affiliated to Tabriz University of Medical Sciences. Hayat 2018; 23(4): 295-306.
Abasszadeh A, Borhani F, Moazen Nematolahi L. Compare the moral sensibility of nursing students and nurses in Kerman University of Medical Sciences. Iranian Journal of Medical Ethics 2010; 4(12): 39-54. [Persian]
Han SS, Kim J, Kim YS, Ahn S. Validation of a Korean version of the Moral Sensitivity Questionnaire. Nursing Ethics 2010; 17(1): 99-105.
Hojjatoleslami S, Ghodsi Z. Respect the rights of patient in terms of hospitalized clients: A cross-sectional survey in Iran, 2010. Procedia-Social and Behavioral Sciences 2012; 31: 464-467.
Carmona González Y, Montalvo Prieto A. Nurses’ Moral Sensitivity Regarding the Terminally Ill. Investigación y Educación en Enfermería 2019; 37(3): e07.
McKenna H. Covid-19: Ethical issues for nurses. International Journal of Nursing Studies 2020; 110: 103673.
Reed CJ. Ethical dilemmas and end-of-life care. Nursing made Incredibly Easy 2015; 13(6): 16-24.
Garrard E, Wilkinson S. Passive euthanasia. Journal of Medical Ethics 2005; 31(2): 64-68.
Filipova AA. Licensed nurses’ perceptions of ethical climates in skilled nursing facilities. Nursing Ethics 2009; 16(5): 574-588.
Jo H, Kim S. Moral Sensitivity, Empathy and Perceived Ethical Climate of Psychiatric Nurses Working in the National Mental Hospitals. Journal of Korean Academy of Psychiatric and Mental Health Nursing 2017; 26(2): 204-215.
Mohammadi S, Borhani F, Roshanzadeh M. Moral sensitivity and delivering bad news skills: A study on critical care unit nurses. Medical Ethics Journal 2016; 10(37): 7-16.
Abbaszadeh A, Borhani F, Moazen NL. The comparison of the level of moral sensitivity in nursing students and nursing staffs in Kerman. Medical Ethics 2010; 4(12): 39-54.
Rezaee N, Mardani-Hamooleh M, Seraji M. Nurses' perception of ethical challenges in caring for patients with COVID-19: a qualitative analysis. Journal of Medical Ethics & History of Medicine 2020; 13(Suppl): 23.
Cardona M, Anstey M, Lewis ET, Shanmugam S, Hillman K, Psirides A. Appropriateness of intensive care treatments near the end of life during the COVID-19 pandemic. Breathe 2020; 16(2): 200062.
Dunwoody DR. Nurses' level of moral distress and perception of futile care in the critical care environment: D'Youville College. Buffalo NY: Proquest LLC; 2010.
Otaghi M, Shirkhani S, Azadi A, Khorshidi A, Rahmatollah S. The Relationship between Perception of Futile Care and Moral Distress of Nurses in Critical Care Units. J Biochem Tech 2018; 9(2): 113-119.
Ferrell B. Understanding the moarl distress of nursing witnessing medical futile care. Oncol Nurs Forum 2006; 33(5): 922-930.
Piers RD, Azoulay E, Ricou B, Ganz FD, Decruyenaere J, Max A, et al. Perceptions of appropriateness of care among European and Israeli intensive care unit nurses and physicians. JAMA 2011; 306(24): 2694-2703.
Aghabarary M, Nayeri ND. Medical futility and its challenges: a review study. Journal of medical ethics and history of medicine 2016; 9: 11.
Arslan FT, Calpbinici P. Moral sensitivity, ethical experiences and related factors of pediatric nurses: a cross-sectional, correlational study. Acta Bioethica 2018; 24(1): 9-18.
Yoo MS, Shon KC. Effects of nursing ethics education on biomedical ethics awareness, moral sensitivity and moral judgment of nursing students. J Korean Bioethics Assoc 2012; 12(2): 61-76.
Mohammadi S, Roshanzadeh M. Exploring the Perception of intensive care unit nurses of futile care. Education & Ethic in Nursing 2014; 3(2): 65-72.
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