Santiago Cecilia, Abdool Steve
Critical Care Department, St. Michael's Hospital, Toronto, Ontario.
Dynamics. 2011 Winter;22(4):26-30.
Clinicians frequently encounter and grapple with complex ethical issues and perplexing moral dilemmas in critical care settings. Intensive care unit (ICU) clinicians often experience moral distress in situations in which the ethically right course of action is intuitively known, but cannot be acted on. Most challenging cases pertain to end-of-life issues. Researchers have shown that moral distress and moral residue are common among critical care nurses. It is, therefore, essential that all ICU clinicians (and nurses, in particular) have an ongoing opportunity to work safely through these ethical dilemmas and conflicts. In this article, we describe the medical surgical intensive care unit (MSICU) experience with its monthly ethics initiative and explore the next steps to enhance its use through maximizing attendance and value to MSICU clinicians. To optimize attendance of staff a small group discussion among critical care clinicians (n = 8) was conducted asking about their perceptions of the debriefing sessions and their suggestions on how to promote their use. Process changes were implemented based on the group's suggestions. The process changes resulted in increased awareness of the benefits, increased frequency of sessions and demonstrated utility. Lessons learned from the MSICU experience will inform the development of education curricula to help critical care nurses with challenging end-of-life situations.
临床医生在重症监护环境中经常会遇到并处理复杂的伦理问题和令人困惑的道德困境。重症监护病房（ICU）的临床医生在那些凭直觉知道符合伦理的正确行动方案，但却无法付诸实践的情况下，常常会经历道德困扰。最具挑战性的案例多与临终问题有关。研究表明，道德困扰和道德残留现象在重症监护护士中很常见。因此，所有ICU临床医生（尤其是护士）必须有持续的机会，安全地应对这些伦理困境和冲突。在本文中，我们描述了外科重症监护病房（MSICU）每月开展的伦理倡议活动的经验，并探讨了通过提高参与度和对MSICU临床医生的价值来加强其应用的后续步骤。为了优化工作人员的参与度，我们组织了一次重症监护临床医生小组讨论（n = 8），询问他们对汇报会的看法以及关于如何促进汇报会使用的建议。根据小组的建议实施了流程变更。流程变更提高了对益处的认识，增加了会议频率，并证明了其实用性。从MSICU经验中吸取的教训将为教育课程的开发提供参考，以帮助重症监护护士应对具有挑战性的临终情况。
