Ntseke S, Coetzee I, Heyns T
Gauteng College of Nursing, Ga-Rankuwa Campus, Pretoria, South Africa.
Department of Nursing Science, University of Pretoria, South Africa.
South Afr J Crit Care. 2023 Jul 28;39(2). doi: 10.7196/SAJCC.2023.v39i2.511. eCollection 2023.
A critical care unit admits on a daily basis patients who are critically ill or injured. The condition of these patients' may deteriorate to a point where the medical practitioner may prescribe or decide on a 'do not resuscitate' (DNR) order which must be executed by a professional nurse, leading to moral distress which may manifest as poor teamwork, depression or absenteeism.
To explore and describe factors contributing to moral distress of critical care nurses executing DNR orders.
The explorative descriptive qualitative design was selected to answer the research questions posed.
Critical care nurses of a selected public hospital in Gauteng Province were selected via purposive sampling to participate in the study, and data were collected through semi-structured interviews.
A shift leader assisted with selection of participants who met the eligibility criteria. The mean age of the participants was 36 years; most of them had more than five years' critical care nursing experience. Twelve critical care nurses were interviewed when data saturation was reached. Thereafter two more interviews were conducted to confirm data saturation. A total of 14 interviews were conducted.
Tesch's eight-step method was utilised for data analysis. The findings were classified under three main themes: moral distress, communication of DNR orders and unavailability of psychological support for nurses.
The findings revealed that execution of DNR orders is a contributory factor for moral distress in critical care nurses. National guidelines and/or legal frameworks are required to regulate processes pertaining to the execution of DNR orders. The study further demonstrated the need for unit-based ethical platforms and debriefing sessions for critical care nurses.
The main contribution of this study was to explore and describe the factors contributing to Moral distress when executing a DNR order. This study raised awareness amongst healthcare providers on the factors contributing to moral distress amongst critical care nurses. This study highlighted the importance of developing national guidelines and legal frameworks pertaining to execution of DNR orders. This study alluded to the value of initiating debriefing sessions for critical care nurses involved in the execution of DNR orders.
重症监护病房每天都会收治重症或受伤患者。这些患者的病情可能会恶化到医生可能会开出或决定“不进行心肺复苏”（DNR）医嘱的程度，而该医嘱必须由专业护士执行，这会导致道德困扰，可能表现为团队协作不佳、抑郁或旷工。
探讨并描述导致执行DNR医嘱的重症监护护士产生道德困扰的因素。
选择探索性描述性定性设计来回答所提出的研究问题。
通过目的抽样法选取豪登省一家选定公立医院的重症监护护士参与研究，并通过半结构化访谈收集数据。
一名轮值主管协助挑选符合资格标准的参与者。参与者的平均年龄为36岁；他们中的大多数人有超过五年的重症监护护理经验。当达到数据饱和时，对12名重症监护护士进行了访谈。此后又进行了两次访谈以确认数据饱和。总共进行了14次访谈。
采用泰施的八步法进行数据分析。研究结果分为三个主要主题：道德困扰、DNR医嘱的传达以及护士缺乏心理支持。
研究结果表明，执行DNR医嘱是导致重症监护护士产生道德困扰的一个因素。需要国家指南和/或法律框架来规范与执行DNR医嘱相关的流程。该研究进一步表明，需要为重症监护护士建立基于科室的伦理平台和汇报会。
本研究的主要贡献在于探索并描述了执行DNR医嘱时导致道德困扰的因素。本研究提高了医疗服务提供者对导致重症监护护士产生道德困扰的因素的认识。本研究强调了制定与执行DNR医嘱相关的国家指南和法律框架的重要性。本研究暗示了为参与执行DNR医嘱的重症监护护士开展汇报会的价值。
