School of Nursing and Midwifery, Golestan University of Medical Sciences, Gorgan, Iran.
Nursing Research Center, Golestan University of Medical Sciences, Gorgan, Iran.
BMC Psychol. 2024 Nov 25;12(1):692. doi: 10.1186/s40359-024-02197-4.
Intensive care units are often presented as environments where ethical issues are common and decisions can determine the life or death of patients, and these units have unique challenges due to critical health care. In these units, the relationship between the medical team and the patient's relatives, their refusal of treatment, informed consent causes the nurses to have conflict in their decision making, therefore, this study aims to determine the level of clinical decision-making and moral distress and the relationship between them in intensive care units nurses.
This cross-sectional study was conducted with a descriptive-analytical approach in 2023 in Gorgan city. The number of 198 nurses in the intensive care units of Gonbad Kavos hospitals in the north of Iran were investigated and evaluated using the Corley Moral Distress questionnaire (2002), and Laurie's Clinical Decision questionnaire (2001) in 2023. Independent T-test and anova analysis of variance were used for bivariate analysis. The significance level in this study was considered 0.05.
The results of the study showed that the mean and standard deviation of clinical decision making was 60.98 ± 10.25 (analytical-systematic level) and moral distress was 92.2 ± 23.61 (moderate level). There was a statistically significant relationship between clinical decision-making and nurses' moral distress (P < 0.001 and r = 0.370). The moral distress score had a statistically significant relationship with marriage, employment status, education level, age, work experience and duration of employment in the special department. Also, the clinical decision score had a statistically significant relationship with employment status, education level, age and work experience.
According to these results, it seems that more attention should be paid to the moral distress of nurses in intensive care units, and it is necessary to improve their decision-making towards intuitive interpretation, which is done by designing and compiling training programs and workshops for nurses can be done, so that we can provide optimal nursing services to the patients of this department.
重症监护病房常被认为是伦理问题频发的场所，其决策可能决定患者的生死，而这些病房由于医疗的紧迫性，存在独特的挑战。在这些病房中，医护团队与患者家属之间的关系、他们对治疗的拒绝、知情同意会导致护士在决策时产生冲突，因此，本研究旨在确定重症监护病房护士的临床决策水平和道德困境及其之间的关系。
这是 2023 年在伊朗北部贡巴德卡武斯医院的重症监护病房进行的一项横断面研究，采用描述性分析方法，调查和评估了 198 名护士，使用的工具是科利道德困境问卷（2002 年）和劳里临床决策问卷（2001 年）。使用独立 T 检验和方差分析进行双变量分析。本研究的显著性水平为 0.05。
研究结果表明，临床决策的平均值和标准差为 60.98±10.25（分析-系统水平）和道德困境为 92.2±23.61（中度水平）。临床决策和护士道德困境之间存在统计学显著关系（P<0.001，r=0.370）。道德困境得分与婚姻、就业状况、教育程度、年龄、工作经验和在特殊部门的工作时间有统计学显著关系。此外，临床决策得分与就业状况、教育程度、年龄和工作经验有统计学显著关系。
根据这些结果，似乎应该更加关注重症监护病房护士的道德困境，并需要通过为护士设计和编制培训计划和研讨会来提高他们的决策能力，即直观解释，以便我们能够为该部门的患者提供最佳的护理服务。
