To provide an insight into the ethical issues that affect admissions into the ICU as well as the process of discharging, the objective of this research if to explore and identify ethical dilemmas that face professionals in the healthcare sector. The main hypotheses is therefore based on the problems that are ethical in in the admission as well as discharge context in the ICU, which are divided into various problems that concern occupancy in full, of the beds as well as problems that are related to decisions on treatment (Ulrich et al, 2010).
Only few empirical studies into the factors that are non-medical, and affect nurses and physicians in making decisions about the process of discharging and admitting patients in the ICU.Information relating to the healthcare professionals attitude about such process can be utilized in enhancing the process of decision making about intensive care resource allocation. The ICU is an environment of high pressure, where there is delivery of expensive health-care by personnel who are highly to patients that suffer from diseases that are potentially life-threatening (Ulrich et al, 2010).There is limited bed availability, which makes high throughput for patients quite important. Such a throughput usually depends on new patients’ admission as well as discharging to general wards of the ones whose care equipment for ICU is meant to have ended. The societal financial pressure and higher management keeps increasing. Care services that are critical give a representation of a proportion of net hospital costs that keep increasing, up right from 1980’s 8% to the 2006’s 20% in the United States for example. In addition, in Netherlands, ICU department costs have been estimated to give a representation of close to 20% of the total budget for the hospitals. The ICU bed number that is limited as well as the ICU care pressure on the total budget for the hospital, makes it necessary for ICU beds’ optimal use as well as flow of patients from the emergency room, general ward and operating theatre to the ICU and the opposite is applicable (McLeod, 2014).
This study was quite descriptive and explorative at the same time as it used qualitative methods, both focus and individual group interviews. Face to face interviews that are semi-structured are quite useful in exploration of topics that are sensitive in depth. In the focus groups that are subsequent, the interaction and group dynamic among participants helps a greater deal in further exploration as well as clarification of views for participants. Those included nurses and physicians in Dutch hospitals, who work either in the ICU department, or regularly in the general ward through admitting of patients from the ICU (McLeod, 2014).
19 individual interviews were conducted as well as 4 focus group interviews accompanies with physicians and nurses that work in the general ward or ICU of 10 Dutch hospitals. Before the study was started, there was establishment of contact through telephone with physicians in the ICU in six different hospitals; two of them being general, two academic and two teaching hospitals. Through all these six contacts for hospitals, nurses and physicians were recruited by use of interviews face-to-face. Criteria for inclusion was basically involvement in care for patients that is post-ICU; working as a nurse or physician in either the general ward or ICU regularly doing admissions for post-ICU patients. All participants who were prospective were informed through email on the study’s objective as well as being invited for participation. The interviews were conducted at the work place for the participants. The number of total interviews highly depended in the saturation point. There was also development of interview guide with questions that are open-ended as well as a pilot testing (McLeod, 2014).
Coding of the focus group and interview transcripts was done by use of ATLAS.ti 6.2. Such analysis was conducted by use of an approach of grounded theory where, the codebook and codes are emerged from the data, contrary to the previous way of formulating tested hypotheses against data that is qualitative. The interviews done on first five individuals were coded as NvS, AO and MZ. After that, any discrepancies that occurred were discussed in depth till consensus was arrived at. A double analysis (MZ and AO) as well as subsequent discussions were also done for interview transcript of the first group. Coding of the entire transcripts was done by one of the researchers (AO). The guideline for COREQ was used for research that is qualitative for both analysis and design. The obtained data’s implications for nursing are that the focus and individual interviews for groups showed that in the admission and discharge process of discharge in the ICU context, ethical problems come up at various points in time. When making decision about patient admissions to the ICU right from the emergency room, general ward or operating theatre (A); During the stay of a patient inside the ICU(B) and, when making decision about a patient discharging from the ICU (Gregory et al, 2004).
It is very important for general wards and ICUs to do good communication and cooperation, as there is a mutual dependency that is on patient flow that is optimal between the various departments. There is need for interventions that help in improving the cooperation as well as understanding between such wards as it helps in mitigation of problems that are ethical. The environment nature of the ICU makes it quite important for professionals in the healthcare field to be aware of the over-treatment risks, do a reflection of the reasons as to why they do that which they do, as well as being mindful of an imminent negative impact of patients over-treatment. Patient’s wishes early discussion in regard to options of treatment is quite important in the prevention of over-treatment. The study identified various problems that are ethical at three various instances during the process of discharge and admission; that which surrounded the admission at the ICU, during stay at the ICU and around discharge at the ICU. They can further be subdivided into two different categories, those that are related to full occupancy of the bed and those that have to do with decisions on treatment (Gregory et al, 2004).
The study’s limitations included; any study that is qualitative has the risk of giving responses that are eliciting false and social desire from the interviewees, particularly when inquiries are being made after all topics in the ethics field. Through asking the various participants to do a description of the examples of problems that themselves went through, the risk is hoped to have been diminished. However, in future, there is need to require more of the quantity of focus group and interview participants ,especially when putting to consideration the qualitative research’s labor-intensiveness as well as the number of interviews that is suggested in the literature (Gregory et al, 2004).
It is very important for general wards and ICUs to do a good cooperation, given that there exists a mutual dependency for the patient flow that is optimal between the various departments. Interventions that aim at improving the cooperation as well as understanding between such wards may go a long way in helping to mitigate problems that are ethical-based (Gregory et al, 2004).
Gregory, K, et al. (2004). Ethical Issues in the Intensive Care Unit : Hospital Physician Board Review Manual, Tuner White Communications, Wayne, PA.. McLeod, A., (2014) . Nurses’ Views of the Causes of Ethical Dilemmas During Treatment Cessation in the ICU: A Qualitative Study in British Journal of Neuroscience Nursing. USA. Ulrich, C.M et al.,(2010). Moral distress: a growing problem in the health professions? Hastings Cent Rep.
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