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Observational Study
. 2019 Dec;47(12):1716-1723.
doi: 10.1097/CCM.0000000000004017.

Perceptions of Ethical Decision-Making Climate Among Clinicians Working in European and U.S. ICUs: Differences Between Nurses and Physicians

Hanne Irene Jensen  1   2 , Stine Hebsgaard  3   4 , Tina Charlotte Bitsch Hansen  5 , Rikke Frank Aagaard Johnsen  2 , Christiane S Hartog  6   7 , Ioanna Soultati  8   9 , Orsolya Szucs  10 , Michael E Wilson  11 , Bo van den Bulcke  12 , Dominique D Benoit  12 , Ruth Piers  13
Affiliations
Observational Study

Perceptions of Ethical Decision-Making Climate Among Clinicians Working in European and U.S. ICUs: Differences Between Nurses and Physicians

Hanne Irene Jensen et al. Crit Care Med. 2019 Dec.

Abstract

Objectives: To examine perceptions of nurses and physicians in regard to ethical decision-making climate in the ICU and to test the hypothesis that the worse the ethical decision-making climate, the greater the discordance between nurses' and physicians' rating of ethical decision-making climate with physicians hypothesized to rate the climate better than the nurses.

Design: Prospective observational study.

Setting: A total of 68 adult ICUs in 13 European countries and the United States.

Subjects: ICU physicians and nurses.

Interventions: None.

Measurements and main results: Perceptions of ethical decision-making climate among clinicians were measured in April-May 2014, using a 35-items self-assessment questionnaire that evaluated seven factors (empowering leadership by physicians, interdisciplinary reflection, not avoiding end-of-life decisions, mutual respect within the interdisciplinary team, involvement of nurses in end-of-life care and decision-making, active decision-making by physicians, and ethical awareness). A total of 2,275 nurses and 717 physicians participated (response rate of 63%). Using cluster analysis, ICUs were categorized according to four ethical decision-making climates: good, average with nurses' involvement at end-of-life, average without nurses' involvement at end-of-life, and poor. Overall, physicians rated ethical decision-making climate more positively than nurses (p < 0.001 for all seven factors). Physicians had more positive perceptions of ethical decision-making climate than nurses in all 13 participating countries and in each individual participating ICU. Compared to ICUs with good or average ethical decision-making climates, ICUs with poor ethical decision-making climates had the greatest discordance between physicians and nurses. Although nurse/physician differences were found in all seven factors of ethical decision-making climate measurement, the factors with greatest discordance were regarding physician leadership, interdisciplinary reflection, and not avoiding end-of-life decisions.

Conclusions: Physicians consistently perceived ICU ethical decision-making climate more positively than nurses. ICUs with poor ethical decision-making climates had the largest discrepancies.

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