The morality of good end‐of‐life care in critical care

• Published in: Nursing in critical care 2017-05, Vol.22 (3), p.123-124
• Main Author: Pattison, Natalie
• Format: Article
• Language: English
• Subjects: Critical care; Morality; Palliative care
• ISSN: 1362-1017; 1478-5153
• DOI: 10.1111/nicc.12293

Critical care nurses encounter issues related to transitions to end of life and end-of-life care on a daily basis, and the consequences of these encounters are well documented, particularly in relation to moral distress and burnout (Epstein and Hamric, 2009). Jameton's (1984) seminal work introduced the concept of moral distress in nursing, and outlined how professional and moral integrity are challenged when nurses find themselves in situations that do not support maintaining integrity, and it becomes hard to 'do the right thing'. Furthermore, these situations make it difficult to maintain professional identity and a moral compass. Where this fails, worsening moral distress is likely to occur. When nurses are aware that they are acting against their own and professional moral code, the net result can be anger, disengagement, frustration, dysfunction and anxiety, which is known to adversely affect patient care (Epstein and Hamric, 2009). Moreover, burnout is associated with intention to leave (Heinen et al., 2013) and, coupled with the acute staffing crisis across the critical care nursing sector in the UK, the result is critical care nurses who may have even less emotional and physical resources to care for these high-need end-of-life patients. It is incumbent on nurse leaders in particular, to find ways to address the factors associated with moral distress and ensure nurses avoid compassion fatigue, the phenomenon where nurses do not have capacity for empathic understanding and compassion (Lombardo and Eyre, 2011). References