Ethical dilemmas experienced by nurses working in critical care units in Kenyatta National Hospital.

Abstract

- Ethical issues have emerged in the recent years as a major component of health care for the critically ill patients, who are vulnerable and totally depend on nurse working in the critical care unit. As the provision of care to the critically ill becomes more complex due to technological advancement, and the profession of nursing more autonomous, professional accountability becomes important. The complex nature of the health problems faced by patients admitted in lCU coupled with extensive use of very sophisticated technology requires at times rapid decision making. Ethical dilemmas have therefore become one of the priority concerns in the nursing profession that require urgent attention in Kenya. Ethical dilemmas confront even the most experienced. Nurses at KNH lCU are not any different particularly considering that KNH is a public hospital having the biggest lCU in the country. The led admits patients from various walks of life and the nurses have diverse socio-¬demographic factors. However their perception and magnitude of ethical dilemmas they face while working in these areas and how they resolve them have not been studied. Duration of the study: The study took five weeks. Pretesting of the questionnaires took two days. Objective: To explore ethical dilemmas experienced by nurses working in the critical care areas at Kenyatta National Hospital and factors influencing nurses' ethical decision making. Study question: What ethical dilemmas face nurses working in the critical care areas at KNH and how do they resolve them? Materials and methods: An exploratory survey of 123 nurses working at KNH- critical care areas was conducted over a period of five weeks. Participation in the study was by written consent. Participants were employees of KNH working in the critical care areas during the time of data collection. Nurses were selected through simple random sampling. Data were collected using a questionnaire 'containing 40 items adapted from Fry and Duffy Ethical issues scale. Modification of the questionnaire was done to' omit questions on personally disturbing ethical dilemmas. J Ethical issues: Authority to conduct the study was obtained from the KNH management while clearance was sought from University of Nairobi and KNH ethical research committee. The xiii

study was done as part fulfillment of the award of a master of science of nursing degree ; the researcher had no conflicting interest with the training institution or the hospital. Data management: Data was cleaned and analyzed using SPSS. Chi square test was used to assess the relationship between variables. Propositions and conclusions were made based on apparent patterns or relationships within the data. Results: The dilemmas of major concern to nurses included: prolonging the dying process, withdrawing/ withholding treatment, resuscitation (DNR) orders, unsafe nurse- patient ratios and allocation of scarce medical resource, rights of pediatric patients, and nursing of critically ill patients who may pose a risk to the nurses. In dealing with the dilemmas majority of the respondents indicated that they would consult with physicians. Some socio- demographic factors were shown to influence the experience of ethical dilemmas by respondents. These included age, level of knowledge on ethical issues, professional -.. qualification and availability of work .place resources. It was noted that respondents aged below 35 years experienced more dilemmas compared- to others. Respondents with knowledge on ethical issues experienced less dilemmas compared to those who with no knowledgeable. Respondents with adequate work place resources experienced fewer

dilemmas. - . Conclusion and recommendations- this study shows that ethical dilemmas are an issue of concern among the nurses working in, the critical care units of the KNH. The experience of ethical dilemmas is influenced by various socio- demographic factors. In resolving the , i dilemmas most nurses would consult the Doctors or make decisions without consulting. Significance of the study: Results of the study will be used to make recommendations for shaping of the curriculum for training of critical care nurses to include ethical decision making process as this need for education on ethical issues has been identified as shown in the results. The findings can be utilized as literature for further research on ethical issues. J