Ethics in the Intensive Care Unit: a Need for Research

Intensive care units are challenging and technologically advanced environments. Dealing with situations that have an ethical dimension is an intrinsic part of working in such a milieu. When a moral dilemma emerges, it can cause anxiety and unease for all staff involved with it. Theoretical and abstract papers reveal that having to confront situations of ethical difficulty is a contributory factor to levels of poor morale and burnout among critical care staff. Despite this, there is a surprising dearth of published nursing research in the UK that investigates how staff deal with ethical issues in intensive care units. The purpose of this paper is to explore and discuss the development of a research framework designed to explore how staff deal with moral dilemmas in a British inten sive care unit.

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‘Who Ya Gonna Call …?’ Ethical and legal dilemmas in specialist children centres and district general hospitals

Clinical Ethics ◽

10.1177/14777509211036649 ◽

2021 ◽

pp. 147775092110366

Author(s):

Harika Avula ◽

Mariana Dittborn ◽

Joe Brierley

Keyword(s):

Intensive Care ◽

Clinical Ethics ◽

Ethical Issues ◽

General Setting ◽

Daily Practice ◽

Paediatric Intensive Care ◽

Ethical Challenges ◽

Legal Cases ◽

Ethics Support ◽

The Uk

The field of Paediatric Bioethics, or ethical issues applied to children's healthcare, is relatively new but has recently gained an increased professional and public profile. Clinical ethics support to health professionals and patients who face ethical challenges in clinical practice varies between and within institutions. Literature regarding services available to paediatricians is sparse in specialist tertiary centres and almost absent in general paediatrics. We performed a mixed-methods study using online surveys and focus groups to explore the experiences of ethical and legal dilemmas and the support structures available to (i) paediatric intensive care teams as a proxy for specialist children's centres and (ii) paediatricians working in the general setting in the UK. Our main findings illustrate the broad range of ethical and legal challenges experienced by both groups in daily practice. Ethics training and the availability of ethics support were variable in structure, processes, funding and availability, e.g., 70% of paediatric intensive care consultants reported access to formal ethics advice versus 20% general paediatricians. Overall, our findings suggest a need for ethics support and training in both settings. The broad experience reported of ethics support, where it existed, was good – though improvements were suggested. Many clinicians were concerned about their relationship with children and families experiencing a challenging ethical situation, partly as a result of high-profile recent legal cases in the media. Further research in this area would help collect a broader range of views to inform clinical ethics support's development to better support paediatric teams, children and their families.

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ICU admissions: Consequences after discharge

InnovAiT Education and inspiration for general practice ◽

10.1177/1755738020932613 ◽

2020 ◽

Vol 13 (9) ◽

pp. 550-556

Author(s):

Minal Karavadra ◽

Ricky Bell

Keyword(s):

Intensive Care ◽

Cognitive Decline ◽

Intensive Care Units ◽

Critically Ill ◽

Critically Ill Patients ◽

Psychiatric Disturbance ◽

Intensive Care Department ◽

Previous Level ◽

The Uk

The intensive care department may seem a long way from the GP's consulting room, but every year tens of thousands of critically ill patients are admitted to intensive care units (ICUs) across the UK. Patients are often left with long term sequelae that may require GP input. Physical weakness, psychiatric disturbance and cognitive decline are not uncommon after an illness that requires a stay in an ICU. These hinder a patient’s return to their previous level of function and impact caregivers after discharge. This article aims to highlight the chronic symptoms patients can acquire during ICU admission that may come to the attention of GPs for their advice and treatment.

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The rate and impact of substance misuse in psychiatric intensive care units (PICUs) in the UK

Advances in Dual Diagnosis ◽

10.1108/add-06-2021-0008 ◽

2021 ◽

Vol ahead-of-print (ahead-of-print) ◽

Author(s):

Hattie Catherine Ann Moyes ◽

Lana MacNaboe ◽

Kate Townsend

Keyword(s):

Intensive Care ◽

Intensive Care Units ◽

Substance Misuse ◽

Well Being ◽

Training Programme ◽

Content Type ◽

National Quality ◽

Improvement Programme ◽

The Uk ◽

The Impact

Purpose This paper aims to understand the current scale of substance misuse in psychiatric intensive care units (PICUs), identify how substance misuse affects members of staff, patients and the running of wards and explore with staff what resources would be most useful to more effectively manage substance misuse and dual diagnosis on PICUs. Design/methodology/approach The paper used a mixed-methods approach, using a quantitative survey to determine the extent of substance use in PICUs and a co-design workshop to understand the impact of substance misuse on PICU wards, staff and patients. Findings The estimated rate of substance misuse in PICUs over a 12-month period is 67%, with cannabis the most frequently used substance. Despite the range of problems experienced on PICUs because of substance misuse, the availability of training and resources for staff was mixed. Research limitations/implications The findings may not be fully generalisable as research participants were members of a national quality improvement programme, and therefore, may not be representative of all PICUs. Data was collected from clinicians only; if patients were included, they might have provided another perspective on substance misuse on PICUs. Practical implications This paper emphasises the importance of substance misuse training for PICU staff to adequately respond to patients who misuse substances, improve the ward environment, staff well-being and patient outcomes. Originality/value This paper provides an updated estimation of rates of substance misuse in PICUs over a 12-month period and make suggestions for a training programme that can better support staff to address substance misuse on PICUs.

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Oxygenation of the critically ill in selected intensive care units in the UK: are we usual?

British Journal of Anaesthesia ◽

10.1016/j.bja.2020.06.033 ◽

2020 ◽

Vol 125 (3) ◽

pp. e277-e279

Author(s):

Benjamin Post ◽

Edward Palmer ◽

Steve Harris ◽

Mervyn Singer ◽

Daniel Martin

Keyword(s):

Intensive Care ◽

Intensive Care Units ◽

Critically Ill ◽

The Uk

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Exploring the human factors of prescribing errors in paediatric intensive care units

Archives of Disease in Childhood ◽

10.1136/archdischild-2018-315981 ◽

2019 ◽

Vol 104 (6) ◽

pp. 588-595 ◽

Cited By ~ 9

Author(s):

Adam Sutherland ◽

Darren M Ashcroft ◽

Denham L Phipps

Keyword(s):

Intensive Care ◽

Human Factors ◽

Intensive Care Units ◽

Information Transfer ◽

Paediatric Intensive Care ◽

Contributory Factor ◽

Prescribing Error ◽

Psychological Burden ◽

Knowledge Based ◽

Paediatric Intensive Care Units

ObjectiveTo explore the factors contributing to prescribing error in paediatric intensive care units (PICUs) using a human factors approach based on Reason’s theory of error causation to support planning of interventions to mitigate slips and lapses, rules-based mistakes and knowledge-based mistakes.MethodsA hierarchical task analysis (HTA) of prescribing was conducted using documentary analysis. Eleven semistructured interviews with prescribers were conducted using vignettes and were analysed using template analysis. Contributory factors were identified through the interviews and were related to tasks in the HTA by an expert panel involving a PICU clinician, nurse and pharmacist.ResultsPrescribing in PICU is composed of 30 subtasks. Our findings indicate that cognitive burden was the main contributory factor of prescribing error. This manifested in two ways: physical, associated with fatigue, distraction and interruption, and poor information transfer; and psychological, related to inexperience, changing workload and insufficient decision support information. Physical burden was associated with errors of omission or selection; psychological burden was linked to errors related to a lack of knowledge and/or awareness. Social control through nursing staff was the only identified control step. This control was dysfunctional at times as nurses were part of an informal mechanism to support decision making, was ineffective.ConclusionsCognitive burden on prescribers is the principal latent factor contributing to prescribing error. This research suggests that interventions relating to skill mix, and communication and presentation of information may be effective at mitigating rule and knowledge-based mistakes. Mitigating fatigue and standardising procedures may minimise slips and lapses.

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Characteristics of patients admitted to psychiatric intensive care units

Irish Journal of Psychological Medicine ◽

10.1017/s0790966700010284 ◽

2007 ◽

Vol 24 (2) ◽

pp. 75-78 ◽

Cited By ~ 5

Author(s):

Yasir Kasmi

Keyword(s):

Intensive Care ◽

Literature Review ◽

Ethnic Minority ◽

Intensive Care Units ◽

Ethnic Minorities ◽

Service Provision ◽

National Guidelines ◽

Minority Overrepresentation ◽

The Uk ◽

Study Designs

AbstractObjective: A paucity of research exists on the types of patients admitted to psychiatric intensive care units (PICUs), which is important in terms of identifying patient needs, training and service provision. Questions have also been raised as to whether or not ethnic minorities are overrepresented in these units.Method: A literature review using MeSH headings from a wealth of databases was performed to identify such studies. In addition studies on ethnic minority overrepresentation in psychiatric care were also identified.Results: Under a dozen studies were identified, mainly from the UK and Australia. Study designs tended to be basic and heterogeneous, but this was reflected in the nature of the study and the data gained. A typical PICU patient emerged, namely a young schizophrenic detained male, belonging to an ethnic minority (if in an inner city), known to mental health services with previous informal, detained and PICU admissions, admitted due to violence and often possessing a forensic history. If a complex need existed, it was usually substance misuse. The inpatient stay tended to be for less than two months and discharge was usually to an acute ward. Ethnic minorities were overrepresented in PICU care.Conclusions: The literature review highlighted a paucity of good-quality studies in this field. The establishment of a national association of intensive care units as well as national guidelines can only improve services. The reason for ethnic minority over-representation on these units is still far from clear.

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