Critical care nurses' attitude towards life-sustaining treatments in South East Iran

doi:10.5847/wjem.j.1920-8642.2016.01.011

Abstract

Abstract:

BACKGROUND: Life-sustaining treatments (LSTs) may prolong life but greatly decrease the quality of death. One factor influencing decision-making about withholding and withdrawing these treatments is the attitude of nurses. This study aimed to evaluate the attitude of critical care nurses towards life-sustaining treatments in South East Iran.
METHODS: In this cross-sectional study, "Ethnicity and Attitudes towards Advance Care Directives Questionnaire" was used to investigate the attitude of 104 critical care nurses towards life-sustaining treatments in three hospitals affiliated to Kerman University of Medical Sciences.
RESULTS:The findings of this study indicated that although a majority of critical care nurses (77%) did not have personal desire for use of LSTs including CPR and mechanical ventilation, they had moderately negative to neutral attitude towards general use of LSTs (2.95 of 5).
CONCLUSIONS:These findings suggest that nurses' attitude towards LSTs can be changed by inclusion of specific courses about death, palliative care and life-sustaining treatments in undergraduate and postgraduate nursing curricula. Educating Muslim nurses about religious aspects of LSTs may also improve their attitudes.

Key words: Life-sustaining treatments, Critical care nurse, Attitude, South East Iran

Farideh Razban, Sedigheh Iranmanesh, Hasan Eslami Aliabadi, Mansooreh Azzizadeh Forouzi. Critical care nurses' attitude towards life-sustaining treatments in South East Iran[J]. World Journal of Emergency Medicine, 2016, 7(1): 59-64.

Figures/Tables 4

Figure 1.

Table 1

Figure 2.

Table 2

References 42

1	Rocker G, Puntillo K, Azoulay É. End of life care in the ICU: From advanced disease to bereavement. Oxford University Press, 2010.
2	Sole ML, Klein DG, Moseley MJ. Introduction to critical care nursing 6: introduction to critical care nursing. Elsevier Health Sciences, 2012.
3	Negri S. Self-determination, dignity and end-of-life care: regulating advance directives in international and comparative perspective (Vol. 7). Martinus Nijhoff Publishers, 2012.
4	Sheehan C, Potter M. Palliative care nursing. Jones & Bartlett Publishers, 2011: 107-108.
5	Peirce AG, Smith JA. Ethical and legal issues for doctoral nursing students: a textbook for students and reference for nurse leaders. DEStech Publications, Inc., 2013.
6	Criner GJ, Barnette RE, D'Alonzo GE. Critical care study guide: text and review: Springer, 2010.
7	Matzo M, Sherman DW. Palliative care nursing: quality care to the end of life. Springer Publishing Company, 2009.
8	Wicclair MR. Conscientious objection in health care: Cambridge. Cambridge University Press, 2011.
9	Williams L. Lippincott's fast facts for NCLEX-PN. Lippincott Williams & Wilkins, 2012.
10	Petty RE, Krosnick JA. Attitude strength: Antecedents and consequences. Psychology Press, 2014.
11	Sjokvist P, Berggren L, Cook D. Attitudes of Swedish physicians and nurses towards the use of life-sustaining treatment. Acta Anaesthesiol Scand 1999; 43:167-172. pmid: 10027023
12	Kim S, Lee Y. Korean nurses' attitudes to good and bad death, life-sustaining treatment and advance directives. Nurs Ethics 2003; 10:624-637.
13	Carmel S, Werner P, Ziedenberg H. Physicians' and nurses' preferences in using life-sustaining treatments. Nurs Ethics 2007; 14:665-674. pmid: 17901176
14	Lindblad A, Juth N, Fürst CJ, Lynöe N. When enough is enough; terminating life-sustaining treatment at the patient's request: a survey of attitudes among Swedish physicians and the general public. J Med Ethics 2010; 36:284-289. pmid: 20439330
15	Rydvall A, Lynöe N. Withholding and withdrawing life-sustaining treatment: a comparative study of the ethical reasoning of physicians and the general public. Crit Care 2008; 12:R13. doi: 10.1186/cc6786.Epub 2008 Feb 15. pmid: 18279501
16	Mogadasian S, Abdollahzadeh F, Rahmani A, Ferguson C, Pakanzad F, Pakpour V, et al. The attitude of Iranian nurses about do not resuscitate orders. Indian J Palliat Care 2014; 20:21-25. doi: 10.4103/0973-1075.125550. doi: 10.4103/0973-1075.125550 pmid: 24600178
17	Abdollahzadeh F, Rahmani A, Paknejad F, Heidarzadeh H. Do not resuscitate order: attitude of nursing students of Tabriz and Kurdistan Universities of Medical Sciences. Iranian Journal of Medical Ethics and History of Medicine 2013; 6:45-56.
18	Ghajarzadeh M, Habibi R, Amini N, Norouzi-Javidan A, Emami-Razavi SH. Perspectives of Iranian medical students about do-not-resuscitate orders. Maedica (Buchar) 2013; 8:261-264.
19	Elliott D, Aitken L, Chaboyer W. ACCCN's critical care nursing. Elsevier Australia, 2011.
20	Abdul-Rahman MS. The Meaning and Explanation of the Glorious Qur'an (Vol. 10). MSA Publication Limited, 2008.
21	Fathalla WM. From quality of life to value of life; an Islamic ethical perspective. Ibnosina Journal of Medicine and Biomedical Sciences 2010; 2:258-263.
22	Bloomer MJ, Al-Mutair A. Ensuring cultural sensitivity for Muslim patients in the Australian ICU: Considerations for care. Aust Crit Care 2013; 26:193-196.
23	Atashzadeh Shorideh F, Ashktorab T, Yaghmaei F. Iranian intensive care unit nurses' moral distress: a content analysis. Nurs Ethics 2012; 19:464-478. pmid: 22691602
24	Blackhall LJ, Frank G, Murphy ST, Michel V, Palmer JM, Azen SP. Ethnicity and attitudes towards life sustaining technology. Soc Sci Med 1999; 48:1779-1789. pmid: 10405016
25	Ko E, Cho S, Bonilla M. Attitudes toward life-sustaining treatment: the role of race/ethnicity. Geriatr Nurs 2012; 33:341-349. doi: 10.1016/j.gerinurse.2012.01.009. Epub 2012 Mar 8. pmid: 22405033
26	Sjökvist P, Berggren L, Svantesson M, Nilstun T. Should the ventilator be withdrawn? Attitudes of the general public, nurses and physicians. Eur J Anaesthesiol 1999; 16:526-533. doi: 10.1046/j.1365-2346.1999.00532.x pmid: 10500941
27	Eifried S. Bearing witness to suffering: the lived experience of nursing students. J Nurs Educ 2003; 42:59-67.
28	Williams L. Lippincott's Nursing Procedures: Lippincott Williams & Wilkins, 2009.
29	Pozgar GD, MBA C. Legal and ethical issues for health professionals: Jones & Bartlett Publishers, 2012.
30	Tai CCC, Ng DLL. Factors influencing decisions to withdraw or continue life support and attitudes towards treatment of the critically ill: a survey of registered nurses in intensive care units. Proceedings of Singapore Healthcare, 2011.
31	Swota AH. Culture, Ethics, and advance care planning. Rowman & Littlefield, 2009.
32	Al-Jahdali H, Baharoon S, Al Sayyari A, Al-Ahmad G. Advance medical directives: a proposed new approach and terminology from an Islamic perspective. Med Health Care Philos 2013; 16:163-169. pmid: 24571002
33	Haker H, Bentele K. Medical ethics in health care chaplaincy (Vol. 1). LIT Verlag Münster, 2010.
34	Esteban A, Gordo F, Solsona JF, Alía I, Caballero J, Bouza C, et al. Withdrawing and withholding life support in the intensive care unit: a Spanish prospective multi-centre observational study. Intensive Care Med 2001; 27:1744-1749. Epub 2001 Oct 12.
35	Zahedi F, Larijani B, Tavakoly Bazzaz J. End of life ethical Issues and Islamic views. Iran J Allergy Asthma Immun 2007; 6(Supple):5.
36	Chirkov V, Ryan R, Sheldon KM. Human autonomy in cross-cultural context: Springer, 2011.
37	DuBrin AJ. Proactive personality and behavior for individual and organizational productivity: Edward Elgar Publishing, 2013.
38	Iranmanesh S, Razban F, Nejad AT, Ghazanfari Z. Nurses' professional autonomy and attitudes toward caring for dying patients in South-East Iran. Int J Palliat Nurs 2014; 20:294-300. doi: 10.12968/ijpn.2014.20.6.294.
39	Amini K, Negarandeh R, Ramezani-Badr F, Moosaeifard M, Fallah R. Nurses' autonomy level in teaching hospitals and its relationship with the underlying factors. Int J Nurs Pract 2015; 21:52-59. doi: 10.1111/ijn.12210 pmid: 24256084
40	Bahramitash R. Gender and entrepreneurship in Iran. Microenterprise and the Informal Sector: Palgrave Macmillan, 2013.
41	Koutoukidis G. Tabbner's Nursing Care: Theory and Practice: Elsevier Australia, 2012.
42	Curtis JR. Managing death in the ICU: the transition from cure to comfort: the transition from cure to comfort. Oxford University Press, 2000.

Items	Mean (SD)
1. If life-prolonging technology exists it should always be used.	3.28 (1.01)
2. Doctors should generally try to keep their patients alive on machines for as long as possible, no matter how uncomfortable the machines are.	2.67 (0.89)
3. If a patient is dying it is best not to prolong his or her lives by medical means.	2.70 (0.91)
4. Life sustaining machines should never be stopped even if the patient appears to be dying because there is always the chance of a miracle.	2.90 (1.17)
5. It is a doctor's duty to stop life prolonging treatments of patients if the patient does not want them anymore.	3.15 (1.10)
6. Even if I were terminally ill, I would want everything done to keep me alive as long as possible.	3.03 (1.39)
7. Life sustaining machines are often painful.	2.34 (0.91)
8. When a person is permanently unconscious (in a coma), with no hope of waking up, medical treatments usually should not be used to keep them alive.	2.79 (1.02)
9. Even if my condition is hopeless I would want my life prolonged as much as possible.	2.60 (1.15)
10. I would not want machines used to keep me alive.	2.67 (1.19)
11. Present day medical care frequently prolongs dying without providing any real benefit to the patient.	3.05 (1.07)
12. If a patient is unable to breathe without a breathing machine it would be wrong to take them off the machine (even if the condition is hopeless) because that would be killing the patient.	3.58 (1.05)
13. The use of life sustaining machines can be humiliating to the patient.	3.67 (1.04)
Total mean score	2.95 (0.47)

Demographic factors	Nurses' attitude towards LSTs
Demographic factors	General attitude towards use of LSTs	Personal desire for LSTs
Age (years)
<27	2.94 (0.40)	0.10 (0.17)
28-35	2.89 (0.47)	0.06 (0.13)
>35	3.19 (0.51)	0.16 (0.22)
	F=2.32	F=2.72
Experience in ICU (years)
<2	2.79 (0.39)	0.08 (0.15)
2-5	2.97 (0.48)	0.07 (0.13)
>5	3.05 (0.49)	0.11 (0.20)
	F=2.13	F=0.64
Gender
Female	2.92 (0.46)	0.07 (0.15)
Male	3.37 (0.48)	0.27 (0.21)
	T=2.28^*	T=2.85^**
Marital status
Single	2.89 (0.43)	0.07 (0.14)
Married	2.97 (0.48)	0.09 (0.17)
	T=0.69	T=0.73
Level of education
Bachelor of Science	2.96 (0.47)	0.09 (0.17)
Master of Science	2.82 (0.54)	0.00 (0.00)
	T=0.55	T=5.25^#

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