Ethical Issues Recognized by Critical Care Nurses in the Intensive Care Units of a Tertiary Hospital during Two Separate Periods

This research aimed to investigate the changes in ethical issues in everyday clinical practice recognized by critical care nurses during two observation periods. We conducted a retrospective analysis of data obtained by prospective questionnaire surveys of nurses in the intensive care units (ICU) of a tertiary university-affiliated hospital in Seoul, Korea. Data were collected prospectively during two different periods, February 2002-January 2003 (Period 1) and August 2011-July 2012 (Period 2). Significantly fewer cases with ethical issues were reported in Period 2 than in Period 1 (89 cases [2.1%] of 4,291 ICU admissions vs. 51 [0.5%] of 9,302 ICU admissions, respectively; P < 0.001). The highest incidence of cases with identified ethical issues in both Periods occurred in MICU. The major source of ethical issues in Periods 1 and 2 was behavior-related. Among behavior-related issues, inappropriate healthcare professional behavior was predominant in both periods and mainly involved resident physicians. Ethical issue numbers regarding end-of-life (EOL) care significantly decreased in the proportion with respect to ethical issues during Period 2 (P = 0.044). In conclusion, the decreased incidence of cases with identified ethical issues in Period 2 might be associated with ethical enhancement related with EOL and improvements in the ICU care environment of the studied hospital. However, behavior-related issues involving resident physicians represent a considerable proportion of ethical issues encountered by critical care nurses. A systemic approach to solve behavior-related issues of resident physicians seems to be required to enhance an ethical environment in the studied ICU.

Competencia cultural para enfermeras hospitalares que cuidan pacientes con enfermedad crónica / Cultural competence for hospital nurses caring for patients with chronic illness

Antecedentes: Colombia es culturalmente diversa y vive procesos de desplazamiento forzado por la violencia siendo uno de los países con mayor desplazamiento interno del mundo. Colombia tiene alta morbilidad y mortalidad por las enfermedades crónicas. Las enfermeras en los hospitales deben cuidar de esas poblaciones de diversos orígenes pero se desconoce si tienen competencia cultural para hacerlo. Objetivo: Describir la competencia cultural expresada por Enfermeras hospitalares, cuando cuidan a pacientes con Enfermedad Crónica. Metodología: Estudio etnográfico interpretativo. Hicieron parte del estudio diez PE con más de un año de trabajo en el Hospital San Antonio con personas adultas con enfermedad crónica en el hospital. Los datos fueron recogidos de la observación participante, grupo focal, seis entrevistas etnográficas y diez narrativas después de 14 meses de trabajo en campo. El análisis de los datos siguieron las fases propuestas por Leininger en un proceso inductivo ­ deductivo. La confirmabilidad, transferibilidad, auditabilidad y credibilidad hicieron parte del rigor metodológico. Todos los aspectos éticos fueron considerados. Resultados: Los hallazgos muestran un tema cultural: Intento por responder al asunto cultural de los pacientes desde mi ética profesional como algo implícito en la práctica de las EH. Así intentan respetar, aprender, ser sensibles y responder a los pacientes de diversos orígenes buscando dignificarlos, este no es un proceso sistemático. Finalmente se concluye que hay un aprendizaje práctico de la experiencia haciendo que no se tenga el conocimiento, ni la habilidad pero si la conciencia de sí, la parte ética las mueve y es ahí donde responden. (AU)

Background: Colombia is culturally diverse and live processes of forced displacement by violence remains one of the countries with the largest internal displacement in the world. Colombia has high morbidity and mortality from chronic diseases. Nurses in hospitals must care for these populations but whether they have the cultural competence. Objective: To describe cultural competence expressed by nurses hospitals when caring for patients with Chronic Disease. Methodology: Interpretive Ethnographic study. They were part of the study ten nurses more than a year of work in the San Antonio Hospital with adults with chronic disease nurses in the hospital. Data were collected from participant observation, focus groups, and ethnographic interviews with six nurses and ten plots after 14 months of field work. The data analysis followed the steps proposed in an inductive process Leininger - deductive. Confirmability, transferability, auditability and credibility are considered as part of the methodological rigor. All ethical issues were considered. Results: The findings show a cultural issue: I try to respond to the cultural issue of patients from my professional ethics as something implicit in the practice of nurses. So nurses try to respect, learn, be sensitive and respond to patients from diverse backgrounds seeking dignify this is not a systematic process. Finally it is concluded that there is a practical learning experience making knowledge is known, but not the ability of self-consciousness, the ethical part the moves and that is where they respond. (AU)