20 September 2022 : Clinical Research
Intensive Care Residents’ Views Regarding Ethical Issues and Practices
Şükran Sevimli1ABCDEF*, Arzu Esen Tekeli2ABCDEFDOI: 10.12659/MSM.937357
Med Sci Monit 2022; 28:e937357
Table 2 ICU ethical issues questionnaire.
| Department Department | Surgery Internal Medicine | |||||
|---|---|---|---|---|---|---|
| N | % | N | % | P<.05 | ||
| 1. How often do you encounter ethical issues in the ICU? | Always | 0 | 0.0 | 10 | 40.0 | 0.284 |
| Usually | 15 | 53.6 | 7 | 28.0 | ||
| Sometimes | 8 | 28.6 | 3 | 12.0 | ||
| Rarely | 4 | 14.3 | 5 | 20.0 | ||
| Never | 1 | 3.6 | 0 | 0.0 | ||
| 2. The most common ethical problem I encounter is during ICU patient admission. | Always | 2 | 7.1 | 0 | 0.0 | 0.089 |
| Usually | 11 | 39.3 | 6 | 24.0 | ||
| Sometimes | 8 | 28.6 | 7 | 28.0 | ||
| Rarely | 7 | 25.0 | 11 | 44.0 | ||
| Never | 0 | 0.0 | 1 | 4.0 | ||
| 3. I encounter the most ethical problems during treatment of intensive care patients. | Always | 1 | 3.6 | 2 | 8.0 | 0.570 |
| Usually | 2 | 7.1 | 2 | 8.0 | ||
| Sometimes | 14 | 50.0 | 6 | 24.0 | ||
| Rarely | 11 | 39.3 | 15 | 60.0 | ||
| 4. I encounter the most ethical problems when patients are discharged from the ICU. | Always | 0 | 0.0 | 5 | 20.0 | 0.043 |
| Usually | 7 | 25.0 | 8 | 32.0 | ||
| Sometimes | 7 | 25.0 | 3 | 12.0 | ||
| Rarely | 12 | 42.9 | 8 | 32.0 | ||
| Never | 2 | 7.1 | 1 | 4.0 | ||
| 5. ICU bed capacity is limited; thus, when chronic patients are taken into intensive care, the inability to accept patients in need poses an ethical problem. | Always | 11 | 39.3 | 8 | 32.0 | 0.081 |
| Usually | 10 | 35.7 | 5 | 20.0 | ||
| Sometimes | 6 | 21.4 | 9 | 36.0 | ||
| Rarely | 1 | 3.6 | 3 | 12.0 | ||
| 6. Admission of pediatric patients to adult intensive care is an ethical problem. | Always | 11 | 39.3 | 8 | 32.0 | 0.365 |
| Usually | 7 | 25.0 | 5 | 20.0 | ||
| Sometimes | 8 | 28.6 | 8 | 32.0 | ||
| Rarely | 1 | 3.6 | 2 | 8.0 | ||
| Never | 1 | 3.6 | 2 | 8.0 | ||
| 7. Lack of space constitutes an ethical issue when transferring patients between different intensive care units. | Always | 12 | 42.9 | 6 | 24.0 | 0.339 |
| Usually | 4 | 14.3 | 5 | 20.0 | ||
| Sometimes | 5 | 17.9 | 4 | 16.0 | ||
| Rarely | 6 | 21.4 | 6 | 24.0 | ||
| Never | 1 | 3.6 | 4 | 16.0 | ||
| 8. The ethical problems I experience in intensive care are due to lack of supplies and technical/equipment problems. | Always | 3 | 10.7 | 10 | 40.0 | 0.066 |
| Usually | 9 | 32.1 | 7 | 28.0 | ||
| Sometimes | 7 | 25.0 | 3 | 12.0 | ||
| Rarely | 9 | 32.1 | 4 | 16.0 | ||
| Never | 0 | 0.0 | 1 | 4.0 | ||
| 9. The lack of clear authority and responsibilities when 2 clinics are involved raises ethical problems. | Always | 14 | 50.0 | 4 | 16.0 | 0.027 |
| Usually | 9 | 32.1 | 11 | 44.0 | ||
| Sometimes | 4 | 14.3 | 4 | 16.0 | ||
| Rarely | 1 | 3.6 | 6 | 24.0 | ||
| 10. It is an ethical issue when clinics avoid responsibility for the patient and refer patients who are not suitable for tertiary ICU treatment to intensive care. | Always | 16 | 57.1 | 7 | 28.0 | 0.023 |
| Usually | 8 | 28.6 | 6 | 24.0 | ||
| Sometimes | 4 | 14.3 | 7 | 28.0 | ||
| Rarely | 0 | 0.0 | 5 | 20.0 | ||
| 11. Some clinics asking anesthesiologists for tests without evaluating the patient presents a problem involving ethics and communication. | Always | 16 | 57.1 | 5 | 20.0 | 0.015 |
| Usually | 5 | 17.9 | 4 | 16.0 | ||
| Sometimes | 5 | 17.9 | 7 | 28.0 | ||
| Rarely | 2 | 7.1 | 9 | 36.0 | ||
| 12. The ethical problems I experience in the ICU are usually caused by the disinterested attitude of hospital management. | Always | 1 | 3.6 | 5 | 20.0 | 0.001 |
| Usually | 9 | 32.1 | 7 | 28.0 | ||
| Sometimes | 9 | 32.1 | 5 | 20.0 | ||
| Rarely | 9 | 32.1 | 8 | 32.0 | ||
| 13. Not paying attention to clinical rules while removing the patient from the intensive care unit is an ethical problem. | Always | 17 | 60.7 | 2 | 8.0 | 0.000 |
| Usually | 2 | 7.1 | 9 | 36.0 | ||
| Sometimes | 7 | 25.0 | 6 | 24.0 | ||
| Rarely | 2 | 7.1 | 8 | 32.0 | ||
| 14. Constant examinations of and unhelpful treatment for patients with minimal signs of life constitute ethical problems. | Always | 13 | 46.4 | 7 | 28.0 | 0.130 |
| Usually | 7 | 25.0 | 3 | 12.0 | ||
| Sometimes | 5 | 17.9 | 11 | 44.0 | ||
| Rarely | 3 | 10.7 | 4 | 16.0 | ||
| 15. The relatives’ insistence on the continuation of futile treatment for patients presents an ethical issue. | Always | 11 | 39.3 | 6 | 24.0 | 0.004 |
| Usually | 11 | 39.3 | 4 | 16.0 | ||
| Sometimes | 3 | 10.7 | 5 | 20.0 | ||
| Rarely | 2 | 7.1 | 6 | 24.0 | ||
| Never | 1 | 3.6 | 4 | 16.0 | ||
| 16. The physician’s insistence on the continuation of futile treatment on patients represents an ethical issue. | Always | 13 | 46.4 | 5 | 20.0 | 0.040 |
| Usually | 5 | 17.9 | 4 | 16.0 | ||
| Sometimes | 7 | 25.0 | 7 | 28.0 | ||
| Rarely | 2 | 7.1 | 9 | 36.0 | ||
| Never | 1 | 3.6 | 0 | 0.0 | ||
| 17. The verbal or physical intervention of the patient’s relatives whether directly or through authorized persons creates ethical issues. | Always | 22 | 78.6 | 12 | 48.0 | 0.361 |
| Usually | 0 | 0.0 | 10 | 40.0 | ||
| Sometimes | 2 | 7.1 | 2 | 8.0 | ||
| Rarely | 4 | 14.3 | 1 | 4.0 | ||
| 18. Many ethical problems I experience in the intensive care unit arise from the visits of large numbers of patient relatives. | Always | 0 | 0.0 | 1 | 4.0 | 0.003 |
| Usually | 1 | 3.6 | 8 | 32.0 | ||
| Sometimes | 14 | 50.0 | 10 | 40.0 | ||
| Rarely | 13 | 46.4 | 6 | 24.0 | ||
| 19. It is an ethical problem when a physician is not familiar with the concept of “Code Blue” and so the responsibility falls to certain clinics. | Always | 1 | 3.6 | 5 | 20.0 | |
| Usually | 4 | 14.3 | 6 | 24.0 | ||
| Sometimes | 0 | 0.0 | 4 | 16.0 | ||
| Rarely | 0 | 0.0 | 8 | 32.0 | ||
| Never | 23 | 82.1 | 2 | 8.0 | ||
| 20. The ethical problems I face in intensive care are caused by the professors’ different approaches to treatment. | Always | 2 | 7.1 | 1 | 4.0 | 0.127 |
| Usually | 9 | 32.1 | 4 | 16.0 | ||
| Sometimes | 7 | 25.0 | 4 | 16.0 | ||
| Rarely | 10 | 35.7 | 13 | 52.0 | ||
| Never | 0 | 0.0 | 3 | 12.0 | ||
| 21. The ethical problems I face in intensive care are caused by the ICU staff (technicians, secretaries, cleaners, etc.) not paying attention to the residents’ warnings. | Always | 2 | 7.1 | 0 | 0.0 | 0.004 |
| Usually | 10 | 35.7 | 2 | 8.0 | ||
| Sometimes | 5 | 17.9 | 3 | 12.0 | ||
| Rarely | 11 | 39.3 | 16 | 64.0 | ||
| Never | 0 | 0.0 | 4 | 16.0 | ||
| 22. The ethical problems I encounter in intensive care stem from my own inexperience. | Always | 1 | 3.6 | 2 | 8.0 | 0.579 |
| Usually | 5 | 17.9 | 5 | 20.0 | ||
| Sometimes | 21 | 75.0 | 14 | 56.0 | ||
| Never | 1 | 3.6 | 4 | 16.0 | ||
| 23. The ethical problems I encounter in intensive care stem from a lack of adequate communication. | Always | 0 | 0.0 | 3 | 12.0 | 0.085 |
| Usually | 4 | 14.3 | 9 | 36.0 | ||
| Sometimes | 8 | 28.6 | 6 | 24.0 | ||
| Rarely | 13 | 46.4 | 5 | 20.0 | ||
| Never | 3 | 10.7 | 2 | 8.0 | ||
| 24. The ethical issues I face in intensive care are caused by the anxiety/stress of patients’ relatives and difficulties in discussing informed consent. | Always | 0 | 0.0 | 4 | 16.0 | 0.028 |
| Usually | 3 | 10.7 | 5 | 20.0 | ||
| Sometimes | 11 | 39.3 | 9 | 36.0 | ||
| Rarely | 13 | 46.4 | 6 | 24.0 | ||
| Never | 1 | 3.6 | 1 | 4.0 | ||
| 25. The ethical problems I encounter in intensive care stem from the lack of intra-clinical communication. | Always | 0 | 0.0 | 1 | 4.0 | 0.232 |
| Usually | 5 | 17.9% | 7 | 28.0% | ||
| Sometimes | 8 | 28.6 | 3 | 12.0 | ||
| Rarely | 13 | 46.4 | 11 | 44.0 | ||
| Never | 2 | 7.1 | 3 | 12.0 | ||
| 26. Ethical problems in the ICU arise from the residents’ limited authority. | Always | 1 | 3.6 | 9 | 36.0 | 0.043 |
| Usually | 6 | 21.4 | 5 | 20.0 | ||
| Sometimes | 9 | 32.1 | 7 | 28.0 | ||
| Rarely | 12 | 42.9 | 4 | 16.0 | ||
| 27. A resident should not be actively involved in resolving ethical problems in intensive care. | Always | 4 | 14.3 | 9 | 36.0 | 0.323 |
| Usually | 9 | 32.1 | 6 | 24.0 | ||
| Sometimes | 6 | 21.4 | 4 | 16.0 | ||
| Rarely | 9 | 32.1 | 4 | 16.0 | ||
| Never | 0 | 0.0 | 2 | 8.0 | ||
| 28. I am tasked with resolving ethical problems experienced in intensive care on my own. | Always | 2 | 7.1 | 7 | 28.0 | 0.538 |
| Usually | 8 | 28.6 | 4 | 16.0 | ||
| Sometimes | 11 | 39.3 | 8 | 32.0 | ||
| Rarely | 7 | 25.0 | 5 | 20.0 | ||
| Never | 0 | 0.0 | 1 | 4.0 | ||
| 29. Improving intra- and inter-clinical communication reduces ethical problems. | Always | 9 | 32.1 | 4 | 16.0 | 0.124 |
| Usually | 7 | 25.0 | 5 | 20.0 | ||
| Sometimes | 7 | 25.0 | 9 | 36.0 | ||
| Rarely | 5 | 17.9 | 3 | 12.0 | ||
| Never | 0 | 0.0 | 4 | 16.0 | ||
| 30. Having a hospital ethics committee and consultations with medical ethicists reduce these problems. | Always | 2 | 7.1 | 6 | 24.0 | 0.696 |
| Usually | 10 | 35.7 | 7 | 28.0 | ||
| Sometimes | 8 | 28.6 | 3 | 12.0 | ||
| Rarely | 5 | 17.9 | 5 | 20.0 | ||
| Never | 3 | 10.7 | 4 | 16.0 | ||
| 31. Eliminating shortages in the intensive care unit reduces ethical problems. | Always | 4 | 14.3 | 6 | 24.0 | 0.563 |
| Usually | 16 | 57.1 | 10 | 40.0 | ||
| Sometimes | 6 | 21.4 | 5 | 20.0 | ||
| Rarely | 1 | 3.6 | 4 | 16.0 | ||
| Never | 1 | 3.6 | 0 | 0.0 | ||
| 32. Ethics training for nurses and employees who are new to the intensive care unit reduces ethical problems. | Always | 8 | 28.6 | 7 | 28.0 | 0.082 |
| Usually | 12 | 42.9 | 5 | 20.0 | ||
| Sometimes | 5 | 17.9 | 6 | 24.0 | ||
| Rarely | 3 | 10.7 | 4 | 16.0 | ||
| Never | 0 | 0.0 | 3 | 12.0 | ||
| χ test. | ||||||