Ethical challenges when intensive care unit patients refuse nursing care: A narrative approach

Area of Science:

• Nursing Ethics
• Intensive Care Medicine
• Patient Autonomy

Background:

• Increasingly awake patients in intensive care units (ICUs) present novel ethical challenges.
• The balance between patient autonomy and necessary medical intervention is a growing concern.

Purpose of the Study:

• To explore and describe the ethical challenges encountered by registered nurses (RNs) when patients refuse care and treatment.
• To understand the lived experiences of RNs in managing patient refusal in critical care settings.

Main Methods:

• Phenomenological hermeneutic analysis of narrative individual open interviews.
• Study conducted with three RNs from an ICU at a Norwegian university hospital.

Main Results:

• RNs experience ethical conflicts navigating decisions made for patients, persuasion, and respecting patient choices.
• Challenges arise from patients engaging in self-harm, neglecting hygiene, or obstructing critical treatments.

Conclusions:

• Pragmatic considerations can challenge professional ethics, increasing the burden on RNs to uphold 'do no harm' and patient dignity.
• Evolving ICU practices necessitate RNs to maintain strong integrity and reflective practice to align ideals with clinical reality for holistic care.