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Nurses are essential in patient care, upholding the ethical principles of their profession and effectively navigating ethical dilemmas. Neglecting ethical issues can lead to inadequate patient care, compromised therapeutic relationships, and moral distress among healthcare workers.
Ethical Concerns in Healthcare:
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According to obedience research, we may harm others under the forceful pressures of an authority figure (Milgram, 1974). How about if the inappropriate orders were delivered with less force? The increasing interdependence between nurses and physicians compelled Hofling and his colleagues to explore nurses’ reactions to a potentially harmful medical request made by the perceived authority figure, the doctor (Hofling, Brotzman, Dalrymple, Graves, & Pierce, 1966). In this situation,...
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Patient-centered care involves delivering care beyond inpatient hospitalization. Reflective practice can enhance a patient-centered approach. Reflective practice is a process of reasoning that considers all aspects of the present situation, including practicalities, learning from personal practice, and consideration of patient needs. Patients appreciate care decisions made while considering their input. Involving the patient in their care provides the patient with a sense of contribution rather...
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Critical Care Physicians' Perspectives on Nudging in Communication.

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Physicians view nudging as a vital communication tool, but ethical concerns about patient autonomy persist. Nudging effectiveness varies by context and physician characteristics, requiring careful consideration in clinical practice.

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Area of Science:

  • Behavioral Economics
  • Medical Ethics
  • Qualitative Research

Background:

  • Behavioral economics reveals human susceptibility to cognitive biases and heuristics.
  • The conscious use of nudges by physicians to influence patient decisions remains unclear.
  • Ethical implications and physician perceptions of nudging in medicine require further investigation.

Purpose of the Study:

  • To explore critical care physicians' perspectives on using nudges in patient clinical decision-making.

Main Methods:

  • Qualitative study utilizing semistructured interviews with 54 critical care physicians across 3 Boston tertiary care hospitals.
  • Physicians were randomly selected from adult, pediatric, and neonatal critical care attending specialties.
  • Thematic analysis of interview transcripts was conducted between October 2024 and February 2025.

Main Results:

  • Nudging is generally perceived as a positive and essential aspect of medical communication.
  • Physicians expressed ethical concerns, particularly regarding patient autonomy.
  • Nudging effectiveness and appropriateness varied by clinical situation, physician specialty, sex, and experience level.
  • Differences observed in nudging strategies: adult intensivists used more direct/transparent nudges, while pediatric/neonatal intensivists favored subtle nudges for shared decision-making. Female physicians focused on emotional well-being, males on efficiency/outcomes. Junior physicians were more hesitant than senior counterparts.

Conclusions:

  • Physicians recognize the importance of nudging in patient communication but acknowledge ethical uncertainties.
  • The findings suggest that nudging can be an effective and appropriate communication technique when tailored to specific contexts.
  • Understanding physician perspectives is crucial for the ethical and effective implementation of nudging in healthcare settings.