Moral distress of critical care nurses when initiating do-not-resuscitate orders for critical ill patients in a specific government hospital

Abstract

Introduction: Patients who are critically ill or seriously injured are routinely admitted to critical care units. If the patient’s condition deteriorates beyond a certain point, the medical practitioner may prescribe or decide on a do-not-resuscitate (DNR) order that must be executed by the professional nurse. Professional nurses may experience moral distress that manifests in poor teamwork, depression, and absenteeism. Aim: To explore and describe factors contributing to moral distress of critical care nurse executing do-not-resuscitate orders. Design: The explorative descriptive qualitative design was selected to answer the research questions posed. Methods: Critical care nurses of a selected public hospital in Gauteng province were selected through purposive sampling to participated in the study. Participants: The shift leader assisted with selection of participants who met the eligibility criteria. The mean age of the participants was 36 years and most of them had more than five years’ critical care nursing experience. Finding: The findings were classified under three main topics which are moral distress; communication and psychological impact of DNR orders. Conclusion: Clearly defined national guidelines or legal framework are required to regulate DNR processes. The study further demonstrated the need for unit based ethical platforms and debriefing sessions for the critical care nurses. Key Words: Critical Care Nurse, Critical Care Unit, Do-not-resuscitate order, Moral distress.