Doctors' and Nurses' Experiences of Ethical Challenges in End of Life Decisions in Critical Care Unit at Kenyatta National Hospital

Abstract

Background: Many nurses and doctors often experience ethical problems around decision making at the end of life. Lack of guiding policies in the unit on how to deal with ethical issues contributes to stress, tension, burnout, conflicts and feelings of guilt among the clinicians, which contribute negatively to the health of the clinicians and care of the patient. It was necessary to explore the experiences of nurses and doctors on these ethical challenges in end of life care so that steps can be taken to help them cope positively. Objective: To explore nurses' and doctors' experiences regarding ethical challenges in end of life care in KNH CCU. Methodology: This was a qualitative study utilizing a descriptive phenomenological approach. Nurses and doctors working in KNH CCU during the study period and were willing to participate by giving informed consent, were interviewed. Purposeful sampling method was used to recruit eighteen participants who were interviewed until data saturation. An audio recording was used to store data from interviews. Data collection took three weeks. Data analysis was guided by transcendental phenomenological data analysis process using N-VIVO software. Clustering of themes took place where the researcher clustered themes that were common from the study findings. Results: There were five major themes identified: Definition of ethical challenges, Encounter of ethical challenges; Experience on decisions in end of life care and decisions arrived at when faced by an ethical challenge. Conclusions: Ethical challenges are a reality at KNH CCU. The nurses and doctors providing care at KNH CCU find themselves in a dilemma when faced with ethical challenges. xii Recommendations: An ethical committee from KNH mandated to handle ethical challenges should be set up. Need for guidelines, protocols or policies documenting exactly what should be done should a health care provider encounter ethical challenges.