Ethical Deliberation in the Intensive Care Unit, Impact of Formalized Multidisciplinary Team Meetings, a Pilot Study

Study Overview
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Brief Summary
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Most patients who die in the intensive care unit do so after a withholding or withdrawing of life sustaining treatments (WWLST) decision. The implementation of formalized interdisciplinary team meetings for ethical deliberation in the ICU may improve nurses participation in WWLST decisions. The investigators decided to implement such team meetings in their ICU. At this occasion, the investigators will measure job satisfaction, job related frustration and ethical decision making climate climate.

Detailed Description
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Most patients who die in the intensive care unit do so after a withholding or withdrawing of life sustaining treatments (WWLST) decision. Because those decisions are value-laden, guidelines as well as french regulations recommend that they should involve not only medical doctors but also nurses. Despite that, nurses' involvement remains incomplete. Poor collaboration between doctors and nurses on ethical decisions is associated with job dissatisfaction, burnout and desire to quit. The implementation of formalized interdisciplinary team meetings for ethical deliberation in the ICU may improve nurses participation in WWLST decisions. For those reasons the investigators decided to implement such team meetings in their ICU. At this occasion, the investigators will measure job satisfaction, job related frustration and ethical decision making climate climate.

Official Title
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Délibération éthique en réanimation, Impact de la Mise en Place de réunions éthiques formalisées, Une étude Pilote

Conditions
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Ethics, Narrative

Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: All patients admitted in the ICU Exclusion Criteria: Age below 18

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Change in nurses perception of ethical decision making climate in the ICU | Nurses answers to the questionnaire Ethical Decision-Making Climate Questionnaire (7 factors evaluated, for each factor score ranges from 1 to 5, higher scores indicate a better climate). | june 2023, january 2024 | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Change in nurses psychological well being at work | Nurses answers to the Index of psychological well being at work (5 factors, for each factor score ranges from 1 to 5, higher scores indicate more well being). | 2 evaluations: may 2023, january 2024 | 
| Change in nurses frustration of job's related psychological needs | Nurses answers to the Job related psychological needs frustration score (3 factors, for each factor score ranges from 1 to 5, higher score indicate more frustration) | 2 evaluations: may 2023, january 2024 | 
| Change in nurses desire to leave | Nurses answers to a one question questionnaire: I have thoughts about leaving my current position/job (lickert scale, score range from 1 to 5, higher score indicate a higher desire to leave) | 2 evaluations: may 2023, january 2024 | 
| Non beneficial care | Duration of mechanical ventilation in patients who ultimately die (number of days) | January 2024 | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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End of life decisions in the ICU, Multidisciplinary team meetings, Ethical decision making climate, Nurses job satisfaction