The Relationship between Futile Care and Moral Sensitivity in Nurses Working in the Neonatal Intensive Care Unit of Medical Training Centers in Gorgan 2024
-
Hamid Hojjati
,
Shiva Eslamian Koupaei
,
Termeh Riahi Madvar
,
Nafiseh Hekmati Pour
,
Ailin Delavari
,
Hossein Motahari Niya
,
Malihe Kabusi
Abstract
Background: Nursing interventions in neonatal intensive care units of hospitals can occasionally turn into futile and costly measures, bringing about ethical conundrums. The aim of the present study was to investigate the relationship between futile care and moral sensitivity among nurses working at the neonatal intensive care units (NICU) of teaching medical centers in Gorgan city, North of Iran.
Methods: This 2024 descriptive-analytical study was conducted on 100 NICU nurses enrolled by quota sampling. Data collection tools included a demographic information questionnaire, the Lutzen moral sensitivity questionnaire, and a futile care questionnaire developed based on the Corley moral distress scale. The data gathered were entered into SPSS version 21 software and analyzed using descriptive (tables, mean, and standard deviation) and inferential (Pearson correlation coefficient) statistics.
Results: According to the results, the participants acquired the mean score of 62.12 ± 4.08 for moral sensitivity and 44.16 ± 5.81 for futile care. The Pearson correlation coefficient showed no significant association between moral sensitivity and futile care (r = - 0.12, P = 0.2).
Conclusion: Regarding the impact of nurses’ moral sensitivity and perception of futile care on the quality of health service provision, authorities are advised to consider plans and solutions (such as professional ethics training courses) to improve nurses’ awareness of ethical dilemmas, moral sensitivity, and attitudes towards futile care.
[1] Kabusi M, Golfiroozi S, Rajabloo M, Yahyanezhad M, Hojjati H. The Effect Of Neonatal Cardiopulmonary Resuscitation Training On The Knowledge Of Neonatal Ward Nurses. Int J Med Investig. 2023;12(3):190-6.
[2] Golfiroozi S, Hojjati H, Hekmati Pour N, Kabusi M, Farhadi S, Yahyanezhad M. Effect of in-service training courses in neonatal cardiopulmonary resuscitation on the rate of successful resuscitation in nurses working in the neonatal department: A quasi-experimental study. J Nurs Rep Clin Pract. 2023;2(4):198-203.
[3] Fathi N, Askari A, Hossinpour R, Babaei Pouya A, Salehi AR, Ghodrati Torbati A, et al. Investigating the Association of Mental Workload, Occupational Fatigue and Job Stress in Emergency Nurses in Iran. Health Emerg Disasters Q. 2024;9(4):295-302.
[4] Ali Khalil H, Radha Aziz A. The relationship between nurses’ clinical competencies and burnout in neonatal intensive care units: A cross-sectional study. J Nurs Adv Clin Sci. 2024;1(3):133-7.
[5] Begjani J, Movahidimoghadam F, Khoshnavay Fomani F, Beiranvand F. The effect of educational and supportive package by peers on the self-efficacy mothers of premature neonates: A quasi-experimental study. J Nurs Adv Clin Sci. 2024;1(2):91-6.
[6] Begjani J, Dizaji NN, Mirlashari J, Dehghan K. Moral Distress and Perception of Futile Care among Nurses of Neonatal Care Units. Indian J Palliat Care. 2022;28(3):301-6.
[7] Zaheri A, Keshavarz F, Mirzaei Z. The relationship between nurses' perception of ethical climate at the workplace and patient satisfaction with health services provided: A cross-sectional study. J Nurs Adv Clin Sci. 2024;2(2):71-6.
[8] Rakhshan M, Joolaee S, Mousazadeh N, Hakimi H, Bagherian S. Causes of futile care from the perspective of intensive care unit nurses (I.C.U): qualitative content analysis. BMC Nurs. 2022;21(1):225.
[9] Ho MH, Lin CC. Futile care and burnout in intensive care unit nurses. Intensive Crit Care Nurs. 2022;71:103228.
[10] Rezaie A, Molayi F, Shaafi MS, Ghanbari Ghalesar M. Nurses’ perception of futile care: A narrative review. J Nurs Adv Clin Sci. 2024;2(2):106-12.
[11] Sibbald R, Downar J, Hawryluck L. Perceptions of “futile care” among caregivers in intensive care units. CMAJ. 2007;177(10):1201-8.
[12] Rostami S, Esmaeali R, Jafari H, Cherati JY. Perception of futile care and caring behaviors of nurses in intensive care units. Nurs Ethics. 2019;26(1):248-55.
[13] Rezaie F, Shohani M, Alijani H, Abedi L. The effect of spiritual self-care training on the attachment of the mothers of premature babies hospitalized in the neonatal intensive care unit (NICU) of Taleghani Hospital, Ilam. Med J Tabriz Uni Med Sci. 2023;45(2):161-70.
[14] Mohammadi S, Roshanzadeh M. Exploring the Perception of intensive care unit nurses of futile care. Educ Ethics Nurs. 2022;3(2):65-72.
[15] Meadow W, Cohen-Cutler S, Spelke B, Kim A, Plesac M, Weis K, et al. The prediction and cost of futility in the NICU. Acta Paediatr. 2012;101(4):397-402.
[16] Borhani F, Mohammadi S, Roshanzadeh M. Moral distress and perception of futile care in intensive care nurses. J Med Ethics Hist Med. 2015;8.
[17] Otaghi M, Shirkhani S, Azadi A, Khorshidi A, Mousavimoghadam SR. The relationship between perception of futile care and moral distress of nurses in critical care units. J Biochem Technol. 2018;9(2-2018):113-9.
[18] Moaddaby S, Adib M, Ashrafi S, Kazemnezhad Leili E. Perception of the Futile Care and its Relationship With Moral Distress in Nurses of Intensive Care Units. J Holist Nurs Midwifery. 2021;31(2):85-92.
[19] Khalighi E, Solaimanizadeh L, Borji M, Tarjoman A, Soltany B, Zareie F. Investigating relationship between religious commitment and moral sensitivity in nurses working in ICU. BMC Res Notes. 2020; 13(1):41.
[20] Kovanci MS, Atli Özbaş A. Moral distress and moral sensitivity in clinical nurses. Res Nurs Health. 2024;47(3):312-23.
[21] Hamzehpour H, Aghahosseini SS. Moral Sensitivity And Interprofessional Collaboration In Nurses: A Correlational Study. Nurs Midwifery J. 2023;21(7):503-10.
[22] Babaei SM, Araghian Mojarrad F, Kamali M, Arab Larimi M, Jafari H. Moral sensitivity and related factors in Iranian critical care nurses: A narrative review. J Nurs Rep Clin Pract. 2023;1(2):78-83.
[23] Ye B, Luo E, Zhang J, Chen X, Zhang J. Moral Sensitivity and Emotional Intelligence in Intensive Care Unit Nurses. Int J Environ Res Public Health. 2022;19(9).
[24] Atashzadeh-Shoorideh F, Tayyar-Iravanlou F, Chashmi ZA, Abdi F, Cisic RS. Factors affecting moral distress in nurses working in intensive care units: A systematic review. Clin Ethics. 2021;16(1):25-36.
[25] Mills M, Cortezzo DE. Moral Distress in the Neonatal Intensive Care Unit: What Is It, Why It Happens, and How We Can Address It. Front Pediatr. 2020;8.
[26] Alamdari MP, Raiesdana N, Nobahar M, Yavari MB. Comparison of the correlation between moral sensitivity and clinical competence in emergency and intensive care nurses: A cross-sectional-correlation study. Int Emerg Nurs. 2024;75:101483.
[27] Schneiderman LJ. Defining Medical Futility and Improving Medical Care. J Bioeth Inq. 2011;8(2):123-31.
[28] Araç B, Doğan R, Sarıtaş S. Determining the Moral Sensitivity of Intensive Care Nurses. Int J Med Investig. 2018;7(1):88-97.
[29] Yildirim G, Işık MT, Yalcin SO. Relationship Between Physician’s and Nurses’ Attitudes Towards Futile Treatment and Their Approach to Death and Terminally Ill Patients. Omega (Westport). 2023; 302228231153712.
[30] Corley MC, Elswick RK, Gorman M, Clor T. Development and evaluation of a moral distress scale. J Adv Nurs. 2001;33(2):250-6.
[31] Hajiloo P, Torabi M. The relationship between moral sensitivity and Nurses' perception of futile care in patients with Covid-19. 2020.
[32] Lützén K, Nordin C, Brolin G. Conceptualization and instrumentation of nurses' moral sensitivity in psychiatric practice. Int J Methods Psychiatr Res. 1994;4(4):241-8.
[33] Maghami M, Yektatalab S, Torabizadeh C. The attitude and the level of ethical sensitivity of nurses towards elder patients in selected hospitals affiliated to Shiraz University of Medical Sciences. J Geriatric Nursing 2018;4(2):35-46.
[34] Amiri E, Ebrahimi H, Namdar Areshtanab H, Vahidi M, Asghari Jafarabadi M. The Relationship between Nurses' Moral Sensitivity and Patients' Satisfaction with the Care Received in the Medical Wards. J Caring Sci. 2020;9(2):98-103.
[35] Goktas S, Aktug C, Gezginci E. Evaluation of moral sensitivity and moral courage in intensive care nurses in Turkey during the COVID-19 pandemic. Nurs Crit Care. 2023;28(2):261-71.
[36] İlter SM, Ovayolu Ö, Serçe S, Ovayolu N. An Investigation of the Relationship Between Compassion Fatigue and Moral Sensitivity of Intensive Care Nurses. Omega (Westport). 2024;90(2):521-35.
[37] Pang F, Zhang Y, Liu H, Du A, Tian Y, Chen H, et al. Factors associated with moral sensitivity among nurses in adult intensive care units: A cross-sectional study in China. Nurs Crit Care. 2024;29(6):1385-93.
[38] Schmocker D, Tanner C, Katsarov J, Christen M. Moral sensitivity in business: A revised measure. Curr Psychol. 2023;42(12):10277-91.
[39] Zadi O, Tavani FM, Behshid M, Sheikhalipour Z, Rahmani P, MT KH. Futile care in COVID-19: how ICU nurses' resilience impacts turnover intention? A cross-sectional descriptive study. BMC Health Serv Res. 2024;24(1):1664.
[40] Dunwoody DR. Nurses' level of moral distress and perception of futile care in the critical care environment: D'Youville College; 2010.
[41] Kadooka Y, Asai A, Fukuyama M, Bito S. A comparative survey on potentially futile treatments between Japanese nurses and laypeople. Nurs Ethics. 2014;21(1):64-75.
[42] Asayesh H, Mosavi M, Abdi M, Masoud MP, Jodaki K. The relationship between futile care perception and moral distress among intensive care unit nurses. J Med Ethics Hist Med. 2018;11:2.
[43] Reed C. Ethical dilemmas and end-of-life care. Nursing Made Incredibly Easy! 2015;13:16-24.
[44] Ashktorab T, Vaezi A. Moral distress: evaluating nurses’ experiences. Iran J Med Ethics Hist Med. 2013;6(1):64-73.
[45] Joolaee S, Jalili HR, Rafii F, Hajibabaee F, Haghani H. Relationship between Moral Distress and Job Satisfaction among Nurses of Tehran University of Medical Sciences Hospitals. J Hayat. 2012;18(1):42-51.
[46] Ferrell BR. Understanding the moral distress of nurses witnessing medically futile care. Oncol Nurs Forum. 2006;33(5):922-30.
[47] Mobarakian M, Taghinejad H, Mohammadi R, Otaghi M. Comparison of the Effect of Self-Care Education by Nurse and Peer on Self-Care Ability of Candidate Patients for Angiography. J Isfahan Med Sch. 2024;41(750):1184-91.
[48] Shahbazi G, Otaghi M, Shahbazi S, Parvaresh-Masoud M. Comparing stress, coping strategies, and quality of life among nurses working in ICU and emergency ward with other hospital departments. Ann Trop Med Public Health. 2018(3.3 Sp):SP53.
[49] Mousavi E, Kavi E, Larti N, Gharahzadeh A. The relationship between attitude toward the effectiveness of teamwork and observing safety standards in Isfahan educational hospitals. Rev Latinoam Hipertens. 2018;13(3).
[2] Golfiroozi S, Hojjati H, Hekmati Pour N, Kabusi M, Farhadi S, Yahyanezhad M. Effect of in-service training courses in neonatal cardiopulmonary resuscitation on the rate of successful resuscitation in nurses working in the neonatal department: A quasi-experimental study. J Nurs Rep Clin Pract. 2023;2(4):198-203.
[3] Fathi N, Askari A, Hossinpour R, Babaei Pouya A, Salehi AR, Ghodrati Torbati A, et al. Investigating the Association of Mental Workload, Occupational Fatigue and Job Stress in Emergency Nurses in Iran. Health Emerg Disasters Q. 2024;9(4):295-302.
[4] Ali Khalil H, Radha Aziz A. The relationship between nurses’ clinical competencies and burnout in neonatal intensive care units: A cross-sectional study. J Nurs Adv Clin Sci. 2024;1(3):133-7.
[5] Begjani J, Movahidimoghadam F, Khoshnavay Fomani F, Beiranvand F. The effect of educational and supportive package by peers on the self-efficacy mothers of premature neonates: A quasi-experimental study. J Nurs Adv Clin Sci. 2024;1(2):91-6.
[6] Begjani J, Dizaji NN, Mirlashari J, Dehghan K. Moral Distress and Perception of Futile Care among Nurses of Neonatal Care Units. Indian J Palliat Care. 2022;28(3):301-6.
[7] Zaheri A, Keshavarz F, Mirzaei Z. The relationship between nurses' perception of ethical climate at the workplace and patient satisfaction with health services provided: A cross-sectional study. J Nurs Adv Clin Sci. 2024;2(2):71-6.
[8] Rakhshan M, Joolaee S, Mousazadeh N, Hakimi H, Bagherian S. Causes of futile care from the perspective of intensive care unit nurses (I.C.U): qualitative content analysis. BMC Nurs. 2022;21(1):225.
[9] Ho MH, Lin CC. Futile care and burnout in intensive care unit nurses. Intensive Crit Care Nurs. 2022;71:103228.
[10] Rezaie A, Molayi F, Shaafi MS, Ghanbari Ghalesar M. Nurses’ perception of futile care: A narrative review. J Nurs Adv Clin Sci. 2024;2(2):106-12.
[11] Sibbald R, Downar J, Hawryluck L. Perceptions of “futile care” among caregivers in intensive care units. CMAJ. 2007;177(10):1201-8.
[12] Rostami S, Esmaeali R, Jafari H, Cherati JY. Perception of futile care and caring behaviors of nurses in intensive care units. Nurs Ethics. 2019;26(1):248-55.
[13] Rezaie F, Shohani M, Alijani H, Abedi L. The effect of spiritual self-care training on the attachment of the mothers of premature babies hospitalized in the neonatal intensive care unit (NICU) of Taleghani Hospital, Ilam. Med J Tabriz Uni Med Sci. 2023;45(2):161-70.
[14] Mohammadi S, Roshanzadeh M. Exploring the Perception of intensive care unit nurses of futile care. Educ Ethics Nurs. 2022;3(2):65-72.
[15] Meadow W, Cohen-Cutler S, Spelke B, Kim A, Plesac M, Weis K, et al. The prediction and cost of futility in the NICU. Acta Paediatr. 2012;101(4):397-402.
[16] Borhani F, Mohammadi S, Roshanzadeh M. Moral distress and perception of futile care in intensive care nurses. J Med Ethics Hist Med. 2015;8.
[17] Otaghi M, Shirkhani S, Azadi A, Khorshidi A, Mousavimoghadam SR. The relationship between perception of futile care and moral distress of nurses in critical care units. J Biochem Technol. 2018;9(2-2018):113-9.
[18] Moaddaby S, Adib M, Ashrafi S, Kazemnezhad Leili E. Perception of the Futile Care and its Relationship With Moral Distress in Nurses of Intensive Care Units. J Holist Nurs Midwifery. 2021;31(2):85-92.
[19] Khalighi E, Solaimanizadeh L, Borji M, Tarjoman A, Soltany B, Zareie F. Investigating relationship between religious commitment and moral sensitivity in nurses working in ICU. BMC Res Notes. 2020; 13(1):41.
[20] Kovanci MS, Atli Özbaş A. Moral distress and moral sensitivity in clinical nurses. Res Nurs Health. 2024;47(3):312-23.
[21] Hamzehpour H, Aghahosseini SS. Moral Sensitivity And Interprofessional Collaboration In Nurses: A Correlational Study. Nurs Midwifery J. 2023;21(7):503-10.
[22] Babaei SM, Araghian Mojarrad F, Kamali M, Arab Larimi M, Jafari H. Moral sensitivity and related factors in Iranian critical care nurses: A narrative review. J Nurs Rep Clin Pract. 2023;1(2):78-83.
[23] Ye B, Luo E, Zhang J, Chen X, Zhang J. Moral Sensitivity and Emotional Intelligence in Intensive Care Unit Nurses. Int J Environ Res Public Health. 2022;19(9).
[24] Atashzadeh-Shoorideh F, Tayyar-Iravanlou F, Chashmi ZA, Abdi F, Cisic RS. Factors affecting moral distress in nurses working in intensive care units: A systematic review. Clin Ethics. 2021;16(1):25-36.
[25] Mills M, Cortezzo DE. Moral Distress in the Neonatal Intensive Care Unit: What Is It, Why It Happens, and How We Can Address It. Front Pediatr. 2020;8.
[26] Alamdari MP, Raiesdana N, Nobahar M, Yavari MB. Comparison of the correlation between moral sensitivity and clinical competence in emergency and intensive care nurses: A cross-sectional-correlation study. Int Emerg Nurs. 2024;75:101483.
[27] Schneiderman LJ. Defining Medical Futility and Improving Medical Care. J Bioeth Inq. 2011;8(2):123-31.
[28] Araç B, Doğan R, Sarıtaş S. Determining the Moral Sensitivity of Intensive Care Nurses. Int J Med Investig. 2018;7(1):88-97.
[29] Yildirim G, Işık MT, Yalcin SO. Relationship Between Physician’s and Nurses’ Attitudes Towards Futile Treatment and Their Approach to Death and Terminally Ill Patients. Omega (Westport). 2023; 302228231153712.
[30] Corley MC, Elswick RK, Gorman M, Clor T. Development and evaluation of a moral distress scale. J Adv Nurs. 2001;33(2):250-6.
[31] Hajiloo P, Torabi M. The relationship between moral sensitivity and Nurses' perception of futile care in patients with Covid-19. 2020.
[32] Lützén K, Nordin C, Brolin G. Conceptualization and instrumentation of nurses' moral sensitivity in psychiatric practice. Int J Methods Psychiatr Res. 1994;4(4):241-8.
[33] Maghami M, Yektatalab S, Torabizadeh C. The attitude and the level of ethical sensitivity of nurses towards elder patients in selected hospitals affiliated to Shiraz University of Medical Sciences. J Geriatric Nursing 2018;4(2):35-46.
[34] Amiri E, Ebrahimi H, Namdar Areshtanab H, Vahidi M, Asghari Jafarabadi M. The Relationship between Nurses' Moral Sensitivity and Patients' Satisfaction with the Care Received in the Medical Wards. J Caring Sci. 2020;9(2):98-103.
[35] Goktas S, Aktug C, Gezginci E. Evaluation of moral sensitivity and moral courage in intensive care nurses in Turkey during the COVID-19 pandemic. Nurs Crit Care. 2023;28(2):261-71.
[36] İlter SM, Ovayolu Ö, Serçe S, Ovayolu N. An Investigation of the Relationship Between Compassion Fatigue and Moral Sensitivity of Intensive Care Nurses. Omega (Westport). 2024;90(2):521-35.
[37] Pang F, Zhang Y, Liu H, Du A, Tian Y, Chen H, et al. Factors associated with moral sensitivity among nurses in adult intensive care units: A cross-sectional study in China. Nurs Crit Care. 2024;29(6):1385-93.
[38] Schmocker D, Tanner C, Katsarov J, Christen M. Moral sensitivity in business: A revised measure. Curr Psychol. 2023;42(12):10277-91.
[39] Zadi O, Tavani FM, Behshid M, Sheikhalipour Z, Rahmani P, MT KH. Futile care in COVID-19: how ICU nurses' resilience impacts turnover intention? A cross-sectional descriptive study. BMC Health Serv Res. 2024;24(1):1664.
[40] Dunwoody DR. Nurses' level of moral distress and perception of futile care in the critical care environment: D'Youville College; 2010.
[41] Kadooka Y, Asai A, Fukuyama M, Bito S. A comparative survey on potentially futile treatments between Japanese nurses and laypeople. Nurs Ethics. 2014;21(1):64-75.
[42] Asayesh H, Mosavi M, Abdi M, Masoud MP, Jodaki K. The relationship between futile care perception and moral distress among intensive care unit nurses. J Med Ethics Hist Med. 2018;11:2.
[43] Reed C. Ethical dilemmas and end-of-life care. Nursing Made Incredibly Easy! 2015;13:16-24.
[44] Ashktorab T, Vaezi A. Moral distress: evaluating nurses’ experiences. Iran J Med Ethics Hist Med. 2013;6(1):64-73.
[45] Joolaee S, Jalili HR, Rafii F, Hajibabaee F, Haghani H. Relationship between Moral Distress and Job Satisfaction among Nurses of Tehran University of Medical Sciences Hospitals. J Hayat. 2012;18(1):42-51.
[46] Ferrell BR. Understanding the moral distress of nurses witnessing medically futile care. Oncol Nurs Forum. 2006;33(5):922-30.
[47] Mobarakian M, Taghinejad H, Mohammadi R, Otaghi M. Comparison of the Effect of Self-Care Education by Nurse and Peer on Self-Care Ability of Candidate Patients for Angiography. J Isfahan Med Sch. 2024;41(750):1184-91.
[48] Shahbazi G, Otaghi M, Shahbazi S, Parvaresh-Masoud M. Comparing stress, coping strategies, and quality of life among nurses working in ICU and emergency ward with other hospital departments. Ann Trop Med Public Health. 2018(3.3 Sp):SP53.
[49] Mousavi E, Kavi E, Larti N, Gharahzadeh A. The relationship between attitude toward the effectiveness of teamwork and observing safety standards in Isfahan educational hospitals. Rev Latinoam Hipertens. 2018;13(3).
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How to Cite
1.
Hojjati H, Eslamian Koupaei S, Riahi Madvar T, Hekmati Pour N, Delavari A, Motahari Niya H, Kabusi M. The Relationship between Futile Care and Moral Sensitivity in Nurses Working in the Neonatal Intensive Care Unit of Medical Training Centers in Gorgan 2024. Arch Anesth & Crit Care. 2025;.
