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Ethical decision-making climate in the ICU: theoretical framework and validation of a self-assessment tool

The result's identifiers

  • Result code in IS VaVaI

    <a href="https://www.isvavai.cz/riv?ss=detail&h=RIV%2F00216208%3A11110%2F18%3A10381898" target="_blank" >RIV/00216208:11110/18:10381898 - isvavai.cz</a>

  • Alternative codes found

    RIV/00064165:_____/18:10381898

  • Result on the web

    <a href="https://doi.org/10.1136/bmjqs-2017-007390" target="_blank" >https://doi.org/10.1136/bmjqs-2017-007390</a>

  • DOI - Digital Object Identifier

    <a href="http://dx.doi.org/10.1136/bmjqs-2017-007390" target="_blank" >10.1136/bmjqs-2017-007390</a>

Alternative languages

  • Result language

    angličtina

  • Original language name

    Ethical decision-making climate in the ICU: theoretical framework and validation of a self-assessment tool

  • Original language description

    Background: Literature depicts differences in ethical decision-making (EDM) between countries and intensive care units (ICU). Objectives: To better conceptualise EDM climate in the ICU and to validate a tool to assess EDM climates. Methods: Using a modified Delphi method, we built a theoretical framework and a self-assessment instrument consisting of 35 statements. This Ethical Decision-Making Climate Questionnaire (EDMCQ) was developed to capture three EDM domains in healthcare: interdisciplinary collaboration and communication; leadership by physicians; and ethical environment. This instrument was subsequently validated among clinicians working in 68 adult ICUs in 13 European countries and the USA. Exploratory and confirmatory factor analysis was used to determine the structure of the EDM climate as perceived by clinicians. Measurement invariance was tested to make sure that variables used in the analysis were comparable constructs across different groups. Results: Of 3610 nurses and 1137 physicians providing ICU bedside care, 2275 (63.1%) and 717 (62.9%) participated respectively. Statistical analyses revealed that a shortened 32-item version of the EDMCQ scale provides a factorial valid measurement of seven facets of the extent to which clinicians perceive an EDM climate: self-reflective and empowering leadership by physicians; practice and culture of open interdisciplinary reflection; culture of not avoiding end-of-life decisions; culture of mutual respect within the interdisciplinary team; active involvement of nurses in end-of-life care and decision-making; active decision-making by physicians; and practice and culture of ethical awareness. Measurement invariance of the EDMCQ across occupational groups was shown, reflecting that nurses and physicians interpret the EDMCQ items in a similar manner. Conclusions: The 32-item version of the EDMCQ might enrich the EDM climate measurement, clinicians&apos; behaviour and the performance of healthcare organisations. This instrument offers opportunities to develop tailored ICU team interventions.

  • Czech name

  • Czech description

Classification

  • Type

    J<sub>imp</sub> - Article in a specialist periodical, which is included in the Web of Science database

  • CEP classification

  • OECD FORD branch

    30223 - Anaesthesiology

Result continuities

  • Project

  • Continuities

    V - Vyzkumna aktivita podporovana z jinych verejnych zdroju

Others

  • Publication year

    2018

  • Confidentiality

    S - Úplné a pravdivé údaje o projektu nepodléhají ochraně podle zvláštních právních předpisů

Data specific for result type

  • Name of the periodical

    BMJ Quality and Safety

  • ISSN

    2044-5415

  • e-ISSN

  • Volume of the periodical

    27

  • Issue of the periodical within the volume

    10

  • Country of publishing house

    GB - UNITED KINGDOM

  • Number of pages

    9

  • Pages from-to

    781-789

  • UT code for WoS article

    000446082200004

  • EID of the result in the Scopus database

    2-s2.0-85048121637