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

Kód výsledku v 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>

Nalezeny alternativní kódy

RIV/00064165:_____/18:10381898

Výsledek na webu

<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>

Jazyk výsledku

angličtina

Název v původním jazyce

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

Popis výsledku v původním jazyce

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.

Název v anglickém jazyce

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

Popis výsledku anglicky

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.

Druh

J_imp - Článek v periodiku v databázi Web of Science

CEP obor

—

OECD FORD obor

30223 - Anaesthesiology

Projekt

—

Návaznosti

V - Vyzkumna aktivita podporovana z jinych verejnych zdroju

Rok uplatnění

2018

Kód důvěrnosti údajů

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

Název periodika

BMJ Quality and Safety

ISSN

2044-5415

e-ISSN

—

Svazek periodika

27

Číslo periodika v rámci svazku

10

Stát vydavatele periodika

GB - Spojené království Velké Británie a Severního Irska

Počet stran výsledku

9

Strana od-do

781-789

Kód UT WoS článku

000446082200004

EID výsledku v databázi Scopus

2-s2.0-85048121637