Moral issues and dilemmas in intensive care unit. The impact of pandemic: A scoping review

Abstract

Introduction: In hospitals, and especially in the Intensive Care Units (ICU), there are constant ethical issues and dilemmas that may concern the patient, the family and the health professionals. These issues increased and intensified during the Covid-19 pandemic, further complicating the work of health workers and affecting treatment processes. Aim: The purpose of this scoping review is to investigate and highlight the most important and common ethical issues and clinical dilemmas identified in ICUs and to investigate and clarify the role of nurses in managing such issues. Method: The electronic databases "Pubmed", "Scopus", "Google scholar" and others were searched, as well as books and other sources, utilizing mainly articles that mentioned and related to the existence of ethical issues and dilemmas in the ICU. The articles had to concern adult population only were limited to the period 2007–2022. Results: Ethical issues and dilemmas worldwide are mainly related to staff conflicts, disease diagnosis, level of knowledge, 'Burnout Syndrome’, the application of clinostatic restrictions to patients, their movement to and from the ICU, the length of hospital stay, the patient's final life stage, patient’s privacy, access to health services, staff and family cooperation, the refusal of intubation and hospitalization, and finally death within the ICU and related communication with the family. Conclusions: The ethical problems and dilemmas in the ICU are mainly related to the relationships and cooperation among patients, family and health professionals, and also the relationships in between the ICU staff. Early identification of these problems, education, information, cooperation and the development of action protocols, are considered necessary to resolve and clarify such issues and dilemmas.