Pneumonia season is in full swing in your facility. Recently in the ICU there have been a string of patients who had do not attempt resuscitation (DNAR) orders in place that followed them from the continuing care setting in which they lived but who nonetheless wound up being treated with antibiotics, using noninvasive ventilation, and remaining in ICU for an extended period of time.
The health care team in the ICU is experiencing Moral Distress due to the fact that they feel the scarce resources of the ICU are being used inappropriately on patients who don’t really want them in the first place, and they feel that discussions about Goals of care are not happening when they should.
The moral distress is widespread, but some members of the team have been taking more time off than usual and there is a perceived increase in “ Presenteeism ”. This is causing resentment on the part of other team members. They have requested that ethics consultants join them during their regular staff meeting, and you have about 45 minutes on the agenda.
In preparing for the consult, you coordinate with the other consultants and between you envision several ways the discussion could be focused, recognizing that not all of the relevant issues will be addressed in the consult.
You prepare to discuss clinical decision making, team function, organizational and system decisions about care provision, and Resource allocation. As the consult begins, it seems that the most effective short-term strategy is to address concerns about clinical decision making.
During the consult, you find yourself wishing that you had more to offer the team to address their moral distress apart from the usual advice to name it, discuss it, and act to alleviate it. You find these consults especially challenging, and often feel that you are not meeting the requestor’s expectation that you are able to help remedy the situation.
In closing, you acknowledge the role of organizational decision making and resource constraints in creating the situation, and promise to raise the concerns with leadership.
Clinical Decision Making Team Function Organizational and System Decisions Limited Resources