Navigating Ethical Dilemmas in Intensive Care Clinical Research From the Perspectives of Nurses: A Qualitative Study

Abstract

BACKGROUND: Medical research in intensive care is done in patients that are often incapacitated, critically ill and unable to make autonomous decisions. In intensive care unit (ICU) research, patients are admitted to a clinical study without their informed consent, a major deviation from the usual method of conducting research. Nurses caring for patients enrolled in ICU research face potentially ethically challenging situations.AIM: To describe intensive care nurses' views on ethical aspects of ICU research.METHODS: Eleven intensive care unit nurses with experience in clinical research and informed consent procedures were purposively selected for semi-structured interviews. The qualitative semi-structured interviews were analysed using thematic deductive analysis.RESULTS: Nurses considered ICU research as a possibility to advance care for future patients. However, nurses identified ambiguous ethical dilemmas associated with ICU research, such as compromised patient autonomy, navigating between beneficence and maleficence and justifying the research by anticipated results. Consequences from loss of autonomy, deviating from the informed consent process and surrogate decision-making were recognised.CONCLUSION: Research in ICU was perceived as ethically ambiguous, probably beneficial despite the possibility of harms and loss of autonomy and justified by results of the studies that will possibly benefit the patient or patients with similar disorders or society in general.