This research aimed to investigate the changes in ethical issues in everyday clinical practice recognized by critical care nurses during two observation periods. We conducted a retrospective analysis of data obtained by prospective questionnaire surveys of nurses in the intensive care units (ICU) of a tertiary university-affiliated hospital in Seoul, Korea. Data were collected prospectively during two different periods, February 2002-January 2003 (Period 1) and August 2011-July 2012 (Period 2). Significantly fewer cases with ethical issues were reported in Period 2 than in Period 1 (89 cases [2.1%] of 4,291 ICU admissions vs. 51 [0.5%] of 9,302 ICU admissions, respectively; P < 0.001). The highest incidence of cases with identified ethical issues in both Periods occurred in MICU. The major source of ethical issues in Periods 1 and 2 was behavior-related. Among behavior-related issues, inappropriate healthcare professional behavior was predominant in both periods and mainly involved resident physicians. Ethical issue numbers regarding end-of-life (EOL) care significantly decreased in the proportion with respect to ethical issues during Period 2 (P = 0.044). In conclusion, the decreased incidence of cases with identified ethical issues in Period 2 might be associated with ethical enhancement related with EOL and improvements in the ICU care environment of the studied hospital. However, behavior-related issues involving resident physicians represent a considerable proportion of ethical issues encountered by critical care nurses. A systemic approach to solve behavior-related issues of resident physicians seems to be required to enhance an ethical environment in the studied ICU.
Critical Care Nursing/*ethics ; Humans ; *Intensive Care Units ; Nurses ; Retrospective Studies ; Terminal Care ; Tertiary Care Centers

PURPOSE: This study was done to clarify nurses' duties, tasks and task elements and to develop a job description for clinical nurses on general and intensive care units in tertiary-level hospitals, and dramatically reflect changing medical trends in Korea. METHODS: The job description was developed based on the Developing a Curriculum Method (DACUM). The questionnaire included frequency, importance, and difficulty of duties, tasks and task elements, measured on a 4-point scale. Results were analyzed using SPSS version 21.0. Data were collected from September 4 to 7, 2017, and analyzed using descriptive statistics and a scattered graph. RESULTS: The job description consisted of 10 duties, 38 tasks, and 51 elements. Of the 10 duties, the highest duty in order of importance was ‘Direct nursing care’ followed by ‘Infection control’. The highest duties according to frequency and difficulty were ‘Document and notify’ and ‘Research and quality improvement’. ‘Safety management’ and ‘Infection control’ were considered as relatively simple duties, however, these two duties were still included as important jobs for clinical nurses. CONCLUSION: The job descriptions for clinical nurses developed from this study contain nursing ethics and safety as well as infection control, to faithfully reflect clinical nurses' jobs.
Critical Care* ; Curriculum ; Ethics, Nursing ; Infection Control ; Intensive Care Units* ; Job Description* ; Korea ; Methods* ; Nursing ; Patients' Rooms*