Clinical Rounds

June 2012 
Volume 42  Number 6
Pages 23 - 25
  PDF Version Available!

Nurses who aren't free to make decisions in their nursing practice experience increased frequency and intensity of moral distress, according to a survey of 255 European intensive care nurses who completed self-administered questionnaires at a major critical care conference. Among the most frequent morally distressing events identified by nurses were * initiating extensive life-saving treatments that only prolong death. * carrying out physicians' orders to provide futile care to patients. * working with colleagues who aren't competent to provide the level of patient care required. * following a family's wishes to continue futile medical treatment.Lower autonomy was also associated with lower levels of perceived nurse/physician collaboration.The researchers found that "frequency of moral distress was associated inversely with collaboration and autonomy, and positively with intention to quit."Source: Papathanassoglou ED, Karanikola MN, Kalafati M, Giannakopoulou M, Lemonidou C, Albarran JW. Professional autonomy, collaboration with physicians, and moral distress among European intensive care nurses. Am J Crit Care. 2012;21(2):e41-e52.Limiting the use of antibiotics not only reduces rates of drug-resistant infections, but also saves millions of dollars, according to a new report based on a 7-year antibiotic stewardship program at the University of Maryland Medical Center. In 2008, when the hospital discontinued the stewardship program in favor of using infectious disease consultations, antibiotic costs increased 32% within 2 years.Researchers conducting a cost analysis before, during, and after the 7-year program found that reducing antibiotic use didn't compromise patient safety. They found no increase in death rates, hospital readmissions, or lengths of stay during the antibiotic stewardship program. But cost savings occurred across hospital departments, including the cancer center, trauma center, surgical and medical ICUs, and transplant service.The stewardship program

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