Abstract:

The purpose of this study was to assess the perception and to examine the ethical dilemma faced by critical care providers in a tertiary teaching hospital in Tanzania when caring for terminal patients. The study was guided by four specific objectives including, first to assess how the critical care Nurses perceive and understands end of life issues encountered during caring for terminal patients, second to explore the ethical dilemmas faced by Nurses during the course of duty in caring for terminal ill client, third to find out the psychological impact of end of life issues to critical care providers working in the ICU and lastly to determine the challenges encountered by critical care providers working in the ICU. The study was conducted from Muhimbili National Hospital (MNH) in Dar es Salaam, Tanzania. The population of the study was subgroup of nurses based on qualifications, expertise and experience, working from medical ICU, surgical ICU, cardiac ICU and CCU. All the nurses who met the above criteria were included in the study. The researcher applied both structure and unstructured interview to collect data. The study results shows that, majority of nurses come across end of life issues more frequently in ICU and most of them find these issues very uncomfortable. Nurses have negative perception towards a number of end of life issues for example they don’t support the medical team to decide on withdrawing treatments. The other study result shows that nurses are psychologically and physically affected by end of life issues whereby most of them suffer from moral distress. Also, ethical dilemmas encountered by nurses in the ICU are mostly on truth telling; withdraw of treatment to vegetative patients and allocation of resources. Lastly the researcher found that, lack of adequate ICU training, lack of policies and protocol on withdraw of treatments and inadequate of equipments as the main challenges among nurses working in the ICU. The researcher suggest that the management must ensure well staffing as per universal standards, ideally nurse patient ratio in ICU should be 1:1, the procurement department must ensure the availability of equipment and consumables which all the nurses cited as one of the biggest hindrance to quality care provision and contributes to their dilemmas and stress. The hospital should do enough capacity building to cater for the size of the hospital, ideally and universal standards says, at least 10% of the total hospital bed capacity should be able to be accommodated into the ICU, hence Muhimbili hospital with a bed capacity of 1500 beds, must have at least 150 ICU beds.

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