Mohammad Torabi
1 
, Parisa Hajilo
2* , Roghayeh Khabiri Nemati
3 , Edris Kakemam
3 , Roya Ahmadi Niya Tabesh
4 1 Malayer School of Nursing, Hamadan University of Medical Sciences, Hamadan, Iran
2 Faculty of Nahavand Paramedical, Hamadan University of Medical Sciences, Hamadan, Iran
3 Tabriz Health Services Management Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
4 Department of Midwifery, Islamic Azad University, Tuyserkan Branch, Tuyserkan, Iran
Abstract
Background. The growing trend of useless care might lead to negative consequences for patients, staff, and the organization. The employees who care for patients in their last stages of life for a long time might not tend to pay enough attention to the patients' pain. As a result, the quality of care services might be negatively affected. This study aimed to compare the perceptions of operating room technicians and nurses regarding futile care in the selected hospitals in Hamadan province, Iran from October to December.
Methods. Using availability sampling method, the present descriptive cross-sectional study was performed on 200 health care workers (114 nurses and 86 operating room technicians). Data collection tools included a two-part demographic information questionnaire and the perception of futile care designed based on the Corley’s Moral Distress Questionnaire. The questionnaires were distributed in person and electronically. Data were analyzed using the Statistical Package for the Social Sciences (SPSS) software version 26. We used frequency, mean, and standard deviation for descriptive statistics and independent t-test and analysis of variance (ANOVA) for analytical statistics.
Results. The mean score of nurses' perceptions regarding futile care was significantly higher (16.53±6.18) than that of operating room technicians. While the nurses' perceptions of futile care in both dimensions of intensity (66.71±13.72) and repetition (60.03±13.72) were at a high level, the perceptions operating room technicians in both dimensions of intensity (50.19±18.90) and repetition (52.43±18.8) were at an average level.
Conclusion. Nurses seem to have a relatively better understanding of futile care compared to operating room technicians. This is probably due to frequent contacts with patients overlooking death, as well as direct contacts with their family and relatives. In this regard, it is essential to develop guidelines in Iran delimiting the standards for the staff’s provision of futile care.
Extended Abstract
Background
Futile care is defined as medical care provided in the end stages of patients’ lives with no expected benefits on their quality of life. Long-term treatment of these conditions leads to a lot of stress, which can affect the quality of nursing care, bringing about important consequences such as neglecting patients' pain, neglecting timely treatment of patients, increasing costs, and wasting energy. It also takes up the staff time. The present study aimed to compare the perceptions of operating room technicians and nurses regarding futile care in selected hospitals in Hamadan province, Iran.
Methods
The present cross-sectional descriptive study was performed on nurses and operating room technicians working in hospitals in Hamadan province. Staff with a bachelor's degree in nursing and operating room and 6 months of work experience were included in the study. To collect data, a two-part questionnaire was used. The first part contained a demographic information form and the second part included the futile care questionnaire based on the Corley’s Moral Distress Questionnaire. To use this questionnaire for the operating room technicians, the questions were reviewed, and changes were made according to the working conditions of the participants. The modified questionnaire was approved by expert panel opinion. Participants were included in the study by availability sampling method. After obtaining permission from the ethics committee of Hamadan University of Medical Sciences, the researcher referred to selected hospitals and distributed the questionnaires. A total of 235 questionnaires were distributed. Incomplete questionnaires was removed and finally 200 questionnaires (114 nurses and 86 operating room experts) were included in the statistical analysis. The validity of the questionnaire was confirmed by ten faculty members of Hamadan University of Medical Sciences and its reliability was obtained with Cronbach's alpha coefficient of 0.89. Data were recorded in the Statistical Package for the Social Sciences (SPSS) software version 26 and analyzed using descriptive and analytical statistics.
Results
Data analysis showed that the average score of nurses' perceptions regarding futile care was higher than that of operating room technicians (16.53±6.18). Among the nursing participants, the highest mean scores were related to the intensity (even if I did not achieve the intended goals for my patient, I continued my work) (4.2±1) and repetition (I followed the doctor's instructions and tests for treating the patient in the last stages of his/her life, even if I do not think it is necessary) (3.9±1.9). Among operating room technicians, the highest mean scores were related to the intensity (I take life-saving measures despite knowing that it only delays death) (3.8±1.5) and repetition (even if I do not achieve the realistic goals set out for the patient, I will continue to provide care) (3.7±1.5). Also, a positive and significant relationship was observed between the age and work experience of nurses and operating room technicians with their perception of unnecessary care.
Conclusion
Medical staff at any level of service delivery face patients with no hope of recovery and receiving useless care. Increasing survival without increasing the quality of life leads to a prolonged process of death of patients and a high economic burden for the organization and families. Nurses have a better understanding of useless care and are more vulnerable than other staff due to long-term exposure to patients. Therefore, it is expected that managers and officials increase the quality of medical care and reduce job stress by reducing unnecessary care in the clinic.