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Nurses as Ethical Guardians in the Intensive Care Unit: A Narrative Review of Bedside Ethics, Dignity, and Moral Responsibility
Abstract
Introduction/Objective
ICU nurses provide continuous bedside care to patients who are unable to self-advocate, creating ethical risks that may be overlooked in routine critical care. This narrative review aimed to explore four ethical domains faced by bedside ICU nurses: sensory awareness in sedated and neuromuscularly paralyzed patients, cross-gender intimate care, dignity maintenance for brain-dead organ donor patients, and management of Do Not Attempt Resuscitation (DNAR) orders.
Methods
A structured literature search was conducted in February 2026 in PubMed/MEDLINE, CINAHL, and Scopus. English-language peer-reviewed studies, professional guidelines, and bioethics frameworks published from January 2010 to December 2025 were reviewed, with seminal earlier sources included through citation searching. Narrative thematic synthesis and gap analysis informed the review.
Results
Four interconnected ethical concerns were identified: the acoustic environment as an underrecognized ethical domain, privacy and modesty risks during cross-gender intimate care, potential reduction in care attentiveness after brain death declaration, and misinterpretation of DNAR orders as permission to reduce care intensity.
Discussion
Across these domains, patient incapacity transfers immediate moral responsibility to the bedside nurse. The findings support the concept of ICU nurses as ethical guardians who protect dignity, privacy, comfort, and care preferences when patients cannot speak for themselves.
Conclusion
Integrated nursing-specific ethics education, clearer bedside communication standards, improved documentation of dignity-related preferences, and institutional support for moral agency are needed to strengthen dignity-preserving ICU care.
1. INTRODUCTION
The Intensive Care Unit (ICU) is one of the most technically sophisticated and, therefore, ethically challenging areas of health care. Its central paradox is that the patients who most need the ongoing care are least able to advocate for it or to evaluate it: sedation, neuromuscular blockade, ventilation, and critical illness itself step-by-step remove the patients' capacity for self-advocacy [1]. This loss of voice does not cancel out but rather accentuates the moral dimension.
The development of critical care bioethics has unfolded over the past 20 years along two distinct pathways: the physician-centered pathway (withdrawal of treatment, DNAR, prognostication) and the abstract pathway of the 4 principles of Beauchamp and Childress [2]. Bedside nursing practice, which is the continuous, communicative, and tactile care that constitutes the vast majority of the patient's ethical experience, has received comparatively limited analysis [3, 4].
It is not a purely academic difference. Nurses are there when doctors are not: they speak for patients who are asleep and/or on a ventilator; they provide intimate care that patients cannot refuse or consent to; they interpret DNAR instructions on the spot; they continue to care for bodies that have been declared dead. They are the principal venues that shape the ethics of care in the ICU, but have been underrepresented in the nursing ethics literature [5, 6].
Some reviews focus on specific issues in this area: Selvaraj et al. [7] on the challenges that ICU nurses face in organ donation, Giles and Moule [8] on nurses' attitudes and experiences regarding DNAR decision-making, and broader reviews on moral distress [5, 6]. However, the cross-gender intimate care of incapacitated patients is an under-examined topic, especially when modesty and same-gender care preferences are culturally or religiously important. This review is unique in bringing together in one bedside-nursing framework these four domains: sedation awareness, cross-gender intimate care, organ donor dignity, and DNAR management.
The common feature of these domains is that the patient is unable to advocate for themselves and that the nurse is always responsible for upholding the dignity, privacy, comfort, and moral status of the patient. They are all due to a form of incapacity, either sedation, neuromuscular blockade, critical illness, or brain death, and in each case, it is the nurse who is the moral agent on behalf of an individual who is unable to act for himself.
1.1. Aim
The objectives of this narrative review are: 1) to identify and analyze four key areas of ethical challenge in bedside ICU nursing; 2) to show that, to the best of the author’s knowledge, these areas have not been integrated in the existing literature in a nursing-centered way; and 3) to propose evidence-based recommendations for nursing practice based on the concept of nurses as ethical guardians for incapacitated patients.
1.2. Research Questions
This narrative review was guided by the following research questions:
- What bedside ethical challenges are faced by ICU nurses when caring for sedated, paralyzed, unconscious, brain-dead, or DNAR-status patients?
- How do the four domains of sedation/paralysis awareness, cross-gender intimate care, organ donor dignity, and DNAR management relate to patient dignity and nursing moral agency?
- How can the concept of the nurse as an ethical guardian inform ICU nursing education, bedside practice, and institutional ethical support?
2. METHODS
2.1. Review Design
Structured searching of literature resources and gap analysis have been used to inform this narrative review. A narrative design was selected as the evidence in the field of ICU nursing ethics includes heterogeneous evidence, qualitative studies, guidelines, and bioethics frameworks, which are not appropriate for quantitative synthesis. Reporting quality was guided by SANRA principles for narrative review articles [9]. Formal quality appraisal tools such as GRADE or CASP were not applied because this was a narrative review; this limitation is acknowledged in the Limitations section.
2.2. Databases and Search Date
In February 2026, a structured search was performed in three databases: PubMed/MEDLINE, CINAHL, and Scopus. Hand searches of the reference lists of all retrieved eligible papers were conducted to identify additional sources.
2.3. Search Concepts and Strategy
Search strings combined the following core concepts using Boolean operators (AND, OR): Core concepts: (“intensive care unit” OR “critical care” OR “ICU”) AND (“nursing” OR “nurse”). Domain 1: Sedation/paralysis: AND (“sedation awareness” OR “neuromuscular blockade” OR “consciousness” OR “auditory awareness” OR “awareness under paralysis”). Domain 2: Intimate care: AND (“intimate care” OR “personal hygiene” OR “cross-gender care” OR “privacy” OR “patient dignity” OR “bodily dignity”). Domain 3: Organ donation: AND (“organ donation” OR “brain death” OR “donor care” OR “deceased donor”). Domain 4: DNAR: AND (“DNAR” OR “do not attempt resuscitation” OR “DNR” OR “end-of-life” OR “withholding resuscitation”). Cross-domain: AND (“ethics” OR “ethical challenges” OR “moral distress” OR “moral agency” OR “dignity”).
2.4. Inclusion and Exclusion Criteria
Sources included were peer-reviewed research, reviews, guidelines, or ethics frameworks published in English that dealt with ethical dimensions of adult ICU nursing that relate to one or more target domains, primarily from January 2010 to December 2025. Citation searching was also performed, and seminal earlier work [10] was also included. Those sources that focused on only pediatric, neonatal, or non-ICU settings, physician/ institutional-only perspectives, and abstract-only records were excluded.
2.5. Study Selection and Source Identification
Following the removal of duplicates, the first author scanned the titles and abstracts of the studies for eligibility, requesting full texts for potentially relevant studies. Thematic synthesis of the key sources directly related to bedside ethics in the ICU was performed from this pool. It is a narrative review; the exact number of sources is not given. The reference list has been inserted to reflect all the sources used.
2.6. Gap Analysis
A gap analysis was completed, whereby retrieved studies were compared to the four domains and three dimensions: (a) nursing versus physician perspective, (b) integrated versus single domain analysis, and (c) bedside versus institutional/policy focus. To our knowledge, no previous review combined all four domains from an exclusively bedside nursing perspective (Table 1), thus making the present review needed.
2.7. Thematic Synthesis
The results were grouped into the four domain labels: evidence-based, ethical challenge for bedside nurses, documented issues of practice, and evidence-informed recommendations. The synthesis of the 'ethical guardian' framework was an iterative process, informed by the principles of autonomy, beneficence, non-maleficence, and justice [2], and nursing ethics theory.
3. RESULTS
Findings are reported narratively across the four ethical domains identified through the structured search and gap analysis. The gap analysis (Table 1) revealed that, to our knowledge, no previous review had included these four aspects in a single bedside nursing framework.
| Domain | Focus of Existing Literature | Missing Nursing-Bedside Perspective | Contribution of this Review |
|---|---|---|---|
| Sedation/paralysis awareness | Sedation protocols; pain assessment tools; post-ICU psychological outcomes [11, 12]. | Nurse vocal/communicative behavior as an ethical act; 'ethical acoustics' framework for education. | First integration of auditory awareness evidence into a nursing communicative ethics argument |
| Cross-gender intimate care | General dignity in care [13]; intimate care and clinician touch [14, 15]; patient preferences regarding nurse gender and opposite-gender care [16, 17]. | Limited ICU-specific analysis of incapacitated patients who cannot express privacy, modesty, or same-gender care preferences during intimate nursing procedures. | Frames cross-gender intimate care of incapacitated ICU patients as an under-addressed bedside ethics issue requiring proactive documentation, privacy protection, same-gender care where feasible, and culturally / religiously sensitive nursing practice. |
| Organ donor dignity | Organ donation process challenges: nurse support [7, 18]. | Day-to-day nursing care behaviors after brain death declaration: moral ambiguity about the nurse's role. | Focuses on bedside care quality as both ethically and clinically required; addresses nurse identity confusion. |
| DNAR management | Nurse attitudes and experiences regarding DNAR decision-making [8]; end-of-life discrepancies [3]. | Differentiation of moral distress subtypes; cross-cultural DNAR communication in multicultural ICU settings. | Distinguishes three forms of DNAR-related moral distress requiring distinct responses; adds a cross-cultural dimension. |
3.1. Theme 1: The Acoustic Environment as Ethical Domain in Sedation and Paralysis Awareness
One of the most commonly held beliefs in intensive care medicine is that patients who are sedated or paralyzed will not be aware of their surroundings. There is no evidence to support this, and direct implications for bedside nursing behavior are sparse.
Hearing is one of the last senses to be affected by sedation and one of the first senses to regain function [10]. On the other hand, Jones et al. [11] discovered that ICU survivors had high rates of recollection of sounds and conversations from what they thought was unconscious time, and that negatively valenced auditory memory, especially overheard clinical conversations, was independently related to subsequent PTSD. Similarly, Granja et al. [19] reported that auditory memories were among the most common recollections from patients with post-ICU psychological morbidity, and Samuelson [12] reported that unpleasant sound memories, procedural distress, and verbal exchanges among staff resulted in long-term psychological sequelae in patients who had been intubated and ventilated.
Ethics are further complicated by the use of Neuromuscular Blocking Agents (NMBAs), like vecuronium, rocuronium, and atracurium, which are used to block motor responses but do not provide sedative or analgesic effects on their own [20, 21]. A patient receiving an NMBA can be completely awake, may be in pain and frightened, but cannot communicate. Puntillo et al. [22] reported the presence of considerable procedural pain and distress in critically ill patients, highlighting the importance of adequate analgesia and nurse sensitivity. While the odds of being awake during a paralyzing procedure are not easy to calculate, they are not to be ignored.
What this review adds is that this evidence is couched as an ethical discussion, not just on assessment of sedation or scoring of pain, but overall acoustic and communicative environment of the ICU. Actionable, ethically concerning nursing behaviors identified are:
- Having conversations within hearing distance of the bedside related to diagnosis, prognosis, or personal information about the patient, even if the patient is apparently conscious.
- Use of language that is casual, depersonalizing, or task-oriented, in which the patient is reduced to a clinical object, which is documented in qualitative nursing studies to occur in high workload situations [4].
- Not calling the patient by name and describing what is about to happen is a simple behavior, shown to have positive effects on psychological patient experience and recall after an ICU stay [10, 11].
- Leading loud social discussions between staff over the patient's bed, which patients have said in retrospect were one of the most distressing aspects of their experience in the intensive care unit [12].
This review suggests a new concept, ‘ethical acoustics' for nursing education: All speech in the potential auditory range of a patient is an ethical act, and the level of bedside communication should be matched to that required for a fully awake and competent patient.
3.2. Theme 2: Cross-Gender Intimate Care and the Suspended Right to Privacy
In health care, patients have the right to privacy, dignity, consent, and appropriate chaperoning during intimate care [23]. The patient's right to exercise this is suspended in the ICU by critical illness and altered consciousness, but the right itself remains intact; responsibility falls to the nursing team to uphold the right.
Intimate care can be felt as exposing, depersonalizing, or dignity-threatening experiences for patients who are in need of support from staff for hygiene, positioning, and care of the body [13, 24-26]. Clinician touch is also found to be sensitive, influenced by privacy, communication, consent, and patient preference [14], and poor management of exposure and touch can cause helplessness and disrespect [15], according to a qualitative systematic review. These are all very relevant to the role of the ICU nurse, as sedated or critically ill patients may not be able to ask for privacy, object to exposure, or express discomfort.
There has been limited research specifically addressing the cross-gender dimension in the ICU. Wider nursing evidence indicates that some patients prefer same-gender nurses for intimate procedures because of modesty, religion, or cultural beliefs [16, 17]. This concern is relevant in Saudi and Muslim contexts of critical care, where modesty, family involvement, privacy, and care that is sensitive to gender may shape nursing practice [27]. However, limited research has addressed the situation in which intimate care is provided in an ICU to a patient of a different gender who is incapacitated and cannot communicate, object, or express preferences, yet retains the right to dignity, privacy, and culturally sensitive care.
The literature recommends the following practices: active maintenance of privacy (full curtains, exclude unnecessary staff), verbal explanation of each step, even if the person is conscious, formal assessment and documentation of gender-related preferences, and handover communication of gender-related preferences [14, 15, 23]. If same-gender care is not immediately available, nurses should minimize exposure, explain the need for it, ensure a chaperone is present if appropriate, and restore privacy as soon as possible. These are not measures to remove the ethical risk, but show proactive safeguarding of dignity for those who cannot protect their own dignity.
3.3. Theme 3: The Brain-Dead Organ Donor and Sustaining Dignity After Legal Death
The legal and clinical determination of brain death does not remove the nurse’s responsibility to provide dignified care to the donor’s body and to support the family. The literature has reported on reduced care attentiveness after brain death declaration, due to an assumed premise that the patient no longer needs or experiences care [18]; although this is not always the case, it is a pattern that has been reported in a range of qualitative studies in different countries.
On a number of grounds, this pattern is an ethical issue. Physiologically, the efforts to maintain hemodynamic stability, temperature regulation, endocrine balance, and infection prevention are interlinked with organ viability; therefore, any loss of nursing care quality is ethically and clinically significant [28]. Family trust, bereavement, and willingness to proceed with the donation or recommend donation are all indirectly impacted by the quality of care observed by the donor's family.
Studies on organ donation in the intensive care units have shown that nurses may experience donation-related care as emotionally and ethically complex, specifically during the transition from curative treatment to donor management [7, 18, 29]. Family members' experiences of organ donation requests after brain death also show the importance of communication, trust, and observed care quality in the critical care setting [30]. The present review extends this literature by specifically examining day-to-day care behaviors (physical care quality, the communicative environment at the bedside, and language used in handover and documentation) instead of the donation process and support structures.
Simonsson et al. [18] reported qualitative findings of nurses, especially those inexperienced in organ donation, expressing uncertainty over whether they were ‘caring for a living person or a dead one’. When not addressed by institutional culture or leadership, this moral ambiguity is a factor that reduces care quality and increases moral distress [7, 18]. In all the sources reviewed, the continued ethical responsibility for the body of the donor, clear education for the nurse, and the emotional complexity of the role are identified as institutional ethical obligations.
3.4. Theme 4: DNAR Orders and the Limits and Obligations of Nursing Practice
Do Not Attempt Resuscitation (DNAR) orders rank high among the most ethically laden documents in the course of an ICU patient's care. Much of their management is delegated to nursing staff as the first responders to clinical deterioration. Nursing literature regarding DNAR orders is relatively advanced, but there are still important practice gaps. The most frequently reported issue in this area is that DNAR orders may be interpreted as indicating that care intensity can be reduced, even though DNAR should apply only to resuscitation and not to other aspects of nursing or medical care [8, 31-33]. The literature has raised concerns that DNAR decisions could be related to uncertainty, decreased intensity of care, or confusion regarding the continuing scope of responsibilities for nursing, specifically when communication and policy guidance are not clear [8, 33].
Ferrand et al. [3] also reported systematic differences between physicians' intent and nurses' interpretation of end-of-life directives in French ICUs. Al Farhan et al. [33] highlighted the importance of clarifying that resuscitation-limitation orders should not restrict other appropriate treatment options. Cook and Rocker [34] confirmed that the care required for dignity in dying in the ICU is active and ongoing nursing care, and that this should not be interpreted to be reduced by DNAR status.
This review builds on this existing analysis to highlight three specific concerns relating to nursing practice, which have been reported across multiple sources but have not been examined together: (1) the DNAR-to-reduced-care misinterpretation described above; (2) inadequate DNAR communication at handover, a patient safety concern documented in qualitative nursing research [8]; and (3) underutilization of ethics consultation resources when nurses experience moral distress in relation to DNAR decisions [5, 6].
In the context of DNAR and end-of-life care, moral distress can manifest in several ways, some of which overlap in the literature but need to be addressed institutionally [35-37]: Distress from perceived futility (performing resuscitation on patients whom nurses believe will not benefit); Distress from perceived abandonment (feeling that DNAR status has lessened the quality of care); and Distress from family or team pressure to contradict carefully considered decisions [5, 6]. It is identified that there is a significant gap in nursing education and institutional policy in differentiating these forms.
Another aspect that needs to be emphasized more is the link between DNAR orders, family communication, and cultural or religious beliefs regarding death, duty, and acceptable limits of treatment. In culturally diverse ICUs, nurses can feel interpersonally and ethically challenged if families believe that DNAR is a form of abandonment or that it conflicts with their personal values. The general palliative care literature emphasizes the significance of effective communication, family engagement, cultural sensitivity, and support from the healthcare system in handling these scenarios [38, 39]. Therefore, institutional practice priorities should be given to culturally sensitive communication with the family, clear handover of the scope of DNAR, and access to ethics consultation, instead of optional supports.
4. DISCUSSION
A common structural finding presented in this review is that the nurse's continuous moral focus at the bedside underlies the four ethical domains explored herein. This review therefore proposes the role of ICU nurses as ethical guardians at the bedside.
It is important to note that the term 'ethical guardian' is not intended as a legal guardian, but a conceptual and professional approach to nursing ethics; the concept of ethical guardianship is distinct and different in significant ways from the more popularly discussed concept of nursing advocacy. According to the International Council of Nurses [40] Code of Ethics, advocacy is when the nurse stands in for or represents a patient who may, for the time being, be unable to speak for themselves. Guardianship suggests a more active and more fundamental role, one of protecting the dignity, privacy, autonomy, and welfare of a patient when the patient is not able to do so, even for the short term. In the ICU, nurses are not merely surrogates for patients who may regain the ability to communicate; they are often the only moral actors protecting patients' rights from violation.
The framework is based on bioethical principles of Beauchamp and Childress [2]. Autonomy (respect for the patient's right to direct the care) does not disappear upon incapacitation; instead, it imposes a responsibility on those exercising authority on behalf of the patient to respect his or her values and preferences as though the patient had expressed them. Beneficence (doing what is in the best interests of the patient) and non-maleficence (doing no harm) mean that nurses need to be aware of potential harms that are part of seemingly normal practices: conversations overheard by patients, improperly managed intimate care episodes, reduced attention after brain death declaration, and misapplied DNAR orders. These standards must be uniformly applied, irrespective of whether the patient is conscious, has a poor prognosis, or lacks decision-making capacity. The ability and motivation to act on these principles, called moral agency, is what makes a competent nurse an ethical guardian [5]. The findings of this review are consistent with previous literature showing that ICU ethical challenges are often experienced by nurses at the level of daily bedside care rather than only through formal decision-making processes. Studies on sedation awareness and post-ICU recollections suggest that communication around apparently unconscious patients may have psychological and ethical consequences. Similarly, studies on dignity, intimate care, and gender-related care preferences show that bodily exposure and clinician touch can become ethically significant when patients cannot express consent, refusal, or preferences. In organ donation and DNAR management, previous studies show that nurses may experience uncertainty, emotional conflict, or moral distress when the meaning of continued care is unclear. This review differs from previous single-domain studies by interpreting these issues as interconnected expressions of a single shared ethical problem: patient incapacity transfers immediate moral responsibility to the bedside nurse.
The gap analysis highlighted that the literature to date has partially addressed each of the four domains: organ donation [7], perceptions of DNAR [8], post-ICU sequelae [12], and broader dignity literature and intimate-care literature on privacy, touch, modesty, and gender-specific care preferences [13, 14, 16, 17]. To the best of our knowledge, no previous review has brought all four together in a single nursing-centered approach. The integration is the contribution and the fact that these areas are not separate issues, but manifestations of the same one: patient incapacity and the devolution of moral responsibility to the bedside nurse.
This integration has a direct practical impact. An ICU nurse with knowledge of DNAR ethics but not sedation awareness ethics may, nonetheless, say the wrong thing at the bedside of a paralyzed patient. Even if a nurse is familiar with the dignity of intimate care but not donor care ethics, they may be more likely to lower the standard of physical care after the brain death declaration. The evidence, together, indicates the need for integrated ethical education, that is, education that explicitly relates all four of these domains within the framework of nursing guardianship.
Limitations of this review should be acknowledged. It is a narrative review and is potentially subject to selection bias; the sources were selected by the author as being relevant and may not be fully representative of the available literature. There is also a differential evidence base across the four domains, with the literature on DNAR management and organ donation stronger for ICUs as a whole, and literature on intimate care and dignity and gender preferences less developed, with some literature coming from more general hospital literature. Much of the literature is from European, North American, and other high-income or urban health care environments and therefore may not be applicable to settings with different staffing ratios, cultural norms, resource levels, or legal frameworks. Another restriction is that the ethics of practices in question are often recorded in qualitative studies and are not necessarily of a generalizable nature, especially in connection with the acoustic environment, intimate care exposure, and care attentiveness after brain death. Lastly, the ‘ethical guardian’ model presented here is conceptually-based and needs to be tested as an educational and practice model.
Future research should focus on: the development and evaluation of nursing ethics teaching programs in the intensive care unit that are integrated within multiple domains; prospective qualitative and observational studies to assess how often and in what context the ethical concerns described in each domain occurred; cross-cultural comparative studies; and the empirical evaluation of the ethical guardian as a model for teaching. The practical nursing recommendations derived from the four ethical domains are summarized in Table 2.
| Ethical Domain | Main Ethical Risk | Nursing Responsibility | Practical Bedside Recommendation | Education/policy Implication |
|---|---|---|---|---|
| Sedation/paralysis awareness | Patient hears conversations while unable to respond; trauma from overheard distressing content. | Maintain communicative conduct at all times as if the patient is fully awake. | Address the patient by name before all procedures; avoid casual or depersonalizing speech at the bedside. | Incorporate 'ethical acoustics' into ICU nurse orientation; include NMBA awareness in mandatory sedation training. |
| Cross-gender intimate care | Patient unable to express privacy, modesty, or same-gender care preferences; risk of exposure, embarrassment, and dignity violation. | Proactively protect privacy and honor documented care preferences. | Document gender-related care preferences where possible; maintain full privacy during all intimate care; explain each step; use a chaperone or same-gender staff when feasible. | Include cross-gender intimate care ethics in ICU orientation; develop culturally and religiously sensitive admission assessment and handover prompts. |
| Organ donor dignity | Reported reduction in care quality following brain death; family observation of care; nurse moral ambiguity. | Maintain full physical and communicative care standards regardless of brain death status. | Continue hygiene, positioning, temperature management, and respectful communication at the bedside. | Mandatory brain death ethics education; access to peer support and debrief after donor cases. |
| DNAR management | Misinterpretation of DNAR as reduced-care permission; inadequate handover; unexpressed moral distress. | Apply DNAR exclusively to resuscitation decisions; maintain full care in all other domains. | Explicitly communicate DNAR scope at every handover; seek ethics consultation when morally distressed. | Differentiated moral distress education; standardized DNAR handover protocols; formal ethics consultation access. |
CONCLUSION
ICU nurses are not silent receptors of decisions made by others regarding ethical issues. They are active moral agents who, in the day-to-day practice of bedside care, can make the difference between the incapacitated patient's rights, dignity, and welfare being respected or undermined. The four domains that were explored in this review, namely, the acoustic environment for sedated and paralyzed patients, cross-gender intimate care, brain-dead organ donors, and DNAR order management, are among the most clinically prevalent and ethically consequential areas of nursing practice in the ICU.
Mistakes in these areas are not necessarily ones of personal intentions. They are educational failures, cultural failures of the institutions, and collective moral failures of critical care environments. This occurs through ongoing, comprehensive, nursing-specific ethics education; institutional structures that promote moral agency and limit moral distress; and leadership that exemplifies moral stewardship as a professional norm.
The silent patient is not ethically invisible. Their silence is the condition for the nurse's ethical guardianship, which is therefore possible and necessary.
AUTHOR’S CONTRIBUTIONS
The author confirms sole responsibility for the following: study conception and design, data collection, analysis and interpretation of results, and manuscript preparation.
LIST OF ABBREVIATIONS
| CINAHL | = Cumulative Index to Nursing and Allied Health Literature |
| CPR | = Cardiopulmonary Resuscitation |
| DNAR | = Do Not Attempt Resuscitation |
| DNR | = Do Not Resuscitate |
| ICU | = Intensive Care Unit |
| MEDLINE | = Medical Literature Analysis and Retrieval System Online |
| NMBA | = Neuromuscular Blocking Agent |
| PTSD | = Post-traumatic Stress Disorder |
| SANRA | = Scale for the Assessment of Narrative Review Articles |
ACKNOWLEDGEMENTS
The author recognizes the role of ICU nursing practitioners in everyday ethical practice in complex clinical environments as a motivator for this review.
