Graduation Date

Spring 5-7-2022

Document Type


Degree Name

Doctor of Philosophy (PhD)



First Advisor

Sue Barnason, Ph.D.

MeSH Headings

Critical Care Nursing, Workload, Nursing Ethics, Pain, Sleep, Delirium


Critically ill patients often experience distressful and impactful symptoms and conditions that include pain, agitation/sedation, delirium, immobility, and sleep disruption (PADIS). The presence of PADIS can affect recovery and long-term patient outcomes. An integral part of critical care nursing is PADIS prevention, assessment, and management. To better understand the complexities of PADIS care, two reviews of the literature were completed. The first is an integrative review of the use of PADIS assessment tools by critical care nurses. The second is a qualitative systematic review of the literature on the integration of care ethics and nursing workload. Ethical sensitivity of everyday nursing practice related to PADIS is an imperative part of implementing evidence-based care for patients.

The aims of this convergent parallel mixed methods study were:

Aim 1: To determine the measured level of ethical awareness as an attribute of ethical sensitivity among the critical care nurse participants.

Aim 2: To explore the ethical sensitivity of critical care nurses related to implementation of PADIS care.

Aim 3: To examine how the measured level of ethical awareness and ethical sensitivity exploration results converge, diverge, relate to each other and/or produce a more complete understanding of PADIS ethical sensitivity by critical care nurses.

The participants were 19 critical care nurses who were observed during patient care, interviewed individually and in a focus group, and administered the Ethical Awareness Scale. Despite high levels of individual ethical awareness among nurses, themes of ambiguous beneficence, heedless autonomy, and moral distress were found related to PADIS care. More effort is needed to establish moral community, ethical leadership, and individual ethical guidance for nurses to establish patient-centered decision making and implement PADIS care.