Date of Award

January 2020

Document Type


Degree Name

Doctor of Nursing Practice (DNP)


Yale University School of Nursing

First Advisor

Mark Lazenby

Second Advisor

Joan A. Kearney



Background: Critical care units are demanding practice settings filled with daily stressors including the ethical climate (America Association of Critical-Care Nurses 2015a; Mealer, & Moss, 2016). Navigating this ethically sensitive area requires critical care nurses have an understanding of ethics at a level appropriate for their practice setting (Bertolini, 1994; Hadjibalassi et al., 2012; Hughes & Dvorak, 1997; Indhraratana & Kaemkate, 2012; Mealer, & Moss, 2016; Rushton & Stutzer, 2015; Schluter, Winch, Holzhauser, & Henderson, 2008; Sellman, 1996). However, current ethics education for critical care nurses is limited to a general understanding of basic ethical principles (American Association of Colleges of Nursing, 2008; National League for Nursing [NLN], 2016; Nursing & Midwifery Council [NMC], 2010). Critical care nurses subsequently report their ethics training to be inadequate leaving them struggling to meet the challenges of their practice area (Bicking, 2011; Choe, Kang, & Park, 2015; Hughes & Dvorak, 1997). Addressing the lack of critical care-specific ethics education would provide a means by which critical care nurses can acquire skills appropriate for their practice setting. Currently, there is no practical, specialty specific, health care ethics education modality for critical care nurses.

Objective: The goal of this Doctor of Nursing Practice project was to provide a means by which registered nurses can gain knowledge in health care ethics specific to critical care settings. This goal was realized through three measurable aims: (1) the development of a critical care-specific ethics curriculum, (2) refinement and validation of the curriculum content by expert panel and, (3) implementation and evaluation the curriculum.

Methods: The project began with the development of a curriculum utilizing the Whittemore, & Knafl, (2005) integrative review methodology along with a one-step modified Delphi panel. The curriculum was then refined and validated by expert panel. Once refinement and validation were complete, the curriculum was placed in a web-based format, uploaded onto a web-based learning platform and made available as a pilot program to the membership of the American Association of Critical-Care Nurses. The pilot ran from January 2020 through February 2020. Data was collected on (1) the number of eligible critical care nurses who consent to participate and (2) the number who complete the curriculum. A comparison analysis of this data was used to evaluate feasibility. Participants who complete the curriculum were given an online course evaluation to collect data on their perceptions regarding the curriculum’s value to practice, the efficacy of course delivery, and overall satisfaction with the course. Analysis of the evaluations was used to evaluate acceptability.

Results: Twenty-seven eligible participants signed up for the pilot and four completed the course indicating that 14.8% of the respondents completed the course. The majority of the respondents (>50%) believed the course: (1) increased the critical care nurse’s knowledge of health care ethics, (2) was delivered in a method appropriate for the content presented, (3) that the content was valuable to their practice, and (4) were overall satisfied with the course.

Discussion: The preliminary results indicate that using a professional organization to facilitate a self-paced, online program may not be the best modality for teaching health care ethics to critical care nurses. Furthermore, the lack of an instructor’s presence, the self-paced online format, and the two-month time period the participants were given to complete the course may have also contributed to the low completion rates. These findings suggest a need for further research on nursing specific health care ethics teaching modalities in the critical care setting.

Keywords: critical care, critical care nurse, health care ethics, curriculum


This thesis is restricted to Yale network users only. It will be made publicly available on 10/19/2021