Implementing structured, multiprofessional medical ethical decision-making in a neonatal intensive care unit

Journal of Medical Ethics 38 (10):596-601 (2012)
Abstract
Background In neonatal intensive care, a child's death is often preceded by a medical decision. Nurses, social workers and pastors, however, are often excluded from ethical case deliberation. If multiprofessional ethical case deliberations do take place, participants may not always know how to perform to the fullest. Setting A level-IIID neonatal intensive care unit of a paediatric teaching hospital in the Netherlands. Methods Structured multiprofessional medical ethical decision-making (MEDM) was implemented to help overcome problems experienced. Important features were: all professionals who are directly involved with the patient contribute to MEDM; a five-step procedure is used: exploration, agreement on the ethical dilemma/investigation of solutions, analysis of solutions, decision-making, planning actions; meetings are chaired by an impartial ethicist. A 15-item questionnaire to survey staff perceptions on this intervention just before and 8 months after implementation was developed. Results Before and after response rates were 91/105 (87%) and 85/113 (75%). Factor analysis on the questionnaire suggested a four-factor structure: participants' role; structure of MEDM; content of ethical deliberation; and documentation of decisions/conclusions. Effect sizes were 1.67 (p<0.001), 0.69 (p<0.001) and 0.40 (p<0.01) for the first three factors respectively, but only 0.07 (p=0.65) for the fourth factor. Nurses' perceptions of improvement did not significantly exceed those of physicians. Conclusion Professionals involved in ethical case deliberation perceived that the process of decision-making had improved; they were more positive about the structure of meetings, their own role and, to some extent, the content of ethical deliberation. Documentation of decisions/conclusions requires further improvement
Keywords info:mesh/Ethics, Nursing  info:mesh/Pastoral Care  Humans   Intensive Care, Neonatal   Questionnaires   Attitude of Health Personnel   Interdisciplinary Communication   Decision Making   Pastoral Care   Social Work   Ethics, Medical   Ethics, Nursing   Adult   Middle Aged   Infant, Newborn   Chaplaincy Service, Hospital   Intensive Care Units, Neonatal   Patient Care Team   Netherlands   Female   Male  info:mesh/Attitude of Health Personnel  info:mesh/Middle Aged  info:mesh/Decision Making  info:mesh/Netherlands  info:mesh/Chaplaincy Service, Hospital  info:mesh/Interdisciplinary Communication  info:mesh/Humans  info:mesh/Adult  info:mesh/Ethics, Medical  info:mesh/Patient Care Team  info:mesh/Intensive Care Units, Neonatal  info:mesh/Intensive Care, Neonatal  info:mesh/Questionnaires  info:mesh/Male  info:mesh/Female  info:mesh/Social Work  info:mesh/Infant, Newborn
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