Implementing structured, multiprofessional medical ethical decision-making in a neonatal intensive care unit
David Bourget (Western Ontario)
David Chalmers (ANU, NYU)
Rafael De Clercq
Ezio Di Nucci
Jack Alan Reynolds
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Journal of Medical Ethics 38 (10):596-601 (2012)
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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