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

Area of Science:

• Medical Ethics
• Neonatal Intensive Care
• Healthcare Management

Background:

• Neonatal deaths often follow medical decisions, yet nurses, social workers, and pastors are frequently excluded from ethical deliberations.
• Lack of clarity on roles and procedures can hinder effective multiprofessional ethical case deliberations.

Purpose of the Study:

• To evaluate the impact of a structured multiprofessional medical ethical decision-making (MEDM) intervention in a neonatal intensive care unit.
• To assess healthcare professionals' perceptions of the implemented MEDM process.

Main Methods:

• A level-IIID neonatal intensive care unit in the Netherlands implemented a structured MEDM process with a five-step procedure and impartial ethicist facilitation.
• A 15-item questionnaire surveyed staff perceptions before and 8 months after implementation, with factor analysis used to assess changes.

Main Results:

• Significant improvements were perceived in participants' roles (effect size 1.67), the structure of MEDM (0.69), and the content of ethical deliberation (0.40).
• No significant improvement was noted in the documentation of decisions/conclusions (effect size 0.07).
• Nurses' perceptions of improvement were comparable to those of physicians.

Conclusions:

• The structured MEDM intervention was perceived positively by professionals, enhancing the ethical decision-making process in neonatal intensive care.
• While satisfaction with meeting structure, roles, and deliberation content increased, further improvements in documentation are necessary.