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A burden of knowledge: A qualitative study of experiences of neonatal intensive care nurses' concerns when keeping
Janet Green1, Philip Darbyshire2, Anne Adams3
1University of Technology, Sydney, Australia janet.green@uts.edu.au.
Insights
Neonatal nurses face ethical dilemmas when withholding information from parents of extremely premature babies, leading to internal conflict and emotional distress. This practice, termed "keeping secrets," challenges the balance between patient confidentiality and the parents
Area of Science:
- Neonatal Intensive Care Nursing
- Bioethics in Healthcare
- Pediatric Patient Advocacy
Background:
- Advances in neonatal intensive care technology improve survival rates for extremely premature infants.
- Neonatal intensive care units (NICUs) are environments where infant conditions can change rapidly.
- Close, trusting relationships develop between neonatal nurses and parents due to prolonged bedside presence.
Purpose of the Study:
- To explore the ethical challenges faced by neonatal nurses withholding information from parents.
- To investigate the conflict between nurses' duty of confidentiality and parents' right to know.
- To understand the emotional impact on nurses when unable to share critical infant condition updates.
Main Methods:
- Qualitative research approach utilizing in-depth interviews.
- Data collected from 24 neonatal nurses in New South Wales, Australia.
- Thematic analysis to identify key issues and experiences.
Main Results:
- Identification of the central theme 'keeping secrets' among neonatal nurses.
- Sub-themes revealed include 'coping with potentially catastrophic news,' 'fear of inadvertent disclosure,' and 'a burden that could damage trust.'
- Nurses experienced guilt and shame when forced to withhold information, creating internal conflict.
Conclusions:
- Withholding information creates significant internal conflict for neonatal nurses, balancing confidentiality with parental rights.
- The practice of 'keeping secrets' can negatively impact the nurse-parent relationship and erode trust.
- Addressing these ethical dilemmas is crucial for supporting neonatal nurses and maintaining therapeutic relationships in the NICU.
Abstract:
Improved life-sustaining technology in the neonatal intensive care has resulted in an increased probability of survival for extremely premature babies. In the neonatal intensive care, the condition of a baby can deteriorate rapidly. Nurses and parents are together for long periods at the bedside and so form close and trusting relationships. Neonatal nurses as the constant caregivers may be presented with contradictory demands in attempting to meet the baby's needs and being a patient and family advocate. This article aims to explore the issues arising for neonatal nurses when holding information about changes to a condition of a baby that they are unable to share with parents. Data were collected via interviews with 24 neonatal nurses in New South Wales, Australia. A qualitative approach was used to analyse the data. The theme 'keeping secrets' was identified and comprised of three sub-themes 'coping with potentially catastrophic news', 'fear of inadvertent disclosure' and 'a burden that could damage trust'. Keeping secrets and withholding information creates internal conflict in the nurses as they balance the principle of confidentiality with the parent's right to know information. The neonatal nurses experienced guilt and shame when they were felt forced by circumstances to keep secrets or withhold information from the parents of extremely premature babies.
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