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Nurses' involvement in ethical decision-making with severely ill newborns
Issues in Comprehensive Pediatric Nursing
|January 1, 1989
Summary
Most nurses in neonatal intensive care units do not significantly influence treatment decisions for infants with severe congenital anomalies, causing ethical distress. Advanced education and hospital support can increase nurses
Area of Science:
- Medical Ethics
- Neonatal Nursing
- Pediatric Critical Care
Background:
- Nurses in neonatal intensive care units (NICUs) often face complex ethical dilemmas regarding life-sustaining treatment for infants with severe congenital anomalies.
- The extent of nurses' involvement in these critical treatment decisions is not fully understood.
- Understanding nurses' roles is crucial for addressing ethical distress and improving patient care.
Purpose of the Study:
- To explore the extent and nature of nurses' participation in resolving treatment dilemmas for infants with severe congenital anomalies.
- To identify factors influencing nurses' involvement in these ethical decision-making processes.
- To understand the impact of non-participation on nurses' occupational stress and ethical anguish.
Main Methods:
- Exploratory investigation utilizing semi-structured interviews with 83 registered nurses.
- Data collection included the use of an investigator-designed case study instrument, The Nursing Ethical Decision-Making Scale.
- Participants were recruited from NICUs in five large urban hospitals in the Southwest.
Main Results:
- A majority of nurses (85%) reported minimal participation in decisions to initiate or withhold life-sustaining treatment for infants.
- Lack of participation in decision-making was a significant source of occupational stress and ethical anguish for 70% of nurses.
- Nurses with graduate education, perceived administrative support, and involvement in hospital committees reported more active roles.
Conclusions:
- Nurses in NICUs are largely excluded from critical treatment decisions for infants with severe congenital anomalies, despite implementing them.
- Non-participation contributes significantly to nurses' ethical distress and occupational stress.
- Factors such as advanced education, administrative support, and established communication mechanisms can enhance nurses' ethical decision-making involvement.