Ethical climate in contemporary paediatric intensive care

Area of Science:

• Healthcare Ethics
• Pediatric Critical Care
• Organizational Psychology

Background:

• Ethical climate (EC) is crucial for institutional ethical responsiveness.
• Existing EC tools inadequately capture the complexities of pediatric intensive care (PIC).
• A contemporary framework is needed to study and improve EC in PIC settings.

Purpose of the Study:

• To propose a novel conceptual framework for ethical climate in PIC.
• To identify measurable domains for assessing ethical climate in PIC.
• To address gaps in current EC measurement within the PIC environment.

Main Methods:

• Extensive literature review of EC definitions, tools, and applications.
• Analysis of ethical challenges and theories relevant to PIC.
• Development of the Paediatric Intensive Care Ethical Climate (PICEC) framework.

Main Results:

• The proposed PICEC framework defines ethical climate as the collective experience of interdisciplinary teams.
• Four core, interrelated domains of PICEC drivers were identified: organizational culture/leadership, team dynamics, child/family-centered care, and ethics literacy.
• The framework aims to capture factors enabling or constraining ethical navigation in PIC.

Conclusions:

• The PICEC framework offers a nuanced approach to understanding ethical climate in PIC.
• Future development of a PICEC measurement tool is recommended for benchmarking and intervention evaluation.
• This framework can guide targeted interventions to foster a healthier ethical climate in PIC settings.