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Identifying Ethical Issues Encountered in a Pediatric Postacute Care Setting
Erica K Salter1, Allison Bajada1, Maggie Mullane2
1Department of Health Care Ethics, Saint Louis University, Saint Louis, MO.
Insights
Healthcare workers in pediatric post-acute care (PPAC) hospitals face ethical challenges, particularly regarding discharge, communication, and care goals. Many feel institutional resources are lacking, highlighting a need for ethics committees.
Area of Science:
- Medical Ethics
- Pediatric Healthcare
- Healthcare Management
Background:
- Pediatric post-acute care (PPAC) settings present unique ethical complexities.
- Understanding employee experiences with ethical challenges is crucial for improving care.
- Existing literature on pediatric ethics often overlooks PPAC-specific issues.
Purpose of the Study:
- To identify the types and frequency of ethical challenges faced by employees in a PPAC hospital.
- To assess the adequacy of current institutional ethics resources.
- To inform strategies for supporting employees and enhancing patient care.
Main Methods:
- Anonymous, mixed-methods survey administered to healthcare providers at a US-based PPAC hospital.
- Survey included questions on demographics, frequency of 33 ethical issues, detailed scenarios, and resource assessment.
- 104 surveys were completed, yielding a 30% response rate.
Main Results:
- Common ethical issues included discharge disposition (41%), inter-team communication (33%), team-parent communication (27%), behavior problems (28%), and goals of care (24%).
- A significant majority (54%) of employees felt institutional resources were inadequate for navigating ethical dilemmas.
- The development of an institutional ethics committee was the most frequently requested resource.
Conclusions:
- Ethical challenges in PPAC settings often revolve around discharge, communication, behavior, and care goals, potentially due to the specialized nature of these institutions.
- Ethical issues such as admissions and discharge decisions in PPAC require further exploration in pediatric ethics research.
- PPAC employees would benefit from enhanced support, including the establishment of an institutional ethics committee for education and consultation.
Objectives:
To identify the nature and frequency of ethical challenges experienced by employees at a pediatric postacute care (PPAC) hospital, and to inform institutional efforts to better meet the needs of employees facing ethical challenges and improve patient care.
Study Design:
We surveyed health care providers at a PPAC hospital in the United States to investigate the ethical challenges they face. The anonymous, mixed-methods survey instrument included 8 multiple choice and free response questions covering the following: demographic information, frequency of encountering 33 potentially ethically-challenging issues, description of 2-3 challenging ethical scenarios, and an assessment of available institutional ethics resources.
Results:
One hundred four individuals completed the survey (response rate: 30%). The most commonly encountered ethical issues in the PPAC setting included discharge disposition (41%), inter-team (33%) and team-parent communication issues (27%), behavior problems (28%), and goals of care (24%). Further, many (54%) employees did not feel they have appropriate institutional resources to navigate ethical dilemmas, with the development of an institutional ethics committee as the most identified needed resource.
Conclusions:
The most commonly encountered ethical issues in PPAC settings relate to discharge, communication, behavior, and goals of care and these challenges may be due to the unique nature of PPAC institutions. Several ethically challenging issues arising in the PPAC setting, like admissions and discharge decisions, are underexplored in the pediatric ethics literature and deserve additional research and attention. PPAC employees would likely benefit from additional resources, like the development of an institutional ethics committee to provide education and consultation.
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