Identifying Ethical Issues Encountered in a Pediatric Postacute Care Setting

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.