Moral responsibility, constrained authority: Neonatal nurses navigating periviable shared decision-making

Area of Science:

• Neonatal Nursing
• Bioethics
• Qualitative Research

Background:

• Shared decision-making for periviable infants presents significant ethical complexities in neonatal care.
• Neonatal nurses' roles are influenced by uncertainty, infant suffering, parental vulnerability, and moral responsibility.

Purpose of the Study:

• To explore neonatal nurses' experiences with shared decision-making for periviable infants.
• To identify ethical tensions, moral responsibilities, and practice challenges in this context.

Main Methods:

• Qualitative Interpretative Phenomenological Analysis (IPA) study.
• Semi-structured, in-depth interviews with 12 registered neonatal nurses.
• Analysis of data from four Level III neonatal intensive care units in Saudi Arabia.

Main Results:

• Nurses experience ethical complexity, uncertainty, and constrained authority.
• Key themes include witnessing suffering, moral responsibility without full authorization, supporting families through fractured decisions, and navigating institutional/cultural factors.
• Relational labor and moral residue are continuously negotiated.

Conclusions:

• Neonatal nurses hold a central, yet often unrecognized, ethical position in periviable infant decision-making.
• Ethical practice requires structures acknowledging nurses' moral agency, relational work, and responsibility.
• Interprofessional collaboration and support are vital for managing the aftermath of these decisions.