Children’s outcomes at 2-year follow-up after 4 years of structured multi-professional medical-ethical decision-making in a neonatal intensive care unit

2017 ◽  
Vol 37 (7) ◽  
pp. 869-874
Author(s):  
J C de Boer ◽  
L Gennissen ◽  
M Williams ◽  
M van Dijk ◽  
D Tibboel ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Decision Making ◽  
Intensive Care ◽  
Neonatal Intensive Care Unit ◽  
Neonatal Intensive Care ◽  
Ethical Decision ◽  
Ethical Decision Making

Neonatal nurse practitioner ethics knowledge and attitudes

2018 ◽  
Vol 26 (7-8) ◽  
pp. 2247-2258
Author(s):  
Mobolaji Famuyide ◽  
Caroline Compretta ◽  
Melanie Ellis
Keyword(s):  
Intensive Care Unit ◽  
Decision Making ◽  
Intensive Care ◽  
Neonatal Intensive Care Unit ◽  
Nurse Practitioners ◽  
Neonatal Intensive Care ◽  
Ethical Decision ◽  
Ethical Decision Making ◽  
Ethical Issues ◽  
Neonatal Nurse Practitioners

Background: Neonatal nurse practitioners have become the frontline staff exposed to a myriad of ethical issues that arise in the day-to-day environment of the neonatal intensive care unit. However, ethics competency at the time of graduation and after years of practice has not been described. Research aim: To examine the ethics knowledge base of neonatal nurse practitioners as this knowledge relates to decision making in the neonatal intensive care unit and to determine whether this knowledge is reflected in attitudes toward ethical dilemmas in the neonatal intensive care unit. Research design: This was a prospective cohort study that examined decision making at the threshold of viability, life-sustaining therapies for sick neonates, and a ranking of the five most impactful ethical issues. Participants and research context: All 47 neonatal nurse practitioners who had an active license in the State of Mississippi were contacted via e-mail. Surveys were completed online using Survey Monkey software. Ethical considerations: The study was approved by the University of Mississippi Medical Center Institutional Review Board (IRB; #2015-0189). Findings: Of the neonatal nurse practitioners who completed the survey, 87.5% stated that their religious practices affected their ethical decision making and 76% felt that decisions regarding life-sustaining treatment for a neonate should not involve consultation with the hospital’s legal team or risk management. Only 11% indicated that the consent process involved patient understanding of possible procedures. Participating in the continuation or escalation of care for infants at the threshold of viability was the top ethical issue encountered by neonatal nurse practitioners. Discussion: Our findings reflect deficiencies in the neonatal nurse practitioner knowledge base concerning ethical decision making, informed consent/permission, and the continuation/escalation of care. Conclusion: In addition to continuing education highlighting ethics concepts, exploring the influence of religion in making decisions and knowing the most prominent dilemmas faced by neonatal nurse practitioners in the neonatal intensive care unit may lead to insights into potential solutions.

Physicians and nurses’ perspectives of encountering neonates with poor prognosis

2020 ◽  
Author(s):  
Zahra Rafiee ◽  
Maryam Rabiee ◽  
Shiva Rafati ◽  
Nahid Rejeh ◽  
Hajieh Borna ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Decision Making ◽  
Intensive Care ◽  
Neonatal Intensive Care Unit ◽  
Poor Prognosis ◽  
Neonatal Intensive Care ◽  
Ethical Decision ◽  
Ethical Decision Making ◽  
Healthcare Providers ◽  
Value Of Life

Abstract Introduction: Decision making regarding the treatment of neonates with poor prognoses is difficult for healthcare staff working in the neonatal intensive care unit (NICU). This study aimed to investigate the attitude of physicians and nurses towards the value of life and ethical decision making when encountering neonates with poor prognosis in the NICU. Methods: A cross-sectional study was conducted in 2016. This study was carried out in five NICUs of five hospitals in Tehran city, Iran. The perspectives of 144 paediatricians, gynaecologist and nurses were assessed using the questionnaire of attitude toward the value of life and agreement on intensive care management on three hypothetical cases scenarios of neonates with poor prognosis. Data was analysed using descriptive and inferential statistics. Results: The negative agreement on the no initiation of intensive care measures and the discontinuation of resuscitation in neonates with poor prognosis was more than the positive agreement. Also, various factors influenced the participants’ decision making for the provision of care to neonates. Regarding the case scenarios, the participants agreed on the provision of aggressive, conservative, and palliative care with various frequencies. This study confirms the importance of healthcare providers’ perspectives and their impacts on ethical decision making. The participants in this study favoured the value or sacredness of life and agreed on the use of all therapeutic measures for neonates with poor prognosis. Conclusion: More studies are required to improve our understandings of factors influencing ethical decision makings by healthcare providers when encountering neonates with poor prognosis in NICUs. Key words: Decision making, ethics, neonatal intensive care unit, poor prognosis, value of life

scholarly journals Physicians’ and nurses’ decision making to encounter neonates with poor prognosis in the neonatal intensive care unit

2020 ◽  
Vol 15 (4) ◽  
pp. 187-196
Author(s):  
Zahra Rafiee ◽  
Maryam Rabiee ◽  
Shiva Rafati ◽  
Nahid Rejeh ◽  
Hajieh Borna ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Decision Making ◽  
Intensive Care ◽  
Neonatal Intensive Care Unit ◽  
Poor Prognosis ◽  
Neonatal Intensive Care ◽  
Ethical Decision ◽  
Ethical Decision Making ◽  
Healthcare Providers ◽  
Value Of Life

Background Decision making regarding the treatment of neonates with poor prognoses is difficult for healthcare staff working in the neonatal intensive care unit (NICU). This study aimed to investigate the attitudes of physicians and nurses about the value of life and ethical decision making when encountering neonates with poor prognosis in the NICU. Methods This cross-sectional study was conducted in five NICUs of five hospitals in Tehran city, Iran. The attitudes of 144 pediatricians, gynecologists and nurses were assessed using the questionnaire of attitude toward the value of life and agreement on intensive care management based on three hypothetical case scenarios of neonates with poor prognosis. Data were analyzed using descriptive and inferential statistics via the SPSS software. Results The negative agreement on the no initiation of intensive care measures and the discontinuation of resuscitation in neonates with poor prognosis was more than the positive agreement. Also, various factors influenced the participants’ decision making for the provision of care to neonates. Regarding the case scenarios, the participants agreed on the provision of aggressive, conservative, and palliative care with various frequencies. This study confirms the importance of healthcare providers’ perspectives and their impacts on ethical decision making. The participants favored the value or sacredness of life and agreed on the use of all therapeutic measures for saving the lives of neonates with poor prognosis. Conclusion More studies are required to improve our understandings of factors influencing ethical decision making by healthcare providers when encountering neonates with poor prognosis in NICUs.

scholarly journals Implementing structured, multiprofessional medical ethical decision-making in a neonatal intensive care unit

2012 ◽  
Vol 38 (10) ◽  
pp. 596-601 ◽  
Author(s):  
Jacoba (Coby) de Boer ◽  
Geja van Blijderveen ◽  
Gert van Dijk ◽  
Hugo J Duivenvoorden ◽  
Monique Williams
Keyword(s):  
Intensive Care Unit ◽  
Decision Making ◽  
Intensive Care ◽  
Neonatal Intensive Care Unit ◽  
Neonatal Intensive Care ◽  
Ethical Decision ◽  
Ethical Decision Making

scholarly journals Patent ductus arteriosus in preterm infants; experience of a tertiary referral neonatal intensive care unit: prevalence, complications, and management

2020 ◽  
Vol 68 (1) ◽  
Author(s):  
Reem M. Soliman ◽  
Fatma Alzahraah Mostafa ◽  
Antoine Abdelmassih ◽  
Elham Sultan ◽  
Dalia Mosallam
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Side Effects ◽  
Patent Ductus Arteriosus ◽  
Neonatal Intensive Care Unit ◽  
Preterm Infants ◽  
Neonatal Intensive Care ◽  
Ductus Arteriosus ◽  
Patent Ductus

Abstract Background Patent ductus arteriosus poses diagnostic and therapeutic dilemma for clinicians, diagnosis of persistent PDA, and determination of its clinical and hemodynamic significance are challenging. The aim of this study is to determine the prevalence of PDA in preterm infants admitted to our NICU, to report cardiac and respiratory complications of PDA, and to study the management strategies and their subsequent outcomes. Result Echocardiography was done for 152 preterm babies admitted to neonatal intensive care unit (NICU) on day 3 of life. Eighty-seven (57.2%) preterms had PDA; 54 (62.1%) non-hemodynamically significant PDA (non-hsPDA), and 33 (37.9%) hemodynamically significant PDA. Hemodynamically significant PDA received medical treatment (paracetamol 15 mg/kg/6 h IV for 3 days). Follow-up echocadiography was done on day 7 of life. Four babies died before echo was done on day 7. Twenty babies (68.9%) achieved closure after 1st paracetamol course. Nine babies received 2nd course paracetamol. Follow-up echo done on day 11 of life showed 4 (13.7%) babies achieved successful medical closure after 2nd paracetamol course; 5 babies failed closure and were assigned for surgical ligation. The group of non-hsPDA showed spontaneous closure after conservative treatment. Pulmonary hemorrhage was significantly higher in hsPDA group. Mortality was higher in hsPDA group than non-hsPDA group. Conclusion Echocardiographic evaluation should be done for all preterms suspected clinically of having PDA. We should not expose vulnerable population of preterm infants to medication with known side effects unnecessarily; we should limit medical closure of PDA to hsPDA. Paracetamol offers several important therapeutic advantages options being well tolerated and having more favorable side effects profile.

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