1 research outputs found
Implementing structured, multiprofessional medical ethical decision-making in a neonatal intensive care unit
Background In neonatal intensive care, a child’s death
is often preceded by a medical decision. Nurses, social
workers and pastors, however, are often excluded from
ethical case deliberation. If multiprofessional ethical case
deliberations do take place, participants may not always
know how to perform to the fullest.
Setting A level-IIID neonatal intensive care unit of
a paediatric teaching hospital in the Netherlands.
Methods Structured multiprofessional medical ethical
decision-making (MEDM) was implemented to help
overcome problems experienced. Important features
were: all professionals who are directly involved with the
patient contribute to MEDM; a five-step procedure is
used: exploration, agreement on the ethical dilemma/
investigation of solutions, analysis of solutions,
decision-making, planning actions; meetings are chaired
by an impartial ethicist. A 15-item questionnaire to
survey staff perceptions on this intervention just before
and 8 months after implementation was developed.
Results Before and after response rates were 91/105
(87%) and 85/113 (75%). Factor analysis on the
questionnaire suggested a four-factor structure:
participants’ role; structure of MEDM; content of ethical
deliberation; and documentation of decisions/
conclusions. Effect sizes were 1.67 (p<0.001), 0.69
(p<0.001) and 0.40 (p<0.01) for the first three factors
respectively, but only 0.07 (pÂĽ0.65) for the fourth factor.
Nurses’ perceptions of improvement did not significantly
exceed those of physicians.
Conclusion Professionals involved in ethical case
deliberation perceived that the process of decisionmaking had improved; they we