摘要:

Using a case study approach this article explores two critical ethical-emotional issues that arise in the nursing care of imperiled infants. The questions concerning who should decide and what should be decided about the care of these infants are discussed. Roles of the parents, physician, and nurse are examined in relation to decision-making. An emphasis is placed on the role of the nurse with three criteria supporting nursing involvement being identified. Ethical theories, ethics by committee, and guidelines for decision-making are briefly discussed.

ISSN:0146-0862    

DOI:10.3109/01460868909026846

出版商:Taylor&Francis    

年代:1989

数据来源: Taylor

摘要:

Ethical debate in neonatal intensive care centers around the lower limits of viability, the use of multiple invasive procedures, and the role of paternalism. The parents' perspective has been addressed infrequently. This report will focus on the parents' statements as obtained through predischarge in-depth interviews with 32 families, each with a high-risk infant(s). Discussion will include a summary of the range of parental perceptions during two major periods of time: preadmission to the NICU and the NICU experience itself. Some possible nursing implications will be drawn that reflect a sensitive response to these parental perceptions.A review of parental perceptions from conception to the high-risk nursery experience shows a variety of responses in relation to the potential ethical problems. This discussion indicates that the process can be a highly stressful, strongly emotional series of events for these parents. The parental focus appears to be targeted on the pregnancy and birth experiences, prior to the discharge of the infant from the NICU. Investigations of later parental perceptions of ethical decision-making in the neonatal nursery are scheduled for the post-discharge period. These reflections will provide evidence for comparison with earlier discussions and development of themes in the parental perspective over time.

ISSN:0146-0862    

DOI:10.3109/01460868909026847

出版商:Taylor&Francis    

年代:1989

数据来源: Taylor

摘要:

A number of ethical issues have been created by the possibility of transplanting organs from anencephalic infants to other children who need an organ in order to live. The issues of moral justification of the practice, adequacy of informed consent procedures involved, and the potential constraints on female integrity are explored and the relevant arguments for and against transplantation efforts are discussed. Nurses are encouraged to become knowledgeable about the issues and to enter into public discussion of the issues as policy initiatives are proposed.

ISSN:0146-0862    

DOI:10.3109/01460868909026848

出版商:Taylor&Francis    

年代:1989

数据来源: Taylor

摘要:

Institutional ethics committees first gained national prominence after the 1976 Karen Ann Quinlin decision by the New Jersey Supreme Court. However, it wasn't until the Federal Government promulgated the Baby Doe regulations in 1983 that significant movement occurred toward implementing such committees. Currently, statistics show that the number of ethics committees are increasing in health care institutions across the country. However, the majority of studies have focused on adult institutions. The membership of ethics committees and the objectives under which the committees function are usually addressed by the studies. Very little attention has been given to the nursing representation on the institutional ethics committee and the unique role played by nurses in the deliberation of ethical decision-making. It is the intent of this research to shed some light on the availability and functions of ethics committees within children's hospitals. Attention has also been given to the nurses' involvement on such committees. Additionally, the study takes a separate look at nursing ethics committees, their function within an institution, and the availability of ethics education for nurses. The study offers information not previously acknowledged in past studies of ethics committees. The study also opens up to consideration the unique concerns of nurses and their roles in ethical decision-making.Ethics, in the context of clinical decision-making, identifies, analyzes, and attempts to resolve the moral problems that arise in patient care. The goal of a formal ethical decision-making process is to foster a climate of quality patient care that is congruent with clear ethical standards. In the past, what was right and good for the patient was seen in relationship to the technical decisions made by the physician. Times have changed. The complexity of the environment supports effective multidisciplinary committees to help guide practitioners. This study demonstrated a clear movement toward this end within children's hospitals. It is important to further explore unanswered questions about the effectiveness of the committees, the impact of education, the types of policies established, and whether environments that have institutional ethics committees and/or nursing ethics committees promote more open discussion and shared decision-making.

ISSN:0146-0862    

DOI:10.3109/01460868909026849

出版商:Taylor&Francis    

年代:1989

数据来源: Taylor

摘要:

This study was an exploratory investigation of the extent and nature of nurses' reported participation in the resolution of treatment dilemmas for infants with severe congenital anomalies. Participants in the study were 83 registered nurses from neonatal intensive care units in five large urban hospitals in the Southwest. Data were collected through the use of intensive semi-structured interviews with each participant and nurse responses to an investigator designed case study instrument, The Nursing Ethical Decision-Making Scale. Results indicated that a majority (85%) of the nurses in the study do not participate in a substantial way in decisions to initiate or forego life-sustaining treatment for their infant patients, yet they bear the major responsibility for implementing those decisions. The lack of participation in the decision-making process was cited by 70% of the nurses as being a major source of occupational stress and ethical anguish. Nurses with graduate educational preparation or advanced clinical practitioner education tended to take a more active role in decision-making. Other factors that appeared to promote participation in decision-making included nurse perceptions of administrative support for involvement, the existence of internal mechanisms for communication about treatment dilemmas (including infant care review committees), and hospital affiliation with a medical school. Eighty-seven percent of the nurses identified themselves as the infant's primary advocate, but only 20% of that group reported that they would pursue decisions through the chain of command outside the neonatal unit if they believed that an infant was not receiving appropriate treatment.

ISSN:0146-0862    

DOI:10.3109/01460868909026850

出版商:Taylor&Francis    

年代:1989

数据来源: Taylor

ISSN:0146-0862    

DOI:10.3109/01460868909026845

出版商:Taylor&Francis    

年代:1989

数据来源: Taylor