Decision Making in the Neonatal Intensive Care Unit

1992 ◽  
pp. 299-316
Author(s):  
Terry Walman
Keyword(s):  
Intensive Care Unit ◽  
Decision Making ◽  
Intensive Care ◽  
Neonatal Intensive Care Unit ◽  
Neonatal Intensive Care

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.

The importance of shared decision-making in the neonatal intensive care unit

2019 ◽  
Vol 40 (3) ◽  
pp. 504-509 ◽  
Author(s):  
Frank Soltys ◽  
Sydney E. Philpott-Streiff ◽  
Lindsay Fuzzell ◽  
Mary C. Politi
Keyword(s):  
Intensive Care Unit ◽  
Decision Making ◽  
Intensive Care ◽  
Neonatal Intensive Care Unit ◽  
Shared Decision Making ◽  
Neonatal Intensive Care ◽  
Shared Decision

scholarly journals Ultrasound Monitoring of Umbilical Catheters in the Neonatal Intensive Care Unit—A Prospective Observational Study

2021 ◽  
Vol 9 ◽  
Author(s):  
Alina Sobczak ◽  
Aleksandra Dudzik ◽  
Piotr Kruczek ◽  
Przemko Kwinta
Keyword(s):  
Intensive Care Unit ◽  
Decision Making ◽  
Intensive Care ◽  
Observational Study ◽  
Neonatal Intensive Care Unit ◽  
Neonatal Intensive Care ◽  
Prospective Observational Study ◽  
Central Line ◽  
Decision Making Process ◽  
Umbilical Catheters

Introduction: Umbilical catheterization provides a quick yet demanding central line that can lead to complications seen nowhere else. The aim of our study was to determine whether the repeated ultrasound scanning can influence the catheterization time, prevent some of the catheter-related complications, support the decision-making process and allow prolonged catheterization in patients without an alternative central access route.Methods: A prospective observational study was performed in a tertiary neonatal intensive care unit. A total of 129 patients and 194 umbilical catheters (119 venous and 75 arterial) were analyzed with a total of 954 scans. Ultrasound screening consisted of 1) assessing the catheter tip, location, movability, and surface and 2) analyzing the catheter trajectory. The outcome variables were defined as 1) catheter dislocation and 2) associated thrombosis.Results: Dislocation of catheter throughout the whole catheterization period was observed in 68% (81/119) of UVCs and 23% (17/75) of UACs. Thrombotic complications were observed in 34.5% (41/119) of UVCs and 12% (9/75) of UACs. 1/3 of UAC-associated thrombi were visible only after catheter removal. 51% (61/119) of UVC patients and 8% (6/75) of UAC patients made a clinical decision regarding the obtained catheter image.Conclusion: Bedside ultrasound imaging of catheters supports the decision-making process related to the catheterization duration, shortening the time if abnormalities are detected and allowing a safer prolonged UC stay when an alternative central line cannot be inserted.

INFORMED CONSENT

PEDIATRICS ◽  
1982 ◽  
Vol 70 (4) ◽  
pp. 556-556
Author(s):  
Keyword(s):  
Intensive Care Unit ◽  
Decision Making ◽  
Intensive Care ◽  
Informed Consent ◽  
Neonatal Intensive Care Unit ◽  
Neonatal Intensive Care ◽  
Newborn Baby ◽  
Maximum Extent ◽  
The Family ◽  
Do So

Let us address ourselves to the problem of informed consent. I believe, as a physician who has had prior contact with the family, that I can persuade 99% of parents to my way of thinking if I really work at it, even if I am 100% wrong. If I tell them in such a way that I appear concerned and that I am knowledgeable and that I have their interests at heart and the interest of their foetus or their newborn baby, there is no question they will be totally agreeable to my suggestion. I think informed consent is an absolute farce, legalistically, morally and ethically. The information is what I want it to be. Certainly, the physician must try to involve the parents in decision making. He should do so to the maximum extent feasible, but we are fooling ourselves if we believe that the parent or the physician can make all the decisions.—Director of a Neonatal Intensive Care Unit.

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

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