Ethical challenges in neonatal intensive care nursing

Mothers' experiences of privacy in neonatal intensive care units: A qualitative study

BACKGROUND

Examining the privacy experiences of mothers in neonatal intensive care units (NICUs) can play a crucial role in bolstering patient privacy safeguards and elevating the overall quality of health care. However, our understanding of mothers' experiences regarding privacy issues they may face after their infants' hospitalization in the NICU is limited.

AIM

This study aimed to investigate the experiences of mothers concerning privacy within NICUs to contribute valuable insights for improving infant care and privacy protection.

DESIGN

A qualitative content analysis using a conventional approach was conducted. A total of 18 participants, with diverse sociodemographic backgrounds, were interviewed using open-ended questions. Qualitative content analysis was undertaken for data analysis.

SETTING

The study was conducted in the NICU of an urban teaching hospital in Iran.

RESULTS

The study identified four main themes: 'understanding of privacy', 'fluctuating respect for privacy', 'efforts to maintain privacy' and 'privacy barriers'. Participants viewed privacy as multidimensional, influenced by cultural and religious factors. Respect for privacy varied, with instances of both adherence and violation. Mothers employed strategies to preserve privacy, emphasizing the importance of their infants' privacy. Privacy barriers included hospital attire, the physical space of the NICU, inhomogeneous human resources and insufficient supervision and training.

CONCLUSION

This study, the first of its kind in the NICU context, provides valuable insights into maternal experiences of privacy. Integrating these insights into practice and future research can contribute to creating more empathetic and privacy-respecting NICU environments.

RELEVANCE TO CLINICAL PRACTICE

Health care providers can use these findings to enhance support for mothers, potentially reshaping physical spaces and communication practices within NICUs.

Support needs of parents with preterm infants at resource-limited neonatal units in Limpopo province: A qualitative study

BACKGROUND

 Preterm birth is often unexpected and life-threatening for the baby and/or the mother. When admitted to the hospital, midwives need to provide informational, instrumental, psycho-cultural and emotional support to enhance post-discharge care.

OBJECTIVES

 This study aimed to explore and describe the support provided to parents of preterm infants in preparing for post-discharge care. The study was conducted in three district hospitals in the Mopani district, South Africa.

METHOD

 A qualitative approach wherein explorative, descriptive and contextual designs were used. A non-probability, convenience sampling was used to select 23 midwives who were working in the maternity unit for at least 2 years. Data were collected through in-depth individual semi-structured interviews until data saturation was reached. The data were analysed through Tesch's open coding method. Trustworthiness was ensured through credibility, transferability and confirmability. Ethical principles adhered to were: informed consent, beneficence, right to self-determination, confidentiality and anonymity.

RESULTS

 The findings revealed that parents need informational, instrumental direct supervision, and psycho-cultural and emotional support during preparation for discharge.

CONCLUSION

 Parents were unsure of their ability to care for the preterm infants after discharge and manage their own needs. The provision of informational, instrumental, psycho-cultural and emotional support needs would play a vital role in their ability to cope with their parental roles and the relationship with their infant.Contribution: The support provided to parents could build parental confidence and act as an integral part of neonatal follow-up programmes.

Moral distress among Iranian neonatal intensive care units' health care providers: a multi-center cross sectional study

Due to the unique nature of the neonatal intensive care unit (NICU) and its moral distress, this study aimed to investigate moral distress in the NICU. This cross-sectional study was conducted on 234 physicians and nurses working in the neonatal wards of eight hospitals. The Corley’s Moral Distress Scale was used to collect data. Findings showed that 25 of the participants were physicians and 209 were nurses. The intensity and frequency of distress among physicians and nurses were assessed as moderate. The mean intensity and frequency of moral distress among nurses and physicians were 48.3%, 41.5% and 46.46%, 15.62% respectively. The results showed that the mean intensity and frequency of distress were higher, however not significantly, among nurses. The intensity and frequency of moral distress had a statistically significant and direct correlation with the intention to leave and the number of staff in each working shift among the nurses. Moral distress in the NICU practitioners was moderate, so addressing this issue and trying to alleviate it was important. Identifying the causes behind moral distress can help adopt appropriate measures to prevent and reduce them.

Nurses' view of the nature of the support given to parents in the neonatal intensive care unit

Background

Most parents of Neonatal intensive care unit (NICU) babies often expressed dissatisfaction with the nursing care in NICU because of their unaddressed needs, resulting in emotional strain. This raises an essential question of how NICU nurses provide support for the parents. However, this can be relatively challenging in the NICU setting.

Objective

To explore nurses' views on the nature of parental support provided in NICU settings in Brunei Darussalam.

Methods

This study employed a qualitative research approach conducted in 2020. Ten nurses were individually interviewed in semi-structured interviews. The data were analysed using thematic analysis.

Results

Three broad themes were identified, namely: (1) Emotional and informational support (2) Keeping the support going (3) Seeking help from others. The data provide insights into how nurses provide emotional and informational support to parents in the NICU setting. Challenges were encountered in providing support and were addressed through the involvement of the doctors and emotional support continuity by nursing colleagues.

Conclusion

This paper describes two critical supports given to the parents in the NICU setting and the challenges that underline these supports and proposes strategies used by nurses to help the parents. The balance needed between work demand and parental support is highlighted. In order to give more robust parental support, ongoing interactions with doctors and nursing colleagues are required.

Evaluation of NICU Healthcare Providers' Experience of Patient Ethics and Communication Excellence (PEACE) Rounds

BACKGROUND

Neonatal intensive care (NICU) providers may experience distress due to controversial orders or the close relationships they form with neonates' families. A "Patient Ethics and Communications Excellence [PEACE] Rounds" intervention developed at Indiana University proved to significantly relieve distress by facilitating interdisciplinary discussions of clinically and ethically challenging issues associated with pediatric intensive care (PICU) patient care. NICU healthcare providers face similar challenges and will benefit from understanding the potential efficacy of PEACE Rounds in this setting.

PURPOSE

This study describes the experiences of NICU healthcare providers who participate in PEACE Rounds and evaluates their perceptions of how it affects their distress levels, contributes to interdisciplinary collaboration, and influences their understanding of ethical decision-making.

METHODS

Researchers conducted semi-structured interviews with 24 intervention participants, observed 12 interventions, facilitated a validation focus group, and performed a constructionist thematic analysis and triangulation based on data from transcribed recordings.

FINDINGS

PEACE Rounds improved interdisciplinary communication and collaboration and demonstrated restorative value through the benefits of voice and collective support. The intervention may reduce, but not replace, the need for formal ethics consultations.

IMPLICATIONS FOR PRACTICE

PEACE Rounds may potentially improve interdisciplinary communications and collaboration, relieve employee distress, and reduce ethics consultations.

IMPLICATIONS FOR RESEARCH

Studies of PEACE Rounds undertaken in other clinical settings, and facilitated by a nurse educator, will help assess the potential benefits of greater reach and access and the efficacy of less structured ethics discussions.

Nurses' ethical challenges caring for people with COVID-19: A qualitative study

Background:

Ethical challenges are common in clinical nursing practice, and an infectious environment could put nurses under ethical challenges more easily, which may cause nurses to submit to negative emotions and psychological pressure, damaging their mental health.

Purpose:

To examine the ethical challenges encountered by nurses caring for patients with the novel coronavirus pneumonia (COVID-19) and to provide nurses with suggestions and support regarding promotion of their mental health.

Research design and method:

A qualitative study was carried out using a qualitative content analysis. The participants were 18 nurses who agreed to attend an interview and describe their own experiences of providing care to COVID-19 patients in China. They were purposively sampled, and structured, in-depth interviews were performed. Data were iteratively collected and analyzed from February to March 2020.

Ethical considerations:

The proposal was approved by the Research Ethics Committee of the Second Hospital of Shandong University, China.

Findings:

The findings revealed three main themes and 10 categories. The themes were the following: (1) ethical challenges (people with COVID-19, inequality, professional ethics, and job competency); (2) coping styles (active control and planning, seeking support as well as catharsis, and staying focused); and (3) impacts on career (specialized nursing skills, scientific research ability, and management skills).

Conclusion:

Nurses faced ethical challenges on multiple fronts in caring for COVID-19 patients. The results may help nurses with more safety, ethics, and humanistic care in nursing practice.

Ethical challenges experienced by clinical research nurses:: A qualitative study

Background:

Clinical investigation is a growing field employing increasing numbers of nurses. This has created a new specialty practice defined by aspects unique to nursing in a clinical research context: the objectives (to implement research protocols and advance science), setting (research facilities), and nature of the nurse–participant relationship. The clinical research nurse role may give rise to feelings of ethical conflict between aspects of protocol implementation and the duty of patient advocacy, a primary nursing responsibility. Little is known about whether research nurses experience unique ethical challenges distinct from those experienced by nurses in traditional patient-care settings.

Research objectives:

The purpose of the study was to describe the nature of ethical challenges experienced by clinical research nurses within the context of their practice.

Research design:

The study utilized a qualitative descriptive design with individual interviews.

Participants and research context:

Participating nurses (N = 12) self-identified as having experienced ethical challenges during screening. The majority were Caucasian (90%), female (83%), and worked in outpatient settings (67%). Approximately 50% had > 10 years of research experience.

Ethical considerations:

The human subjects review board approved the study. Written informed consent was obtained.

Findings:

Predominant themes were revealed: (1) the inability to provide a probable good, or/do no harm, and (2) dual obligations (identity as a nurse vs a research nurse). The following patterns and subthemes emerged: conflicted allegiances between protocol implementation, needs of the participant, desire to advance science, and tension between the nurse–patient therapeutic relationship versus the research relationship.

Discussion:

Participants described ethical challenges specific to the research role. The issues are central to the nurse–participant relationship, patient advocacy, the nurse’s role in implementing protocols, and/or advancing science.

Conclusion:

Ethical challenges related to the specialized role of clinical research nurses were identified. More research is warranted to fully understand their nature and frequency and to identify support systems for resolution.