School of Nursing, China Medical University, Taichung, Taiwan.
J Med Ethics. 2013 Jun;39(6):382-6. doi: 10.1136/medethics-2011-100428. Epub 2012 May 5.
The purposes of research were to describe the neonatal clinicians' personal views and attitudes on neonatal ethical decision-making, to identify factors that might affect these attitudes and to compare the attitudes between neonatal physicians and neonatal nurses in Taiwan. Research was a cross-sectional design and a questionnaire was used to reach different research purposes. A convenient sample was used to recruit 24 physicians and 80 neonatal nurses from four neonatal intensive care units in Taiwan. Most participants agreed with suggesting a do not resuscitate (DNR) order to parents for dying neonates (86.5%). However, the majority agreed with talking to patients about DNR orders is difficult (76.9%). Most participants agree that review by the clinical ethics committee is needed before the recommendation of 'DNR' to parents (94.23%) and nurses were significantly more likely than physicians to agree to this (p=0.043). During the end-of-life care, most clinicians accepted to continue current treatment without adding others (70%) and withholding of emergency treatments (75%); however, active euthanasia, the administration of drug to end-of-life, was not considered acceptable by both physicians and nurses in this research (96%). Based on our research results, providing continuing educational training and a formal consulting service in moral courage for neonatal clinicians are needed. In Taiwan, neonatal physicians and nurses hold similar values and attitudes towards end-of-life decisions for neonates. In order to improve the clinicians' communication skills with parents about DNR options and to change clinicians' attitudes for providing enough pain-relief medicine to dying neonates, providing continuing educational training and a formal consulting service in moral courage are needed.
研究目的在于描述新生儿临床医生对新生儿伦理决策的个人观点和态度，确定可能影响这些态度的因素，并比较台湾新生儿医生和新生儿护士之间的态度。研究采用横断面设计，使用问卷达到不同的研究目的。采用方便样本，从台湾的四个新生儿重症监护病房招募了 24 名医生和 80 名新生儿护士。大多数参与者同意向濒死新生儿的父母建议不复苏（DNR）医嘱（86.5%）。然而，大多数人同意与患者讨论 DNR 医嘱是困难的（76.9%）。大多数参与者同意在向父母推荐“DNR”之前，需要临床伦理委员会进行审查（94.23%），护士比医生更有可能同意这一点（p=0.043）。在临终关怀期间，大多数临床医生接受继续目前的治疗而不增加其他治疗（70%）和不进行紧急治疗（75%）；然而，在本研究中，医生和护士都认为主动安乐死（给予药物结束生命）是不可接受的（96%）。根据我们的研究结果，需要为新生儿临床医生提供道德勇气方面的持续教育培训和正式咨询服务。在台湾，新生儿医生和护士对新生儿临终决策持有相似的价值观和态度。为了提高临床医生与父母就 DNR 选择进行沟通的技巧，并改变临床医生为临终新生儿提供足够止痛药物的态度，需要提供道德勇气方面的持续教育培训和正式咨询服务。
