Webb Mary S, Passmore Denise, Cline Genieveve, Maguire Denise
University of South Florida, USA
University of South Florida, USA.
Nurs Ethics. 2014 Sep;21(6):731-41. doi: 10.1177/0969733013513919. Epub 2014 Jan 24.
Currently preterm births are the leading causes of newborn deaths and newborn mortality in developed countries. Infants born prematurely remain vulnerable to many acute complications and long-term disabilities. There is a growing concern surrounding the moral and ethical implications of the complex and technological care being provided to extremely low birth weight infants in neonatal intensive care units in the developed nations.
The purpose of this study was to describe the ethical and moral issues that neonatal intensive care nurses experience when caring for low birth weight preterm infants and their families.
A phenomenological method design was used to describe the lived experiences of nurses with ethical and moral issues encountered in the neonatal intensive care unit. One-on-one, semi-structured interviews using open-ended questions were used to gather data from the participants.
The setting for this study was a 97-bed neonatal intensive care. A total of 16 female nurses were interviewed.
Approval to conduct the research study was obtained from the institutional review board of the hospital where the study was conducted. Formal signed consent was obtained from each participant. To ensure confidentiality, each participant was asked to choose a confederate name to be used in the interview and the transcriptions.
The thematic analysis identified five recurring themes: (a) at the edge of viability, (b) infant pain and discomfort, (c) crucial decisions, (d) communicating with parents, and (e) letting go.
Neonatal intensive care unit nurses indicated that they often had challenges to their own sense of morality as they struggled to protect the infant from pain and unnecessary discomfort, provide care to an infant and their family whom they thought was faced with a lifetime of challenges and poor health, accepting decisions made by parents, and feeling as if parents were not adequately informed about outcomes.
目前，早产是发达国家新生儿死亡和新生儿死亡率的主要原因。早产婴儿仍然容易出现许多急性并发症和长期残疾。发达国家新生儿重症监护病房为极低出生体重儿提供的复杂技术护理所涉及的道德和伦理问题，正受到越来越多的关注。
本研究的目的是描述新生儿重症监护护士在护理低出生体重早产儿及其家庭时所经历的伦理和道德问题。
采用现象学方法设计，以描述护士在新生儿重症监护病房遇到的伦理和道德问题的实际经历。使用开放式问题进行一对一的半结构化访谈，以收集参与者的数据。
本研究的场所是一家拥有97张床位的新生儿重症监护病房。共采访了16名女护士。
本研究已获得开展研究所在医院的机构审查委员会的批准。每位参与者均获得了正式签署的同意书。为确保保密性，要求每位参与者选择一个化名用于访谈和记录。
主题分析确定了五个反复出现的主题：(a) 在存活边缘，(b) 婴儿疼痛与不适，(c) 关键决策，(d) 与父母沟通，以及 (e) 放手。
新生儿重症监护病房的护士表示，在努力保护婴儿免受疼痛和不必要的不适、为他们认为面临一生挑战和健康不佳的婴儿及其家庭提供护理、接受父母做出的决定以及感觉父母未充分了解结果时，他们自身的道德感常常受到挑战。
