Kadivar Maliheh, Mosayebi Ziba, Asghari Fariba, Zarrini Pari
Professor, Department of Pediatrics, Division of Neonatology, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran;
Associate Professor, Department of Pediatrics, Division of Neonatology- Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran;
J Med Ethics Hist Med. 2015 Feb 4;8:1. eCollection 2015.
The challenging nature of neonatal medicine today is intensified by modern advances in intensive care and treatment of sicker neonates. These developments have caused numerous ethical issues and conflicts in ethical decision-making. The present study surveyed the challenges and dilemmas from the viewpoint of the neonatal intensive care personnel in the teaching hospitals of Tehran University of Medical Sciences (TUMS) in the capital of Iran. In this comparative cross-sectional study conducted between March 2013 and February 2014, the physicians' and nurses' perceptions of the ethical issues in neonatal intensive care units were compared. The physicians and nurses of the study hospitals were requested to complete a 36-item questionnaire after initial accommodations. The study samples consisted of 284 physicians (36%) and nurses (64%). Content validity and internal consistency calculations were used to examine the psychometric properties of the questionnaire. Data were analyzed by Pearson's correlation, t-test, ANOVA, and linear regression using SPSS v. 22. Respecting patients' rights and interactions with parents were perceived as the most challenging aspects of neonatal care. There were significant differences between sexes in the domains of the perceived challenges. According to the linear regression model, the perceived score would be reduced 0.33 per each year on the job. The results of our study showed that the most challenging issues were related to patients' rights, interactions with parents, communication and cooperation, and end of life considerations respectively. It can be concluded, therefore, that more attention should be paid to these issues in educational programs and ethics committees of hospitals.
当今新生儿医学的挑战性因重症监护和病情较重新生儿治疗方面的现代进展而加剧。这些发展在伦理决策中引发了众多伦理问题和冲突。本研究从伊朗首都德黑兰医科大学（TUMS）教学医院新生儿重症监护人员的角度调查了挑战和困境。在这项于2013年3月至2014年2月期间进行的比较性横断面研究中，比较了医生和护士对新生儿重症监护病房伦理问题的看法。要求研究医院的医生和护士在初步适应后完成一份包含36个条目的问卷。研究样本包括284名医生（36%）和护士（64%）。采用内容效度和内部一致性计算来检验问卷的心理测量特性。使用SPSS v. 22通过Pearson相关性分析、t检验、方差分析和线性回归对数据进行分析。尊重患者权利以及与家长的互动被视为新生儿护理中最具挑战性的方面。在感知到的挑战领域中，性别之间存在显著差异。根据线性回归模型，工作年限每增加一年，感知得分将降低0.33。我们的研究结果表明，最具挑战性的问题分别与患者权利、与家长的互动、沟通与合作以及临终关怀有关。因此，可以得出结论，医院的教育项目和伦理委员会应更多地关注这些问题。
