The role of the neonatal intensive care nurse in decision-making: Advocacy, involvement in ethical decisions and communication

Authors

  • Leanne Monterosso RN BN(Hons) PhD FRCNA,

    Corresponding author
    1. Senior Health Researcher, Clinical Research and Education, Princess Margaret Hospital for Children, Perth, Western Australia, Australia, and Bluey Day Senior Research Fellow Paediatric Oncology, School of Nursing and Public Health, Edith Cowan University, Churchlands, Western Australia, Australia
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  • Linda Kristjanson RN PhD,

    1. Professor, School of Nursing and Public Health, Edith Cowan University, Churchlands, Western Australia, Australia
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  • Peter D Sly MBBS MD DSc FRACP,

    1. Professor of Paediatrics and Head of Clinical Services, TVW Telethon Institute for Child Health Research, Perth, Western Australia, Australia
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  • Mary Mulcahy RN,

    1. Clinical Nurse, Women and Children's Health Service, Perth, Western Australia, Australia
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  • Beng Gee Holland RN,

    1. Clinical Nurse,  Women and Children's Health Service, Perth, Western Australia, Australia
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  • Sarah Grimwood RN,

    1. Clinical Nurse,  Women and Children's Health Service, Perth, Western Australia, Australia
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  • Kate White RN MN PhD

    1. Associate Professor, School of Nursing and Public Health, Edith Cowan University, Churchlands, Western Australia, Australia
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Leanne Monterosso, School of Nursing and Public Health, Edith Cowan University, Pearson Street, Churchlands WA 6018, Australia. Email: l.monterosso@ecu.edu.au

Abstract

Neonatal intensive care unit (NICU) nurses are often faced with complex clinical and ethical problems. Little is known about the role of the NICU nurse in ethical decision-making, or processes that inform decision-making in this setting. The purpose of this study was to explore and describe nurses’ perceptions of their role as patient advocate, clinical situations that cause them concern and the extent of their involvement in ethical decision-making. A combined quantitative and qualitative research design was used. A questionnaire was administered to nurses working in the NICU of the sole perinatal tertiary referral centre of Western Australia, Australia. Findings showed that NICU nurses saw their role in ethical decision-making primarily as advocating for the best interests of the infant and family, that they used clinical knowledge and experience to guide ethical decision-making, they were able to clearly articulate ethical problems and respond to them according to the clinical scenario and, while being primarily assertive in presenting their views, some nurses took a more passive approach. These findings support the need for development of a multidisciplinary model for ethical decision-making, where the view of all team members are considered.

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