MEDICAL

Progress has been made in identifying newborns, who despite best hopes and efforts, are not responding to intensive care support. There are groups of children with diagnoses such as extreme prematurity, absence or failure of vital organs, birth accidents, and congenital conditions, whose status, despite extensive intervention, will remain unchanged or deteriorate. There are other newborns in which the prognosis may be less clear and for whom ethical decisions must be made at various stages in their treatment plans. Society has struggled to reach a consensus regarding the appropriate degree of medical intervention and parental involvement in decision-making for these infants as well as the basis on which these decisions should be made. The diversity of our culture, the differing theoretical backgrounds of nurses and physicians, and society’s opinions sometimes makes reaching such a consensus difficult.

Parents, neonatal nurses, and other members of the health care team often use the “best interests of the patient” standard when making ethical decisions concerning the treatment of the critically ill newborn. We understand, however that a family will need to assess what is good for the family as a whole when extraordinary demands are made upon them.

Process of Collaborative Decision Making
1. All infants born should receive an initial assessment, warmth, and comfort.
2. The parents must have access to appropriate, understandable information about the infant’s condition, including the potential risks and benefits to the infant of various options for treatment.
This includes the risks, benefits, and potential long term sequelae of technology use to keep the infant alive. Preferably this education would begin prenatally, and when applicable, include a parent driven plan.
3. The parents must be able to weigh the risks and benefits to the infant of the proposed treatment and express their wishes based on their own values and the information they possess, and a collaborative effort will be made to address these wishes.
4. All plans of care should have “revisit” points. Reassessment of whether the plan is working to achieve a desired outcome is essential.

In the context of the decision-making process for the critically ill newborn, parents require considerable assistance from the health care team to interpret and process complex information regarding their infant’s condition. At times, the uncertainty of the prognosis may well make such interpretation even
more difficult. Parents must be included in day-to-day decisions in order to develop an understanding of their infant’s changing condition. They must receive the same information from each member of the health care team. Recent developments such as Parents on Rounds and the Parents’ Medical Record can assist in this effort.

Parents may have difficulty identifying whether to continue or discontinue certain treatments. They also will need relief from the burden or liability of feeling they have the sole responsibility for any decisions made for their infants. For this reason, a team approach to decision making that includes the parents, health care providers, clergy, and social work is the method most likely to satisfy the requirements of informed consent for infants, who cannot communicate and whose best interests are at stake for all concerned.

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<h2>NICU Nurse Involvement in Ethical Decisions</h2> <p style="text-align: justify;">Progress has been made in identifying newborns, who despite best hopes and efforts, are not responding to intensive care support. There are groups of children with diagnoses such as extreme prematurity, absence or failure of vital organs, birth accidents, and congenital conditions, whose status, despite extensive intervention, will remain unchanged or deteriorate. There are other newborns in which the prognosis may be less clear and for whom ethical decisions must be made at various stages in their treatment plans. Society has struggled to reach a consensus regarding the appropriate degree of medical intervention and parental involvement in decision-making for these infants as well as the basis on which these decisions should be made. The diversity of our culture, the differing theoretical backgrounds of nurses and <a title="physicians" href="http://911medicalcare.com/medicalcare/physicians/">physicians</a>, and society’s opinions sometimes makes reaching such a consensus difficult.</p> <p style="text-align: justify;">Parents, neonatal nurses, and other members of the health care team often use the “best interests of the patient” standard when making ethical decisions concerning the treatment of the critically ill newborn. We understand, however that a family will need to assess what is good for the family as a whole when extraordinary demands are made upon them.</p> <p style="text-align: justify;">Process of Collaborative Decision Making<br /> 1. All infants born should receive an initial assessment, warmth, and comfort.<br /> 2. The parents must have access to appropriate, understandable information about the infant’s condition, including the potential risks and benefits to the infant of various options for treatment.<br /> This includes the risks, benefits, and potential long term sequelae of technology use to keep the infant alive. Preferably this <a title="education" href="http://911medicalcare.com/medicalcare/education/">education</a> would begin prenatally, and when applicable, include a parent driven plan.<br /> 3. The parents must be able to weigh the risks and benefits to the infant of the proposed treatment and express their wishes based on their own values and the information they possess, and a collaborative effort will be made to address these wishes.<br /> 4. All plans of care should have “revisit” points. Reassessment of whether the plan is working to achieve a desired outcome is essential.</p> <p style="text-align: justify;">In the context of the decision-making process for the critically ill newborn, parents require considerable assistance from the health care team to interpret and process complex information regarding their infant’s condition. At times, the uncertainty of the prognosis may well make such interpretation even<br /> more difficult. Parents must be included in day-to-day decisions in order to develop an understanding of their infant’s changing condition. They must receive the same information from each member of the health care team. Recent developments such as Parents on Rounds and the Parents’ Medical Record can assist in this effort.</p> <p style="text-align: justify;">Parents may have difficulty identifying whether to continue or discontinue certain treatments. They also will need relief from the burden or liability of feeling they have the sole responsibility for any decisions made for their infants. For this reason, a team approach to decision making that includes the parents, health care providers, clergy, and social work is the method most likely to satisfy the requirements of informed consent for infants, who cannot communicate and whose best interests are at stake for all concerned.</p> <p style="text-align: justify;">(Read More on Free Ebook at PDF Format)</p> <p style="text-align: justify;"><a href="http://911medicalcare.com/pdf/nicu-nurse-involvement-in-ethical-decisions" target="_blank">Download</a> NICU <a title="Nurse" href="http://911medicalcare.com/healthcare/nurse/">Nurse</a> Involvement in Ethical Decisions.pdf</p><br/><a href="http://www.socialmarker.com/?link=http://911medicalcare.com/nurse/nicu-nurse-involvement-in-ethical-decisions/&title=NICU+Nurse+Involvement+in+Ethical+Decisions&text=...&tags=" target="_blank"><img src= "http://www.socialmarker.com/bookmark.gif" border="0" /></a><noscript><a href="http://www.socialmarker.com" >Social Bookmarking</a></noscript> <p>The article <a href="http://911medicalcare.com/nurse/nicu-nurse-involvement-in-ethical-decisions/">NICU Nurse Involvement in Ethical Decisions</a> is provided by <a href="http://911medicalcare.com" title="Manual Nurse and health Guidelines"> Manual Nurse and Health Guidelines</a>. The article from<a href="http://911medicalcare.com" title="Medical"> Medical</a> site is freely distributed for non-commercial purposes to include the source for the article and does not alter the content.</p>

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