Managing moral distress and complex ethical challenges in the NICU

IF 3.2 3区医学 Q1 OBSTETRICS & GYNECOLOGY

Seminars in perinatology Pub Date : 2025-04-01 DOI:10.1016/j.semperi.2025.152050

Béatrice Boutillier , Audrey Larone Juneau , Martin Reichherzer , Christine Tremblay , Annie Janvier

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引用次数: 0

Abstract

Background

In neonatology, end-of-life and complex ethical issues are frequent. This may lead to experiences of moral distress (MoD) for members of the clinical team. Here, we identify the causes, contributing factors, and contexts of MoD in the neonatal intensive care unit (NICU) and review interventions designed to manage complex ethical issues and alleviate MoD. We give a practical example of how support clinicians can help manage MoD.

Methods

Systematic reviews identify the causes, contributing factors, and contexts of MoD in NICUs as well as interventions to alleviate MoD. We trained an interdisciplinary team of support clinicians to be mentors in the NICU, to support other clinicians in managing the MoD associated with challenging cases.

Results

Managing MoD in NICUs is complex. Support clinicians actively assisted over 400 other clinicians. All were satisfied with the training and used their skills, mainly to optimize communication between clinicians and parents and/or for palliative care cases; 60% of all cases support clinicians managed were directly related to MoD; the majority resolved with initial reflective steps.

Conclusion

An interdisciplinary and multifaceted approach to addressing MoD in the NICU can be operationalized through support clinicians providing interdisciplinary and multifaceted interventions.

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处理新生儿重症监护室的道德困境和复杂的伦理挑战

在新生儿科，生命终结和复杂的伦理问题是常见的。这可能会导致临床团队成员经历道德困扰（MoD）。在这里，我们确定了新生儿重症监护病房（NICU）中MoD的原因、影响因素和背景，并回顾了旨在管理复杂伦理问题和缓解MoD的干预措施。我们给出了一个实际的例子，说明临床医生如何帮助管理MoD。以及新生儿重症监护室中MoD的背景以及缓解MoD的干预措施。我们培训了一支跨学科的支持临床医生团队，作为新生儿重症监护室的导师，支持其他临床医生管理与挑战性病例相关的MoD。结果新生儿重症监护病房的MoD管理较为复杂。支持临床医生积极协助400多名其他临床医生。所有人都对培训感到满意，并将其技能用于优化临床医生与家长之间的沟通和/或姑息治疗病例；支持临床医生管理的所有病例中有60%与MoD直接相关；大多数人都采取了初步的反思措施。结论通过支持临床医生提供跨学科和多方面的干预措施，可以实现解决新生儿重症监护室MoD的跨学科和多方面的方法。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Seminars in perinatology 医学-妇产科学

CiteScore

5.80

自引率

2.90%

发文量

审稿时长

6-12 weeks

期刊介绍： The purpose of each issue of Seminars in Perinatology is to provide authoritative and comprehensive reviews of a single topic of interest to professionals who care for the mother, the fetus, and the newborn. The journal''s readership includes perinatologists, obstetricians, pediatricians, epidemiologists, students in these fields, and others. Each issue offers a comprehensive review of an individual topic, with emphasis on new developments that will have a direct impact on their practice.