The Journal of perinatal & neonatal nursing
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J Perinat Neonatal Nurs · Apr 2005
ReviewResearch with newborn participants: doing the right research and doing it right.
Research ethics encompass debate about what research topics matter, for example in relation to social values and individual needs, and debate about how to conduct research in an ethical manner, for example in relation to protecting the rights of vulnerable research participants. Research in the neonatal intensive care unit (NICU), where critically ill infants receive expensive and often invasive treatment, raises unique issues with regard to what research should be conducted and how to conduct it in an ethical manner. ⋯ A greater level of involvement is now needed, particularly at the policy level where funding and procedural issues are decided. New approaches are also needed and could involve more direct collaboration between nurses and parents.
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J Perinat Neonatal Nurs · Apr 2005
The legal landscape at the threshold of viability for extremely premature infants: a nursing perspective, part I.
One of the most difficult decisions that can confront a family is what medical treatment to seek for an extremely premature infant at the threshold of viability. The complexity of the treatment options, competing interests of healthcare providers and the family, consideration of the parents' values, and the sheer immensity of making decisions that affect such a new and fragile life all converge on parents when making such decisions. Overlying this are the legal context and the healthcare professionals and institutions that often may have more direct control and impact on those decisions than the parents. ⋯ Parental consent to treatment of their infants is at the crux of these conflicts. Part I of this article discusses the evolving legal landscape of decision making for treatment of infants at the threshold of viability. Part II will address informed consent and the fundamental role nurses can play in creating a collaborative decision-making process that respects the best interests of the infant and the family.
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J Perinat Neonatal Nurs · Apr 2005
ReviewThinking outside the box: prenatal care and the call for a prenatal advance directive.
The concept of advance directives is well-known in the care of adults as a mechanism for choosing in advance the extent of medical interventions desired in clinical situations, particularly life-extending interventions such as ventilation support and drugs to maintain cardiopulmonary status. Infants born extremely prematurely often require life-supporting measures for which their parents or guardians report feeling unprepared to make decisions about. Current prenatal care does not include an educational component that teaches women about the length of gestation needed for a healthy viability, survivorship, and outcome without major impairment. ⋯ New York: Routledge Press; 2001) requires that healthcare decisions be based on education, context, and particular situations. The purpose of this article is to examine the current content of typical prenatal care and education and to suggest an additional educational component to prenatal care-education of women about infant viability and the planning of future decisions if a nonviable or critically ill newborn is delivered. A prenatal discussion and parental/family directive is suggested.
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J Perinat Neonatal Nurs · Apr 2005
Clinical Trial Controlled Clinical TrialEffectiveness of an intervention to improve parent-professional collaboration in neonatal intensive care.
This study tested the effect of an intervention to strengthen parent-professional collaboration by increasing the accuracy of parents' understanding of medically relevant information and providing parent-professional meetings to plan infants' care. ⋯ Statistically significant change was found in 6 of 9 scales used to measure collaboration and accuracy of parents' understanding. The intervention group had fewer unrealistic concerns (P = .018), and less uncertainty about infant medical conditions (P = .003); less decision conflict (P < or = .001), more satisfaction with the process by which medical decisions were made (P = .012) and with the amount of decision input they had (P = .058), and reported more shared decision making with professionals (P = .010). There were no statistically significant differences between the groups in satisfaction with infants' care, satisfaction with relationships with physicians and nurses, and satisfaction with the decisions made for their infants' treatment. Infant birth weight and gestational age and maternal demographic characteristics were found to influence collaboration results. The intervention was especially effective in improving understanding and collaboration in low-income, young, minority mothers.