Final Paper

Table of Contents

centercenter    Clinical expertise case analysis090900    Clinical expertise case analysis4364182307763Leslie BensonSubmitted to Josh Evans in fulfillment of HCE604 – Ethics for Nurse LeadersRegis UniversityJuly 29, 20190Leslie BensonSubmitted to Josh Evans in fulfillment of HCE604 – Ethics for Nurse LeadersRegis UniversityJuly 29, 2019As a future Neonatal Nurse Practitioner there is a known assumption that as clinicians, we are faced with ethical dilemmas in the NICU each and every day. It is important to know how to not only make ethical decisions regarding patients, but to be an adequate part of the team in helping to reach these decisions together. Developing the skills to participate collaboratively in ethical decisions is key to overall patient care. All persons in the involvement of ethical decisions in the NICU setting must have an educational understanding in ethics, moral reasoning and dilemma resolution. It is important to first understand roles as an interdisciplinary team. Being parents in the NICU setting is a unique role as they bear the emotional and financial responsibility of their child. Not only is it a difficult task, but also potentially confusing with all the complex treatment alternatives NICU’s now possess. One unique factor about the role of a parent is their decisions are marked by high emotions and may conflict with other ideas as far as the best interest of the child. The role of the physician, courts and ethics committees are important for the fact that they are all best qualified in their roles. With medical breakthroughs physicians now encounter a multitude of ethical issues. New policies have been created by the court system to influence treatment of these tiny humans and medical staff delivery of care. The ethics committee is an advisory role, an outside source if you will, to develop a case that focuses solely on what is best for the infant. As a Neonatal Nurse Practitioner providing leadership on an ethics committee, this is a very unique role. Not only is it a collaborative position, but truly provides a missing link between bedside nurse, physician and family. It is important to establish insight into family values, emotional responses and an extreme knowledge of the infant. Often times the case studies examined closely in the NICU realm have always been and will continue to be the resuscitation of infants born at an extremely preterm. There are obligations for physicians, family members, staff and for the infant themselves. The case study focused on in this paper is supporting both the parents and neonatal staff in decision making regarding care of a premature infant. A mother arrived at the hospital in preterm labor, that was unable to be stopped by her obstetrician team. The parents eager to know and understand what this may mean for their infant and for them as parents included discussions of the extreme uncertainty of their child’s future, the advancement of technology in the neonatal realm and the risks and benefits of the NICU team doing everything they could for their child and the difficulty of comfort care. In counseling the parents and the hospital team from an ethics leadership approach as a future NNP at a Catholic hospital it is of upmost important to maintain honesty and value the parent’s thoughts and options to decide on a course of action. Questions that may be considered at the beginning of the discussion may include what is best for their child, for their family, and how it will affect their lives. They also may wonder about the cost of care, suffering, survival potential, immediate and long-term complications, disabilities, and quality of life. From a professional standpoint the parents need more information to make an autonomous decision. Looking beyond statistics and predicting outcomes there are other variables that need to be taken into account. Offering information about choosing resuscitation would lead into a trial of treatment for care. This would allow the parents more concrete options about burdens of treatment outweighing potential benefits or vice versa. Another outlook to present to parents is that resuscitation may not be successful regardless of efforts. It is impossible to know the benefits or burdens in choosing resuscitation. This of course is also based on gestation and this case study the baby’s gestation is 23 weeks and 3 days. With babies born at such young gestations information about the treatment of care must be presented that includes all body systems and how they potentially could be affected, along with arising complications that may happen related to the interventions themselves. From the framework of an ethics committee, the information could inadvertently influence parental decision, so it is extremely important to present both sides in an unbiased manner. Information and guidance should be presented by multiple specialties involved in the care, including collaboration and consultation. After being presented with all information the parents are still turning towards the physician and ethical team to help make a decision. Although the professional team can offer medical knowledge based off the parent’s values, this in turn becomes somewhat paternalistic unless the parents have specifically asked, which in this case they have. In this case, it’s important to have a good understanding of values, concerns and circumstances for the family. The complexity of this situation and ethical dilemma in this case study is extremely difficult. As leadership on the ethics committee, recommendation would be to first know that no one can assess quality of life. It is important to stress to the family that regardless of the decision they make, that it is the right decision for their infant and as staff it will be supported. The right to life is indispensable and hard to weigh against goods or desires. Made in the likeness of God, human dignity from a catholic viewpoint forbids weighing the life of another. However, if there becomes a time where medical intervention is not an indication to continuing life support, there is no moral obligation to preserve life. Rather a palliative approach may be presented. After choosing trial of treatment & then furthering into palliative care from the recommended course of action related to the Catholic perspective, the collaborative team embraced and supported the parents and infant. This decision represented the catholic perspective for the patient and caregivers.