Ethical challenges in neonatal intensive care nursing.

BACKGROUND: Neonatal nurses report a great deal of ethical challenges in their everyday work. Seemingly trivial everyday choices nurses make are no more value-neutral than life-and-death choices. Everyday ethical challenges should also be recognized as ethical dilemmas in clinical practice. RESEARCH OBJECTIVE: The purpose of this study is to investigate which types of ethical challenges neonatal nurses experience in their day-to-day care for critically ill newborns. RESEARCH DESIGN: Data were collected through semi-structured qualitative in-depth interviews. Phenomenological-hermeneutic analysis was applied to interpret the data. PARTICIPANTS AND RESEARCH CONTEXT: Six nurses from neonatal intensive care units at two Norwegian hospitals were interviewed on-site. ETHICAL CONSIDERATIONS: The study is designed to comply with Ethical Guidelines for Nursing Research in the Nordic Countries and the Helsinki declaration. FINDINGS: Findings suggest that nurses experience a diverse range of everyday ethical challenges related to challenging interactions with parents and colleagues, emotional strain, protecting the vulnerable infant, finding the balance between sensitivity and authority, ensuring continuity of treatment, and miscommunication and professional disagreement. DISCUSSION: A major finding in this study is how different agents involved in caring for the newborn experience their realities differently. When these realities collide, ethical challenges arise. Findings suggest that acting in the best interests of the child becomes more difficult in situations involving many agents with different perceptions of reality. CONCLUSION: The study presents new aspects which increases knowledge and understanding of the reality of nursing in a neonatal intensive care unit, while also demanding increased research in this field of care.

Living the situation stress-experiences among intensive care patients.

The study is about the types of stress that patients in intensive care units experience. Ten reviewed articles selected from Cinahl and Pubmed between 1994 and 2003 constitute the data. The paper is a literature review, and the data is analysed from the phenomenological-hermeneutical point of view. Stress related to the body, room and relationships is discussed. Experiences of stress that are related to the body include bodily stress reactions, deprivation of control, emotions related to technical equipment, procedures and loss of meaning. Stress related to the room highlights the environment and the situation in which the patient finds him/herself. The ethical relations of professionals and separation of patients from their significant others constitute stress related to relationships.