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首页> 外文期刊>Journal of perinatology: Official journal of the California Perinatal Association >Moral distress in the neonatal intensive care unit: caregiver's experience.
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Moral distress in the neonatal intensive care unit: caregiver's experience.

机译：新生儿重症监护室的精神困扰：看护者的经验。

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BACKGROUND: The Neonatal Intensive Care Unit (NICU) can be ethically charged, which can create challenges for health-care workers. OBJECTIVE: To determine the frequency with which nurses and residents have experienced ethical confrontations and what factors are associated with increased frequency. DESIGN/METHODS: An anonymous questionnaire was distributed to nurses in a university center, a high-risk obstetric service, a maternity hospital NICU with 85% in-born patients and an outborn NICU, most of whose preterm admissions are those with surgical complications. Obstetric and pediatric residents in the four universities of the province also received the questionnaire, which included demographics, opinions regarding the gestational age threshold at which resuscitation of a premature infant with bradycardia was appropriate, knowledge of cerebral palsy (CP) outcomes (as an indicator of knowledge about long-term sequelae of prematurity) and questions about ethical confrontation in the NICU. RESULTS: Two hundred and seventy-nine caregivers participated (115 full time nurses and 164 residents). All the distributed questionnaires were completed. Frequent ethical confrontation was reported by 35% of the nurses and 19% of the residents. Among the nurses, moral distress differed significantly between work environments. Nurses working in an out-born NICU and obstetric nurses were more likely to overestimate CP prevalence (P<0.05). Nurses who overestimated CP rates had higher thresholds for resuscitation and were more likely to experience ethical confrontations. Of the residents, 60% were pediatric and 40% obstetric. All groups of residents frequently overestimated the prevalence of CP, and knowledge differed significantly by residency program (P<0.05). The residents who overestimated CP rates had higher thresholds for resuscitation, had more incorrect answers regarding prematurity outcomes and were less likely to have ethical confrontations. CONCLUSIONS: A large proportion of nurses and residents report frequent ethical confrontations. Many residents and nurses have limited knowledge of outcomes and high threshold for resuscitation. Ethical confrontation is more common among nurses with poor knowledge about outcomes, and less common in residents with poor knowledge about outcomes.
机译：背景：新生儿重症监护病房（NICU）可能在道德上受到指控，这可能给医护人员带来挑战。目的：确定护士和住院医师经历道德对抗的频率，以及哪些因素与频率增加有关。设计/方法：向大学中心的护士，高危产科服务，有85％的新生儿患者的产科新生儿重症监护病房和新生儿的重症监护病房分发了匿名调查表，其中大多数早产儿是外科手术并发症患者。全省四所大学的产科和儿科居民也收到了调查表，其中包括人口统计资料，关于早搏婴儿心动过缓适宜的胎龄阈值的意见，脑瘫（CP）结局的知识（作为指标） （关于早产的长期后遗症的知识），以及在新生儿重症监护病房（NICU）中的道德对抗问题。结果：279名护理人员参加（115名全职护士和164名居民）。所有分发的调查表均已填写。据报告，35％的护士和19％的居民经常发生道德冲突。在护士中，工作环境之间的道德困扰有显着差异。在新生儿重症监护病房（NICU）工作的护士和产科护士更可能高估CP患病率（P <0.05）。高估CP率的护士进行复苏的门槛较高，并且更有可能遇到道德冲突。在居民中，60％为儿科，40％为妇产科。所有居民群体都经常高估CP的患病率，并且根据居住计划，知识差异显着（P <0.05）。高估CP率的居民有更高的复苏阈值，关于早产结局的答案不正确，发生道德冲突的可能性也较小。结论：很大比例的护士和住院医师报告经常发生道德冲突。许多居民和护士对结局了解有限，复苏门槛很高。在对结局了解不足的护士中，道德对抗更为普遍，而对结局了解不足的居民则较少发生伦理冲突。

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