Life-Sustaining Support: Ethical, Cultural, and Spiritual Conflicts Part II: Staff Support– A Neonatal Case Study

Abstract

<jats:p>As medical knowledge and technology continue to increase, so will the ability to provide life-sustaining support to patients who otherwise would not survive. Along with these advances comes the responsibility of not only meeting the clinical needs of our patients, but also of understanding how the family’s culture and spirituality will affect their perception of the situation and their decision-making process. As the U.S. continues to become a more culturally diverse society, health care professionals will need to make changes in their practice to meet the psychosocial needs of their patients and respect their treatment decisions. Part I of this series (April 2002) discussed how the cultural and spiritual belief systems of Baby S’s family affected their decisionmaking processes and also their ability to cope with the impending death of their infant. The development of a culturally competent health care team can help bridge the gap between culturally diverse individuals.</jats:p><jats:p>This article addresses the following questions:</jats:p><jats:p>1. What legal alternatives are available to the staff to protect the patient from suffering associated with the continuation of futile life-sustaining support?</jats:p><jats:p>2. What conflicts might the staff experience as a result of the continuation of futile life-sustaining support?</jats:p><jats:p>3. What efforts can be made to support members of the staff?</jats:p><jats:p>4. What can be done to prepare others in the health care professions to deal more effectively with ethical/cultural issues?</jats:p>

Implementing a Palliative Care Program in a Newborn Intensive Care Unit

“…Debriefing sessions for staff can provide a much needed outlet for discussion of ethical conflicts; moreover, being able to name the sources of personal suffering supports the transformation of suffering into meaning. 6,22 In retrospect, a debriefing session before Baby G's death might have decreased the anguish experienced by his nurses.…”

“…[2][3][4] Professionals may struggle with the ethics of providing care that, in their opinion, causes more burden than benefit to the infant. [5][6][7] The challenges of creating a palliative care environment in the NICU, 8,9 where aggressive technological care is the norm, may seem overwhelming. Standardized protocols and guidelines can support staff in meeting these challenges.…”

“…2,20 Compassionate support for the professionals who care for dying infants may reduce the emotional distress inherent in providing this care. 2,6,22 Moral distress is defined as the inability of the nurse to advocate for a patient's interests due to institutional or professional constraints. 23 End-of-life issues are a common cause of moral distress among critical care nurses.…”

“…23 End-of-life issues are a common cause of moral distress among critical care nurses. 5,6,[23][24][25][26] In the neonatal literature, moral distress has been described among staff caring for a previable infant. 15 Another source of moral distress is the prolongation of an infant's suffering in order to meet the family's wish to sustain their child's life as long as possible.…”

“…15 Another source of moral distress is the prolongation of an infant's suffering in order to meet the family's wish to sustain their child's life as long as possible. 5,6 The purpose of this article is to describe the activities undertaken in developing a neonatal palliative care program and to share resources and knowledge that may support other facilities in implementing formal palliative care practices in the NICU.…”