Objective: To explore the clinical staff attitudes towards ethical decision-making in neonatal intensive care units (NICUs) in Ireland, establish differences between physicians and nurses, and compare attitudes in Ireland to those in Europe.
Design: Cross-sectional study by means of an anonymous questionnaire. Sixty-four physicians and 228 nurses in seven NICUs participated (response rates 76 and 79%, respectively). Through factor analysis the staff answers to 12 attitude statements were used to build a score whose range varied from zero (preservation of life in any case) to 10, indicating a more individualized approach according to patient’s best interest.
Main outcome measure: Staff attitudes to ethical decision-making in NICU.
Results: Mean values of attitude scores were 5.8 (95% CI 5.3-6.2) for physicians, and 6.0 (95% CI 5.5-6.5) for nurses. Respondents with experience in follow-up of NICU graduates had significantly higher scores (6.7 versus 5.4, p=0.018), while the opposite was true among more religious staff (5.8 versus 6.9, p=0.026) and particularly for minority religions such as Muslim (4.1, 95% CI 3.1-5.2). Scores were higher after age 30 for nurses, and after age 40 for doctors, suggesting the adoption of a less vitalistic viewpoint as respondents grow older and more experienced. Among physicians, a relationship was found between the attitude score and their self-reported non-treatment practices.
Conclusions: In Ireland, NICU doctors and nurses hold similar attitudes towards ethical decision-making. Personal and professional factors have a statistically significant impact on attitude score. Compared to the rest of Europe, attitudes in Ireland appear more similar to those of Southern European rather than Northern European countries.
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