title: Ethical challenges in the neonatal intensive care units: perceptions of physicians and nurses; an Iranian experience.
abstract: The challenging nature of neonatal medicine today is intensified by modern advances in intensive care and treatment of sicker neonates. These developments have caused numerous ethical issues and conflicts in ethical decision-making. The present study surveyed the challenges and dilemmas from the viewpoint of the neonatal intensive care personnel in the teaching hospitals of Tehran University of Medical Sciences (TUMS) in the capital of Iran. In this comparative cross-sectional study conducted between March 2013 and February 2014, the physicians' and nurses' perceptions of the ethical issues in neonatal intensive care units were compared. The physicians and nurses of the study hospitals were requested to complete a 36-item questionnaire after initial accommodations. The study samples consisted of 284 physicians (36%) and nurses (64%). Content validity and internal consistency calculations were used to examine the psychometric properties of the questionnaire. Data were analyzed by Pearson's correlation, t-test, ANOVA, and linear regression using SPSS v. 22. Respecting patients' rights and interactions with parents were perceived as the most challenging aspects of neonatal care. There were significant differences between sexes in the domains of the perceived challenges. According to the linear regression model, the perceived score would be reduced 0.33 per each year on the job. The results of our study showed that the most challenging issues were related to patients' rights, interactions with parents, communication and cooperation, and end of life considerations respectively. It can be concluded, therefore, that more attention should be paid to these issues in educational programs and ethics committees of hospitals.
authors.affiliation: Professor, Department of Pediatrics, Division of Neonatology, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran;
authors.forename: Maliheh
authors.initials: M
authors.lastname: Kadivar
authors.affiliation: Associate Professor, Department of Pediatrics, Division of Neonatology- Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran;
authors.forename: Ziba
authors.initials: Z
authors.lastname: Mosayebi
authors.affiliation: Associate Professor, Medical Ethics and History of Medicine Research Center, Tehran University of Medical Sciences, Tehran, Iran;
authors.forename: Fariba
authors.initials: F
authors.lastname: Asghari
authors.affiliation: Neonatologist, Department of Pediatrics, Division of Neonatology- Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran.
authors.forename: Pari
authors.initials: P
authors.lastname: Zarrini
keywords: ethical issues; hospital ethics committee; neonatal intensive care unit (NICU); nursing ethics
references.citation: J Perinatol. 2011 Jan;31(1):1-9
references.pmid: 20336075
references.citation: Semin Fetal Neonatal Med. 2013 Apr;18(2):105-10
references.pmid: 23200701
references.citation: JAMA. 2003 Sep 3;290(9):1166-72
references.pmid: 12952998
references.citation: Nurs Ethics. 2008 Nov;15(6):729-44
references.pmid: 18849364
references.citation: BMC Med Ethics. 2012 Mar 16;13:2
references.pmid: 22424271
references.citation: Pediatrics. 2010 Apr;125(4):742-6
references.pmid: 20194289
references.citation: Nurs Ethics. 2010 Jul;17(4):511-21
references.pmid: 20610584
references.citation: Nurs Ethics. 2003 Sep;10(5):472-84
references.pmid: 14529114
references.citation: Acta Paediatr Suppl. 2006 Jul;95(452):42-6
references.pmid: 16801166
references.citation: Nurs Ethics. 2001 Jul;8(4):299-312
references.pmid: 16004085
references.citation: Cogn Process. 2010 Aug;11(3):219-26
references.pmid: 19727878
references.citation: Arch Pediatr Adolesc Med. 2008 Apr;162(4):368-73
references.pmid: 18391146
references.citation: BMJ. 2004 Apr 17;328(7445):950-2
references.pmid: 15087349
references.citation: Nurs Ethics. 1995 Sep;2(3):233-42
references.pmid: 7583429
references.citation: J Med Ethics. 2008 Jun;34(6):450-5
references.pmid: 18511618
references.citation: Nurse Educ Today. 2007 Oct;27(7):796-807
references.pmid: 17166636