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ID 29676
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title alternative
Moral Space and Ethical Decision Making in Neonatal Care Study about Practical use of 'Guidelines for Healthcare Providers and Parents to Follow in Determining the Medical Care of Newborns with Severe Diseases'. <Original Article>
creator
Nakagomi, Satoko
subject
モラルスペース
重篤な疾患を持つ新生児
倫理的意思決定
Moral space
Newborn with severe disease
Ethical decision making
NDC
Medical sciences
abstract
本研究は, 全国新生児専門医制度研修施設の基幹施設と指定施設の「重篤な疾患を持つ新生児の医療をめぐるガイドライン」の活用状況に関する看護師と医師の認識を通して, 本ガイドラインの理念を達成するために取り組むべき課題を検討した.

全国262施設に配布し, 194施設, 276名から回答があった(回収率52.7%). そのうち, 看護師と医師の両者が回答したのは83施設(31.7%)であった.

新生児の治療をめぐる話し合いを進めるための課題として, アドボカシーのためのモラルスペースが有効と考えられた. すなわち1)父母と医療スタッフの自律性が尊重される姿勢があること, 2)自己の良心からの反論を表明できる機構づくり, 3)非公式に倫理観の違いが検討され, 倫理的な問題は常に話し合いをする環境づくりが必要と考えられた.

また, 本ガイドラインが重篤な疾患を持つ新生児に対し, その子どもの最善の利益を導くために広く活用されるようになるためには, 1)父母と医療者の双方が意思決定に参加し, 共通のステップを踏めるような具体的な話し合いのガイドにし, 2)感情の対処に加え倫理分析を実行できるような内容を加える必要があると考えられた.
abstract
The purpose of this study was to investigate the strategy of ethical decision making and moral space in the neonatal intensive care unit (NICU) from the perception of nurses and physicians about practical use of 'Guidelines for Healthcare Providers and Parents to follow in determining the medical care of newborns with severe diseases'.

The subjects of this survey were NICU nurse managers and physician managers (neonatologists) in 262 Neonatal intensive care units in Japan. 276 (52.7%) persons replied to the questionnaire and 83 (31.7%) units were these that both nurse and physician sent back.

When the parents and healthcare providers determine together the medical care for the newborn with severe diseases, there must be a moral space: 1) respect for each autonomy, 2) both parents, nurses, and neonatologists need to be permitted to follow the dictates of their conscience, and 3) there is a need to talk about their own values and to discuss ethical issues.

Practical use of Guidelines will be more widely provided that 1) have more concrete steps to make decisions for parents and health providers, and 2) stress the importance of ethical analysis as well as to support each other emotionally.
journal title
Journal of Japan Academy of Neonatal Nursing
volume
Volume 13
issue
Issue 3
start page
26
end page
33
date of issued
2007-12
publisher
日本新生児看護学会
issn
1343-9111
ncid
language
jpn
nii type
Journal Article
HU type
Journal Articles
DCMI type
text
format
application/pdf
text version
publisher
rights
Copyright (c) 2007 日本新生児看護学会
department
Graduate School of Health Science
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