Mapping Perspectives on an Ethically Challenging Paediatric Case

Objectives This project aims to identify and examine in detail some of the ethically challenging aspects of the care of infants who have serious medical conditions, by looking at a multidisciplinary team (MDT) and whãnau involved in a single neonatal case. An objective is to identify what was especially important to the whãnau during the care of their baby, and examine the perspectives of various MDT members around these factors. A further objective is to identify the differing perspectives of various health professionals as well as the whãnau relating to specific themes identified, and map how these perspectives relate to one another. In order to make more sense of this data, I look at clinical and ethical frameworks that are appropriate to apply to the results of this study. An overarching objective here is to produce information that can inform health professionals, as to enhance their practise collaboratively and effectively in such testing paediatric cases during their professional careers. In particular, the case- related data may constitute a useful resource for inter-professional education sessions. Study design Seven MDT members (transport nurse, social worker, neonatologist, charge nurse, paediatrician, clinical geneticist and midwife) and the whãnau were interviewed using semi-structured qualitative interviews. Interviews were transcribed in full, and then analysed using a grounded theory-lite coding system to extract important themes. Results The analysis revealed several important themes, with each overarching theme encompassing several smaller sub-themes. The themes explored were: 1) Communication 2) Ethical issues 3) Source of perspective The family identified that effective communication from the MDT was a crucial element throughout all stages of their journey with their baby. In general, MDT members also valued communication highly, both within the team itself, and between the team and the whanau. It emerged that different MDT members have different priorities when it came to the way that they used communication. The family emphasised that it was important to them to consider the impact on the family as a whole when it came to ethical decision points. The MDT tended to focus more on the best interest of the baby as an individual. It was found that very few of the MDT members interviewed could recall any specific ethics education, and even fewer MDT members consistently used an ethical framework to assist them when considering ethically complex cases. Conclusion The single in-depth paediatric case study revealed the intricacies involved in making ethical decisions, working well within a multi-disciplinary team, and forming a relationship with the whãnau. It is clear that cases such as these are multi-faceted and that many factors contribute to either a poor or good outcome for the whãnau. Upon analysis and discussion of results and themes, I conclude that using the Family- Centered Care clinical model and Ethic of Care ethical framework in similar cases may show great benefit for both the families and MDTs. Early inter-professional education may be one way of implementing these models and ideas