背景:新生儿重症监护病房(NICU)的婴儿住院在道德上具有挑战性。有限的研究已将道德困扰的概念扩展到NICU住院的婴儿的父母。这个话题需要进一步调查。
方法:本前瞻性定性研究于2023年2月至2023年5月进行。数据是通过半结构化的深度访谈收集的,在访谈时,对15名在NICU住院的婴儿的父母进行了面对面的研究。使用目的抽样。采用专题分析法对数据进行分类和分析。
结果:本实证研究的数据分析产生了三个主题。数据分析中出现了一个具有两个方面(一个动态和一个静态)的内在维度和另一个关注父母道德困扰的人际维度。此外,在这些主题中出现了七个子主题:(1)父母由于无法履行其照顾/父母角色而经历了自我导向的负面感受;(2)父母在应对道德困境时经历了激烈的内部冲突,被认为是无法解决的;(3)客观上不合理的,父母经历了自我导向的负罪感或失败感;(4)由于患病婴儿的形象不佳,父母遭受了道德困扰;(5)信息不足可能使父母容易遭受道德困扰;(6)新生儿学家\的照顾行为被父母不适当地视为家长式行为;(7)合理或合理的制度规则被父母不适当地视为约束。
结论:一般来说,这项研究的结果支持Mooney-Doyle和Ulrich提出的父母道德困扰的综合定义。此外,本研究引入了新的信息。该研究区分了父母道德困扰现象的内在维度的动态和静态方面。此外,参与者经历了道德困扰,因为他们过度地认为某些情况会导致道德困扰。此外,信息不足可能会使父母容易经历道德困境。这项研究的结果可能有助于在NICU背景下促进以家庭为中心的护理。
BACKGROUND: The hospitalization of infants in the neonatal intensive care unit (NICU) is an ethically challenging situation. A limited number of studies have extended the concept of moral distress to parents of infants hospitalized in the NICU. This topic requires further investigation.
METHODS: The present prospective qualitative
study was conducted from February 2023 to May 2023. Data were collected through semistructured in-depth interviews, which were conducted in-person with fifteen parents of infants who were hospitalized in the NICU at the time of the interviews. Purposive sampling was used. The data were classified and analyzed using thematic analysis.
RESULTS: Three themes emerged from the data analysis performed for this empirical
study. One intrapersonal dimension featuring two aspects (one dynamic and one static) and another interpersonal dimension focusing on parental moral distress emerged from the data analysis. Furthermore, seven subthemes emerged across these themes: (1) self-directed negative feelings were experienced by parents due to their inability to fulfill their caregiving/parental roles; (2) intense internal conflict was experienced by parents in response to a moral dilemma that was difficult, which was perceived as irresolvable; (3) objectively unjustified, self-directed negative feelings of guilt or failure were experienced by parents; (4) parents experienced moral distress due to the poor image of the ill infants; (5) inadequate information may predispose parents to experience moral distress (6) neonatologists\' caring behaviors were unduly perceived by parents as paternalistic behaviors; (7) reasonable or justified institutional rules were unduly perceived by parents as constraint.
CONCLUSIONS: In general, the results of this study support the integrated definition of parental moral distress proposed by Mooney-Doyle and Ulrich. Furthermore, the present
study introduces new information. The
study distinguishes between the dynamic and static aspects of the intrapersonal dimension of the phenomenon of parental moral distress. Moreover, participants experienced moral distress because they unduly perceived certain situations as causing moral distress. In addition, inadequate information may predispose parents to experience moral distress. The findings of this
study may contribute promote family-centered care in the NICU context.