Technological advances in neonatal care have meant that the survival rates of preterm infants have dramatically increased. Improvements in mortality have not been reflected in improvements in morbidity, however, and the chances of extremely preterm infants surviving free from serious morbidity remain low. Concerns regarding mortality and morbidity rates have resulted in a plethora of ethical debates surrounding extremely preterm infants. The application and cost of advancing technology has been questioned. The impact that the risk of severe disability should have on decision making, along with who should make these decisions, the parents or the health care professionals, remains under debate. The influence that advancing fertility treatment has on decision making has yet to be explored, despite causing controversy in the media. Improving mortality rates have also prompted a proposal to reduce the current abortion limits in the United Kingdom. Despite a wealth of research into these ethical dilemmas, the voices of neonatal nurses towards these debates surrounding the infants which they care for have remained silent. The aim of this study is to therefore explore the perceptions of neonatal nurses towards extremely preterm infants. Q methodology was used to explore the attitudes of 36 nurses working in a perinatal network in the United Kingdom. Nurses 'sorted' a set of 53 statements developed from literature and previous research which represented the debates surrounding extremely preterm infants. Nurses then participated in a 'post Q sort' interview to explore the rationale behind their placement of the statements. The findings indicated that there were three types of nursing perceptions towards extremely preterm infants, centred on the involvement of parents in making difficult decisions. Some nurses reported their belief in accounting for parental choice is making difficult decisions. For others, they discussed their beliefs that the health care professional should undertake difficult decisions. The remaining nurses reported a belief in technology over and above decision making, suggesting that technology would prevail and allow more preterm infants to survive. The findings reflected the complex neonatal environment where core 'learnt' nursing values were often difficult to implement. Highlighting the perceptions of neonatal nurses' towards extremely preterm infants allowed for an in-depth exploration of the rationale behind these patterns of perceptions. Conclusions were drawn from this regarding how to improve the engagement of not only neonatal nurses, but the parents also, in the infant's care. A palliative care policy is suggested from these findings in order to help nurses make the transition from curative to palliative care. The conceptual framework developed for the study was adjusted accordingly, and future clinical and research recommendations made.
| Identifer | oai:union.ndltd.org:bl.uk/oai:ethos.bl.uk:523071 |
| Date | January 2010 |
| Creators | Gallagher, Katie |
| Publisher | University of Nottingham |
| Source Sets | Ethos UK |
| Detected Language | English |
| Type | Electronic Thesis or Dissertation |
| Source | http://eprints.nottingham.ac.uk/12697/ |
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