Making the Best of a Bad Situation: Clinician’s Perspectives on Ethics Rounds

• Published in: Pediatrics (Evanston) 2019-08, Vol.144 (2_MeetingAbstract), p.384-384
• Main Authors: Abecassis, Leah, DeCourcey, Danielle, Richards, Teresa, Steadman, Jennifer, Friedson, Judi
• Format: Article
• Language: English
• Subjects: Ethics; Medical personnel; Night shifts; Nurses; Patients; Pediatrics; Personnel management; Polls & surveys; Workers
• ISSN: 0031-4005; 1098-4275
• DOI: 10.1542/peds.144.2MA4.384

Working in a Pediatric Medicine Intensive Care Unit (MICU) brings together two ethically fraught populations: the critically ill and the chronically ill. As a result, moral distress, along with ethical concerns, is prevalent amongst the health care professionals. In an effort to address moral distress, we have trialed numerous methods aimed at improving understanding of ethical principles. Ethics Rounds are one way to support healthcare personnel in handling ethically difficult situations. Ethics Rounds are held on our unit monthly and are led by a nurse ethicist, an ICU attending, and unit-based Nurse Practice Specialist. While moral distress around the case is discussed, the primary focus of the rounds has been joint formulation of the ethical question/s ("If __ is true, then is ___ ethical?") and a group effort to resolve the relevant issues that emerge. Rounds are attended by nurses, physicians, nurse practitioners, social workers, and specialists involved in the case. This allows for a well-rounded multidisciplinary discussion where each discipline can bring their concerns and viewpoints. The aim of this project was to evaluate how Ethics Rounds were experienced by the multidisciplinary staff and to identify ways to improve the ethical climate for the staff. A four question survey was emailed to the multidisciplinary MICU team to determine how helpful Ethics Rounds have been in the past year and in what ways they can be modified to meet the needs of the participants. The survey was sent to 147 MICU team members and 42 participants responded. Respondents included nurses (60% of total responses), physicians (30%), social work, chaplaincy, and child life specialists (total of 10% combined). From the respondents, 62% had participated in an Ethics Rounds in the past year, 69% or staff felt that rounds helped them understand their patients better, and 76% felt that rounds improved the care of their patient. Suggestions to improve Ethics Rounds included informing the night shift of what occurs in Ethics Rounds during the day through a summary if possible. Additional suggestions involved improving the nurses voice in the rounds and improving attendance overall. Next steps include implementation of these suggestions with further evaluation of the efficacy of our interventions.