Appropriateness of care and XXXX among neonatal intensive care unit staff: repeated measurements.

@entity1 @entity147
BACKGROUND: Perceived constraints to providing @entity1 care in their own morally justified way may cause @entity147 ( @entity147 ) in neonatal nurses and physicians. Negative long-term effects of @entity147 include substandard @entity1 care, burnout and leaving the profession. AIM: To assess the immediate impact of perceived inappropriate @entity1 care on nurses' and physicians' @entity147 intensity, and explore a possible moderating effect of ethical climate. DESIGN: In a repeated measures design, after baseline assessment, each @entity1 completed self-report questionnaires after five randomly selected shifts. Data were analysed with logistic and Tobit regression. @entity1 : Data were collected among 117 of 147 eligible nurses and physicians (80%) in a level-III neonatal intensive care unit in the Netherlands. RESULTS: At baseline, overall @entity147 was relatively low; in nurses, it was significantly higher than in physicians. Few morally distressing situations were reported in the repeated measurements, but distress could be intense in these cases; nurses' and physicians' scores were comparable. Physicians were significantly more likely than nurses to disagree with their @entity1 ' level of care (p   =   0  02). Still, perceived overtreatment, but not undertreatment, was significantly related to distress intensity in both professional groups; ethical climate did not moderate this effect. Substandard @entity1 care due to lack of continuity, poor communication and unsafe levels of staffing were rated as more important causes of @entity147 than perceived inappropriate care. CONCLUSIONS: Although infrequently perceived, overtreatment of @entity1 caused considerable distress in nurses and physicians. Our unit introduced multidisciplinary medical ethical decision making 5 years ago, which may partly explain the low @entity147 at baseline. RELEVANCE TO CLINICAL PRACTICE: @entity147 might be prevented by improved continuity of care, safe levels of staffing and better team communication, along with other targeted interventions with demonstrated effectiveness, such as palliative care programs and facilitated ethics conversations.
