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Woods, M. (2001). Balancing rights and duties in 'life and death' decision making involving children: A role for nurses? Nursing Ethics, 8(5), 397–408.
Abstract: This article examines a growing number of cases in New Zealand in which parents and guardians are required to make life and death ethical decisions on behalf of their seriously ill child. Increasingly, nurses and other practitioners are expected to more closely inform, involve and support the rights of parents or guardians in such situations. Differing moral and ethical values between the medical team and parents or guardians can lead to difficult decision making situations. The article analyses the moral parameters, processes, outcomes and ethical responses that must be considered when life and death ethical decisions involving children are made. It concludes with a recommendation that nurses should be recognised as perhaps the most suitable of all health care personnel when careful mediation is needed to produce an acceptable moral outcome in difficult ethical situations.
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Rose, L., Nelson, S., Johnston, L., & Presneill, J. J. (2008). Workforce profile, organisation structure and role responsibility for ventilation and weaning practices in Australia and New Zealand intensive care units. Journal of Clinical Nursing, 17(8), 1035–1043.
Abstract: The aim of this research is to provide an analysis of the scope of nursing practice and inter-professional role responsibility for ventilatory decision-making in Australian and New Zealand intensive care units (ICU). Self-administered questionnaires were sent to nurse managers of eligible ICUs within Australia and New Zealand. Survey responses were available from 54/180 ICUs. The majority (71%) were located within metropolitan areas and categorised as a tertiary level ICU (50%). The mean number of nurses employed per ICU bed was 4.7 in Australia and 4.2 in New Zealand, with 69% (IQR: 47-80%) of nurses holding a postgraduate specialty qualification. All units reported a 1:1 nurse-to-patient ratio for ventilated patients with 71% reporting a 1:2 nurse-to-patient ratio for non- ventilated patients. Key ventilator decisions, including assessment of weaning and extubation readiness, were reported as predominantly made by nurses and doctors in collaboration. Overall, nurses described high levels of autonomy and influence in ventilator decision-making. Decisions to change ventilator settings, including FiO(2) (91%, 95% CI: 80-97), ventilator rate (65%, 95% CI: 51-77) and pressure support adjustment (57%, 95% CI: 43-71), were made independently by nurses. The authors conclude that the results of the survey suggest that, within the Australian and New Zealand context, nurses participate actively in ventilation and weaning decisions. In addition, they suggest, the results support an association between the education profile and skill-mix of nurses and the level of collaborative practice in ICU.
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