Developing Morally Sensitive Policy in the NICU: Donation after Circulatory Determination of Death
| Autor: | Michael van Manen, Nicole Kain |
|---|---|
| Rok vydání: | 2017 |
| Předmět: | |
| Zdroj: | The Qualitative Report. |
| ISSN: | 2160-3715 1052-0147 |
| DOI: | 10.46743/2160-3715/2017.2589 |
| Popis: | Policies are fundamental for the provision of interdisciplinary healthcare:An explicit health policy can achieve several things: it defines a vision for the future which in turn helps to establish targets and points of reference for the short and medium term. It outlines priorities and the expected roles of different groups; and it builds consensus and informs people. (World Health Organization, 2015)Procedures and guidelines are helpful, and while can be supported by explicit policy, are of a different order. Procedures typically detail steps, activities, and practices for a defined task as they represent the implementation of a policy to a specific situation (Lemer, Cheung, Viner, & Wolfe, 2015). Guidelines may be used to reflect a softer, gentler, or laxer requirement for adherence. In turn, existing procedures and guidelines may be used to help formulate policy (Brouwers et al., 2010).Policies provide directives for members of an organization. Without policy the actions of healthcare practitioners may seem arbitrary, obscure, unaccountable, and, if things go wrong, indefensible. At the same time, sometimes people may hide behind policy. That is why, in healthcare, it is crucial that policy is clear and yet leaves room for professional discretion. For health professionals and patient-families, policies hopefully reflect thoughtful intent, careful deliberation, and best available evidence because they often serve as a starting point or even a guide towards professional practice (Ham, Hunter, & Robinson, 1995). Policy development for healthcare, however, can be challenging when dealing with a diversity of opinions and limited available evidence (Mahgoub, van Manen, Byrne, & Tyebkhan, 2014). The requirement for rigor in policy development is crucial for moral-ethically complex issues whereby transparency in the process of policy development may be as important as the ethics of the policy itself.When policies are determined and imposed by central institutional administrators they may not be supported by the professional practitioners who must abide by them. That is why it is crucial that policy development in high-risk healthcare contexts is accomplished through a participatory design mode. Qualitative research has much to offer clinicians and policy-makers (Tong, Morton, & Webster, 2016). As such, it is not simply that qualitative research studies may be critically reviewed in formulating policy; individuals with expertise in qualitative data collection and analytic methods may be called on to support policy development projects. In this article, we present our experience of using an iterative design method employing qualitative methods for policy development for donation after circulatory death (DCD) for our neonatal intensive care program. We begin with a brief review of existing methods for policy development and the challenges presented by DCD before presenting our experience of piloting this approach.Methods for Policy DevelopmentIn the medical literature and health practice, multiple methods exist for crafting policy (Mills, 2012). Consultation with expert or purposeful expert writing of policy is a common practice (Morgan, 2014). While an expert may contribute his or her judgement based on his or her background and experiences, review and integration of available evidence serve to support and strengthen the policy document (Cookson, 2005). If evidence is not available, qualitative and/or quantitative methods may be utilized. For example, methods such as interviews, focus groups, or surveys may be employed to elicit opinions and beliefs to inform the expert for policy development (Brownson, Chriqui, & Stamatakis, 2009).Use of multiple experts in the form of an advisory or working group may further inform policy development. From a group milieu, the direction of policy development, in addition to the policy itself, may be informed by various experts' backgrounds and experiences (Lemer et al. … |
| Databáze: | OpenAIRE |
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