Relational, Emotional, and Pragmatic Attributes of Ethics Consultations at a Children's Hospital.

Background: Pediatric ethics consultations are important but understudied, with little known about consultations' contextual attributes, which may influence how ethically problematic situations are perceived and addressed.

Methods: We analyzed data regarding 245 pediatric clinical ethics consultations performed between 2013 and 2018 at a large children's hospital. Prespecified data elements included 17 core problematic issues that initiate consultations, 9 ethical considerations identified by the consultation service, and 7 relational, emotional, and pragmatic contextual attributes of the consultation.

Responding to Moral Distress and Ethical Concerns at the Intersection of Medical Illness and Unmet Mental Health Needs.

Some of the most difficult clinical ethics consultations involve patients who have both medical and mental health needs, as these cases can result in considerable moral distress on the part of the bedside staff. In this article we examine the issues that such consults raise through the illustrative example of a particular case: several years ago our ethics consultation service received a request from a critical care attending physician who was considering a rarely performed psychosurgical intervention to address intractable and life-threatening agitation and aggression in an adolescent patient for whom standard treatments had proven unsuccessful. We consider strategies that may be useful in addressing not only the ethical dilemmas or the clinical problems, but also the emotional, social, and moral distress that arise in delivering care in such complex cases, in which standard routine practices of care have been exhausted.

Parent and nurse partnership model for teaching therapeutic relationships.

The development of trusting, caring, boundaried, mutual relationships between staff, patients, and families in health care settings demands a set of staff skills that reflect an understanding of the perspective of patient/family as well as one's colleagues. When nurse leaders collaborate with families in teaching nurses, they offer a powerful means of gaining an understanding of the complexities inherent in the health care partnership. This shared nurse leader/family approach to education provides an opportunity to apply relationship principles to real life care situations and creates a forum for discussion of the various perspectives.