Anemia of Prematurity - Portal Neonatal

In some situations, tragic situations leave only tragic options. Guidelines cannot resolve the hurt
associated with the emotional investment made toward patient care when outcomes are dismal.
Following a guideline does not necessarily make a dismal outcome easier to bear.
Responsibilities
Basis on fact: Guidelines need to be based on fact. The use of data is fundamental to the credibility
of guidelines. Such data should be more than anecdotal and ideally should reflect local institutional or
regional experience rather than national data, which may represent a significantly dissimilar population
that undergoes vastly different experiences over remote points of time. Data should be current,
complete, and comprehensive.
Currency of guidelines: Guidelines should be kept current. When conditions in place at the time a
guideline was developed change (eg, local population; availability of healthcare technology; social,
political, or fiscal influences), evaluate the guidelines and, if necessary, change them to reflect the new
paradigm.
Responsibility for public disclosure: Responsibility for public disclosure exists within any institution
that develops or uses guidelines. Patients who are subject to care under certain guidelines have a
right to know how they are affected by them, and healthcare professionals have a duty to inform
patients of these guidelines. This responsibility stems from the principles of respect for persons,
patient autonomy, avoidance of harm, and maximizing benefit. This is the nature of fiduciary, or trustbased,
relationships between healthcare professionals and their patients. Only in this way can such
professionals truly be advocates for their patients. Advocacy begins with staff involvement in the
development of guidelines, but it realizes itself in the conveying of information to patients and families
to facilitate their understanding of why care proceeds along certain lines and how they can contribute
to it.
ACHIEVING THE GOOD Section 6 of 8
In addressing the third question, doing what is good for critically ill newborns, the concept of doing
good is worthy of some attention. Doing good appeals to people of sound moral character and is
assumed practically in all who have pursued professions in the healing arts. Healthcare professionals
are healers. They are people who look out for the well being of their patients. They act positively to
accomplish good health and to avoid perceived harms that would be contrary to their patients' good
health. Traditionally, communities or populations who share moral traditions have subscribed to a
concept of the good. These communities and populations may include the following:
• Communities of faith
• Communities with a shared ethnic or social heritage
• Perhaps, a perceived image of health that is shared
Recent reflection makes it clear that a great deal of diversity exists in the moral concepts of what is the
good to which individuals should aspire. Given the many diverse communities across the United
States, that they do not universally share the very idea of good health is not surprising. Perhaps the
peculiar American emphasis on individuality and independence has disrupted previously shared
values of what good health is within traditional moral or faith communities.
Even in the NICU environment, where shared professional training, avowed determination to work for
their patient's best interests, and experiences that would appear commonplace to all are present, a
diversity in the concept of the good exists. This leads to instances in which no universal agreement
occurs as to which of many alternatives is the right good or even whether the good that is pursued is
worthwhile. How, then, is "the good" defined?
In many specific healthcare environments, a concept of the good must be refined to reflect the
peculiarities of the patients, their conditions, the available treatment alternatives, the values placed
upon those alternatives by relevant parties, the likely outcomes of treatment or nontreatment, and the