Moral tensions at the bedside: A survey of neonatal nurses' perceptions of trisomy 18 care.

We sought to characterize bedside nurses' perceptions of providing intensive care to patients with trisomy 18 (T18) in a level IV neonatal intensive care unit (NICU). NICU nurses were anonymously surveyed with an electronic, mixed-methods survey. Items included quantitative questions about whether T18 is "incompatible with life," whether interventions should be offered, open-ended free-text questions, and demographic items. Survey results were analyzed with descriptive statistics and thematic analysis. There were 145 responses (response rate 46%). Most (53%) agreed that T18 was "incompatible with life", and 59% felt that this diagnosis should impact interventions offered. Two major themes emerged from 114 free-text responses, including "perceptions of prognosis" and "ethical considerations." Though most nurses believe that T18 is "incompatible with life" and interventions should be restricted, a substantial minority endorse other perspectives. A range of ethical considerations shape nurses' diverse views, suggesting that they are morally rooted and may contribute to ethical distress.