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Enhancing maternal child nursing practice through ethical insight.

As nurses working in perinatal and neonatal settings, we recognize the importance of maintaining and updating our clinical skills. We also know, however, that we must place similar emphasis on refining our knowledge of ethical issues, professional standards of ethical conduct, and corresponding ethical decision-making skills and actions. Take a moment to reflect on a maternal child nursing care situation that you personally found distressing. Perhaps you encountered a situation when an excessive dose of a drug was ordered for your patient, or maybe your patient’s birth plan was not honored. Perhaps you were not sure that truly informed consent was in place for a patient, or perhaps you worried that a colleague was acting unethically. Maybe the distressing situation involved watching a neonate die after prolonged intensive invasive procedures? Were parents left out of important decisions about the care of their neonate? Were family-centered care practices not provided to a childbearing family? As you reflect, think about the events preceding the prominent issue and the ensuing actions you took as well as those of other members of the healthcare team. Are there actions you now wish you did not take? Or, perhaps there were opportunities to intervene on behalf of your patient or family members that went relatively unnoticed? What skills did you need to be more effective in that situation? How could issues have been resolved differently? This issue of MCN: The American Journal of Maternal/Child Nursing is dedicated to helping perinatal and neonatal nurses expand their ethical insight. We aim to provide an increased understanding of ethical professional standards, ethical terms, and ethical decision making through an exploration of ethical issues pertinent to the perinatal and neonatal settings. In the first article, we present an overview of ethical principles and frameworks; ethical decision making; and the concepts of moral distress and moral courage. Healthcare team relationships are also addressed. The second and third articles, written by Dr. Callister, focus on perinatal ethical issues, including those associated with genetic testing, infertility and ART among other issues. In the fourth and fifth articles, Dr. Sudia-Robinson provides an emphasis on neonatal ethical issues. Specifically, the focus is on ethical issues surrounding newborn screening, viability, life-limiting conditions, advance directives, and palliative care. In each of these articles, you will find a synopsis of the issues with practical implications for nursing practice. Current practical resources, case studies, and questions to encourage reflection and discussion are also incorporated. Maternal child nurses are the important link for patients and their families as they navigate unfamiliar and life-changing events, often in highly technological healthcare environments. Expanding your knowledge of ethical issues and developing ways to maintain your ethical decision-making skills will help ensure that you provide optimal family-centered nursing care. We encourage you to ask questions, seek additional clarification, explore options, and revisit decisions. Hopefully, the content provided in this issue of MCN will serve as a guide for further exploration of maternal child ethical issues and improved ethical decision making. ✜