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Ethics consultation in paediatric and adult emergency departments: an assessment of clinical, ethical, learning and resource needs
  1. Keith A Colaco1,
  2. Alanna Courtright1,
  3. Sandra Andreychuk2,
  4. Andrea Frolic2,
  5. Ji Cheng3,4,
  6. April Jacqueline Kam1
  1. 1 Division of Pediatric Emergency Medicine, Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
  2. 2 Office of Clinical and Organizational Ethics, Hamilton Health Sciences, Hamilton, Ontario, Canada
  3. 3 Biostatistics Unit, St. Joseph’s Healthcare, Hamilton, Ontario, Canada
  4. 4 Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada
  1. Correspondence to Dr April Jacqueline Kam, Department of Pediatrics, McMaster Children’s Hospital, 1200 Main Street West, HSC 2N49-I Hamilton, ON L8N 3Z5, Canada; kama{at}


Objective We sought to understand ethics and education needs of emergency nurses and physicians in paediatric and adult emergency departments (EDs) in order to build ethics capacity and provide a foundation for the development of an ethics education programme.

Methods This was a prospective cross-sectional survey of all staff nurses and physicians in three tertiary care EDs. The survey tool, called Clinical Ethics Needs Assessment Survey, was pilot tested on a similar target audience for question content and clarity.

Results Of the 123 participants surveyed, 72% and 84% of nurses and physicians fully/somewhat agreed with an overall positive ethical climate, respectively. 69% of participants reported encountering daily or weekly ethical challenges. Participants expressed the greatest need for additional support to address moral distress (16%), conflict management with patients or families (16%) and resource issues (15%). Of the 23 reported occurrences of moral distress, 61% were associated with paediatric mental health cases. When asked how the ethics consultation service could be used in the ED, providing education to teams (42%) was the most desired method.

Conclusions Nurses report a greater need for ethics education and resources compared with their physician colleagues. Ethical challenges in paediatric EDs are more prevalent than adult EDs and nurses voice specific moral distress that are different than adult EDs. These results highlight the need for a suitable educational strategy, which can be developed in collaboration with the leadership of each ED and team of hospital ethicists.

  • Emergency Medicine
  • Ethics Committees/Consultation
  • End of Life Care
  • Education for Health Care Professionals
  • Clinical Ethics

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  • Contributors AJK, SA, and AF conceived and designed the study. AJK, AC, SA and AF supervised the conduct of the study, recruitment of participants and data collection. KAC and JC analysed the data. KAC drafted the manuscript, and all authors contributed substantially to its revision. AJK and KAC take responsibility for the paper as a whole.

  • Competing interests None declared.

  • Ethics approval Hamilton Integrated Research Ethics Board.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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