The educational needs of neonatal nurses regarding neonatal palliative care

Self-Assessed Educational Needs of Chinese Pediatric Clinicians Regarding Pediatric Palliative Care: A Cross-Sectional Investigation

BACKGROUND

An important first step in enhancing professional palliative care training is to investigate the educational needs of pediatric clinicians in this field. The aims of this research were to analyze the extent of end-of-life care experience of Chinese pediatric clinicians and identify the differing educational needs of physicians and nurses as well as associated impact factors.

METHODS

A cross-sectional descriptive survey via a structural questionnaire was used in this research.

RESULTS

In total, 187 clinicians, comprising 52 physicians and 135 nurses, participated in this study. The topics "pain management", "symptom management", and "discussing the prognosis with family members" were the most expressed educational needs among both physicians and nurses. Compared to nurses, physicians placed greater emphasis on the importance of "communication" and "pain and symptom management" (p < 0.05). Clinicians with more extensive end-of-life care experience more strongly felt the importance of learning about pain management and communication regarding end-of-life care (p < 0.05).

CONCLUSIONS

Research showed that the education currently provided to pediatric clinicians does not meet their distinctive needs. Future palliative care education must be a continuing multi-level, interdisciplinary program and different education should be provided to physicians and nurses based on their respective needs.

Neonatal nurses' educational needs in a family-centered partnership program: Five ways of knowing

BACKGROUND

Partnerships between parents and nurses are essential to provide comprehensive family-centered care (FCC) in the neonatal intensive care unit (NICU).

OBJECTIVES

We aimed to identify the educational needs of neonatal nurses to develop a family-centered partnership program with parents based on five ways of knowing.

DESIGN

We conducted focus group interviews with 18 NICU nurses working at a tertiary hospital. Data were analyzed using inductive content analysis.

METHOD

Data were collected from February to March 2023 through semi-structured interviews and then carefully transcribed and analyzed using a qualitative content analysis approach.

RESULTS

We used Carper and Chinn and Kramer's five ways of knowing as a framework for data analysis. Twelve categories emerged: staying updated with evidence-based practice, recognizing FCC, practicing neonatal nursing skills and participating in continued education and professional development (empirical knowledge); engaging in self-reflection and expressing therapeutic empathy (personal knowledge); fostering effective communication and leading cooperative readership, building integrity (esthetic knowledge); maintaining ethical responsibility (ethical knowledge); and developing collaborative teamwork, growing cultural competence (emancipatory knowledge).

CONCLUSIONS

This study could be used as a foundation for enhancing NICU nurses' partnerships with parents based on FCC and nurses' educational needs and preferences.

Describing Nurses' Work and Educational Needs in Providing Neonatal Palliative Care: A Narrative Review

Nurses in NICUs report insufficient education as a persistent barrier to providing quality neonatal palliative care (NPC). Since existing literature on educational interventions in NPC is limited, this review aimed to identify and narratively synthesize literature both about nurses' attitudes toward NPC and the NPC education received by nurses. We conducted a nonsystematic narrative literature review. Four themes were identified from the 28 articles included in this review. These were as follows: (a) nursing work in NPC, (b) NICU nurses' experiences and perceptions of NPC, (c) facilitators and barriers to nursing work in NPC, and (d) educational interventions in NPC. This literature review identified studies about NICU nurses' experiences and education in providing NPC. NICU nurses both desired and lacked education in NPC. This literature review identifies the importance of developing and evaluating NPC education for nurses.

Neonatal intensive care unit nurses knowledge and attitude toward neonatal palliative care: review of the literature

Aim

To review studies regarding neonatal nurses' knowledge and attitude toward neonatal palliative care (NPC).

Method

The researchers searched internet sources such as Google Scholar for NPC, Nurses, Knowledge, Attitude, and Educational Intervention.

Results

Subheadings identified in the literature review were Nurses Knowledge toward NPC in NICU, Nurses Attitude toward NPC in NICU, correlation between Knowledge and Attitude toward NPC in NICU, The Effect of Educational program on Nurses Knowledge and Attitude toward NPC in NICU, and the Predictors of Knowledge and Attitude toward NPC among Nurses in NICU and Barriers to NPC provision and improvement.

Conclusion

There are few studies from different nations regarding NPC found nurses have an inadequate knowledge of NPC, which also reflects their attitude.

Neonatal palliative care: Assessing the nurses educational needs for terminally ill patients

BACKGROUND

For terminally sick neonates and their families, it's crucial to provide holistic nursing care that incorporates both curative and palliative care as much as feasible. It is well known that the biggest obstacle to delivering palliative care for neonatal children is a lack of training for nurses. Aim: The aim of this research is to investigate the experiences of nurses who provide care for neonates who are terminally ill as well as their educational requirements for neonatal palliative care.

METHOD

A cross-sectional descriptive study was conducted among 200 nurses working in a tertiary center providing care for terminally ill neonates in Saudi Arabia. Data was collected from using Neonatal Palliative Care Questionnaire (QNPC) from January 2021 to March 2021.

RESULTS

Two hundred nurses were surveyed (the response rate was 79%). The mean age of the 158 participants was 35.67 (standard deviation (SD): 7.43), and the majority were female (151; 95.6%). The majority were bachelor's holders (119; 75.3%), with more than 5 years of experience in providing care for neonates (100; 63.3%). Most of the participants reported not receiving any education about palliative care (115; 72.8%). Nurses reported a moderate level of experience in all areas of neonatal palliative care. The total mean score of palliative care experiences of neonates was 3.42 (SD: 1.35). However, the majority of nurses reported little experience discussing the transition period to palliative care for neonates 2.95 (SD: 1.93), the discussion of code status (DNR) during terminal illness of neonates 3.11 (SD: 1.54) and spiritual support 2.90 (SD: 1.55).

CONCLUSION

The assessment of the fundamental skills of neonatal palliative care by nurses was insufficient. To enhance the quality of care, it is crucial to incorporate education on neonatal palliative care into programs for nursing staff development.

Moral distress among Iranian neonatal intensive care units' health care providers: a multi-center cross sectional study

Due to the unique nature of the neonatal intensive care unit (NICU) and its moral distress, this study aimed to investigate moral distress in the NICU. This cross-sectional study was conducted on 234 physicians and nurses working in the neonatal wards of eight hospitals. The Corley’s Moral Distress Scale was used to collect data. Findings showed that 25 of the participants were physicians and 209 were nurses. The intensity and frequency of distress among physicians and nurses were assessed as moderate. The mean intensity and frequency of moral distress among nurses and physicians were 48.3%, 41.5% and 46.46%, 15.62% respectively. The results showed that the mean intensity and frequency of distress were higher, however not significantly, among nurses. The intensity and frequency of moral distress had a statistically significant and direct correlation with the intention to leave and the number of staff in each working shift among the nurses. Moral distress in the NICU practitioners was moderate, so addressing this issue and trying to alleviate it was important. Identifying the causes behind moral distress can help adopt appropriate measures to prevent and reduce them.

Compassionate extubation protocol to improve team communication and support in the neonatal intensive care unit

OBJECTIVE

Compassionate extubation (CE) can be stressful for staff and families in the neonatal intensive care unit (NICU). Our quality improvement initiative developed and implemented a novel symptom management and family support checklist and post-debriefing template to improve team communication and staff support.

STUDY DESIGN

An interprofessional team performed a needs assessment, determined key drivers and intervention steps, and implemented changes using Plan-Do-Study-Act cycles. Outcomes included nursing perception of good communication with the medical team, nursing assessment of patient comfort after CE, and frequency of post-event debrief. Outcomes were analyzed using time series design with 12 months baseline data and 6 months post-implementation monitoring.

RESULT

Eighteen events were studied. Respondents endorsing "good" communication with the medical team increased by 60%, and debrief participation rate improved by 96%.

CONCLUSION

Implementation of a CE checklist and post-event debriefing sheet was associated with increased rate of debriefs and improved team communication.

Italian Nurses' Attitudes Towards Neonatal Palliative Care: A Cross-Sectional Survey

PURPOSE

Neonatal palliative care becomes an option for critically ill neonates when death is inevitable. Assessing nurses' attitudes towards, barriers to, and facilitators of neonatal palliative care is essential to delivering effective nursing care.

METHODS

This study was conducted from January to September 2015 and involved Italian nurses employed in Level III neonatal intensive care units in 14 hospitals in northern, central, and southern Italy. A modified version of the Neonatal Palliative Care Attitudes Scale (NiPCAS) was adopted to assess nurses' attitudes.

FINDINGS

A total of 347 neonatal nurses filled out the questionnaire. The majority were female (87.6%), with a mean age of 40.38 (±8.3) years. The mean score in the "organization" factor was 2.71 (±0.96). The "resources" factor had a mean score of 2.44 (±1.00), while the "clinician" factor had a mean score of 3.36 (±0.90), indicating the main barriers to and facilitators of implementing palliative nursing care.

CONCLUSIONS

Italian neonatal nurses may face different obstacles to delivering neonatal palliative care and to improve their attitudes in this field. In the Italian context, no facilitators of, only barriers to, palliative care delivery were identified.

CLINICAL RELEVANCE

Nurses' attitudes towards neonatal palliative care are essential to supporting nurses, who are constantly exposed to the emotional and moral distress connected with this field of end-of-life nursing care.

A Concept Analysis of Neonatal Palliative Care in Nursing: Introducing a Dimensional Analysis

Despite the increasing need for neonatal palliative care, it is not adequately implemented in practice. This analysis aimed to clarify the dimension of the neonatal palliative care concept to increase understanding of the concept to give more insight into clinical practice. Using dimensional analysis methodology, 46 English language papers from 2001-2018 were analyzed. The coding of the literature for the perspective, context, conditions, process, and consequences of the concept was completed. Five dimensions informed the conceptualization of this concept and interrelationships among their themes/sub-themes were presented in the matrix named, "improving quality of life and death". Within the family-centered care perspective and under different conditions/contexts through the processes of neonate's comfort and providing holistic care, the consequences of this care were improving quality of life/a good death. Family-centered care was the fundamental dimension and essential to achieving the consequences. The other dimensions of context, conditions, and processes were also affected by the family's needs, preferences, culture, and expectations. This analysis reinforces that neonatal palliative care is a multidimensional concept. To provide the standard of neonatal palliative care an integrated plan to get together many stakeholders including community, parents, clinical staff, policymakers, insurance authorities, health care systems, and education system is required. All NICUs should have neonatal palliative care-trained nurses and protocols with a family-centered care approach to focus on the quality of life of neonates with life-threatening conditions from diagnosis of disease to death. Regular training and educational courses on neonatal palliative care and family-centered care principles can make nurses more sensitive to their advocacy role.

A mixed-methods systematic review and meta-analysis of barriers and facilitators to paediatric symptom management at end of life

BACKGROUND

Symptom management for infants, children and young people at end of life is complex and challenging due to the range of conditions and differing care needs of individuals of different ages. A greater understanding of these challenges could inform the development of effective interventions.

AIM

To investigate the barriers and facilitators experienced by patients, carers and healthcare professionals managing symptoms in infants, children and young people at end of life.

DESIGN

A mixed-methods systematic review and meta-analysis was undertaken (PROSPERO ID: CRD42019124797).

DATA SOURCES

The Cochrane Library, PROSPERO, CINAHL, MEDLINE, PsycINFO, Web of Science Core Collection, ProQuest Dissertations & Theses Database, Evidence Search and OpenGrey were electronically searched from the inception of each database for qualitative, quantitative or mixed-methods studies that included data from patients, carers or healthcare professionals referring to barriers or facilitators to paediatric end-of-life symptom management. Studies underwent data extraction, quality appraisal, narrative thematic synthesis and meta-analysis.

RESULTS

A total of 64 studies were included (32 quantitative, 18 qualitative and 14 mixed-methods) of medium-low quality. Themes were generated encompassing barriers/facilitators experienced by carers (treatment efficacy, treatment side effects, healthcare professionals' attitudes, hospice care, home care, families' symptom management strategies) and healthcare professionals (medicine access, treatment efficacy, healthcare professionals' demographics, treatment side effects, specialist support, healthcare professionals' training, health services delivery, home care). Only one study included patients' views.

CONCLUSION

There is a need for effective communication between healthcare professionals and families, more training for healthcare professionals, improved symptom management planning including anticipatory prescribing, and urgent attention paid to the patients' perspective.

[Bereavement Care for Parents in the Neonatal Intensive Care Unit: A Literature Review]

Purpose

The purpose of this study was to review studies investigating the effect of bereavement care provided for parents in the neonatal intensive care unit.

Methods

We conducted a literature review of databases (MEDLINE, Embase, Cochrane Library, and CINAHL) for studies published in English and four databases (RISS, KISS, NANET, and KoreaMed) for Korean studies. The selection criteria included original articles that evaluated the parents' perceptions or responses to bereavement care provided in the neonatal intensive care unit. Of 889 articles from the initial screening, 66 articles underwent full-text review and five articles were finally selected for analysis.

Results

None of the studies was conducted in Korea. Only one study used a randomized control trial design. The forms of bereavement care reviewed included a provision of a memory package, grief information, and emotional and/or social support from peers or health care providers. The effectiveness of bereavement care was measured by including grief, social support, and depression.

Conclusion

Bereavement care can be considered to be beneficial for relieving grief reactions and enhancing the personal growth of bereaved parents. Future research should assess the needs of bereaved parents in Korea. Nurses may play a role in developing the bereavement care for parents.

Nurses' experiences of providing nonpharmacological pain management in palliative care: A qualitative study

AIM AND OBJECTIVES

To explore the experiences and views of nurses who provide nonpharmacological therapies for chronic pain management in palliative care.

BACKGROUND

Nursing expertise in palliative care is essential in providing pain relief to patients with chronic diseases. Examinations of the use of nonpharmacological therapies for chronic pain management in palliative care have revealed what nonpharmacological therapies have been used, but there is insufficient knowledge regarding nurses' attitudes, views and experiences regarding pain therapies in this context.

DESIGN

A qualitative descriptive design was chosen.

METHODS

Data were collected through individual interviews in a purposive sample with 15 nurses to ensure maximum variation. The data were analysed using qualitative content analysis. This study aligns with the consolidated criteria for reporting qualitative research (COREQ) checklist.

RESULTS

The analysis yielded four categories, as follows: "building and sustaining favourable therapeutic relationships" involved the creation of trust and a solid relationship; in "recognising the diversity of patients' needs," person-centred care is expressed as being vital for individualised nonpharmacological pain management; "incorporating significant others" describes how nurses can help to ease the patient's pain by identifying positive encounters with family members or friends; and in "recognising the existence of barriers," nurses highlight vulnerable groups such as children, for whom nurses require special education to enable optimal nonpharmacological pain management.

CONCLUSION

The unique knowledge that nurses gain about the patient through the nurse-patient relationship is central and crucial for successful nonpharmacological pain management.

RELEVANCE TO CLINICAL PRACTICE

This study emphasises the need for nurses to get to know their patient and to be open and sensitive to patients' descriptions of their unique life situations, as this provides the necessary knowledge for optimal care and pain management. Nurses should be encouraged and given the opportunity to attend specialised training in palliative care and pain management.

Experience of nurses who work with children with palliative care needs: A mixed-method systematic review

OBJECTIVE

The importance of palliative care education for nurses has been recognized worldwide. The study aims to explore the experiences of nurses working with children with palliative care needs and to identify any related educational needs.

METHODS

The electronic databases of CINAHL, Cochrane, PubMed, OVID, Social Care Online, Web of Science, Scopus, and ProQuest were searched for the period 2000-2015.

RESULTS

Finding revealed that working with children with palliative care needs is an emotionally struggling job for nurses, especially when they try to manage the transition of pediatric patients from curative to palliative care. Staffing level and time constraints comprise a major obstacle in pediatric palliative care. Focusing on invasive treatment and technology in spite of the feelings that it will not improve patients' health status intensifies the feeling of guilt and helplessness for nurses. Finally, nurses asserted the importance of receiving pediatric palliative care education, especially how to communicate with children with palliative care needs and their families.

SIGNIFICANCE OF RESULTS

Further research is recommended with regard to nurses' experience in communication with children with palliative care needs. Nursing education in pediatric palliative care is significantly important, especially how to communicate with children with palliative care needs and their families.

Perinatal palliative care education: An integrative review

OBJECTIVES

The aim of this review was to analyze the effectiveness of teaching healthcare professionals in perinatal palliative care, methods of evaluating the teaching, and the teaching strategies used.

DESIGN

An integrative review.

METHODS

A systematic search was conducted for English language peer reviewed publications of any research design via SCOPUS, Medline/PubMed, EBSCOhost, Science Direct, ERIC, Web of Science, Wiley, Nursing Ovid, and ProQuest databases. Fourteen research papers published between 2002 and 2017 that met the selection criteria were included in the review.

FINDINGS

All 14 studies considered perinatal bereavement education to be effective. Eight studies reported statistical improvements in knowledge, security/comfort in providing end-of-life care, or increased perceptions of the emotional care needs of bereaved families, after attending an educational program. Questionnaires or interviews were used to evaluate the educational programs. Innovative teaching strategies, in particular, were evaluated positively (e.g., simulation, discussion, and arts-based methods).

CONCLUSION

Perinatal palliative care education is essential in pregradual education for midwives and neonatal nurses. Other research is vital for finding out the effectiveness of this education for pregraduate nursing students. Perinatal palliative care education programs need to be available in postgraduate education for professionals who encounter perinatal death and bereaved families in hospital and community care.

End-of-Life Care in Neonatal Intensive Care Units from an Asian Perspective: An Integrative Review of the Research Literature

Background: End-of-life (EOL) care in neonatal intensive care units (NICUs) can vary depending on religious beliefs of health care providers and families as well as the sociocultural environment. Although guidelines exist for EOL care in NICUs, most are based on Western studies, and little is known about such care in Asian countries, which have different religious and social background. Objective: This review synthesized empirical research to reveal the state of the science on infant EOL care in Asian countries. Design: This was an integrative review. Setting/Subjects: Data were collected from studies identified in CINAHL, Embase, PsycINFO, and PubMed. The search was limited to current empirical studies involving infant EOL care in Asian countries and published in English between 2007 and 2016. Results: Of 286 studies initially identified, 11 empirical studies conducted in Hong Kong, India, Israel, Japan, Mongolia, Taiwan, and Turkey were included in the review. Four themes were captured: factors influencing decision making, trends in decision making, practical aspects of EOL care, and health care providers' preparation. In most NICUs, health care providers controlled decisions regarding use of life-sustaining treatment, with parents participating in decision making no more than 60% of the time. Although care decisions were gradually changing from "do everything" for patient survival to a more palliative approach, comfort care at the EOL was chosen no more than 63% of the time. Conclusion: While infant EOL care practice and research vary by country, few articles address these matters in Asia. This integrative review characterizes infant EOL care in Asia and explores cultural influences on such care.

A Network Approach to Neonatal Palliative Care Education: Impact on Knowledge, Efficacy, and Clinical Practice

More than 80 000 babies are admitted to specialist neonatal units in the United Kingdom every year, with approximately 2109 neonatal deaths a year; 98% in hospital. A common element in guidance and pathways to facilitate the provision of palliative care to infants and their families is the importance of good education and training to develop high-quality staff and services. This article presents a mixed-methods, sequential, explanatory design evaluation of 1 day palliative care education workshops delivered using a network-wide approach to multidisciplinary professionals. Workshops were delivered by healthcare professionals and bereaved parents and evaluated using questionnaires, adapted for neonatal staff from standardized measures, and follow-up interviews. The workshop content and shared learning approach resulted in significant improvements in participant's knowledge, attitude, self-beliefs and confidence in neonatal palliative care, enhanced awareness of services, and improved links between professionals. Participants cascaded their learning to their teams and provided examples of changes in their clinical practice following the workshop. Parent stories were identified as a very powerful component of the training, with lasting impact on participants. Formal, integrated palliative care education programs for perinatal and neonatal staff and longitudinal research into the impact on practice and the experience received by families are needed.

Brazilian Neonatal Nurses' Palliative Care Experiences

The purpose of palliative care (PC) is to minimize suffering and improve quality of life. Although PC has been well studied, the experience of neonatal intensive care unit (NICU) nurses in Brazil, where little PC training is provided, requires further investigation. The objective of this study was to explore the PC experiences of Brazilian NICU nurses. An exploratory, qualitative, descriptive study was conducted using semistructured, individual interviews with NICU nurses. This study was conducted in a 30-bed NICU in a teaching hospital in Sao Paulo, Brazil. A convenience sample of registered nurses (N = 9) was recruited. Interviews were recorded and transcribed verbatim, and thematic analysis was used to analyze the data. Four themes were identified: (a) living with the grief, (b) identifying with the family, (c) providing humane care, and (d) feeling unprepared. Nurses experienced intense grief while providing PC. They closely identified with the families and aimed to provide humane care that respected the families' values and the infants as human beings. The nurses also felt they lacked adequate training in PC and expressed a need for additional education and emotional support. NICU nurses need adequate education and emotional support to ensure quality nursing care for this vulnerable population of infants and their families.

The experiences and needs of healthcare professionals facing perinatal death: A scoping review

BACKGROUND

Globally, perinatal death is on a decline. However, its impact on the healthcare profession is huge. The existing literature focuses on examining perinatal death from parents' perspectives and patient death from the perspectives of nurses and a few doctors in critical care, oncology, and neonatology in the West. Due to the unique setting of maternity units where death is not routinely anticipated, as well as distinctive socio-cultural views surrounding death, there is a need to comprehensively review literature examining the impact of perinatal death on the perspectives of healthcare professionals working in maternity units.

OBJECTIVES

To examine available literature on the needs and experiences of healthcare professionals working in maternity units who have experienced perinatal death.

DESIGN

A scoping review of published and unpublished data.

DATA SOURCES

A systematic literature search from 1st January 1996 to 5th August 2016 was made in the following databases: PubMed, CINAHL, Embase, PsycINFO, ScienceDirect, and Web of Science. Cochrane Library, Joanna Briggs Institute Library of Systematic Reviews, York Centre for Reviews and Dissemination, Open Grey, ProQuest Dissertation and Theses, and Mednar were reviewed for grey literature. A hand search of the reference lists of the included papers was performed.

REVIEW METHODS

Based on the pre-set inclusion criteria, 1519 articles were screened for their titles and abstracts. Eighty-five full-text papers were reviewed, resulting in 30 papers included for this review. The data were extracted and cross-checked between the reviewers. Any discrepancy between the authors' views would be discussed with a third reviewer until consensus was reached. Thematic analysis was used to categorise the results into themes.

RESULTS

Two major themes emerged from the review: the experiences and needs of healthcare professionals. Six subthemes emerged from the experiences of healthcare professionals: 1) psychological impact, 2) physical impact, 3) positive feelings, 4) coping strategies, 5) personal factors influencing the experience, and 6) cultural factors influencing the experience. Three subthemes including 1) social support, 2) training and education, and 3) other needs explained the needs of healthcare professionals. Studies focusing on the experiences and needs of physicians were scarce.

CONCLUSIONS

Perinatal death has a profound impact on the psychological and physical wellbeing of healthcare professionals. They have unmet needs that need to be addressed. Though they use internal and external resources to combat their stress, institutional support acknowledging their stress and their needs is essential. Culturally-sensitive education and training are needed to provide support to these professionals.

Effectiveness of Pediatric Palliative Care Education on Pediatric Clinicians

A lack of knowledge and skills in pediatric palliative care may create hesitation in caring for children with serious life-threatening conditions and their families. Our research examined the effectiveness of pediatric palliative care training for pediatric clinicians. A pretest–posttest study provided educational training in pediatric palliative care to pediatric clinicians and used a pretest and a posttest to assess outcomes. Fifty pediatric clinicians attended this research with 83.3% response rate. After training, participants reported significantly increased confidence in a variety of areas, including providing emotional support to clinicians, personal knowledge, skills, and communication; ethical and legal concerns; and providing emotional support to dying children and their families. Results showed a significant main effect of training on confidence levels ( p < .000). This suggests that education can effectively boost pediatric clinicians’ confidence regarding providing pediatric palliative care and therefore should regularly be provided to clinicians.

Evidence for Implementation Strategies to Provide Palliative Care in the Neonatal Intensive Care Unit

BACKGROUND

Palliative care is a holistic framework that is designed to improve quality of life by identifying and treating distressing symptoms of life-threatening or complex conditions. Neonatal palliative care (NPC) has potential benefits for parents, staff, and patients, yet evidence suggests that implementation and utilization of organized NPC services are low.

PURPOSE

The purpose of this study is to answer the clinical question: In neonatal intensive care, what evidence can be used to guide implementation of palliative care protocols?

SEARCH STRATEGY

A literature search was conducted using CINAHL (Cumulative Index of Nursing and Allied Health Literature), PubMed, and the Cochrane Library databases. Publications with a focus on neonates, neonatal intensive care unit, and implementation or evaluation of a palliative care protocol, team, or educational intervention were retained.

RESULTS

The search yielded 17 articles that fit with the following themes: NPC protocols or teams (n = 8), healthcare team needs (n = 3), and barriers to implementation (n = 6). Approaches to NPC implementation were varied, and outcome data were inconsistently reported. Healthcare team members cited a need for education and consistent, ethical delivery of NPC. Common barriers were identified as lack of NPC education, poor communication, and lack of adequate resources such as staff and space.

IMPLICATIONS FOR PRACTICE AND RESEARCH

Successful team approaches included standardized order sets to initiate NPC, NPC education for staff, and references to NPC guidelines or protocols. Barriers such as lack of interdisciplinary cooperation, lack of appropriate physical space, and lack of education should be addressed during program development. Further research priorities for NPC include seeking parent perceptions, shifting focus from mostly end-of-life to an integrated model, and collecting outcome data with rigor and consistency.

Baby O and the Withdrawal of Life-Sustaining Medical Treatment in the Devastated Neonate: A Review of Clinical, Ethical, and Legal Issues

The discontinuation of life sustaining medical treatment (LSMT) in severely and permanently impaired neonates, especially artificial nutrition and hydration (ANH) is subject to uncertainty and controversy. Definitive clinical guidelines are lacking, clinical research is limited, ethical disagreement is commonplace, and while case and statutory law provide legal underpinning for the practice in defined circumstances, uncertainty in this realm likely influences clinical practice. We use the case of a neurologically devastated neonate to highlight and review these arenas, and show how, using available legal, ethical, and clinical standards and practice, the case of Baby O was resolved, and to underline the need for further research in neonatal palliative care.

Nursing care for the families of the dying child/infant in paediatric and neonatal ICU: nurses' emotional talk and sources of discomfort. A mixed methods study

BACKGROUND

The majority of in-hospital deaths of children occur in paediatric and neonatal intensive care units. For nurses working in these settings, this can be a source of significant anxiety, discomfort and sense of failure.

OBJECTIVES

The objectives of this study were to explore how NICU/PICU nurses care for families before and after death; to explore the nurses' perspectives on their preparedness/ability to provide family care; and to determine the emotional content of language used by nurse participants.

METHODS

Focus group and individual interviews were conducted with 22 registered nurses from neonatal and paediatric intensive care units of two major metropolitan hospitals in Australia. All data were audio recorded and transcribed verbatim. Transcripts were then analysed thematically and using Linguistic Inquiry to examine emotional content.

RESULTS

Four core themes were identified: preparing for death; communication challenges; the nurse-family relationship and resilience of nurses. Findings suggested that continuing to provide aggressive treatment to a dying child/infant whilst simultaneously caring for the family caused discomfort and frustration for nurses. Nurses sometimes delayed death to allow families to prepare, as evidenced in the Linguistic Inquiry analysis, which enabled differentiation between types of emotional talk such as anger talk, anxiety talk and sadness talk. PICU nurses had significantly more anxiety talk (p=0.018) than NICU nurses.

CONCLUSION

This study provided rich insights into the experiences of nurses who are caring for dying children including the nurses' need to balance the often aggressive treatments with preparation of the family for the possibility of their child's death. There is some room for improvement in nurses' provision of anticipatory guidance, which encompasses effective and open communication, focussed on preparing families for the child's death.