Barriers to Palliative Care in the Neonatal Intensive Care Unit from Nurses’ Perspective: A Qualitative Study

Background: The American Academy of Pediatrics and the National Association of Neonatal Nurses recommend that palliative care be provided as standard care in neonatal intensive care units (NICUs). Objectives: The present study aimed to explain the nurses' experiences of barriers to palliative care in NICUs. Methods: This qualitative study was conducted using the content analysis approach in NICUs of Beheshti and Amin hospitals in Isfahan in 2020. The data were collected using semi-structured in-depth interviews with 12 nurses who had palliative and end-of-life care experiences for infants and families. The nurses were selected using purposive sampling. The duration of each interview varied from 25 to 50 minutes. Data were analyzed using conventional qualitative content analysis conducted inductively with Graham and Lundman’s approach. The criteria proposed by Guba and Lincoln were used to ensure the credibility and reliability of the data. Results: Three main categories were extracted from the data, including unfavorable conditions (subcategorized into “unsuitable physical environment” and “shortage of nurses”), nurse's mental problems (with the subcategories of “nurses’ mental problems in providing neonatal care” and “nurses’ mental problems in providing family care”) and challenges ahead (with the subcategories of "parental presence challenge” and “doctor's instructions challenge”). Conclusions: The findings of the present study revealed the barriers to palliative care for infants and families in NICUs. Given the importance of palliative care in NICUs, effective measures must be taken to overcome these barriers.

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Relief and care in the shade: A concept extracted from practices of neonatal nurses during pain management

Nursing Practice Today ◽

10.18502/npt.v7i3.3349 ◽

2020 ◽

Author(s):

Zahra Hadian Shirazi ◽

Mitra Soltanian ◽

Raheleh Sabet Sarvestani

Keyword(s):

Content Analysis ◽

Intensive Care ◽

Pain Management ◽

Intensive Care Units ◽

Neonatal Intensive Care ◽

Family Care ◽

Neonatal Intensive Care Units ◽

Structured Interviews ◽

Knowledge And Attitude ◽

The Impact

Background & Aim: Nowadays, despite the improvements in the knowledge and attitude of healthcare professionals, there are still obstacles against pain management in neonatal intensive care units. Hence, it is necessary to know about the problems of pain management in neonatal intensive care units. This research aimed to explore the pain management experiences of neonatal intensive care unit nurses and neonatologists. Methods & Materials: This content analysis study was conducted on six experienced neonatal intensive care units nurses and two neonatologists in one hospital affiliated to Shiraz University of Medical Sciences who were selected through purposive sampling which continued until saturation. The data were collected through semi-structured interviews and field notes. The data were simultaneously analyzed using inductive content analysis. Results: Analysis of the data generated one theme and three categories and seven subcategories. The theme was “pain relief in the shade”. The categories were “responsibility versus ignorance”, “family caregiver as a barrier or facilitator”, and “newborn, sacrificed due to imbalanced context”. This study showed that professional caregivers managed pain on the margin of other cares. The effects of family care were identified as paradox, helping, or disturbing. The participants also emphasized the impact of environmental disruptions on pain management. Conclusion: The experiences of pain management in neonatal intensive care units were identified at three levels of professional caregivers, family caregivers, and organizational atmosphere. Exploring this experience could help improve pain management and reduce its side effects in susceptible neonates. Hence, healthcare workers are recommended to ensure effective pain management in neonatal intensive care units by ongoing monitoring and audit.

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Barriers of Palliative Care in Neonatal Intensive Care Units

American Journal of Hospice and Palliative Medicine® ◽

10.1177/1049909115616597 ◽

2016 ◽

Vol 34 (3) ◽

pp. 205-211 ◽

Cited By ~ 10

Author(s):

Mansooreh Azzizadeh Forouzi ◽

Marjan Banazadeh ◽

Jila Soltan Ahmadi ◽

Farideh Razban

Keyword(s):

Palliative Care ◽

Organizational Culture ◽

Intensive Care ◽

Intensive Care Units ◽

Neonatal Intensive Care ◽

Attitude Scale ◽

Neonatal Intensive Care Units ◽

Cross Sectional ◽

Neonatal Nurses ◽

Eol Care

Objective: Neonatal nurses face numerous barriers in providing end-of-life (EOL) care for neonates and their families. Addressing neonatal nurses’ attitudes could provide insight into barriers that impede neonatal palliative care (NPC). This study thus conducted to examine neonatal nurses’ attitude toward barriers in providing NPC in Southeast Iran. Method: In this cross-sectional study, a translated modified version of Neonatal Palliative Care Attitude Scale was used to examine attitudes of 70 nurses toward barriers of palliative care in 3 neonatal intensive care units in Southeast Iran. Results: Findings indicated that overall 42.63% of nurses were strongly agreed or agreed with the proposed barriers in NPC. Among all categories, the highest and the lowest scores belonged to the categories of “insufficient resources” (3.42 ± 0.65) and “inappropriate personal and social attitudes” (2.33 ± 0.48), respectively. Neonatal nurses who had less education and study regarding NPC reported the presence of more barriers to NPC in the categories of “inappropriate organizational culture” and/or “inadequate nursing proficiency.” Also, younger nurses had more positive attitudes toward the category of inappropriate organizational culture as being a barrier to provision of NPC (4.62). Conclusion: The findings suggest that developing a context-based instrument is required to represent the barrier more precisely. Neonatal palliative care can be improved by establishing a special environment to focus on infants’ EOL care. This establishment requires standard palliative care guidelines and adequate NPC-trained nurses.

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Parents' friends and families in neonatal intensive care units: A cross‐national qualitative study on staff perceptions and experiences

Journal of Clinical Nursing ◽

10.1111/jocn.16139 ◽

2021 ◽

Author(s):

Renée Flacking ◽

Helle Haslund‐Thomsen ◽

Rakel Jónsdóttir ◽

Sini Poropudas ◽

Anna Axelin

Keyword(s):

Intensive Care ◽

Qualitative Study ◽

Intensive Care Units ◽

Neonatal Intensive Care ◽

Neonatal Intensive Care Units ◽

Staff Perceptions ◽

Cross National

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Parents’ views on care of their very premature babies in neonatal intensive care units: a qualitative study

BMC Pediatrics ◽

10.1186/1471-2431-14-230 ◽

2014 ◽

Vol 14 (1) ◽

Cited By ~ 49

Author(s):

Gillian Russell ◽

Alexandra Sawyer ◽

Heike Rabe ◽

Jane Abbott ◽

Gillian Gyte ◽

...

Keyword(s):

Intensive Care ◽

Qualitative Study ◽

Intensive Care Units ◽

Neonatal Intensive Care ◽

Neonatal Intensive Care Units ◽

Premature Babies

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Parents’ Perceptions Regarding Readiness for Their Infant’s Discharge from the NICU

Neonatal Network The Journal of Neonatal Nursing ◽

10.1891/0730-0832.32.5.324 ◽

2013 ◽

Vol 32 (5) ◽

pp. 324-334 ◽

Cited By ~ 23

Author(s):

Natasha Burnham ◽

Nancy Feeley ◽

Kathyrn Sherrard

Keyword(s):

Intensive Care Unit ◽

Content Analysis ◽

Intensive Care ◽

Neonatal Intensive Care Unit ◽

Neonatal Intensive Care ◽

Qualitative Content Analysis ◽

Hands On ◽

Need For Information

Purpose: To identify what parents need to feel ready for the discharge of their infant from the neonatal intensive care unit (NICU).Design: Qualitative.Sample: 20 parents of infants admitted to a Canadian Level III NICU were interviewed (2011–2012) and asked to identify what they require to feel ready for discharge. Interview transcripts underwent qualitative content analysis to produce a descriptive summary of parents’ perceptions of their needs.Results: Parents indicated a need for information and hands-on experience to enhance their readiness for discharge. Observations of their infant and of the NICU environment impacted parents’ perceptions of their infant’s readiness for discharge, which influenced perceptions of their own readiness for discharge. Finally, parents require tailoring of information and experiences to meet the unique needs of their family.

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