What are the experience of neonatal nurses in providing palliative care in NICU?

Abstract

Background: The survival rate of infants in neonatal intensive care units has improved dramatically. However, there are still a significant number of infants with limited chances of survival. It has been estimated that 75% of neonatal deaths occur during the first week, and approximately one million newborns die related to multiple life-threatening conditions (WHO, 2022). Identifying facilitators and barriers to enhance palliative care provision is crucial. There have been adverse effects associated with a lack of palliative care protocols for neonatal palliative care. Also, it has been demonstrated that NICU nurses are uniquely qualified to influence infants' and their families' experiences with endof-life care.

Aim: To explore neonatal nurses' perspectives on their experiences with palliative care for critically ill neonates in neonatal intensive care units.

Design: Thomas and Harden’s (2008) thematic synthesis method design.

Data Sources: The extended literature review studies were identified through three electronic databases (CINHAL, ASSIA, and PUBMED). Additional records were identified through google scholar and reference lists of the studies, which were systematically searched from March 2022 to July 2022. The eligibility criteria were primary qualitative studies, English language published between 2012 to 2022.

Review Method: The included studies focused on neonatal nurses' experiences while providing palliative care for an infant with a life-threatening condition. Quality appraisal was applied using Critical Appraisal Skills Programme tool, and qualitative thematic, line-by-line coding was performed.

Results: Eight primary qualitative studies were eligible for inclusion. Six descriptive themes were identified: the first descriptive theme is nurses' communication in relation with colleges, families, and parents, and it is sub-themes were (a) nurse's communication and enhancing parent decision-making, (b) nurses' communication in enhancing parent-infant attachment and their role in supporting extended families (c) Nurses communication between allied healthcare providers. The second descriptive theme is nurses' moral distress, values, and beliefs during palliative care, which is subthemed into three (a) nurses-moral distress and self-reflection during providing palliative care, (b) nurses-moral distress and developing strategies to cope with suffering, (c) nurses-moral distress and living with the grief. The third descriptive theme is nurses' lack of knowledge and educational needs and has one sub-theme (a) nurses' lack of knowledge in relation to lack of experiences. The fourth descriptive is nurses' attitudes in relation to cultural and religious considerations. The fifth descriptive theme is quality of life-enhancing nursing practices and has one sub-theme: nurses’ practice and enhance nursing practice by making memories. The sixth descriptive theme is nurses' perceived barriers to providing quality palliative care and their attitude toward death. Four analytical themes emerged: write more (a) Memories, (b) Balance, (c) Navigating (d) Trust.