Italian Nurses’ Attitudes Towards Neonatal Palliative Care: A Cross‐Sectional Survey

Abstract

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.

Barriers to and Facilitators of Neonatal Palliative Care Among Neonatal Professionals in China

“…Five barriers emerged from this study: (1) discomfort with the use of technological life support; (2) parental demands; (3) a sense of personal failure when a baby dies; (4) a sense of personal trauma when caring for dying babies; (5) the belief that curative care is more important than palliative care in the NICU. These findings are likely consistent with previous studies in Australia, Taiwan, Iran, and in the U.S. [9][10][11][12][13][14][15][16] In this research population, Facilitator 1 and Barrier 5 are clearly contradictory. Participating clinicians strongly agreed that palliative care is as important as curative care in the neonatal environment (Item 1), yet they also somewhat agreed that "in the NICU, curative care is more important than palliative care."…”

“…This result was likely similar to previous studies. 9,11,12,16 The findings revealed that neonatal clinicians were uncomfortable with using advanced technology to prolong the lives of critically ill neonates and with parental demands for such care. Moreover, the majority reported personal feelings of failure at the death of babies (Item 3) and feelings of trauma when caring for dying babies (Item 17), highlighting the moral anxiety and distress felt by clinicians caring for dying or untreatable neonates.…”

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

“…Cerratti et al also found that people involved in palliative care for infants are more likely to experience emotional and moral distress and that their attitudes toward end-of-life care can greatly affect their ability to adapt to this situation. Italian nurses experience many ethical dilemmas regarding palliative care (9). In a qualitative study, ethics, beliefs, and values were found as important factors in providing quality palliative care.…”

“…Nurses who are involved in infant and family palliative care experience many psychological problems, and thus, they need to be supported to maintain their health. For palliative care for infants, nurses who are constantly exposed to work-related emotional distress in end-of-life care require more support (9). Employee support can help reduce emotional stress.…”

“…The goal of end-of-life care is to prevent infant pain and provide support for the parents and involve them in decision-making for infant care. Palliative care decisions should involve physicians, nurses, parents, and the team that should support the family after the infant dies (9).…”