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Why Is End-of-Life Care Delivery Sporadic?: A Quantitative Look at the Barriers to and Facilitators of Providing End-of-Life Care in the Neonatal Intensive Care Unit

Wright, Valerie MSN, RN; Prasun, Marilyn A. PhD, CCNS, FAHA; Hilgenberg, Cheryl EdD, RN, CTN-A, CNE

Section Editor(s): Catlin, Anita

doi: 10.1097/ANC.0b013e3182085642
Ethical Issues in Newborn Care

PURPOSE: According to the Centers for Disease Control and Prevention Infant Mortality Statistics, 28 384 infants died in the United States in 2005. On examining the state of the science in providing end-of-life care for newborns, it is important to examine the practice of providing compassionate and dignified palliative care at the end of life. The purpose of this research study was to examine the barriers to and facilitators of providing a quality end-of-life care in one large Midwestern tertiary NICU.

SUBJECTS: A convenience sample of 50 NICU registered nurses from a Level III Midwestern Facility participated.

METHODS: A quantitative, prospective, cross-sectional design was used. Data were collected with the Neonatal Palliative Care Attitude Scale questionnaire.

RESULTS: Five barriers and 8 facilitators to end-of-life care practice in the NICU were identified. The 5 barriers were the nurses' inability to express opinions values and beliefs regarding palliative care (M = 2.98, SD = 1.30), less than ideal physical environment (M = 2.70, SD = 1.31), technological imperatives (M = 3.22, SD = 1.11), parental demands (M = 3.46, SD = 1.07), and, finally, lack of education (M = 2.86, SD = 1.44). The 8 facilitators were supportive medical staff (M = 3.60, SD = 1.29), parental involvement of decisions (M = 3.76, SD = 1.17), parents informed of options (M = 3.32, SD = 1.22), support from medical team when palliative care is implemented (M = 3.20, SD = 1.28), staffing (M = 3.60, SD = 1.29), time spent with dying baby (M = 3.52, SD = 1.31), policies/guidelines supporting palliative care (M = 3.76, SD = 1.19), and available counseling (M = 3.566, SD = 1.26).

CONCLUSIONS: Barriers and facilitators continue to exist within neonatal end-of-life care. There is significant importance for NICU nurses to recognize and understand the barriers to and facilitators of providing end-of-life care within their specific unit. Further research is warranted regarding implementation of end-of-life care education in the NICU to improve patient care.

NICU, Carle Foundation Hospital, Urbana, Illinois (Mrs Wright); and School of Nursing, Millikin University, Decatur, Illinois (Drs Prasun and Hilgenberg).

Correspondence: Valerie Wright, MSN, RN, 1410 E Amy Dr, Mahomet, IL 61853 (

© 2011 by The National Association of Neonatal Nurses