Facilitators and Barriers for Delivery of Palliative Care Practices among Nurses in Neonatal Intensive Care Unit

International Journal of Nursing and Health Science
© 2020 by SSRG - IJNHS Journal
Volume 6 Issue 1
Year of Publication : 2020
Authors : Maysa Saber Mohamed Ismail, Ebtsam S. Mahrous, Rodaina Ahmed Mokbel
How to Cite?

Maysa Saber Mohamed Ismail, Ebtsam S. Mahrous, Rodaina Ahmed Mokbel, "Facilitators and Barriers for Delivery of Palliative Care Practices among Nurses in Neonatal Intensive Care Unit," SSRG International Journal of Nursing and Health Science, vol. 6,  no. 1, pp. 17-27, 2020. Crossref, https://doi.org/10.14445/24547484/IJNHS-V6I1P103


A. Background: Neonatology has made significant advances in the last 30 years. Despite the advances in treatment, not all neonates survive, and a palliative care model is required within the neonatal context. Palliative care is an approach by which healthcare providers support both dying neonates and their families to improve their quality of life.
B. Aim: This study aimed to identify the facilitators and barriers to delivering palliative care practices among nurses in the neonatal intensive care unit.
C. Design: A descriptive correlational study design was adopted to carry out this study. Setting: the study was conducted at the Neonatal Intensive Care Unit (NICU) at Alexandria University Children's Hospital (AUCH) in El Shatby.
D. Subjects: The total number of the purposively selected nurses was 130 worked at neonatal intensive care unit Tools: data were collected using two tools; tool (I) entitled Nurses’ Knowledge Structured Questionnaire about Palliative care: tool (II) Neonatal Palliative Care Attitude Scale (NIPCAS).
E. Results: Detected that 62% of the studied nurses had a moderate level of barriers to palliative care, and 22% of them had a high level, while 16% of them had a low level. In addition to this, it was observed that there was a highly positive correlation between insufficient resources and technology, personal & social attitude, and organizational culture. According to the linear regression model, it was observed that there was a significantly higher frequencies effect of gender and professional degree as predictors on palliative care (p = <0.01). At the same time, religion was not predicted by relation to palliative care (p = 0.065).
F. Recommendations: Neonatal nurses should have adequate training regarding the delivery of palliative care. In addition, standard palliative care guidelines should be available at the NICU to assist in delivering such care.


Neonatal, Palliative care, Nurses, Intensive care unit, Barriers, facilitators.


[1] Price J, Mendizabal R. Juggling amidst complexity' – Hospice staff's experience in providing palliative care for infants referred from a neonatal unit. Journal of Neonatal Nursing., 25(4) (2019) 189-193.
[2] Ghoshal A, Damani A, Muckaden M. Palliative care in the neonatal intensive care unit: An Indian experience. Journal of Neonatal Nursing.,23(2) (2017) 75-81.
[3] Word Health Organization. Media Centre. Preterm birth.Fact sheet. Geneva: World Health Organization; Available from: www.who.int/news-room/fact-sheets/details/preterm-birth., (2018).
[4] Voyles E.The development and outcomes of a pediatric palliative care program: A quality improvement process. Journal of Pediatric Nursing. 28(2) (2013) 196-199.
[5] American Academy of Pediatrics.Committee on Bioethics and Committee on Hospital Care.Palliative care for children.Pediatrics., 106(2 pt 1) (2000) 351–357.
[6] Catlin A, Carter B.Creation of a neonatal-end-of-life palliative care protocol. Journal of Perinatology., 22 (2002) 184–195.
[7] Gale G, Brooks A. Implementing a palliative care program in a newborn intensive care unit. Advances in Neonatal Care. 6 (1) (2006) 37–53.
[8] National Association of Neonatal Nurses (USA) (NANN) Palliative and End-of-Life Care for Newborns and Infants, (2015).
[9] International Council of Nurses. The Global Nursing Shortage: Priority Areas for Intervention. A Report from ICN/FNIF. (2006). Available from: www.who.int/workforcealliance/knowledge/resources/icn_nursesretention/en/
[10] End of Life Nursing Education Consortium (ELNEC). Fact Sheet., (2017). Available from https://www.aacnnursing.org
[11] Catlin A, Brandon D, Wool C, Mendes J. Palliative and end-of-life care for newborns and infants: From the National Association of Neonatal Nurses.Advances in Neonatal Care. 15(4) (2015) 239-40.
[12] Kenner C. The Role of Neonatal Nurses in Palliative Care. Newborn and Infant Nursing Reviews., 16(2) (2016) 74-77.
[13] Kain V, Gardner G, Yates P. Neonatal palliative care attitude scale: development of an instrument to measure the barriers to and facilitators of palliative care in neonatal nursing. Pediatrics., 123(2) (2009) e207-e213.
[14] Chen CH, Huang LC, Liu HL, Lee HY, Wu SY, Chang YC, Peng NH. To explore the neonatal nurses’ beliefs and attitudes towards caring for dying neonates in Taiwan. Maternal and Child Health Journal., 17(10) (2013) 1793-1801.
[15] Kain VJ.A pilot study of an instrument to measure attitudes to palliative care practice in neonatal intensive care nursing.Collegian., 14(4) (2007) 16-20.
[16] Abdel Razeq, NM. Physicians’ standpoints on end-of-life decisions at the neonatal intensive care units in Jordan. Journal of Child Health Care., 23(4) (2019) 579-595.
[17] Zaki A, El-Sayed E, Said K, Ali R. Assessment of nurses' performance regarding care for neonates with necrotizing enterocolitis at intensive care units. Egyptian Journal of Health Care. 9(3) (2018) 111-124.
[18] Ali RA, Obeisat SM, Tarawneh LH. Improving nursing knowledge and care for neonates with respiratory distress in Jordan. International nursing review. 66(3) (2019) 338-345.
[19] Peng NH, Liu HF, Wang TM., Chang YC, Lee HY, Liang HF. Evaluation of comfort and confidence of neonatal clinicians in providing palliative care. Journal of palliative medicine. 2018; 21(11), 1558-1565.
[20] Abdel Razeq, NM. End-of-life decisions at neonatal intensive care units: Jordanian nurses' attitudes and viewpoints of who, when, and how. Journal of pediatric nursing. 2019; 44: e36-e44.
[21] Kilcullen M, Ireland S. Palliative care in the neonatal unit: neonatal nursing staff perceptions of facilitators and barriers in a regional tertiary nursery. BMC palliative care. 16(32) (2017) 1-12.
[22] Forouzi A, Banazadeh M, Ahmadi JS, Razban F. Barriers of palliative care in neonatal intensive care units. American Journal of Hospice and Palliative Medicine., 34(3) (2017) 205-211.
[23] KycSJ, Bruno CJ, Shabanova V, Montgomery AM. Perceptions of Neonatal Palliative Care: Similarities and Differences between Medical and Nursing Staff in a Level IV Neonatal Intensive Care Unit. Journal of Palliative Medicine.2019; Doi:10.1089/jpm.2019.0523
[24] Davies B. Sehring SA, Partridge JC, Cooper BA, Hughes A, Philip JC, Amidi-Nouri A, Kramer RF. Barriers to palliative care for children: perceptions of pediatric health care providers. Pediatrics., 121(2) (2008) 282-288.
[25] Dombrecht L, Piette V, Deliens L, Cools F, Chambaere K, Goossens L, Naulaers G, Cornette L, Beernaert K, Cohen J. Barriers to and facilitators of end-of-life decision making by
neonatologists and neonatal nurses in neonates: A qualitative study. Journal of Pain and symptom management., (2019) doi:10.1016/j.jpainsymman.2019.10.007
[26] Kim S, Savage TA, Song MK, Vincent C, Park, CG, Ferrans CE, Kavanaugh K. Nurses' roles and challenges in providing end-of-life care in neonatal intensive care units South Korea. Applied Nursing Research. (2019) 50: 151204.
[27] Dombrecht L, Cohen J, Cools F, Deliens L, Goossens L, Naulaers G, Chambaere K. Psychological support in end-of-life decision-making in neonatal intensive care units: Full population survey among neonatologists and neonatal nurses. Palliative medicine. (2019) doi:10.1177/0269216319888986.
[28] Cortegiani A, Russotto V, Raineri SM, Gregoretti C, Giarratano A, Mercadante S. Attitudes towards end-of-life issues in the intensive care unit among Italian anesthesiologists: a nationwide survey. Supportive Care in Cancer., 26(6) (2018) 1773-1780.
[29] Ke YX, Hu SH, Takemura N, Lin CC. Perceived quality of palliative care in intensive care units among doctors and nurses in Taiwan. International Journal for Quality in Health Care. (2019) doi: 10.1093/intqhc/mzz003.
[30] Park JY, Oh J. Influence of perceptions of death, end-of-life care stress, and emotional intelligence on attitudes towards end-of-life care among nurses in the neonatal intensive care unit. Child Health Nursing Research., 25(1) (2019) 38-47.
[31] Al-Hajery M, Al-Mutairi H, Ayed A, Ayed MK. Perception, knowledge, and barriers to end of life palliative care among neonatal and pediatric intensive care physicians. Journal of Palliative Care and Medicine. 8(1) (2018) 326.
[32] Ganz FD, Sapir B. Nurses' perceptions of intensive care unit palliative care at the end of life. Nursing in critical care. 24(3) (2019) 141-148.
[33] Quinn M, Gephart S. Evidence for implementation strategies to provide palliative care in the neonatal intensive care unit. Advances in Neonatal Care., 16(6) (2016) 430-438.
[34] Keslant DO, Tucker M, Linebarger J. A unique model for palliative care in a level IV neonatal intensive care unit.Nursing in critical care., 19(4) (2019) 55-63.
[35] Marc-Aurele KL, English NK. Primary palliative care in neonatal intensive care.Seminars in perinatology., 41(2) (2017) 133-139.