Facilitators and Barriers Affecting Implementation of Neonatal Palliative Care by Nurses in Mainland China

Abstract

Neonatal nurses in mainland China encounter various challenges when it comes to delivering palliative care to neonates. The aim of this study was to determine the barriers and facilitators of neonatal nurses' attitudes to palliative care for neonates in mainland China. A simplified Chinese version of the Neonatal Palliative Care Attitude Scale was piloted, administered, and analyzed using survey methods. Nurses in neonatal intensive care units in mainland China regardless of experience in the field were invited to take part in. Over a five-month period in 2019, we surveyed neonatal nurses from 40 hospitals in five provinces of China. The response rate was 92.5% (N = 550). This study identified eight facilitators and four barriers to neonatal palliative care implementation. In terms of nurses' attitudes on providing palliative care, younger and older nurses were more positive, whereas middle-aged nurses were less so. Nurses' emotional wellbeing was rarely impacted by neonatal death. They considered neonatal palliative care, particularly pain management, to be just as important as curative treatment. Parents were invited to participate in decision-making by nurses. Nurses reported having access to professional counseling and talking about their concerns with other healthcare professionals. The following barriers to neonatal palliative care were identified in this study that were not observed in the original English version scale research in 2009: a lack of clinicians, time, clinical skills, systematic education, neonatal palliative care experience, and social acceptance. Future research is required to investigate each barrier in order to improve the implementation of neonatal palliative care in mainland China.

Development of the Simplified Chinese version of neonatal palliative care attitude scale

“…Nurses working in tertiary hospitals accounted for 86% ( n = 473), secondary hospitals 9.8% ( n = 54), and primary, private or other hospitals 4.2% ( n = 23). Table 1 summarizes the demographic characteristics of the participants ( 41 ).…”

Knowledge, attitudes and practices of critical care unit personnel regarding pediatric palliative care: a cross-sectional study

“…The Butterfly House at Changsha First Social Welfare Institute was the first hospice center for children to be built in China, and Daisy House in Beijing Songtang Hospital is the only family-type pediatric palliative care center in China. In addition to the limited number of specialized centers, it is recognized that there are various barriers to palliative care among medical personnel in China [ 18 , 19 ]. However, few studies have evaluated the perceptions of healthcare providers in China regarding pediatric palliative care, particularly in critical care units (PICUs), where many children receive palliative care [ 20 ].…”

Nurses' and midwives' perceptions and strategies to cope with perinatal death situations: A systematic literature review

“…It can occur in maternity units or in Perinatal Hospice (PH) units. There exist various forms of PH or Neonatal Palliative Care (NPC) (Flaig et al, 2019;Kain& Chin, 2020;Miller et al, 2014) across the world, in which nursing care is also provided.Although these units are not equally well known or similarly widespread (Cerratti et al, 2020;Gruszka et al, 2019;Zhong et al, 2022), nurses and midwives who work in such units are required to deal with stillbirth and perinatal death more often than in a common maternity unit. Often located in NICUs, these programmes and units have proved to be very useful (with psychological benefits) for both families and professionals (Dahò, 2021).…”