Background. Nurses who provide end of life and bereavement care to neonates and their families are potentially at risk for developing stress-related health problems. These health problems can negatively affect nurses’ ability to care for their patients. Purpose. Nurses need to be knowledgeable about end of life and bereavement issues to provide quality care. This study sought to evaluate the effect of a bereavement seminar on the attitudes of nurses regarding end of life and palliative care of neonates. Design. A convenience sample of fourteen neonatal nurses completed a Bereavement/End of Life Attitudes about Care of Neonatal Nurses Scale after a bereavement seminar designed to provide information on end of life care. A pre- and posttest design with an intervention and control group was used to assess changes in nurse bereavement attitudes in relationship to comfort, role, and involvement. Results. After bereavement seminar, the seminar attendees had higher levels of comfort in providing end of life care than nurses in the control group ( ; = 0.04). Discussion. Nurses' comfort levels can be improved by attending continuing education on end of life care and having their thoughts on ethical issues in end of life care acknowledged by their peers. 1. Introduction Nurses who provide end of life and bereavement care to infants and their families are potentially at great risk for developing stress-related health problems. The emotional strain associated with end of life and bereavement care not only affects a nurse’s health but can also affect relationships at home and with coworkers. The stress experienced by a nurse can even affect the quality of care provided to patients and parents [1, 2]. Moral distress is recognized as one of the major sources of stress for nurses who provide end of life care to infants. Factors that induce moral distress in nurses can result from providing care to infants who have withdrawal of treatment followed by death or extending futile treatment that induces unnecessary suffering [3]. There has been an increase in the proportion of deaths associated with decisions to forgo intensive care treatment from 23% in 1987 to 1988 to 64% in 1998 to 1999 [4]. More than half of neonatal deaths are associated with withdrawal of treatment [5], and treatment-related stressors to health care professionals have no doubt increased over the years as a result of advanced treatment options [6, 7]. Nurses need to be knowledgeable about bereavement and end of life issues and need to be comfortable in their interactions in order to provide quality
References
[1]
M. C. Corley and P. Minick, “Moral distress or moral comfort,” Bioethics Forum, vol. 18, no. 1-2, pp. 7–14, 2002.
[2]
B. M. Yam, J. C. Rossiter, and K. Y. Cheung, “Caring for dying infants: experiences of neonatal intensive care nurses in Hong Kong,” Journal of Clinical Nursing, vol. 10, no. 5, pp. 651–659, 2001.
[3]
G. Gale and A. Brooks, “Implementing a palliative care program in a newborn intensive care unit,” Advances in Neonatal Care, vol. 6, no. 1, pp. 37–53, 2006.
[4]
C. M. Hagen and T. W. Hansen, “Deaths in a neonatal intensive care unit: a 10-year perspective,” Pediatric Critical Care Medicine, vol. 5, no. 5, pp. 463–468, 2004.
[5]
D. J. Wilkinson, J. J. Fitzsimons, P. A. Dargaville et al., “Death in the neonatal intensive care unit: changing patterns of end of life care over two decades,” Archives of Disease in Childhood, vol. 91, no. 4, pp. F268–F271, 2006.
[6]
C. A. Fajardo, S. Gonzalez, G. Zambosco, et al., “End of life, death and dying in neonatal intensive care units in Latin America,” Acta Paediatrica, vol. 101, no. 6, pp. 609–613, 2012.
[7]
W. Meadow, “End-of-life: death and dying in neonatal intensive care units-a North American perspective,” Acta Paediatrica, vol. 101, no. 6, pp. 550–551, 2012.
[8]
M. F. Chan, F. L. Lou, F. L. Cao, P. Li, L. Liu, and L. H. Wu, “Investigating factors associated with nurses' attitudes towards perinatal bereavement care: a study in Shandong and Hong Kong,” Journal of Clinical Nursing, vol. 18, no. 16, pp. 2344–2354, 2009.
[9]
C. Moon Fai and D. Gordon Arthur, “Nurses' attitudes towards perinatal bereavement care,” Journal of Advanced Nursing, vol. 65, no. 12, pp. 2532–2541, 2009.
[10]
C. H. Rushton, B. D. Kaylor, and M. Christopher, “Twenty years since Cruzan and the patient self-determination act: opportunities for improving care at the end of life in critical care settings,” AACN Advanced Critical Care, vol. 23, no. 1, pp. 99–106, 2012.
[11]
American Academy of Pediatrics, “American academy of pediatrics. Committee on bioethics and committee on hospital care. Palliative care for children,” Pediatrics, vol. 106, no. 2, part 1, pp. 351–357, 2000.
[12]
B. Davies, S. A. Sehring, J. C. Partridge et al., “Barriers to palliative care for children: perceptions of pediatric health care providers,” Pediatrics, vol. 121, no. 2, pp. 282–288, 2008.
[13]
M. F. Chan, L. H. Wu, M. C. Day, and S. H. Chan, “Attitudes of nurses toward perinatal bereavement: findings from a study in Hong Kong,” Journal of Perinatal and Neonatal Nursing, vol. 19, no. 3, pp. 240–252, 2005.
[14]
B. Ferrell, M. Grant, and R. Virani, “Nurses urged to address improved end-of-life care in textbooks,” Oncology Nursing Forum, vol. 28, no. 9, p. 1349, 2001.
[15]
J. M. Fredrickson, W. Bauer, D. Arellano, and M. Davidson, “Emergency nurses' perceived knowledge and comfort levels regarding pediatric patients,” Journal of Emergency Nursing, vol. 20, no. 1, pp. 13–17, 1994.
[16]
C. H. Rushton, “Principled moral outrage: an antidote to moral distress?” AACN Advanced Critical Care, vol. 24, no. 1, pp. 82–89, 2013.
[17]
K. J. Gold, “Navigating care after a baby dies: a systematic review of parent experiences with health providers,” Journal of Perinatology, vol. 27, no. 4, pp. 230–237, 2007.
[18]
A. E. Kopelman, “Understanding, avoiding, and resolving end-of-life conflicts in the NICU,” Mount Sinai Journal of Medicine, vol. 73, no. 3, pp. 580–586, 2006.
[19]
C. Hammerman, E. Kornbluth, O. Lavie, P. Zadka, Y. Aboulafia, and A. I. Eidelman, “Decision-making in the critically ill neonate: cultural background v individual life experiences,” Journal of Medical Ethics, vol. 23, no. 3, pp. 164–169, 1997.
[20]
K. L. Moseley, A. Church, B. Hempel, H. Yuan, S. D. Goold, and G. L. Freed, “End-of-life choices for African-American and white infants in a neonatal intensive-care unit: a pilot study,” Journal of the National Medical Association, vol. 96, no. 7, pp. 933–937, 2004.
[21]
A. J. Engler, R. M. Cusson, R. T. Brockett et al., “Neonatal staff and advanced practice nurses' perceptions of bereavement/end-of-life care of families of critically ill and/or dying infants,” American Journal of Critical Care, vol. 13, no. 6, pp. 489–498, 2004.
