Abstract
BackgroundNeonatology has made significant advances in the last 30 years. Despite the advances in treatments, not all neonates survive and a palliative care model is required within the neonatal context. Previous research has focused on the barriers of palliative care provision. A holistic approach to enhancing palliative care provision should include identifying both facilitators and barriers. A strengths-based approach would allow barriers to be addressed while also enhancing facilitators. The current study qualitatively explored perceptions of neonatal nurses about facilitators and barriers to delivery of palliative care and also the impact of the regional location of the unit.MethodsThe study was conducted at the Townsville Hospital, which is the only regional tertiary neonatal unit in Australia. Semi-structured interviews were conducted with a purposive sample of eight neonatal nurses. Thematic analysis of the data was conducted within a phenomenological framework.ResultsSix themes emerged regarding family support and staff factors that were perceived to support the provision of palliative care of a high quality. Staff factors included leadership, clinical knowledge, and morals, values, and beliefs. Family support factors included emotional support, communication, and practices within the unit. Five themes emerged from the data that were perceived to be barriers to providing quality palliative care. Staff perceived education, lack of privacy, isolation, staff characteristics and systemic (policy, and procedure) factors to impact upon palliative care provision. The regional location of the unit also presented unique facilitators and barriers to care.ConclusionsThis study identified and explored facilitators and barriers in the delivery of quality palliative care for neonates in a regional tertiary setting. Themes identified suggested that a strengths-approach, which engages and amplifies facilitating factors while identified barriers are addressed or minimized, would be successful in supporting quality palliative care provision in the neonatal care setting. Study findings will be used to inform clinical education and practice.
Highlights
Neonatology has made significant advances in the last 30 years
Results are presented within a framework of the facilitators and barriers of quality palliative care, followed by the effects of regional location and culture on palliative care
Facilitators of good care Six themes were identified regarding family support and staff factors that were perceived to support the provision of quality palliative care
Summary
Despite the advances in treatments, not all neonates survive and a palliative care model is required within the neonatal context. A holistic approach to enhancing palliative care provision should include identifying both facilitators and barriers. Despite the advances in treatments, not all neonates survive and a palliative care model is Kilcullen and Ireland BMC Palliative Care (2017) 16:32. The aims of palliative care in the neonatal context are to prevent and relieve pain and suffering of neonates and provide support for families. Such care includes planning with the family about the practicalities of the death and continuing family support after the baby dies [6, 7]. The basic elements for palliative care include the need for warmth, dignity, human contact and pain relief for the neonate and neonatal nurses are at the forefront of such care in the neonatal unit
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