Neonatal Intensive Care Unit Nurses Research Articles

Nurses' Assessment of Pain in Saudi Neonatal Intensive Care Units

BackgroundResearch reveals that neonatal pain management in Neonatal Intensive Care Units (NICUs) is suboptimal. There is limited research that assessed NICU nurses’ pain assessment practices in Saudi Arabia. AimTo assess the nurses’ pain assessment practices in the NICU in Saudi Arabia. DesignThis study used a descriptive cross-sectional design. SettingsResearch was conducted using an online survey. Participants/SubjectsThis study was carried out on 65 NICU nurses. The participants were recruited from one governmental and one private hospital in Saudi Arabia. MethodsData on pain assessment practices were collected, including the frequency of pain assessment, pain assessment scales used for preterm and term neonates, and pain assessment documentation. Data were analyzed using frequencies and percentages. ResultsThe majority of the participants (94%) routinely assessed pain and documented pain assessment (97%). One-third of the participants assessed pain regularly every hour (32%). The most used pain assessment scales for term neonates were the neonatal infant pain scale (40%) and the cry, required oxygen, increased vital signs, expression, and sleeplessness scale (23%). The most used pain assessment scales for preterm neonates were the neonatal infant pain scale (31%), the cry, required oxygen, increased vital signs, expression, sleeplessness scale (19%), and the premature infant pain profile (17%). ConclusionsNICU nurses in Saudi Arabia consistently assessed for and documented pain; however, the tools chosen were sometimes suboptimal. A substantial number of NICU nurses used invalid tools to assess pain in term and preterm neonates. An interventional program is needed to enhance the use of evidence-based practice recommendations regarding neonatal pain assessment by nurses in the Neonatal Intensive Care Units in Saudi Arabia.

Ecological predictors of cultural competence among nurses in the neonatal intensive care unit: A cross-sectional descriptive study.

Active migration and globalization have led to increased opportunities for critical care nurses to care for patients from diverse racial and cultural backgrounds. This study thus aimed to identify the individual, interpersonal, and organizational factors affecting cultural competence levels among neonatal intensive care unit (NICU) nurses based on an ecological model. This was a cross-sectional descriptive study that included 135 NICU nurses in South Korea. A hierarchical multiple linear regression analysis was conducted using the proposed ecological model, and a regression model for each of the four subdomains of cultural competence was constructed and compared. NICU nurses' cultural competencies were influenced not only by the "necessity of multicultural education" and "ethnocultural empathy" at the individual level but by the "hospital's readiness and support for cultural competencies" at the organizational level. To promote the cultural competence of nurses in critical care settings, environmental and organizational support should be improved, along with developing strategies that focus on nurses' individual characteristics. It is also necessary to investigate the "intersectionality" of the effects of individual and environmental factors on cultural competence.

Compassionate Care: Listening Visits Provided by Neonatal Intensive Care Unit Nurses.

Although mothers of infants hospitalized in a neonatal intensive care unit (NICU) often experience clinically significant levels of depression symptoms, accessing mental-health treatment may be difficult. NICU mothers need emotional support that is conveniently delivered at the infant's point-of-care by a trusted professional who is knowledgeable about the medical and nursing care in the NICU. Listening Visits are an effective and accessible, nurse-delivered depression intervention, yet little is known about what mothers discuss during these sessions. This analysis of sessions recorded during the randomized controlled trial evaluation of Listening Visits in the NICU provides a glimpse into NICU mothers' concerns and experiences. This is a secondary, qualitative case analysis of the recorded Listening Visits sessions of four depressed NICU mothers as indicated by a score of 12 or above on the Edinburgh Postnatal Depression Scale. The mothers, who were all White, varied in their economic resources, educational level, availability of support, and infant illness severity. Mothers discussed similar concerns and experiences, often at analogous temporal points in the six Listening Visit sessions, as well as one common concern they voiced throughout: family and friends do not understand what it is like to have an infant in the NICU. For mildly to moderately depressed mothers of infants hospitalized in the NICU, Listening Visits provide a way for bedside nurses to deliver compassionate care by listening to mothers' concerns and experiences.

Neonatal Intensive Care Nurses' Knowledge of Neonatal Pain Assessment in Private and Public Hospitals in Jeddah, Saudi Arabia: A Cross-Sectional Study.

Neonatal Intensive Care Unit (NICU) nurses with adequate neonatal pain assessment knowledge are crucial in effective neonatal pain management. There is limited research that assessed the knowledge of NICU nurses in Saudi Arabia regarding neonatal pain assessment. To assess the knowledge of NICU nurses in Saudi Arabia regarding neonatal pain assessment. A cross-sectional design using an online survey was conducted to capture information regarding neonatal pain assessment knowledge from 125 NICU nurses in Saudi Arabia. Knowledge of pain assessment was assessed using a modified version of the knowledge, attitudes, and practice scale. Knowledge scores were classified as high, average, and low. Participants' knowledge regarding neonatal pain assessment was inadequate (Mean = 63/100). The majority of the participants had a low to average level of knowledge (n= 97, 78%). A significant proportion of NICU nurses had inadequate knowledge regarding neonatal pain assessment, which can be improved. Educational interventions are needed to boost these nurses' knowledge regarding neonatal pain assessment.

Study on the Effect of Early Oral Motor Intervention in Preterm Infants in Neonatal Intensive Care Unit

Objective: To study the effective value of introducing the concept of early oral exercise in the process of nursing intervention for preterm infants in the neonatal intensive care unit (NICU). Methods: 96 cases of preterm infants diagnosed from January 2022 to August 2022 were selected and randomly divided into two groups: the general practice group (general nursing intervention), and the early practice group (early oral exercise intervention), and the effect of intervention on preterm infants in the two groups was observed. Results: After nursing care, the mean value of the non-nutritive sucking ability assessment (76.54 ± 5.82), the mean value of the intellectual development degree assessment (104.57 ± 8.45), the mean value of the psychomotor development degree assessment (102.33 ± 6.74), and the mean value of behavioral neural reflexes ability assessment (38.71 ± 2.40) in the early practice group were better than that as compared to the general practice group (P < 0.05); the mean value of oral feeding start time of preterm infants in the early practice group (35.42 ± 7.63) weeks, the mean value of all oral feeding time (34.12 ± 5.28) weeks, and the mean time of hospital intervention (15.33 ± 4.25) days were lesser than compared to those of the general practice group at 37.4 ± 5.82 weeks, 37.46 ± 3.55 weeks, and 20.46 ± 2.91 days, respectively (P < 0.05); the rate of adverse reactions in preterm infants in the early practice group significantly lower than that of the general practice group (P < 0.05). Conclusion: The introduction of the concept of early oral exercise intervention among NICU nurses improved the feeding effect, sucking ability of preterm infants, and intellectual development. Hence, early oral motor care should be popularized.

Support for the Right to Life among Neonatal Intensive Care Nurses in Korea.

The increase of high-risk newborns due to societal changes has presented neonatal intensive care unit nurses with more ethical challenges and heightened their perception of neonatal palliative care. Therefore, this study was a descriptive survey exploring the perceptions of neonatal intensive care unit nurse regarding biomedical ethics and neonatal palliative care in neonatal intensive care units. The research participants were 97 neonatal intensive care unit nurses who had been directly involved with end-of-life care for high-risk babies. Data were collected from November to December 2021 through an online survey. The Korean version of Neonatal Palliative Care Attitude Scale and the tool of biomedical ethics were used. The collected data were analyzed using the T-test, ANOVA, Scheffé test, Pearson correlation coefficient, and multiple regression analysis. The mean score for perception of biomedical ethics in neonatal intensive care unit nurses was 2.89 of 4, and that of neonatal palliative care in neonatal intensive care unit nurses was 3.10 of 5. Existence of a protocol of neonatal palliative care, the experience of patients dying, and the right to life of neonates were factors influencing the perception of neonatal palliative care. The explanatory power was 12.5%. The data support the importance of guidelines regarding systematic neonatal palliative care. Also, developing programs for sharing and supporting experiences of patients dying among colleagues and persistent education about the right to life of neonates for neonatal intensive care unit nurses can improve perception of neonatal palliative care.

Nurses' Job Burnout and Resilience in Neonatal Intensive Care Units.

To assess the relationship between job burnout and resilience among nurses working in neonatal intensive care units (NICUs) in Oman. NICUs induce a significant amount of stress that predisposes nurses to a substantial degree of burnout. Resilience can play a role in reducing the effects of job burnout. A limited number of studies have examined job burnout and resilience among NICU nurses. A cross-sectional survey design was utilized. The Maslach Burnout Inventory was used to assess burnout, and the Brief Resilience Scale was used to assess perceptions of resilience. Pearson correlation was used to assess the relationship between job burnout and resilience. A total of 173 staff nurses participated. Participants reported low levels of emotional exhaustion and depersonalization but moderate levels on the personal accomplishment subscale. Nurses reported moderate levels of resilience. Emotional exhaustion and depersonalization were negatively correlated with resilience, while personal accomplishment was positively correlated with resilience. This study demonstrated that enhancing resilience can reduce the effect of burnout among NICU nurses. Enhancing levels of resilience among NICU nurses, in addition to providing adequate managerial support and good collegial relations, is essential to reduce their perceived job burnout.

Being a "Good Parent" to a NICU Infant With a Major Congenital Anomaly.

In the United States, up to one-third of infants with a congenital anomaly require neonatal intensive care unit (NICU) hospitalization. Parents of these infants may have different decision-making priorities, which may be influenced by the timing of the infant's diagnosis. (1) To compare the ranked importance of decision-making beliefs for parents of infants who received a prenatal versus postnatal congenital diagnosis and (2) explore how parents describe their decision-making beliefs. A cross-sectional, sequential mixed-methods pilot design was applied to collect quantitative data using the Good Parent Ranking Exercise and further explore parents' decision-making beliefs through qualitative interviews. Maximum difference scaling/hierarchical Bayes estimation and content analysis were used to analyze the quantitative and qualitative data, respectively. Forty mothers completed the Good Parent Ranking Exercise and 20 mothers completed qualitative interviews. Four of the top 5 ranked parenting beliefs were shared by mothers in the prenatal and postnatal groups. Mothers in the postnatal group ranked "focusing on my child's quality of life" higher. Qualitative interviews revealed that previously identified decision-making beliefs were consistent in this NICU parent population, with 1 additional belief identified. Mixed-methods analysis revealed high concordance between the prenatal and postnatal groups. NICU nurses need to know that decision-making beliefs for parents who receive a prenatal versus postnatal congenital diagnosis, while largely similar, may have differences. Future research should explore decision-making beliefs in demographically diverse parent groups (ie, fathers, partnered vs nonpartnered couples) and effective strategies for promoting NICU parents' decision-making beliefs.

Development of a Protocol for the Direct Breastfeeding of Premature Infants in Neonatal Intensive Care Units.

This study aimed to develop a direct breastfeeding protocol for premature infants admitted to neonatal intensive care units (NICUs) and investigate its efficacy. Direct breastfeeding increases the amount and duration of breastfeeding. However, NICUs have low direct feeding rates owing to medical staff anxiety, lack of knowledge and experience, and fear of overwork. Accordingly, this study developed a protocol for direct breastfeeding in the NICU and evaluated its effect. The protocol was developed through a literature review, expert validation, and preliminary investigation. Its application effects were identified using a nonexperimental, evidence-based research design targeting premature infants, their mothers, and NICU nurses. The protocol comprised 5 areas and 23 items. Application of the protocol resulted in continuous weight gain of the infants and increased self-efficacy in the mothers' direct breastfeeding ( t = 3.219, P = .004). Significant increases were noted in NICU nurses' direct breastfeeding activities ( t = 3.93, P < .001), breastfeeding rates in the NICU ( P = .037), and direct breastfeeding rates ( P = .007). Results underscore the value of an evidence-based protocol for improving breastfeeding rates in premature infants. This study highlights the need for continuous nursing education on protocol applications and human resource support.

Neonatal Intensive Care Unit Nurses' Knowledge and Use of Sucrose for Neonatal Pain Management in Saudi Arabia.

Sucrose is an evidence-based intervention used for short-term pain management and distress from minor procedures. Limited research exists on nurses' knowledge and use of sucrose in Neonatal Intensive Care Units in Saudi Arabia. To assess nurses' knowledge and use of sucrose in Neonatal Intensive Care Units in Saudi Arabia. A cross-sectional online survey was used to collect data from a convenience sample of 68 neonatal intensive care nurses in Saudi Arabia. A modified tool assessed the knowledge and use of sucrose. Logistic regression analysis was used to find the predictors for sucrose use. Most respondents never used sucrose for neonatal pain management and did not receive any training on sucrose. The mean knowledge of nurses regarding sucrose and its use was very low (38%): 16% had a high level of knowledge regarding sucrose, 13% moderate, 19% low, and 52% very low. Nurses who received training on sucrose use and nurses who read or heard about sucrose predicted the use of sucrose. Nurses' knowledge and use of sucrose were inadequate. Interventional programs are needed to enhance the nurses' knowledge regarding sucrose and its use and to enhance the utilization of sucrose as a pain management intervention in the Neonatal Intensive Care Units in Saudi Arabia.

Quality improvement for reducing nasal continuous positive airway pressure related nasal injury in neonatal intensive care unit

To reduce the incidence and severity of nasal injury in nasal continuous positive airway pressure ventilated neonates through a quality improvement project, a quality improvement project has been impleted in a neonatal intensive care unit (NICU) in a Level III hospital. Newborns requiring nasal continuous positive airway pressure (NCPAP) ventilation admitted to the NICU were included in this quality improvement project. A quality improvement team was established and developed guidance applicable to our unit on a standard method for nasal prong wear. Then, all the NICU nurses received a 15-minute uniform training session on nasal prong/mask-wearing standards. In addition, daily clinical inspections were made to give targeted 1-on-1 instruction to those who did not implement the method correctly. The primary outcome measures were the rate of correct nasal prong/mask wear and the incidence rate of neonatal NCPAP-related nasal injury. The secondary outcome measure was the prevalence rate of nasal injury. The quality improvement project was conducted in April 2020 and April 2021. The rate of correct nasal prong/mask wear (78.17% vs. 83.29%, χ2 = 18.660, p &lt; 0.001), the incidence rate of neonatal NCPAP-related nasal injury (18.26% vs. 8.36%, χ2 = 19.674, p &lt; 0.001), and the prevalence rate of nasal injury (27.52% vs. 13.85%, χ2 = 166.299, p &lt; 0.001) all showed statistically significant differences before and after the quality improvement. Standardizing the way in which nasal prongs/masks are worn can reduce the incidence of nasal injury with low costs and relatively high benefits; thus, this approach is worth promoting.

Family-Centered Care Across Thai Neonatal Intensive Care Units

Background: Implementing family-centered care (FCC) presents challenges to parental-healthcare provider partnership and collaboration in newborn care in neonatal intensive care units (NICUs). Aims: To explore NICU nurses' perceptions of FCC (respect, collaboration, and support) during the COVID-19 pandemic and to compare these between nurses working in secondary and tertiary/higher care settings. Methods: A multicenter, cross-sectional exploratory online survey design study was conducted to identify Thai NICU nurses' perceptions. The online survey of the Perceptions of Family-Centered Care—Staff (PFCC-S) was distributed via a Web page and professional networks between July and September 2022. Results: Of the 187 survey respondents, most NICU nurses worked in the NICU for less than 16 years and were employed in tertiary care/higher care settings in southern Thailand. There was a significant difference in perceptions of support subscale between NICU nurses in secondary (mean: 3.32, SD ± 0.53) and tertiary/higher care settings (mean: 3.17, SD ± 0.46) (P &lt; .05). Conclusion: Despite the challenges of the visitation restriction of COVID-19 in Thailand, nurses' perceptions of the value of FCC were maintained. Relevance to Clinical Practice: Further research is recommended to investigate how FCC can be implemented where there is a lack of material and infrastructure resources and staff shortage.

Impact of Quiet Time on Psychological Outcomes of Neonatal Intensive Care Unit Nurses in Jeddah, Saudi Arabia: A Cross-Sectional Study.

Although quiet time is implemented in neonatal intensive care units (NICUs) for the benefit of infants, it may also positively impact the psychological outcomes of healthcare professionals. Several studies have examined the impact of quiet-time implementation on patients; however, there is a paucity of research assessing its impact on the psychological outcomes of NICU nurses, particularly in Saudi Arabia. This study aimed to assess the impact of quiet time on the psychological outcomes (stress, anxiety, and depression) of NICU nurses in Jeddah, Saudi Arabia. A cross-sectional design was used for this study. A total of 87 NICU nurses from two hospitals participated in this study. One group did not practice quiet time, while the second group did. A questionnaire survey assessed participants' demographic characteristics, and their depression, anxiety, and stress were assessed using the depression, anxiety, and stress scale-21 (DASS-21). The data were analyzed for frequency, percentage, mean, and standard deviation (SD). Bivariate analysis, independent t-tests, and one-way analysis of variance were used to test the differences between variables and groups. Pearson's correlation coefficient (r) was used to analyze the relationships between continuous variables and perceived stress, anxiety, and depression. A substantial number of NICU nurses perceived stress, anxiety, and depression; however, there were no significant differences in perceived stress, anxiety, and depression between the nurses who worked in NICUs that applied quiet time and NICUs that did not (P≤ 0.05). This study found no statistically significant relationship between quiet-time implementation and perceived stress, anxiety, or depression among NICU nurses. Further research with a larger sample size or increased quiet-time implementation may be required.

The Effect of Problem Solving Skills Training on Moral Distress of Neonatal Intensive Care Unit Nurses

Introduction: Moral distress is one of the ethical challenges in the nursing profession. Nurses in the neonatal ward are at risk of moral distress most commonly results from disproportionate interventions perceived to not be in the child’s best interests. The aim of this study was to determine the effect of problem-solving skills training on the moral distress of neonatal intensive care unit nurses. Methods: This quasi-experimental study performed on70 nurses working in neonatal intensive care units at Pediatric Medical Center affiliated Tehran University of Medical Sciences from December 2019-June 2020. They were assigned randomly in two equal groups. Corley Ethical Distress Scale Corley was completed before and four weeks after the intervention in two groups. Problem-solving skills training was conducted in (6 sessions of 1.5 hours (2 sessions per week) as a group for the intervention group. Data were analyzed using the software SPSS 22 and tests, chi-square, Fisher's exact, t-test, and paired t-test with significance. 0.5% . Results: The results of comparing the moral distress of nurses working in the neonatal intensive care unit showed that before the intervention, the score of moral distress in the intervention group (150.07 ± 6.87) and in the control group (146.05±6.36) Although before the intervention, the moral distress score of the nurses in the test group was significantly higher than the intervention group P=0.013, but 4 months after the intervention, this score decreased significantly (P &lt;0 01). Conclusion: According to the findings of this study, problem-solving skills improve moral distress in nurses. Therefore, due to the destructive effects of moral distress on the quality of nurses' work, it is suggested that nursing managers develop programs to improve problem solving skills in nurses.

Sustained Effect of Simulation-Based Resuscitation Education on Knowledge, Self-Confidence, and Performance Ability of Neonatal Intensive Care Unit Nurses.

Simulation education is essential for the development of nurses' practical skills. This study evaluated the impact and duration of simulation-based neonatal resuscitation education on the knowledge, self-confidence, and performance ability of neonatal intensive care unit (NICU) nurses. This quasi-experimental study was conducted in South Korea and included 35 NICU nurses working in tertiary hospitals between August and October 2021. Simulation-based neonatal resuscitation education (NRE) was provided for 80 minutes, and its effectiveness was measured in terms of nurses' knowledge, self-confidence, and performance ability. Data collection was conducted before, 1 week after, 3 weeks after, and 5 weeks after the training, and the collected data were calculated and analyzed using a t test and repeated measures analysis of variance. Simulation-based NRE improved knowledge, self-confidence, and performance in neonatal resuscitation. Performance ability showed greater improvement than knowledge or self-confidence, and all three areas showed significant differences in score changes over time. The duration of the training effect should be considered an important factor. [J Contin Educ Nurs. 2024;55(2):79-86.].

Neonatal nurses' educational needs in a family-centered partnership program: Five ways of knowing

BackgroundPartnerships between parents and nurses are essential to provide comprehensive family-centered care (FCC) in the neonatal intensive care unit (NICU). ObjectivesWe aimed to identify the educational needs of neonatal nurses to develop a family-centered partnership program with parents based on five ways of knowing. DesignWe conducted focus group interviews with 18 NICU nurses working at a tertiary hospital. Data were analyzed using inductive content analysis. MethodData were collected from February to March 2023 through semi-structured interviews and then carefully transcribed and analyzed using a qualitative content analysis approach. ResultsWe used Carper and Chinn and Kramer's five ways of knowing as a framework for data analysis. Twelve categories emerged: staying updated with evidence-based practice, recognizing FCC, practicing neonatal nursing skills and participating in continued education and professional development (empirical knowledge); engaging in self-reflection and expressing therapeutic empathy (personal knowledge); fostering effective communication and leading cooperative readership, building integrity (esthetic knowledge); maintaining ethical responsibility (ethical knowledge); and developing collaborative teamwork, growing cultural competence (emancipatory knowledge). ConclusionsThis study could be used as a foundation for enhancing NICU nurses' partnerships with parents based on FCC and nurses' educational needs and preferences.

Mobile-Enhanced Family-Integrated Care for Preterm Infants: Nurse and Physician Views About Implementation.

The mobile-enhanced family-integrated care (mFICare) model addresses inconsistencies in family-centered care (FCC) delivery, with an evidence-based bundle of staff training, parent participation in rounds, parent classes, parent peer mentors, expanded role for parents in infant caregiving, and a parent-designed app. Our aim was to explore the views of neonatal intensive care unit (NICU) nurses and physicians about mFICare implementation, including what worked well and what could be improved. As part of a larger study to compare mFICare with FCC, we invited registered nurses, nurse practitioners, and fellow and attending physicians at the 3 study sites to participate in a survey about mFICare implementation. Data were analyzed with descriptive statistics and thematic analysis. The majority of the 182 respondents with experience delivering mFICare positively rated parent-led rounds, parent classes, parent skills acquisition, and the nurse-family relationship resulting from participation in mFICare. Respondents were less familiar or neutral regarding the parent peer mentor and app components of mFICare. Most respondents agreed that the mFICare program improved parent empowerment, and they shared suggestions for optimizing implementation. Physicians experienced more challenges with parent participation in rounds than nurses. Three themes emerged from the free-text data related to emotional support for parents, communication between staff and parents, and the unique experiences of families receiving mFICare. The mFICare program was overall acceptable to nurses and physicians, and areas for improvement were identified. With implementation refinement, mFICare can become a sustainable model to enhance delivery of FCC in NICUs.

Motheŕs own milk (MOM) feeding in preterm infants in Germany – A status quo of personal attitudes

Abstract Background The best nutrition for all new-borns and especially vulnerable groups like preterm infants is motheŕs own milk (MOM). Nevertheless, recent research showed that many preterm infants receive formula in neonatal intensive care units (NICU) in Germany. In order to achieve MOM feeding in preterm infants, a MOM-friendly clinical environment is crucial. In Germany, no data is yet available on the attitudes towards MOM of physicians and nurses in NICUs and mothers. Methods Written surveys were conducted to assess attitudes and the current status of MOM-feeding from different perspectives (medical and nursing staff and mothers of preterm infants). Questions included personal attitudes towards MOM and perceived lactation support in NICUs. Descriptive statistics and bivariate tests (Spearman's rho, Pearson chi2) were examined. Results Data of 158 leading physicians (response rate: 76%), 143 nurses (response rate: 68%) and 533 mothers (response rate: 32%) was included. The personal importance of MOM feeding is slightly higher in both physicians and nurses than their attitude towards the effects of feeding with MOM on the medical outcome of preterm infants (M: 9.5/9.5 vs. 8.3/8.9; [1-10]). Mothers predominantly perceived the NICU staff as MOM promotive (M:4.7,4.9; [1-6]) and reported an overall positive attitude towards feeding preterm infants with MOM (M:5.6; [1-6]). Their attitude showed no significant differences between educational levels (p = 0.635), age (p = 0.079) or ethnicity (p = 0.184), whereas the MOM promotive NICU staff was significantly correlated to the motherś attitude (p = 0.001, p = 0.001). Conclusions The status quo of attitudes towards MOM in Germany is rather positive in both health care professionals and mothers, independently of sociodemographic characteristics. Presumably, the challenge in achieving MOM feeding seems to occur in transferring positive attitudes to actual interventions. Key messages • To enhance MOM feeding in preterm infants, future interventions should focus on the transmission of positive attitudes to actual strategies. • NICU staff that is MOM promotive is eminent for the maternal attitudes towards MOM.

Chinese Neonatal Nurses' Lived Experiences of Providing End-of-Life Care in the NICU: A Descriptive Phenomenological Study.

Although end-of-life care (EOLC) has been well-studied, the experience of neonatal intensive care unit (NICU) nurses in China, where little EOLC training is provided, requires further investigation. To explore the lived experience of EOLC delivery among NICU nurses, to provide evidence to enhance nurses' EOLC skills and improve their overall quality. This qualitative study adopted a phenomenological approach. A total of 11 NICU nurses participated in semistructured in-depth interviews between June and July 2022 at the First Affiliated Hospital of University of Science and Technology of China (USTC). Colaizzi's 7-step method was used to analyze the data. Five main themes were identified: (a) multiple emotions are experienced during EOLC delivery; (b) EOLC delivery is stressful from various sources for nurses; (c) expressing empathy and compassion is important; (d) ethical and clinical decision-making are key components of EOLC delivery; and (e) there are challenges in improving neonatal EOLC understanding and delivery. The experience of EOLC among Chinese NICU nurses is multidimensional and intensive. Institutions or units must establish and implement related protocols and guidelines to address differences between clinical practice and ideal protocols for neonatal EOLC. Educational programs that consider nurses' personal and interpersonal factors, including local culture, must be developed. Neonatal nurses in Western countries encountering Chinese-born parents who have lost their infants can gain an understanding of parents' perceptions from this study. Future research should focus on developing and testing interventions to train and support NICU nurses working with end-of-life neonates.

Qualitative evaluation of missed nursing care in neonatal intensive care units in a teaching hospital in Jordan

PurposeMissed nursing care (MNC) is a worldwide patient safety issue. However, little is known about MNC in neonatal intensive care units (NICU). The aim of this paper is to explore the elements and factors influencing the occurrence of MNC in the NICU in a teaching hospital in Amman, Jordan. Design and methodsThe study used a qualitative descriptive design. Semi-structured interviews were conducted with NICU nurses. Purposeful sampling was used to select the participants and data collection was performed in the period August 2022 to September 2022. Data were analyzed using thematic analysis. ResultsThe participants included 15 female nurses. The majority of the participants held a bachelor's degree in nursing. Five themes emerged from the analysis of data namely: (1) Conceptualizations of MNC (2) Missed care elements in the NICU (3) Reasons behind MNC in the NICU (4) Consequences of MNC and (5) Strategies to reduce the occurrence of MNC. Feeding,changing diapers, monitoring vital signs, and medication administrationwere identified as missed care elements in the NICU. ConclusionsThe findings of this research may inform the development of interventions that may reduce missed care incidents in the NICU. Practice implicationsAddressing staff shortages and the provision of necessary materials and equipment appear to be the key factors that may reduce the frequency of MNC. Thus, enhancing patient safety and quality healthcare in this challenging healthcare environment.