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Published on: January 7, 2020
Evidence for Implementation Strategies to Provide Palliative Care in the Neonatal Intensive Care Unit
1The University of Arizona College of Nursing, Tucson (Ms Quinn and Dr Gephart); and Banner Health, Cardon Children's Medical Center, Mesa, Arizona (Ms Quinn).
Insights
Implementing neonatal palliative care (NPC) requires standardized protocols, staff education, and addressing barriers like communication and resources. Further research should focus on parent input and integrated care models.
Area of Science:
- Neonatal Intensive Care
- Palliative Care
- Healthcare Implementation Science
Background:
- Palliative care enhances quality of life for patients with complex conditions.
- Neonatal palliative care (NPC) offers benefits but faces low implementation rates.
Purpose of the Study:
- To identify evidence guiding the implementation of palliative care protocols in neonatal intensive care.
Main Methods:
- A comprehensive literature search was performed across CINAHL, PubMed, and Cochrane Library.
- Included studies focused on neonates, NICU settings, and NPC protocol implementation or evaluation.
Main Results:
- Seventeen articles were reviewed, identifying themes in NPC protocols, healthcare team needs, and implementation barriers.
- Common barriers included lack of NPC education, poor communication, and inadequate resources (staff, space).
Conclusions:
- Successful NPC implementation involves standardized order sets, staff education, and adherence to guidelines.
- Addressing interdisciplinary cooperation, space, and education is crucial for program development.
- Future research should explore parent perceptions, integrated NPC models, and rigorous outcome data collection.
Background:
Palliative care is a holistic framework that is designed to improve quality of life by identifying and treating distressing symptoms of life-threatening or complex conditions. Neonatal palliative care (NPC) has potential benefits for parents, staff, and patients, yet evidence suggests that implementation and utilization of organized NPC services are low.
Purpose:
The purpose of this study is to answer the clinical question: In neonatal intensive care, what evidence can be used to guide implementation of palliative care protocols?
Search Strategy:
A literature search was conducted using CINAHL (Cumulative Index of Nursing and Allied Health Literature), PubMed, and the Cochrane Library databases. Publications with a focus on neonates, neonatal intensive care unit, and implementation or evaluation of a palliative care protocol, team, or educational intervention were retained.
Results:
The search yielded 17 articles that fit with the following themes: NPC protocols or teams (n = 8), healthcare team needs (n = 3), and barriers to implementation (n = 6). Approaches to NPC implementation were varied, and outcome data were inconsistently reported. Healthcare team members cited a need for education and consistent, ethical delivery of NPC. Common barriers were identified as lack of NPC education, poor communication, and lack of adequate resources such as staff and space.
Implications For Practice And Research:
Successful team approaches included standardized order sets to initiate NPC, NPC education for staff, and references to NPC guidelines or protocols. Barriers such as lack of interdisciplinary cooperation, lack of appropriate physical space, and lack of education should be addressed during program development. Further research priorities for NPC include seeking parent perceptions, shifting focus from mostly end-of-life to an integrated model, and collecting outcome data with rigor and consistency.
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