Martin Melissa
Neonatal Unit, Evelina London Children's Hospital, Guys and St Thomas' NHS Foundation Trust, Westminster Bridge Road, SE1 7EH, London, England.
Int J Palliat Nurs. 2013 May;19(5):251-6. doi: 10.12968/ijpn.2013.19.5.251.
Despite clear guidance from the Royal College of Paediatrics and Child Heath and Together for Short Lives, among others, the delivery of palliative care remains inconsistent on neonatal intensive care units, with many infants receiving full intensive care measures until the final moments of their lives. This case study identifies barriers faced by members of the neonatal team: fear of respiratory depression surrounding opiate use at the end of life, conflict among members of the care team leading to moral distress, and inadequate training and support for staff, which can inhibit the full transition to a palliative care framework at the end of life. Recommendations from the literature are collated to address these barriers.Training programmes for staff covering the tenets of palliative care, including symptom management, analgesic use, and communication skills, as well as regular multidisciplinary forums and debriefings are necessary to improve the care provided to infants and their families where there is a palliative care need.
尽管皇家儿科学与儿童健康学院以及“携手呵护短暂生命”组织等提供了明确指导，但新生儿重症监护病房的姑息治疗服务仍不一致，许多婴儿在生命的最后时刻仍接受全面的重症监护措施。本案例研究确定了新生儿团队成员面临的障碍：对临终时使用阿片类药物导致呼吸抑制的恐惧、护理团队成员之间的冲突导致道德困扰，以及工作人员培训和支持不足，这可能会阻碍在生命末期完全过渡到姑息治疗框架。整理文献中的建议以解决这些障碍。为工作人员开展涵盖姑息治疗原则的培训项目，包括症状管理、镇痛药物使用和沟通技巧，以及定期的多学科论坛和汇报会，对于改善有姑息治疗需求的婴儿及其家庭所接受的护理是必要的。
