Kyc Stephanie J, Bruno Christie J, Shabanova Veronika, Montgomery Angela M
Division of Neonatal-Perinatal Medicine, Department of Pediatrics, Yale University School of Medicine, New Haven, Connecticut, USA.
Department of Pediatrics, Yale University School of Public Health, New Haven, Connecticut, USA.
J Palliat Med. 2020 May;23(5):662-669. doi: 10.1089/jpm.2019.0523. Epub 2019 Dec 5.
A significant number of newborns are affected by life-limiting or life-threatening conditions. Despite this prevalence, there are inconsistencies in attitudes toward, and delivery of, neonatal palliative care. Implementing neonatal palliative care practice requires a multidisciplinary, collaborative effort. To examine institutional and individual barriers to and facilitators of neonatal palliative care from both medical and nursing perspectives. A prospective cross-sectional study design was used to collect data using the Neonatal Palliative Care Attitude Scale (NiPCAS) survey from medical providers and nurses in a 64-bed level IV neonatal intensive care unit in the United States. The response rate was 67%. The NiPCAS survey included 26 attitudinal questions on a Likert scale. The instrument included three subscales: organization, resources, and clinician, in addition to other questions. Six facilitators to neonatal palliative care were identified: (1) support of palliative care by the health care team, (2) support of palliative care by medical and nursing practice, (3) agreement that palliative care is as important as curative care, (4) parental involvement in decision making, (5) recognition of the importance of palliative care education, and (6) prioritizing pain relief. Three barriers to neonatal palliative care were highlighted: (1) a physical environment that is not conducive to providing palliative care, (2) technological obligations and parental demands, and (3) the societal belief that babies should not die. In addition, there were differences between medical and nursing staffs' attitudes on several topics. Several facilitators and barriers of neonatal palliative care were identified. There were similarities and differences in perceptions of neonatal palliative care between medical and nursing staff. Future work should be done to strengthen facilitators and to mitigate barriers.
相当数量的新生儿受到危及生命或生命受限疾病的影响。尽管存在这种普遍性，但在对新生儿姑息治疗的态度和提供方式上仍存在不一致之处。实施新生儿姑息治疗实践需要多学科的协作努力。从医学和护理角度检查新生儿姑息治疗的机构和个人障碍及促进因素。采用前瞻性横断面研究设计，在美国一家拥有64张床位的四级新生儿重症监护病房，使用新生儿姑息治疗态度量表（NiPCAS）对医疗服务提供者和护士进行调查以收集数据。回复率为67%。NiPCAS调查包括26个李克特量表式的态度问题。该工具除其他问题外，还包括三个子量表：组织、资源和临床医生。确定了六个新生儿姑息治疗的促进因素：（1）医疗团队对姑息治疗的支持，（2）医疗和护理实践对姑息治疗的支持，（3）认为姑息治疗与治愈性治疗同样重要的共识，（4）父母参与决策，（5）认识到姑息治疗教育的重要性，（6）将缓解疼痛列为优先事项。突出了三个新生儿姑息治疗的障碍：（1）不利于提供姑息治疗的物理环境，（2）技术义务和父母需求，（3）社会认为婴儿不应死亡的观念。此外，医护人员在几个主题上的态度存在差异。确定了新生儿姑息治疗的几个促进因素和障碍。医护人员对新生儿姑息治疗的认知存在异同。未来应努力加强促进因素并减轻障碍。
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