The critical role of education in shaping nurses' attitudes and intentions towards neonatal palliative care: A network analysis.

BACKGROUND

Neonatal palliative care is an essential component of comprehensive neonatal care; however, its implementation remains challenging worldwide, particularly in low- and middle-income countries due to limited resources, cultural barriers, and lack of training.

OBJECTIVES

The aim of this study was to investigate the structural characteristics of neonatal nurses' attitudes towards neonatal palliative care and their intention to provide such care using network analysis to identify key influencing factors and interrelationships.

DESIGN

A multi-center cross-sectional study.

SETTING

The setting was 92 hospitals across 28 provinces in mainland China.

PARTICIPANTS

A convenience sampling method was employed to recruit 893 neonatal nurses from October 2023 to February 2024.

METHODS

The web-based survey included a sociodemographic questionnaire, the simplified Chinese version of the Neonatal Palliative Care Attitude Scale (NiPCAS), and a single question gauging participants' intention to provide neonatal palliative care. Network analysis techniques were used to examine the structural characteristics of the attitude network.

RESULTS

A total of 767 valid questionnaires were received. The estimated network comprised 26 nodes representing individual NiPCAS items, with 150 non-zero edges out of a possible 325 connections. In-service education experience emerged as the most central and influential node, demonstrating the highest centrality (strength = 2.511; bridge strength = 3.144) and predictability (R = 0.475). This was followed by the ideal palliative care environment and staff support for palliative care. On average, 29.3 % of each item's variance could be accounted for by surrounding items. The strongest associations with the intention to provide neonatal palliative care were observed with beliefs about the necessity of palliative care in neonatal nurse education (edge weight = 0.29).

CONCLUSIONS

The findings highlight the pivotal role of in-service education experience in shaping nurses' attitudes towards neonatal palliative care, suggesting that educational interventions may significantly influence overall attitudinal structures. The strong associations between the intention to provide neonatal palliative care, and beliefs about the necessity of palliative care in neonatal nurse education, further reinforce the critical role of education in fostering positive attitudes and intentions. The significance of organizational and resource-related factors suggests that efforts to improve neonatal palliative care should focus on enhancing staff support and creating supportive work environments.