Li Yuan, Peng Hanmei, Kain Victoria, Huang Xi, Li Ying-Xin, Li Xia, Shi Zeyao, Yang Ru, Wan Xingli, Luo Biru, Hu Yanling
Department of Nursing, West China Second University Hospital, Sichuan University, Chengdu, China; Department of Neonatology, West China Second University Hospital, Sichuan University, Chengdu, China; Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, China.
School of Nursing and Midwifery, Griffith University, Brisbane, Queensland, Australia.
Nurse Educ Today. 2025 Feb;145:106505. doi: 10.1016/j.nedt.2024.106505. Epub 2024 Nov 23.
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.
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.
A multi-center cross-sectional study.
The setting was 92 hospitals across 28 provinces in mainland China.
A convenience sampling method was employed to recruit 893 neonatal nurses from October 2023 to February 2024.
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.
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).
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.
新生儿姑息治疗是全面新生儿护理的重要组成部分；然而，其实施在全球范围内仍然具有挑战性，特别是在低收入和中等收入国家，由于资源有限、文化障碍和缺乏培训。
本研究的目的是使用网络分析来确定关键影响因素和相互关系，调查新生儿护士对新生儿姑息治疗态度的结构特征及其提供此类护理的意愿。
一项多中心横断面研究。
研究地点为中国大陆28个省份的92家医院。
采用便利抽样方法，在2023年10月至2024年2月期间招募了893名新生儿护士。
基于网络的调查包括一份社会人口学问卷、中文版简化版新生儿姑息治疗态度量表（NiPCAS），以及一个衡量参与者提供新生儿姑息治疗意愿的单一问题。使用网络分析技术来检查态度网络的结构特征。
共收到767份有效问卷。估计的网络由代表NiPCAS各个项目的26个节点组成，在可能的325个连接中有150个非零边。在职教育经历成为最核心和最具影响力的节点，显示出最高的中心性（强度 = 2.511；桥接强度 = 3.144）和可预测性（R = 0.475）。其次是理想的姑息治疗环境和工作人员对姑息治疗的支持。平均而言，每个项目29.3%的方差可以由周围项目解释。与提供新生儿姑息治疗意愿的最强关联出现在对新生儿护士教育中姑息治疗必要性的信念上（边权重 = 0.29）。
研究结果突出了在职教育经历在塑造护士对新生儿姑息治疗态度方面的关键作用，表明教育干预可能会显著影响整体态度结构。提供新生儿姑息治疗的意愿与对新生儿护士教育中姑息治疗必要性的信念之间的紧密关联，进一步强化了教育在培养积极态度和意愿方面的关键作用。组织和资源相关因素的重要性表明，改善新生儿姑息治疗的努力应侧重于加强工作人员支持和创造支持性的工作环境。
