Neonatal palliative care nursing: working with infants on the cusp of life - a thematic review

Neonatal palliative care requires personal and professional commitment on behalf of nurses. Technological advances can maintain infants, but when decisions from the beginning of life are about how best to die, the medical, emotional and moral dilemmas are complex. Palliative care should begin when illness is diagnosed and continue regardless of any treatment an infant may receive directed at their illness. Research has shown that while nurses find palliative care rewarding, the emotional effects upon them need further investigation. This thematic review analyses 16 articles to identify nurses' experience of providing palliative care and to identify potential barriers to managing this care effectively. Findings revealed that nurses felt distressed trying to manage the transition from curative to palliative care for neonates. Nurses expressed ambivalence regarding the use of invasive technology and were concerned with enhancing the quality of life during the period of dying. Experience and education emerged as critical factors when nurses were managing the complexities of palliative care and the emotional wellbeing of nurses was a vital element to enabling comprehensive care for neonates. A palliative care protocol developed by a multidisciplinary team may bring consensus to using such a protocol in the neonatal intensive care unit (NICU). Future research is recommended to focus on the nursing experience of providing palliative care. Nurses working in an NICU develop skills and attributes that may be lost to the profession if their experiences are not sought and validated.