P alliative care for newborns and their families is urgent. Nurses' experiences need to be considered in order to implement palliative care. Therefore, the present study was conducted to explain the Nurses' Experiences of Palliative Care in the NICU.

 

This study was conducted by qualitative content analysis in the neonatal intensive care units of Isfahan, Iran, in 2020. Inclusion criteria for nurses were the consent to participate in the study and experience of caring for the newborn and their family at the end of life. For data collection by the purposeful sampling method, in-depth semi-structured interviews were conducted with 12 nurses. Interviews were recorded, typed, and analyzed. Goba and Lincoln criteria were used to ensure the rigor of the data.

Research has shown that the main values ​​of palliative care for infants include compassion, dignity, respect, cooperation with the family, interventions to support the infant's health, such as prescribing analgesics and managing symptoms, and psychosocial support to parents [2]. Different studies have shown that pediatricians are less involved in end-of-life care than nurses. Nurses spend a lot of time by the crib to provide care for the baby and interact with the parents compared to the other members of the team [25]. In other studies, physicians reported greater confidence and convenience in providing palliative care to infants than nurses. The role of nurses in the palliative care process is primarily to provide parental support and education, support for the child and family, and build prenatal memory. The nurses stated that they are less involved in decision-making, while they notice the baby's suffering before the doctor and the family [2]. One study found that only 56% of nurses received end-of-life care training, and 77 percent said their training was insufficient. In another study, 66.9% of neonatal physicians received no formal training in end-of-life care, while 96.7% stated that it should be part of their training program [2].
Therefore, as in line with the present study, the results of various studies showed that to provide palliative care for infants, nurses need to receive the necessary training in palliative care, end-of-life care, and pain relief to be accompanied by sufficient skill and conscientiousness work care. Various studies have reported the implementation of palliative care in neonatal intensive care units; however, participants believed that palliative care was not performed well in the present study.
In the present study, one of the main classes of palliative care for infants was end-of-life spiritual care. The nurses believed that at the time of the infant's death, the infant should be treated appropriately and given spiritual-religious care.
In one study, physicians stated that palliative care provides emotional and spiritual support and helps families adjust to complex situations [26]. Palliative care is a complex model that requires attention to individuals and includes spirituality. Nurses must play an active role in meeting patients' spiritual needs because it is directly related to improving patients' quality of life and satisfaction with care. Studies have shown that spiritual care is often not well received by nurses. Because they believe that spirituality is a personal matter, they feel that they do not have enough time to provide spiritual care and that it is difficult to assess the spiritual needs of patients when they have different perspectives. In addition to the above, the lack of spiritual care training is also a preventive factor in providing spiritual care [13].
According to the present study results and the emphasis that nurses had on caring with compassion and spiritual care for the end of life of the infant and family and by reviewing related texts in this field, the importance of palliative care in the neonatal ward is determined. In line with the above studies, the participants in the present study also believed that they did not have enough time to provide spiritual-religious care and did not receive the necessary training in this field.
In the present study, the nurses stated that palliative care should be taken care of the family before the baby dies, and the reality of the baby's condition should not be hidden from the parents and bad news should be given to the family by the trained person.
Good communication with parents and family is the core of quality palliative care. Developing a good partnership requires understanding the differences in families. Parents and most families (grandparents, siblings) need to be involved in infant care discussions from the outset. In giving information, one should pay attention to the differences between families and provide a secluded environment [3].
According to the results of the present study and the emphasis that studies have placed on the importance of considering the family in the neonatal intensive care unit, information related to the infant's condition should be provided to families according to their understanding and bad news or truth should be reported through scientific methods and be delivered to families. Therefore, the results of the present study are in line with the studies, and giving importance to the family in the neonatal intensive care unit, like all the above studies, is of particular significance.
In the present study, nurses stated that the family suffers from spiritual distress after the infant's death and needs empathy. Given that it is essential to consider the family, it is necessary to consider palliative care of the family after a baby's death.
 
 

The results of this research are in line with the WHO definition of palliative care in pediatric, which refers to the active total care of the child's body, mind and spirit, and family support. The results of this research are used to improve the care of infants and families at the end of life and death for officials and nurses of the NICU.
 
 

The present study is approved research in Islamic Azad University, Isfahan Branch (Khorasgan). All costs of the above research have been paid by the Islamic Azad University of Isfahan (Khorasgan). The researchers would like to thank all the Islamic Azad University executive staff, Isfahan Branch (Khorasgan), and the authorities of all the mentioned centers, and the participants who participated in this research.
 
 

The authors declared no conflict of interest.