Neonatal End Of Life Care

Nurses play an intricate role in neonatal end-of-life care. While providing care to a family who has made the difficult decision to allow natural death of their infant, nurses must be sensitive, compassionate and astute to their various needs. Furthermore, nurses must recognize the profound impact the time surrounding an infant’s death has on the psychological, emotional, and physical health of the parents, siblings, grandparents as well as other members of the family. A holistic nursing approach is pivotal in assuring the highest quality of care is provided. However, due to inadequate education and training, many are not comfortable with their role and responsibilities regarding communication, shared decision making, interventions, and bereavement
In an aim to improve parents’ experiences in end-of-life decision making; Michelson, Patel, Haber-Barker, Emanuel and Frader (2013), suggested use of a framework to structure health care providers’ role and responsibilities. Michelson’s et al., (2013) proposed framework is primarily centered on three principle role categories, which include directive, value neutral, and organizational. Directive roles lead families, purposefully or not, in the direction of a specific course of action. While value-neutral roles encourage and support the families’ spiritual, physiological, cognitive and physical decision making process in a nondirective and nonjudgmental manner. Lastly, nurses are immensely responsible for organizational roles, which address care coordination to ensure holistic and collaborative care is successfully delivered.
Throughout care, nurses must make themselves present and available. Therapeutic communication techniques such as active listening, reflecting, and therapeutic use of silence must be consistently implemented while providing care and discussing infants’ diagnoses and disease trajectories. Often times a therapeutic presence encompasses all that is needed. Many individuals will disclose more information regarding their feelings and wishes when given the opportunity, which may only occur
Provision of interdisciplinary collaboration and care is necessary. Nurses must ensure there is adequate access to multidisciplinary resources to ensure the needs of the family are adequately met. Access to spiritual, physiological and emotional care, as well as peer support, from parents who have survived similar life events, is critical for the family during the bereavement time. According to the National Association of Neonatal Nurses 2015), nurses should introduce families to members of local support groups or present families with information regarding available support