Nurses' Perception of Pain Management in Neonatal Palliative Care

Abstract

Neonatal palliative care, focusing on comfort and quality of life, necessitates effective pain management. Nurses play a crucial role, but their perceptions and experiences regarding pain management in end-of-life neonates remain under-examined. This systematic literature review (SLR) aimed to synthesize qualitative studies examining nurses' perceptions of pain management in neonatal palliative care. A systematic search of CINAHL and PubMed (2017-2024) yielded 10 qualitative studies, evaluated for quality using established criteria. The study applied Watson's theory of transpersonal caring as a theoretical framework. Thematic analysis was used to identify themes from the studies. Nurses acknowledge the importance of pain relief but face difficulties in assessment, particularly with preterm or unresponsive infants. Two major themes emerged from the thematic analysis: (1) nurses' perceptions of neonatal pain management, often highlighting uncertainty in assessment, conflicting priorities, and undertreatment concerns; and (2) factors impacting effective palliative care, including knowledge and training gaps, workload pressures, resource limitations, and the need for clearer guidelines and protocols. This review advocates for a holistic, family-centered approach to neonatal palliative care. Enhanced training, standardized pain assessment protocols, improved interprofessional communication, and increased resources are essential to support nurses in providing compassionate and effective pain management for dying neonates.