Table_2_Facilitators and Barriers Affecting Implementation of Neonatal Palliative Care by Nurses in Mainland China.DOCX

Neonatal nurses in mainland China encounter various challenges when it comes to delivering palliative care to neonates. The aim of this study was to determine the barriers and facilitators of neonatal nurses' attitudes to palliative care for neonates in mainland China. A simplified Chinese version of the Neonatal Palliative Care Attitude Scale was piloted, administered, and analyzed using survey methods. Nurses in neonatal intensive care units in mainland China regardless of experience in the field were invited to take part in. Over a five-month period in 2019, we surveyed neonatal nurses from 40 hospitals in five provinces of China. The response rate was 92.5% (N = 550). This study identified eight facilitators and four barriers to neonatal palliative care implementation. In terms of nurses' attitudes on providing palliative care, younger and older nurses were more positive, whereas middle-aged nurses were less so. Nurses' emotional wellbeing was rarely impacted by neonatal death. They considered neonatal palliative care, particularly pain management, to be just as important as curative treatment. Parents were invited to participate in decision-making by nurses. Nurses reported having access to professional counseling and talking about their concerns with other healthcare professionals. The following barriers to neonatal palliative care were identified in this study that were not observed in the original English version scale research in 2009: a lack of clinicians, time, clinical skills, systematic education, neonatal palliative care experience, and social acceptance. Future research is required to investigate each barrier in order to improve the implementation of neonatal palliative care in mainland China.

中国大陆新生儿科护士在为新生儿提供舒缓疗护（palliative care）时，常面临各类实践挑战。本研究旨在明确中国大陆新生儿科护士对新生儿舒缓疗护的态度相关的障碍因素与促进因素。研究采用调查法，对简体中文版《新生儿舒缓疗护态度量表》（Neonatal Palliative Care Attitude Scale）开展预试验、正式施测与数据分析。研究招募了中国大陆新生儿重症监护病房（neonatal intensive care units）的护士，无论其是否具备该领域从业经验均可参与。2019年的五个月周期内，研究团队从中国五个省份的40家医院共调查了新生儿科护士，最终有效回收率为92.5%（有效样本量N=550）。本研究共识别出8项新生儿舒缓疗护实施的促进因素与4项障碍因素。在护士对新生儿舒缓疗护的态度层面，年轻及年长护士的态度更为积极，而中年护士的态度相对消极。新生儿死亡鲜少对护士的情绪健康产生负面影响。护士们认为新生儿舒缓疗护（尤其是疼痛管理）与治愈性治疗同等重要，且会邀请患儿家长参与医疗决策过程。研究对象表示可获取专业咨询支持，并能与其他医疗专业人员交流自身执业顾虑。本研究还发现了2009年原版英文量表研究未观测到的新生儿舒缓疗护障碍因素：临床人员短缺、时间资源不足、临床技能匮乏、系统性教育培训缺失、新生儿舒缓疗护从业经验不足以及社会认可度偏低。未来需针对各项障碍开展专项研究，以推动中国大陆新生儿舒缓疗护的规范化实施与推广。