Background: Approximately 25,000 pediatric deaths occur in hospitals in the United States each year with over 50% of these deaths occurring in Newborn Intensive Care Units (NICU). NICU nurses are frequently involved in end-of-life (EOL) care and face unique obstacles. Objective: The objective of this study was to obtain NICU nurses suggestions for improving obstacles in EOL care in NICUs. Methods: Suggestions were obtained through mailed survey research in qualitative study design. Returned surveys yielded 121 nurse respondents who gave a total of 138 suggestions.Results: A total of 10 cohesive themes were identified: (1) environmental design issues, (2) improved communication between healthcare teams, (3) ending futile care earlier, (4) realistic and honest physician communications to families, (5) providing a œgood death, (6) improved nurse staffing, (7) need for EOL education, (8) earlier entry into hospice/palliative care, (9) availability of ancillary staff, and (10) allowing parents more time to prepare for death.Conclusions: Despite the variety of obstacles encountered in providing EOL care to dying infants and their families, NICU nurses can use self-assessment tools to identify obstacles to EOL care and collaborate with key members of the healthcare team to alleviate these obstacles.

In the United States, 10% to 15% of newborns are admitted to the neonatal intensive care unit (NICU). Painful procedures are unavoidable during NICU care; the neonate experiences approximately 12 painful procedures per day. Inconsistent and/or inappropriate pain management in the NICU remains a problem. The purpose of this study is to identify the prevalent factors that influence the implementation of pain management strategies among nurses who work in a NICU setting in a Central Florida hospital. This study was conducted using a voluntary and anonymous electronic survey. The survey was divided into two sections; the first section designed to describe the sample, and the second section containing a Likert-type scale that assessed the nurses’ general pain knowledge, knowledge of pain assessment, and awareness of accepted pain management strategies. The survey was adapted from previously published research. Results indicate pain was more likely to be addressed when nurses collaborated closely with the attending physician. The majority of nurses were aware of current protocols for pain management on the unit but not all nurses agreed those protocols were adequate. Results also indicated pain assessment education is being provided in the NICU and the nurses feel confident in their skills to assess pain, however, not all nurses agreed that pain is being well managed in their unit. There appears to be a gap between the nurse’s knowledge/skill to assess pain and implementation of strategies to decrease pain. Although it is the nurse’s responsibility to prevent and treat newborn pain in the NICU, not all nurses agreed that newborn pain is well managed in their unit and some believe pain to be an unavoidable experience in the NICU. Nurse-physician collaboration is key to evidence based newborn pain management.