Nurses' Perceptions of End-of-Life Care Practice in Korean Neonatal Intensive Care Units

Background About half of pediatric deaths in Korea are infants’ death, and most occur in neonatal intensive care units (NICU). Because nurses play pivotal roles in actual practice of end-of-life care for dying infants and their families, exploring their perceptions of end-of-life care in NICU is important. Aim This study aimed to describe nurses’ perceptions of end-of-life care practice in Korean NICUs. Fortney and Steward’s (2014) framework for good neonatal death was used as the conceptual framework in developing the interview guide and analyzing the study results. Methods A qualitative descriptive study was conducted using individual semi-structured interviews of 20 neonatal nurses in two hospitals in Seoul, which has the highest infant mortality rate in Korea. Following the interviews, conventional and directed content analyses were performed. By examining inter-coder agreement, the code book had been modified. The finalized code book and selected quotes were translated in English. Results Among the participated nurses, only two had received infant end-of-life education. Nurses’ perceived end-of-life care practice were providing information and support, enhancing attachment, providing direct care, and completing documentation. However, the nurses identified gaps between the end-of-life care currently provided and the care they want to provide, and expressed negative feelings that derived from their perceived gaps. The nurses described facilitators of and barriers to providing quality end-of-life care in their unit. Such factors influencing quality of end-of-life care were categorized into infant, family, nurse, physician, interaction, and environmental domains. While most of the influencing factors were similar to the factors of Fortney and Steward’s framework, this study results revealed Korean nurses’ unique considerations on infant’s precious birth, maternal postpartum health, grandparents’ participation, physicians’ perceptions, and cultural perceptions. Conclusion The study revealed nurses’ perceptions of which task were difficult and what the nurses thought should be done in the future. In addition, the further description of cultural considerations in quality end-of-life care and extended considerations of the conceptual framework’s scope were suggested. To better understand quality end-of-life care, the perspectives of dying infants and their families should be studied.