Educational interventions in end-of-life care: part I: an educational intervention responding to the moral distress of NICU nurses provided by an ethics consultation team

Adv Neonatal Care. 2008 Feb;8(1):56-65. doi: 10.1097/01.ANC.0000311017.02005.20.


Purpose: This study was conducted to assess whether neonatal nurses who care for dying infants could be assisted in their knowledge and comfort via an educational intervention provided by hospital ethics committee members and hospice specialists.

Participants: Eighty-two registered nurses working in a level III neonatal intensive care unit (NICU) were included.

Methods and design: This was a quantitative pretest, intervention, post-test design with a single group undergoing educational sessions in the 6 areas of pain management, symptom management, ethical/legal issues, communication/culture, spiritual/anxiety, and prevention of compassion fatigue.

Main outcome measurements: An instrument, "Comfort in Caring for Dying Infants" (CLCDI), was developed to assess pre- and posteducational knowledge and comfort in these areas.

Results: There were statistically significant higher levels of comfort and knowledge in care for dying infants in the areas of ethical/legal issues and symptom management after the educational programs. Although not statistically significant, mean scores were higher after the educational sessions on pain management, spirituality/anxiety, and prevention of compassion fatigue. The communication/culture module scores were lower in the post-test administration.

Conclusions: Education by hospice experts in the NICU can assist nurses' comfort with care of the dying infant. In addition, ongoing support is highly desirable for all staff participating in such care. The authors suggest incident debriefings from outside experts, debriefing after each infant's death, multidisciplinary meetings for the whole team, and having sessions of lessons learned on infant death cases.

Publication types

  • Evaluation Study

MeSH terms

  • Analysis of Variance
  • Attitude of Health Personnel*
  • Education, Nursing / methods*
  • Ethics, Clinical / education*
  • Ethics, Nursing
  • Health Knowledge, Attitudes, Practice
  • Hospice Care
  • Humans
  • Infant
  • Infant, Newborn
  • Intensive Care, Neonatal* / ethics
  • Intensive Care, Neonatal* / psychology
  • Nurses / psychology*
  • Organizational Case Studies
  • Surveys and Questionnaires
  • Terminal Care / ethics*
  • Terminal Care / psychology
  • United States