58: Delivering Palliative Care in a Neonatal Intensive Care Unit
Notice bibliographique
Résumé
The World Health Organization defines paediatric palliative care as holistic care for mind, body and spirit of the child with life threatening/life limiting conditions and his/her family. Neonatal palliative care is increasingly recognized as an important aspect of the care of critically ill neonates, especially with increasing survival of extremely premature infants with complex medical issues. However, neonatal palliative care is not being implemented in a comprehensive manner in many neonatal units across North America. The aim of the study is to explore the concept of ‘neonatal palliative care’ as understood by parents and health care professionals in the neonatal intensive care unit (NICU) setting in Edmonton, Alberta. The secondary aim is to identify the factors that either enable or impede delivery of palliative care to these infants and their families. Four focus groups composed of NICU nurses/nurse practitioners, neonatologists and parents whose critically ill infants had received care in the NICU were conducted. Data from the focus groups were analysed using qualitative content analysis. Anticipated death of a critically ill infant is a tragic, traumatic and paradoxical event, primarily for the families, but also for the health care professionals involved in providing treatment and care. The parents, while acknowledging the high quality of care delivered, expressed a need for consistent care and support as well as respect for the role of parents in the decision-making process. The nurses emphasized the need for better communication, support to families and nurses and early identification of the need for palliative care. The physicians acknowledged the lack of specific training they had in effective delivery of palliative care, and ambiguity as to how this should be delivered. Most saw this as part of their own role. Lack of suitable private space for palliative care, absence of a written policy and limited resources were expressed as obstacles, while the quality of care and a family-focused approach were acknowledged as facilitators in the process of delivering palliative care. The need for an on-going education in palliative care and creating a multi-disciplinary team support was emphasized by health care professionals. Delivering Neonatal palliative care is a complex multidisciplinary process that is resource intensive requiring specialised skill sets. Various factors that would enable or impede effective palliative care delivery were identified. The need for developing a broader, integrated and flexible model of palliative care that includes prenatal and post bereavement care was underlined.
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Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,002 | 0,005 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,000 |
| Bibliométrie | 0,000 | 0,000 |
| Études des sciences et des technologies | 0,004 | 0,002 |
| Communication savante | 0,001 | 0,001 |
| Science ouverte | 0,001 | 0,003 |
| Intégrité de la recherche | 0,001 | 0,001 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,008 | 0,001 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».