NICU, neonatal nursing, infants, infant deaths


Background: Neonatal deaths (infants less than 28 days old) account for two thirds (66.7%) of all infant deaths with most occurring in an ICU setting. 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 “good 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 influence environmental factors, help improve communication, and use self-assessment tools to identify current EOL care practices.

Original Publication Citation

Beckstrand, R. L., Isaacson, R. F.**, Macintosh, J. L., Luthy, K. E., & Eden, L. (2019). NICU nurses' suggestions for improving end-of-life care obstacles. Journal of Neonatal Nursing, 25(1), 32-36.

Document Type

Peer-Reviewed Article

Publication Date


Permanent URL


Journal of Neonatal Nursing





University Standing at Time of Publication

Assistant Professor