Background: Neonatology has made significant advances in the last 30 years. Despite the advances in treatments,\nnot all neonates survive and a palliative care model is required within the neonatal context. Previous research has\nfocused on the barriers of palliative care provision. A holistic approach to enhancing palliative care provision should\ninclude identifying both facilitators and barriers. A strengths-based approach would allow barriers to be addressed\nwhile also enhancing facilitators. The current study qualitatively explored perceptions of neonatal nurses about facilitators\nand barriers to delivery of palliative care and also the impact of the regional location of the unit.\nMethods: The study was conducted at the Townsville Hospital, which is the only regional tertiary neonatal unit\nin Australia. Semi-structured interviews were conducted with a purposive sample of eight neonatal nurses. Thematic\nanalysis of the data was conducted within a phenomenological framework.\nResults: Six themes emerged regarding family support and staff factors that were perceived to support the\nprovision of palliative care of a high quality. Staff factors included leadership, clinical knowledge, and morals, values, and\nbeliefs. Family support factors included emotional support, communication, and practices within the unit. Five themes\nemerged from the data that were perceived to be barriers to providing quality palliative care. Staff perceived education,\nlack of privacy, isolation, staff characteristics and systemic (policy, and procedure) factors to impact upon palliative care\nprovision. The regional location of the unit also presented unique facilitators and barriers to care.\nConclusions: This study identified and explored facilitators and barriers in the delivery of quality palliative care for\nneonates in a regional tertiary setting. Themes identified suggested that a strengths-approach, which engages and\namplifies facilitating factors while identified barriers are addressed or minimized, would be successful in supporting quality\npalliative care provision in the neonatal care setting. Study findings will be used to inform clinical education and practice
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