P3.120: Caring for each other: Assessing current practices to provide bereavement support to NICU staff

Background: There is a large body of literature on support for neonatal intensive care unit (NICU) patients and families during end-of-life care. Less is known about support for the teams who provide end-of-life care in the NICU. There is evidence that health care professionals feel distress surrounding patient death which, if unaddressed, can lead to compassion fatigue, moral distress, and burnout.

We designed a survey for health care professionals in various clinical roles to: 1) identify current practices intended to provide bereavement support for team members at level IV NICUs following a patient death; 2) identify inter-center variation in bereavement support practices for NICU staff; and 3) describe team member satisfaction with bereavement support practices for NICU staff. All team members from level 4 NICUs within the Children’s Hospitals Neonatal Consortium (CHNC) were invited to participate.

Methods: The survey instrument was developed collaboratively by members of the CHNC Palliative Care and Ethics Focus Group. Survey questions included both fixed-choice and open-ended, allowing for quantitative and qualitative analysis of results. An anonymous REDCap survey link was shared though the site sponsor and nursing leader email lists. Email recipients were encouraged to share broadly across their sites. Qualitative analysis is ongoing.

Results: A total of 465 surveys were completed, with responses from 46/47 (98%) of CHNC clinical sites. The majority of respondents identified as nurses (52%) or attending neonatologists (20%); the remainder represented a wide variety of clinical roles. Respondents described significant variability in resources available to staff across time points: anticipatory bereavement training/supports, preparation for an anticipated patient death, immediately after a death, and days to weeks after a death. Only 42% of respondents indicated that they were either satisfied or very satisfied with their NICU’s overall support of team members through bereavement (Table 1). However, NICU staff reporting awareness of supportive resources was significantly positively associated with satisfaction (Table 2).

Conclusion: Team members from CHNC NICUs across endorsed utilizing different resources to support staff through NICU bereavement. Availability of resources was variable across centers. Study participants described low satisfaction with currently available bereavement support, with increased resources being associated with increased satisfaction. Opportunity exists to improve the bereavement support for NICU medical teams.