Nurse-perceived infant well-being and associations with survival

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The Ohio State University

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Background: More than 500,000 US infants are admitted to the neonatal intensive care unit (NICU) each year, with many experiencing discomfort as a result of medical intervention. This study explored associations between COMFORT-B Scale scores and nurse perceptions of infant discomfort, as well as between nurses' perceptions of suffering and QOL (quality of life) and expectations for survival. Theoretical Framework: Fortney & Steward's (2014) Framework for a Good Neonatal Death that highlights accurate symptom assessment as an important component of the neonatal palliative and end-of-life experience was used to guide this study. Methods: In this exploratory descriptive study, infant participants were recruited from a Level IV NICU in the Midwest. Nurses caring for enrolled infants completed the Nurse Perceptions of Infant Well-Being questionnaire regarding their perceptions of the infant symptom experience and expectations for survival. Weekly behavioral observations of infants were obtained before and after standard delivery of care to obtain a COMFORT-B score. Using Pearson's r, nurse survey data was compared to the total COMFORT-B score and associations between nurses' perceptions of the symptom experience and expectations for survival were explored. Results: 237 nurses who cared for 83 infants completed 593 surveys over a period of 28 months. Bivariate correlations indicated that the COMFORT-B score was not significantly correlated with nurse perceptions of infant discomfort. But, nurse-perceived infant suffering was significantly correlated with nurse-reported expectations for survival during hospitalization, within the next 6 months, and within the next year (r=-.296, -.323, -.349, p<0.001). Further, nurse-perceived infant QOL was also significantly correlated with nurse-reported nurse expectations for survival (r=.560, .629, .647, p<0.001). Discussion: Even though associations between COMFORT-B scores and nurse perceptions of infant discomfort were not significant, they are discrepant. It is unclear whether the COMFORT-B scale performs better than the perceptions of the bedside nurse. Further, nurse perceptions of infant suffering or poor QOL is related to expectations for infant survival, which may affect decision-making, recommendations for care, and care delivery. Future research should focus on the development of improved assessment of the infant symptom experience in the NICU, as well as the effect of nurse expectations for infant survival on care delivery.



Infant, Neonatal intensive care unit, Quality of life, Symptom assessment, Palliative care