Decreasing Moral Distress in New Graduate Neonatal ICU Nurses Providing End-Of-Life Care

Nurses in the neonatal intensive care unit (NICU) provide extensive end-of-life (EoL) care, and this can lead to feelings of moral distress and fear, regardless of preparation. New graduate nurses largely report lack of EoL care training in their undergraduate education and feel unprepared for these situations, which has been associated with feelings of moral distress, fear of death, professional inadequacy, lack of knowledge/confidence, and burnout. Simulations have been increasingly used to expose new graduate nurses and nursing students to EoL care scenarios in an effort to improve competency and confidence. Using the FADE Model a DNP Project developed a combination of EoL didactic education and EoL simulation to improve new graduate NICU nurse moral distress, fear of dying, and EoL knowledge. Over an implementation window of six weeks new graduate nurses received didactic education and participated in EoL simulations. Participants completed surveys assessing moral distress, fear of dying process, and knowledge of EoL care before education, after didactic education, and after simulation. The project was implemented in a feasible, sustainable manner, but results found no statistical significantly change in any factors assessed, though EoL knowledge increased and fear of dying process decreased following didactic education and EoL simulation. Specifically moral distress increased by the end of implementation, suggesting that moral distress may not accurately be assessed until nurses have been exposed to EoL scenarios.Doctor of Nursing Practic