Exploring the Experiences of Neonatal Nurses in Providing End-of-Life Care to Newborns and their Families

Abstract

Background: Caring for critically ill newborns at the end of life is among the most emotionally and ethically demanding roles in nursing. Neonatal intensive care unit (NICU) nurses must simultaneously manage the physical needs of fragile infants and the grief of families who are often wholly unprepared for what lies ahead. Purpose: This study set out to understand how neonatal nurses at Doctor Soliman Fakeeh Hospital in Jeddah, Saudi Arabia, experience end-of-life care in practice and what weighs on them emotionally, the moral conflicts they encounter, how Islamic and family-centered values shape their work, and what helps them carry on. Method: Ten neonatal nurses participated in semi-structured interviews employing a phenomenological approach. Reflexive thematic analysis identified patterns related to emotional strain, moral tensions, the influence of religious beliefs, and the sources of meaningful support for the nurses. Results: Four main themes emerged: First, nurses faced significant emotional burdens due to prolonged exposure to infant death, leading to grief or emotional numbness. Second, ethical issues created moral conflict, with some nurses feeling anguish over a baby's suffering while feeling compelled to act. Third, cultural and Islamic values, along with family expectations, influenced care delivery, with prayer and Quranic recitation providing comfort but sometimes conflicting with clinical decisions. Fourth, coping mechanisms and support systems were essential for nurses. Conclusion: Neonatal nurses in Saudi Arabia encounter considerable emotional, ethical, and cultural challenges. While personal resilience and support from colleagues help, a deficiency in structured training and institutional backing is notable. To enhance care for nurses and families, improvements in ethics education, support programs, and culturally appropriate communication tools are necessary.