End-of-Life Self-Efficacy Initiative for Advanced Practice Providers in the NICU

Background: End-of-life care is ever-present in the newborn intensive care unit, with approximately 5% of neonatal patients in the United States requiring end-of-life care annually. A scarcity of educational resources currently exists with little to no formal training offered to advanced practice providers in the newborn intensive care unit. Yet these professionals provide front line management and collaborative coordination for end-of-life care. Methods: This quality improvement project utilized staff surveys to identify needs gaps for end- of-life support and education for advanced practice providers in the newborn intensive care unit. Survey responses indicated a number of proposals for items needed to create a robust end-of-life evidence-based practice toolkit. Results led to the development of an end-of-life pocket card. Education on the end-of-life pocket card was provided, and 10 mock cards were distributed with a follow up evaluation to elicit feedback for improvements on the usefulness of the card. Results: Responses to the pre-intervention survey were categorized by themes, categories, and topics. This qualitative approach was employed to ease analysis of the survey data. The pre- intervention survey was developed to maximize data gathering, with nested questions and free text boxes allowing participants to further elaborate upon their answers to select questions. Thus, the total number of survey questions varied across participants. The pre-intervention survey included 42 respondents and elicited some of the following information: 81% (n=35) received no EOL training, 57% did not feel comfortable with end-of-life conversations, 55% felt an end-of-life pocket card would be useful. A post-intervention survey revealed advanced practice provider willingness to utilize the end-of-life pocket card and the proposed future end- of-life evidence-based practice toolkit items to be implemented at a later date. 100% of the post- survey responses (n=10) identified willingness to utilize the end-of-life pocket card and future proposed toolkit items and perceived it would improve their self-confidence and ability to provide care during end-of-life experiences. Conclusion: The end-of-life survey elucidated how underprepared providers are in managing and collaborating on end-of-life care. Prior to this project there were few to no formal educational resources for advanced practice providers, and currently there are limited to no formal intra-hospital trainings offered within this institution. Providing end-of-life resources and training improves provider confidence.