Date of Award


Degree Type

Evidence-Based Project Report

Degree Name

Doctor of Nursing Practice (DNP)



First Advisor

Suzanne E. Zentz


The World Health Organization (2013) states palliative care for children should begin at diagnosis which may even occur prenatally. Neonatal palliative care is variable due to the high technological, curative environment in the newborn intensive care unit, and the uncertain prognoses of infants born at the edge of viability. The purpose of this EBP project was to determine the influence of establishing a neonatal palliative care protocol on nurses’ perceived barriers to palliative care and moral distress. Corley’s Moral Distress theory and Stetler’s Model were used as guides for the framework of the project. The protocol, based on guidelines supported by the American Academy of Pediatrics and the National Association of Neonatal Nurses, included forming a care team for the infant and family and educational sessions for the nurse based on the End of Life Nursing Education Curriculum. Pre-invention and post-invention surveys were administered which measured perceived barriers and moral distress. The pre intervention and the post-intervention groups differed by gender (X2(1) = 4.483, p<0.05) and formal education (X2(2) = 6.357, p<0.05). A significant decrease in perceived barriers were found in (a) medical staff support palliative care (t (42) = 2.031, p<0.05), (b) physical environment for palliative care (t (43) = 3.216, p<0.01), (c) policies/guidelines are present for palliative care (t (41) = 2.634, p<0.05), (d) palliative care options are given to families (t (42) = 2.075, p<0.05), and (e) team member express opinions, values, and beliefs (t (43) = 2.951, p<0.01). A significant decrease in moral distress was noted in the concepts of witnessing providers giving false hope to families (t (43) = 2.321, p<0.05) and working with unsafe providers (t (41) = 2.300, p<0.05). A significant increase was noted, though, in the concept of working with incompetent providers (t (41) = -2.152, p<0.05). The neonatal palliative care protocol has been adopted by the clinical agency