Critical Reflection as a Facilitator of Palliative Care in the Neonatal Intensive Care Unit A Concept Clarification

The purpose of this article was to perform a concept clarification of critical reflection and its association as a possible facilitator of palliative care delivery in neonatal intensive care unit settings. Palliative care delivery and established programs for neonatal intensive care units are well researched in the literature. However, research also indicates that as few as 24% of dying infants in neonatal intensive care unit environments receive comprehensive palliative care. Barriers to palliative care delivery have been identified, and two of those barriers are the presence of moral distress in neonatal intensive care unit nurses who care for dying babies and a lack of palliative care education for these healthcare professionals. Norris's method of concept clarification was utilized, and a literature search related to critical reflection was performed within the nursing discipline as well as other disciplines. Multiple definitions of the concept were synthesized to identify antecedents, consequences, and mediators of critical reflection in the neonatal intensive care unit. A new operational definition specific to neonatal intensive care units is proposed, as well as a model representation of the critical reflection process for use in this setting. Implications from this new knowledge include the ability, through operationalization, to study further the effects of critical reflection as a facilitator of palliative care delivery in neonatal intensive care unit environments.