Coping while caring for the dying child: nurses' experiences in an acute care setting

The Lived Experiences of Hospice Healthcare Workers Caring for Adolescents and Young Adults With Advanced Cancer: An Interpretative Phenomenological Analysis

Objective: To understand the lived experience of healthcare workers who provide palliative care to adolescents and young adults living with advanced cancer. Methods: Interpretative phenomenological analysis was the design of this study. Hospice healthcare workers from four pediatric hospices across Canada were recruited through purposive sampling. Semistructured in-person interviews were conducted. Results: Eighteen hospice healthcare workers participated. Two superordinate themes were identified. First, balancing on the tightrope of uncertainty wherein hospice healthcare workers strive to do their best while aiming to take the path of least regret. This theme was underscored by a notion of doing for the adolescents and young adults. Second, acting as a proxy revolves around the importance of fostering relationships with adolescents and young adults through honesty and transparency. The cycle of protection between adolescents and young adults, families, and healthcare providers was emphasized. Conclusions: An action-focused orientation when supporting adolescents and young adults was shared by the healthcare workers. The need to do for adolescents and young adults and the need to protect not only the people they care for but also themselves. More exploration is needed on how healthcare workers who care for adolescents and young adults can be supported while better understanding coping mechanisms.

Perceptions of Interprofessional Practitioners Regarding Pediatric Palliative Transports

BACKGROUND

Pediatric palliative transport (PPT) is the practice of offering critically and terminally ill children requiring life-sustaining measures the opportunity to be discharged from the hospital to home or a hospice facility for end-of-life care. Although studies have shown PPT to favorably affect both children and their families, limited research exists on the perspectives of health care practitioners.

OBJECTIVES

To understand the experience of interprofessional practitioners who have cared for a critically or terminally ill child during a PPT and their perception of PPT as a care option.

METHODS

This study is a qualitative descriptive inquiry conducted using 8 focus groups. Participants included interprofessional staff from 4 specialty intensive care units, the pediatric advanced care team, and the critical care transport team at a quaternary, freestanding children's hospital. Content analysis was used to summarize themes and recommendations.

RESULTS

Five overarching themes were identified: PPT as a care pathway, education, communication, support, and closure. Use of PPT was perceived as aligned with the hospital's mission of family-centered care and as providing a way for the health care team to support a family's choice. Participants recommended further development of information to guide communication and processes of care that would enhance the experience for families and staff and support PPT as a care pathway.

CONCLUSIONS

Pediatric palliative transport is considered a feasible, valuable, and critical end-of-life intervention. The value that PPT has brought to participating families warrants continued investment in the intervention's standardization and enhancement.

"A Life Slips Through Our Fingers" Experiences of Nurses Working in Pediatric Intensive Care Units About Children's Death: A Qualitative Study

Caring for a dying child can be an experience full of all kinds of negative emotions, pain and stress for the pediatric nurse. In this study, which was carried out in Turkey, we aimed to determine how nurses working in a pediatric intensive care unit remembered and made sense of their experiences regarding children's deaths. In-depth interviews were held with 13 nurses. The data were analyzed using the content analysis method. Three themes were identified. These were (1) Personal effects of death, (2) Difficulties in care, and (3) Coping with death. It was clear that the nurses were traumatised by their exposure to infant deaths. The findings showed that nurses experienced regret, fatigue and posttraumatic stress disorder. In addition, it was determined that nurses should be supported to cope with child deaths, which is a complicated process involving the child and the family, especially emotionally. Moreover, providing institutional support to nurses and referring them to cognitive-behavioral therapies may make it easier for them to cope with the emotional burden they carry, as well as the burnout they experience.

Experience of pediatric nurses in nursing dying children - a qualitative study

PURPOSE

To explore pediatric nurses' challenges and effective coping strategies in caring for dying children.

METHODS

A descriptive qualitative study was adopted. Data were collected using a semi-structured interview with ten nurses from the pediatric, pediatric emergency, and neonatology departments.

RESULTS

Three themes were generated: stressors, consequences, and coping strategies. Ten sub-themes were generalized: negative emotions; helplessness; questioning rescue behavior; fear of communication; lack of workforce for night rescue; compassion fatigue; burnout; changes in life attitudes; self-regulation; leadership approval and no accountability.

CONCLUSIONS

Through qualitative research, nurses' challenges and effective coping strategies in caring for dying children were found, which provides information for nurses' career development and related policy formulation in China.

CLINICAL RELEVANCE

While there are many articles in China on hospice care, there is little research on the nurses' experience of caring for dying children. Many studies have mentioned the adverse consequences of caring for dying children in foreign countries, leading to post-traumatic stress disorder (PTSD). However, domestic discussion of such problems is rare, and no corresponding coping strategies exist. This study explores pediatric nurses' challenges and effective coping strategies in caring for dying children.

Nurses and nursing students' experiences on pediatric end-of-life care and death: A qualitative systematic review

BACKGROUND

End-of-Life care and experiencing death of infants, children, and teenagers remain one of the most difficult and traumatic events for nurses and nursing students, potentially leading to personal and professional distress. Although efforts have been made to alleviate stressors in these settings, improvements remain slow. Understanding nurses and nursing students' experiences of pediatric End-of-Life care and death in multiple care settings may direct interventions to better support quality of care and healthcare professionals in these areas.

OBJECTIVE

This review aimed to qualitatively synthesize existing literature to examine the nurses and nursing students' experiences of providing End-of-Life care to children and the death of pediatric patients.

DESIGN

The qualitative systematic review was conducted using Sandelowski and Barroso's guidelines. The included studies were appraised using the Critical Appraisal Skill Program.

DATA SOURCES

This qualitative systematic review was registered with the International Prospective Register of Systematic Reviews. Six electronic databases (Cumulative Index of Nursing and Allied Health Literature, PubMed, Embase, PsychINFO, Scopus, and Mednar) were searched from the database inception date through May 2021.

RESULTS

Thirty articles were included to form three key themes: (1) Emotional impact of pediatric End-of-Life care and death, (2) Perspective of delivering optimal care: What works and what does not, and (3) The complex role of nurses in pediatric End-of-Life care. Overall, the findings suggested that in an emotionally taxing environment, clinical and emotional support were paramount. Furthermore, there is a need to examine nurses' role in End-of-Life decision making and provide more discussion on professional boundaries.

CONCLUSION

This review offered nurses' and nursing students' perceptions of pediatric End-of Life care and death in the nursing profession. Findings can provide useful insights towards the planning of educational programs and institutional changes that supports nurses and nursing students in these settings.

Resilience and Burnout in Pediatric Nurses in a Tertiary Children's Hospital

PURPOSE

To identify levels of burnout and resilience in pediatric nurses in a tertiary children's hospital in New Zealand.

METHODS

Registered nurses providing pediatric care participated in a survey that included the Connor-Davison resilience scale and Maslach burnout scale. Nurses identified specific factors related to workload stress and strategies for enhancing resilience.

RESULTS

Participants were 197 nurses. We found low levels of resilience and high levels of burnout, although personal accomplishment scores were high. Nurses with <10 years of experience who worked >40 hours per week had significantly higher levels of emotional exhaustion compared with those who had >10 or more years of experience or worked <40 hours per week. There were differences in resilience levels based on years of practice and hours worked. Levels of depersonalisation were higher in different ethnic groups.

CLINICAL IMPLICATIONS

Burnout remains a significant problem for pediatric nurses. Job demands are likely to rise with the increased complexity of children with long-term conditions and families requiring support. Developing supportive plans to strengthen resilience and limit burnout are required. Further research is needed on how organizations can foster resilience practices and limit burnout, nurses feeling emotionally exhausted, reducing depersonalisation, and enhancing feelings of personal accomplishment. Nurse leaders can role-model positive resilience practices when engaging their teams in open conversations about preventing or reducing burnout.

Depressive, anxiety, and burnout symptoms on health care personnel at a month after COVID-19 outbreak in Indonesia

BACKGROUND

Health care personnel (HCP) who demonstrated close contact with Corona virus disease (COVID-19) patients might experience a higher risk of infection and psychological problems. This study aims to explore depressive, anxiety, and burnout symptoms among HCP with a higher risk for psychological trauma.

METHODS

This study was a cross-sectional study using secondary data from an online assessment, which was conducted 1 month after the COVID-19 outbreak. A total of 544 respondents from 21 provinces in Indonesia were included. Data on depressive, anxiety, and burnout symptoms were transformed first using the Rasch model and then categorized. Data from HCP in the higher risk group and the lower risk group were analyzed.

RESULTS

A higher percentage of HCP experiencing depressive symptoms (22.8%), anxiety (28.1%), and burnout (26.8%) are found in the higher risk group. The chance for the higher risk group's HCP to present with moderate and severe depressive symptoms, anxiety, and burnout are: 5.28 (Confidence interval (CI): 2.01-13.89; p < 0.05), 1.36 (CI: 0.09-1.96; p >  0.05), and 3.92 (CI: 2.08-7.40; p < 0.05) times higher, respectively. The probability for patient-induced burnout is 2.13 (CI: 1.51-3.007; p < 0.05) times higher and highest among the other burn out dimensions. The depressive symptoms complained were similar between groups: loneliness, sleep disturbances, difficulty concentrating, and inability to initiate activities. Loneliness demonstrates the highest logit value among the symptoms.

CONCLUSIONS

HCP with direct contact and responsibility to treat COVID-19 patients exhibit a higher risk to experience depressive symptoms and burnout. Communication with peers and staying in contact with family needs to be encouraged. Psychological well-being should be considered for high-risk HCP. Incentive or insurance guaranteed by the government or institution is essential as a reward and compensation during this period.

Emotional Responses of Neonatal Intensive Care Nurses to Neonatal Death

The study was planned as a descriptive qualitative study to determine the emotional responses of neonatal intensive care nurses to work in the neonatal unit and to neonatal deaths. The sample of the study consisted of 7 nurses who work at the neonatal intensive care unit since data saturation was achieved. The data were collected using the "Semi-Structured In-Depth Interview Guide for Nurses". The data were analyzed using the content analysis method. Following codes were reached as a result of the study: 'happiness-sadness', 'professional satisfaction-exhaustion', 'empathy', 'responsibility-guilt', 'hope-despair' under the theme of being a nurse at neonatal unit'; 'unforgettable first loss', 'professionalism in intervention-and then: sadness, 'mature-premature difference', 'difficulty in giving hurtful news-inability to associate with death' and 'attachment-burnout' under the theme of experiencing neonatal loss.It was seen that nurses' emotions about working at neonatal intensive care unit were generally positive; however, these emotions changed to negative after neonate's relapsing and death.

Experiences of new nurses dealing with death in a paediatric setting: A descriptive qualitative study

AIMS

To explore and describe the experiences, challenges and coping strategies of new nurses dealing with paediatric death in a clinical setting.

DESIGN

A descriptive qualitative study design was used.

METHODS

Semi-structured interviews were conducted to explore the experiences of 12 new paediatric nurses from a tertiary public hospital in Singapore. Data were collected from September 2019-December 2019. A thematic analysis was performed for data analysis.

RESULTS

Four themes were generated: (a) a spectrum of emotions; (b) the 'blame' game; (c) getting through the grief; and (d) new nurses' wish list. The new nurses tended to be emotionally affected by their first death experience. They felt anxious and personally responsible for the death but eventually controlled their emotions. Colleagues, religion and self-actualization were key in overcoming grief.

CONCLUSION

The experiences nurses go through at the early stages of their profession shape future workplace attitudes. Additional training and support should be provided to new nurses to build their confidence in managing end-of-life care. Training should include cultural awareness and communication skills to equip nurses with the necessary skills.

IMPACT

This research will have an impact on institutions, which develop culturally congruent training and support platforms that prepare new nurses for nursing practice. This research will drive future investigations on the long-term effects of paediatric death on new nurses.

Caring for deteriorating paediatric patients in the emergency department: A mixed method study

BACKGROUND

Paediatric presentations to emergency departments are common for a range of conditions with varying severity. Children can compensate well and early signs of deterioration may not be obvious. Nurses working in emergency departments (ED) should not only have the knowledge and skill to recognise the unwell child, but also be confident and competent to provide care.

AIM

To explore the self-reported preparedness, confidence and competence of emergency nurses in caring for deteriorating paediatric patients, and to identify how their confidence and competence could be improved.

METHODS

An exploratory sequential mixed methods study with two phases was used. In Phase One, qualitative data were collected via focus group and thematically analysed. The findings from Phase One informed Phase Two survey development, with quantitative data collected and analysed.

RESULTS

Findings from both phases identified that emergency nurses' confidence and competence when caring for deteriorating paediatric patients did not correlate with their level of qualification. In contrast, increased years of experience in caring for this cohort did increase level of confidence. Availability of human resources further impacted nurses' confidence when caring for deteriorating paediatric patients and emergency nurses showed an interest and enthusiasm for further education in caring for the deteriorating paediatric patient.

CONCLUSIONS

Regular exposure to paediatrics was key to nurses having confidence and competence to care for deteriorating patients, irrespective of educational qualifications. A focus on interprofessional insitu simulation could address human resource challenges to enhance skill development.

Health professionals' experiences of grief associated with the death of pediatric patients: a systematic review

OBJECTIVE

The objective of this review was to synthesize the experiences of health professionals who have experienced grief as a result of a pediatric patient dying.

INTRODUCTION

There has been some research into health professionals' grief experiences associated with the death of pediatric patients, but there has not been a review that synthesizes the findings of these experiences. Other related reviews have focused on prenatal, perinatal or adult deaths or the coping strategies employed by health professionals. This review highlights the complexities of experiences faced by pediatric health professionals.

INCLUSION CRITERIA

Qualitative studies involving pediatric health professionals working in any healthcare setting who had experienced grief from the death of a patient were considered for inclusion. Studies were conducted in any country, at any time and published in English.

METHODS

The search was conducted in PubMed, CINAHL, Embase, PsycINFO, Scopus and ProQuest Dissertations and Theses. The search was completed in January 2019. The review followed principles of meta-aggregation in line with the JBI approach. Methodological quality assessment was based on representation of participants' voices and congruence between research methodology and both research question and analysis of data.

RESULTS

Meta-aggregation led to three synthesized findings from 12 qualitative studies that met the inclusion and methodological quality criteria. Studies predominantly included nurses working in a hospital, with sample sizes ranging from six to 25 participants. The synthesized findings were physical, behavioral, psychological or spiritual symptoms; compounding grief; and alleviating grief. Physical, behavioral, psychological, or spiritual symptoms highlighted the various characteristics of grief experiences by health professionals. Compounding grief was the largest synthesized finding and incorporated the various factors that contributed to a poorer experience of grief. Alleviating grief showed the limited identified factors that improved the experience of grief. Methodological quality led to synthesized findings receiving a ConQual rating of low or moderate.

CONCLUSIONS

The synthesized findings from this review highlight the varied reported experiences of grief in health professionals. The methodological quality and reporting of studies, however, led to decreased confidence in the synthesized findings and recommendations arising from this review. Healthcare professionals should be aware of the potential for experiencing grief when a patient dies and the compounding and alleviating factors associated with this. Further research could expand participant and language limitations, and improve methodological quality and reporting.

Experience of nurses who work with children with palliative care needs: A mixed-method systematic review

OBJECTIVE

The importance of palliative care education for nurses has been recognized worldwide. The study aims to explore the experiences of nurses working with children with palliative care needs and to identify any related educational needs.

METHODS

The electronic databases of CINAHL, Cochrane, PubMed, OVID, Social Care Online, Web of Science, Scopus, and ProQuest were searched for the period 2000-2015.

RESULTS

Finding revealed that working with children with palliative care needs is an emotionally struggling job for nurses, especially when they try to manage the transition of pediatric patients from curative to palliative care. Staffing level and time constraints comprise a major obstacle in pediatric palliative care. Focusing on invasive treatment and technology in spite of the feelings that it will not improve patients' health status intensifies the feeling of guilt and helplessness for nurses. Finally, nurses asserted the importance of receiving pediatric palliative care education, especially how to communicate with children with palliative care needs and their families.

SIGNIFICANCE OF RESULTS

Further research is recommended with regard to nurses' experience in communication with children with palliative care needs. Nursing education in pediatric palliative care is significantly important, especially how to communicate with children with palliative care needs and their families.

Nurses’ Experiences in End-of-Life Care in the PICU: A Qualitative Systematic Review

The experiences of end-of-life care by nurses in the pediatric intensive care unit are the subject of this systematic review. Six qualitative articles from three different countries were chosen for the review using methods from Joanna Briggs Institute. The themes discovered included the following: insufficient communication, emotional burden, moral distress from medical futility, strengthening resilience, and taking steps toward hospice. These themes are discussed in detail followed by recommendations for practice to assist nurses in their quest for a good death for their pediatric patients.

Health professionals' experiences of grief associated with the death of pediatric patients: a qualitative systematic review protocol

REVIEW QUESTION

What are health professionals' experiences of grief associated with the death of pediatric patients in acute or community healthcare settings?

Reflections on the Emotional Hazards of Pediatric Oncology Nursing: Four Decades of Perspectives and Potential

THEORETICAL PRINCIPLES

Pediatric oncology nurses are particularly vulnerable to emotional distress. Responsible for the oversight of a child's care, these nurses sustain close interactions with multiple patients and families over time, many of whom are coping with life-limiting diagnoses. The world of pediatric oncology nurses is one where tragedy is routinely witnessed thus demanding self-care and healing across a continuum.

PHENOMENON ADDRESSED

The aim of this article is to outline and review the emotional sequelae of pediatric oncology nurses' work and to suggest interventions to support well-being in light of prolonged caregiving. Three major categories that are addressed include the aspects of clinical practice that influence caregiving, the risks of burnout, compassion fatigue, moral distress and grief, and interventions to counteract these phenomena.

RESEARCH LINKAGES

Future-nursing research should focus upon the development of validated, psychometrically sound measurement tools to assess nurse-specific variants of burnout, compassion fatigue, moral distress, and nurse grief. Qualitative research should investigate the relationship between personal variables, workplace and team characteristics, age and experience, and their influence on the predominance of burnout, compassion fatigue, moral distress, and nurse grief. Lastly, the phenomena of resiliency demands further study.

Secondary Posttraumatic Stress and Nurses' Emotional Responses to Patient's Trauma

Alarmingly high percentages of secondary posttraumatic stress have been reported in several nursing domains such as critical care and emergency nursing, oncology, pediatric nursing, mental health nursing, and midwifery. The purpose of this review is to examine and describe nurses' emotional responses in the face of their exposure to patients' trauma. Lack of understanding of the dynamics of trauma may limit nurses' ability to interact in a meaningful and safe way with patients and their families. Spirituality can be a precious compass in the long-term journey of resolving feelings of grief and loss at work and of building a strong professional identity.

Maintaining Integrity: How Nurses Navigate Boundaries in Pediatric Palliative Care

PURPOSE

To explore how nurses manage personal and professional boundaries in caring for seriously ill children and their families.

DESIGN AND METHODS

Using a constructivist grounded theory approach, a convenience sample of 18 registered nurses from four practice sites was interviewed using a semi-structured interview guide.

RESULTS

Nurses across the sites engaged in a process of maintaining integrity whereby they integrated two competing, yet essential, aspects of their nursing role - behaving professionally and connecting personally. When skillful in both aspects, nurses were satisfied that they provided high-quality, family-centered care to children and families within a clearly defined therapeutic relationship. At times, tension existed between these two aspects and nurses attempted to mitigate the tension. Unsuccessful mitigation attempts led to compromised integrity characterized by specific behavioral and emotional indicators. Successfully mitigating the tension with strategies that prioritized their own needs and healing, nurses eventually restored integrity. Maintaining integrity involved a continuous effort to preserve completeness of both oneself and one's nursing practice.

CONCLUSIONS

Study findings provide a theoretical conceptualization to describe the process nurses use in navigating boundaries and contribute to an understanding for how this specialized area of care impacts health care providers.

PRACTICE IMPLICATIONS

Work environments can better address the challenges of navigating boundaries through offering resources and support for nurses' emotional responses to caring for seriously ill children. Future research can further refine and expand the theoretical conceptualization of maintaining integrity presented in this paper and its potential applicability to other nursing specialties.

The emergence of personal growth amongst healthcare professionals who care for dying children

Objective:

Compassion fatigue, burnout, and vicarious traumatization are prominent topics in the current literature on the impact of the rewarding but challenging work of healthcare professionals who care for patients with life-limiting illnesses. The positive effects of caregiving constitute a newly emerging outcome that has been relatively unexplored in the pediatric literature, and yet they may play an important role in contributing to the satisfaction and well-being of the healthcare professionals who care for children who have a life-limiting illness.

Method:

This paper reports the results of a secondary analysis of qualitative interview transcripts that explored the experiences of hospital-based pediatric healthcare providers caring for children with varied life-limiting illnesses. In-depth qualitative interviews were conducted with 25 healthcare professionals (9 social workers, 8 nurses, and 8 physicians). The majority of participants were women (80%), with an age range between 20 and 60 years, and most (84%) had the experience of caring for more than 15 dying children. Thematic analysis was conducted using interpretive description and constant comparison.

Results:

Every healthcare professional interviewed experienced personal growth as a result of their providing care for dying children. Three dimensions of personal growth were most consistently reported: (1) new or altered life perspectives, (2) enhanced personal resources, and (3) benevolence.

Significance of results:

A deeper understanding of the phenomenon of personal growth could help healthcare organizations to implement innovative approaches that would counterbalance compassion fatigue, and thereby enhance both healthcare provider well-being and child and family outcomes.

Exploring NICU Nurses' Affective Responses to End-of-Life Care

BACKGROUND

The survival rate for infants born with life-threatening problems has improved greatly over the last few decades. Nevertheless, infants still die in neonatal intensive care units (NICUs) every day. Despite existing standards of care, some aspects of end-of-life care (EOLC) are still not delivered consistently. Little is known about how NICU nurses' individual experiences affect EOLC.

PURPOSE

The purpose of this study was to explore, through lived and told stories, the affective, interactional, and meaning-related responses that NICU nurses have while caring for dying infants and their families. Coping strategies and changes in practice were also explored.

METHODS

Thirty-six members of the National Association of Neonatal Nurses submitted written narratives about an EOLC experience during which the nurse experienced strong emotions.

FINDINGS

Narrative analysis revealed many affective responses, but 3 were the most frequent: responsibility, moral distress, and identification. Coping methods included healthy and less healthy strategies, such as colleague support, informal and formal debriefing, practicing intentional gratefulness, avoidance, and compartmentalization. Changes in practice identified were universally described as professional growth through the use of reflective practice.

IMPLICATIONS FOR PRACTICE & RESEARCH

Educators should discuss the range of emotions experienced by caregivers related to EOLC and healthy coping strategies and encourage the use of reflective practice as a facilitator of professional growth. Nurse leaders should promote supportive environments in NICUs and ensure debriefing opportunities for nurses who have recently cared for a dying infant. Future research should focus on formulating interventions to utilize debriefing with NICU nurses and perhaps the development of EOLC mentors.

Secondary Traumatic Stress and Burnout Among Muslim Nurses Caring for Chronically Ill Children in a Turkish Hospital

PURPOSE

This study investigated secondary traumatic stress and its relationship to burnout among nurses working at a Turkish hospital.

DESIGN

A mixed-methods design included a cross-sectional survey administering the Professional Quality of Life instrument and Maslach Burnout Inventory to 106 nurses. Interviews with a subgroup of eight participants explored nurses' experiences and coping strategies related to caring for chronically ill pediatric patients.

RESULTS

High risk levels of secondary traumatic stress existed among 40.6% participants, and those over the age of 40 years were at greater risk. Two main interview themes emerged that identified (a) consequences and (b) coping strategies while caring for chronically ill children. Nurses experience emotional burdens and may purposefully distance themselves from chronically ill children. Social support from nurse colleagues and spiritual beliefs assist coping.

IMPLICATIONS

Workplaces should acknowledge stressors inherent in chronic pediatric nursing care. Environments that welcome spiritual practices and actively encourage social support could address job hazards.

Healthcare staff 's experience in providing end-of-life care to children: A mixed-method review

BACKGROUND

Staff who provide end-of-life care to children not only have to deal with their own sense of loss but also that of bereaved families. There is a dearth of knowledge on how they cope with these challenges.

AIM

The aim of this review is to explore the experiences of healthcare professionals who provide end-of-life care to children in order to inform the development of interventions to support them, thereby improving the quality of paediatric care for both children and their families.

DATA SOURCES

Searches included CINAHL, MEDLINE, Web of Science, EMBASE, PsychINFO and The Cochrane Library in June 2015, with no date restrictions. Additional literature was uncovered from searching reference lists of relevant studies, along with contacting experts in the field of paediatric palliative care.

DESIGN

This was a systematic mixed studies review. Study selection, appraisal and data extraction were conducted by two independent researchers. Integrative thematic analysis was used to synthesise the data.

RESULTS

The 16 qualitative, 6 quantitative and 8 mixed-method studies identified included healthcare professionals in a range of settings. Key themes identified rewards and challenges of providing end-of-life care to children, the impact on staff's personal and professional lives, coping strategies and key approaches to help support staff in their role.

CONCLUSION

Education focusing on the unique challenges of providing end-of-life care to children and the importance of self-care, along with timely multidisciplinary debriefing, are key strategies for improving healthcare staff's experiences, and as such the quality of care they provide.

Caring for the Acutely, Severely Ill Child-A Multifaceted Situation with Paradoxical Elements: Swedish Healthcare Professionals' Experiences

The aim of this study was to describe healthcare professionals' experience of caring for acutely, severely ill children in hospital in Sweden.

DESIGN AND METHODS

Five focus group interviews were conducted with nurses, nurse assistants and physicians comprising a total of 20 participants. Data were analyzed using qualitative content analysis.

RESULTS

An overall theme emerged that describes healthcare professionals' experiences as: "being in a multifaceted area of tension with paradoxical elements". The theme is based on three categories: proficiency of the individuals and the team is the fundamental base; interactions are crucial in an area of tension; and wellbeing of the individual is a balance of contradictory emotions. With maintained focus on the ill child, proficiency is the fundamental base, interactions are crucial, and moreover contradictory emotions are described.

CONCLUSIONS

The interplay based on proficiency may influence the assessments and treatments of acutely, severely ill children.

PRACTICE IMPLICATIONS

Recognizing the multifaceted area of tension with paradoxical elements, practical teamwork exercises, a structured approach, and assessment tools could be a possible way to develop interprofessional team collaboration to improve the care of acutely, severely ill children in order to increase patient safety.

Living with Dying in the Pediatric Intensive Care Unit: A Nursing Perspective

BACKGROUND

Despite reported challenges encountered by nurses who provide palliative care to children, few researchers have examined this phenomenon from the perspective of nurses who care for children with life-threatening illnesses in pediatric intensive care units.

OBJECTIVES

To describe and interpret the essence of the experiences of nurses in pediatric intensive care units who provide palliative care to children with life-threatening illnesses and the children's families.

METHODS

A hermeneutic phenomenological study was conducted with 12 pediatric intensive care unit nurses in the northeastern United States. Face-to-face interviews and field notes were used to illuminate the experiences.

RESULTS

Five major themes were detected: journey to death; a lifelong burden; and challenges delivering care, maintaining self, and crossing boundaries. These themes were illuminated by 12 subthemes: the emotional impact of the dying child, the emotional impact of the child's death, concurrent grieving, creating a peaceful ending, parental burden of care, maintaining hope for the family, pain, unclear communication by physicians, need to hear the voice of the child, remaining respectful of parental wishes, collegial camaraderie and support, and personal support.

CONCLUSION

Providing palliative care to children with life-threatening illnesses was complex for the nurses. Findings revealed sometimes challenging intricacies involved in caring for dying children and the children's families. However, the nurses voiced professional satisfaction in providing palliative care and in support from colleagues. Although the nurses reported collegial camaraderie, future research is needed to identify additional supportive resources that may help staff process and cope with death and dying.

Coping strategies used by Iranian nurses to deal with burnout: a qualitative research

Background:

Although numerous studies have reported about coping strategies among health care worker throughout the world, but no research-based data are available on the perception of coping strategy among Clinical nurses in the Islamic Republic of Iran.

Objective:

The aim of the present study was to describe and explore the experiences of Iranian nurses about their coping strategies.

Methods:

In this study we used a qualitative research approach to explore how Iranian nurses perceive and resolve their burnout at work. Twelve nurses were selected by purposive sampling and in-depth semi structured interviews were conducted. All interviews were tape recorded, transcribed verbatim and then analyzed by means of the conventional qualitative content analysis method.

Results:

The 5 main themes that evolved from content analysis included “religious responsibility”, “approximation to God”, “spiritual reward”, “Holiness of the job” and “spiritual journey” emerged as the most important among these.

Conclusions:

The results of this study emphasized that religious or spiritual beliefs give purpose and meaning to nursing interventions, help them tolerate the problems at work, and make nursing care pleasurable. Therefore, although burnout is an important issue in nursing, attending to this dimension of their job is essential and healthcare authorities should pay a special attention to it.

End-of-life care in the pediatric ICU

PURPOSE OF REVIEW

Pediatric ICUs frequently provide end-of-life (EOL) care to children. Our understanding of how EOL care is delivered to children and what constitutes effective care for dying children and their families in the ICU setting continues to evolve. This review identifies recent work describing events related to the death of a child in the ICU as well as interventional efforts to improve family and provider support.

RECENT FINDINGS

Pediatric ICUs (PICUs) often provide EOL care to children who die in the developed world. Areas of active investigation include identifying effective communication techniques, meeting the needs of patients and parents, and providing support to care providers.

SUMMARY

PICU practitioners are developing flexible and novel approaches to pediatric EOL care in the ICU setting.