Communication During Palliative Care and End of Life: Perceptions of Experienced Pediatric Oncology Nurses

A meta-synthesis of the experience of paediatric nurses in communication with children

AIM

This study aimed to conduct a meta-synthesis to explore the experiences of paediatric nurses in communication with children.

METHOD

We conducted a meta-synthesis review, following the outline proposed by Sandelowski, Barrosso & Voils. Our search encompassed six electronic databases, namely PubMed, Scopus, EBSCO (MEDLINE), Web of Science, SAGE, and Wiley. The Primary keywords used were "nurse", "child", "communication", and "qualitative". We included qualitative articles in English within the field of paediatric nursing between 1990 and 2023. Initially, 1980 records were identified which reduced to 1339 references after removing duplicates. Subsequently, we assessed 112 full-text articles for eligibility and 14 relevant studies were ultimately included in our review. Quality appraisal was conducted using the Critical Appraisal Skill Programme checklist with no study being excluded based on quality criteria. Data were synthesized using the qualitative thematic analysis method.

RESULTS

The data analysis yielded three themes and seven sub-themes. These themes include swinging between triadic and dyadic communication, applying a hybrid of communication methods, and influential factor in communication.

CONCLUSIONS

This study highlighted the significance of establishing a balanced approach between dyadic communication (nurse and child) and triadic communication (nurse-parent-child) in paediatric care. Paediatric nurses emphasized the simultaneous use of verbal and non-verbal methods to enhance effective communication. Additionally, identifying the influential factors in communication can aid in developing and improving nurses' competency in communication skills within paediatric departments.

IMPLICATIONS

Understanding the communication process and the factors that influence it can be instrumental in equipping paediatric nurses with enhanced communication skills in their practice.

IMPACT

Establishing a balanced approach between dyadic communication (nurse and child) and triadic communication (nurse-parent-child) in paediatric care is crucial. Paediatric nurses emphasized the simultaneous use of verbal and non-verbal methods to enhance effective communication. Identifying the influential factors in communication can aid in developing and improving nurses' competency in communication skills within paediatric departments.

Simulation, Storytelling, and Pediatric End-of-Life Care: A Continuing Professional Development Approach for Nurse Residents

Background: Providing end-of-life (EOL) care to pediatric patients and their families is challenging. Newly licensed nurses, especially those working with the hematology/oncology population, have little to no experience providing the specialized care needed for the dying child. An evidence-based continuing professional development activity provided a novel approach to improve the knowledge, attitudes, and comfort levels of nurse residents related to pediatric EOL care. Method: A high-fidelity simulation module of a pediatric oncology patient at the EOL was embedded into a 12-month nurse residency program. The module employed several teaching strategies including a storytelling approach. Results: Thirteen pediatric nurse residents participated in the program. While the evidence-based intervention increased participants' EOL care knowledge, their overall attitudes, and comfort levels remained unchanged. Discussion: EOL simulation with a storytelling approach is a highly valuable method of teaching new nurses how to care for a dying patient. Additional studies are needed to explore how to increase the comfort levels of new nurses in the delicate population of pediatric hematology/oncology.

Perspectives From Adolescent and Young Adult Cancer Survivors for a Planned Nurse-Patient Dyadic Storytelling Intervention

Purpose: This qualitative study aimed to explore the perspectives of adolescents and young adults (AYA) on a planned nurse-patient dyadic storytelling intervention. Background: Cancer is a highly distressful event for AYA. AYA with cancer experience multidimensional suffering while dealing with their developmental transition from adolescence to young adulthood. Their unique needs require appropriate, well-tailored psychosocial support. Nurses can provide such support through storytelling approaches.

METHOD

AYA cancer survivors participated in cross-sectional qualitative interviews to provide feedback on the nurse-patient storytelling intervention model.

ANALYSIS

Qualitative content analysis was used to interpret and categorize the data.

FINDINGS

Barriers and facilitators of the intervention emerged. Themes related to barriers included (a) the disadvantages of an online program, (b) the limitations of the in-person program, (c) interacting with nurses, (d) sharing personal stories with others, and (e) the timing of the program. Themes regarding facilitators included (a) benefits to AYA with cancer, (b) benefits to nurses, (c) benefits of online/in-person programs, and (d) willingness to participate. Conclusions: AYA with cancer may benefit from the nurse-patient dyadic storytelling intervention. Developing innovative methods to optimize and customize interventions based on preferences is essential. Future research should involve nurse feedback and tailored approaches for AYA with cancer.

Nurse experiences of partnership nursing when caring for children with long-term conditions and their families: A qualitative systematic review

AIM

To explore the experiences of partnership nursing among nurses when caring for children and young people with long-term conditions, and their families.

BACKGROUND

Partnership nursing is promoted as a positive model of care among paediatric nurses, where shared roles and decision-making, parental participation, mutual trust and respect, communication and negotiation are valued to create positive care experiences and enhance patient outcomes. Little is known about how nurses use partnership with both the patient and the parents in this triad to deliver partnership nursing.

DESIGN

A qualitative systematic review followed Joanna Briggs Institute meta-aggregation approach and has been reported according to PRISMA guidelines.

METHODS

A comprehensive systematic search was conducted in seven electronic databases. Studies were assessed according to a pre-determined inclusion criteria. Qualitative findings with illustrative participant quotes were extracted from included studies and grouped into categories to inform overall synthesised findings. Methodological quality assessment was conducted.

FINDINGS

A total of 5837 publications were screened, and 41 qualitative studies were included. Three overarching synthesised findings were identified: (1) Using education to promote feelings of safety and support, (2) Partnering to develop a strong therapeutic relationship and (3) Optimising communication underpinned by shared decision-making principles to deliver individualised care.

CONCLUSION

Nurses demonstrated successful partnership in their practice, but focused on developing dyadic nurse-parent and dyadic nurse-child partnerships. Future practice development that creates a three-way triadic partnership may aid therapeutic relationships and shared decision-making.

IMPLICATIONS FOR CLINICAL PRACTICE

Clinicians can reflect on how dyadic partnerships (focusing on the child or the parent) may exclude opportunities for coherent care. Further exploration in practice, policy and research as to how nurses determine child competency and child and parent level of engagement in triadic partnership may improve the potential of meaningful shared decision-making.

Realities and ideals: Experiences and needs of pediatric oncology nurses in communication processes with children and their families at the end-of-life period: A photovoice qualitative study

Effective communication in end-of-life care for pediatric cancer patients is crucial. Yet, limited research focuses on the communication experiences of pediatric oncology nurses during this period. This study aims to investigate the communication experiences and needs of these nurses with children and their families during the end-of-life period. A qualitative study design with photo voice methodology was followed. The research was conducted with 16 pediatric oncology nurses working in the pediatric oncology wards of a university hospital between January and May 2023. Data were collected the "Characteristic Information Form", "Semi-Structured Interview Form", and photovoice methodology. Data were analyzed through reflexive thematic analysis. Most of the nurses are at the undergraduate level, and their working experience in pediatric oncology wards ranges from 4 months to 17 years. Seven main themes emerged: Optimistic Communication-Interaction, Mindfulness, Active Coping, Behavioral Actions, Death Uncertainty Dilemma, Interpersonal and Environmental Factors, and Discrepancy between Ideals and Reality. The study sheds light on the importance of pediatric oncology nurses' ideals versus realities upstream approach in communicating with end-of-life children and their families, empowering pediatric oncology nurses on the journey to ideal end-of-life care.

Vicarious learning and communication self-efficacy: A pediatric end-of-life simulation for pre-licensure nursing students

BACKGROUND

End-of-life clinical experiences, particularly in pediatrics, are quite limited for pre-licensure nursing students. Though effective, end-of-life simulations can be costly, require facilitators trained in palliative and end-of-life care, and are restricted by limited space and time availability. Such barriers prompt the question as to whether there is an effective alternative to simulation by which students can gain improved self-efficacy in therapeutic communication during pediatric end-of-life situations.

PURPOSE

Bandura's Social Cognitive Theory and work exploring self-efficacy posits that vicarious learning provides learners opportunities to gain experience and knowledge through observation of peers in simulated settings. This study evaluated the effectiveness of vicarious versus active learning on pre-licensure nursing students' perceived self-efficacy in providing therapeutic communication during a pediatric end-of-life situation.

METHOD

Data were collected over three time points - pre-simulation, post-simulation, and post-debriefing - using a modified Self-Efficacy in Communication Scale.

RESULTS

Learners in both groups had significant improvement in self-efficacy across all time points. Only two items had significant differences between vicarious and active learner groups, but the effect was minor.

CONCLUSION

Vicarious learning presents as a viable pedagogical approach for providing pre-licensure nursing students important learning opportunities related to pediatric end-of-life simulations during both the scenario and debriefing.

The Perceptions of Children and Adolescents with Cancer Regarding Nurses' Communication Behaviors during Needle Procedures

Background: Communicating with children and adolescents with cancer during a needle procedure can prove challenging for healthcare professionals. Objective: Our aim was to explore the perceptions of children and adolescents with cancer regarding communication with nurses during needle procedures. Method: Thus was a qualitative phenomenological study. Data were gathered through seven in-depth interviews with a convenience sample of children and adolescents with cancer. Data were analyzed using a grounded theory approach to identify themes in the participants' narratives. Results: The analysis revealed three themes describing participants' experience: (1) nurses need to explain clearly what they are going to do while also allowing children to express their emotions without feeling coerced; (2) nurses need to be honest and approachable and relate to children as active participants in the treatment process; and (3) it is distressing to hear other children who are undergoing a needle procedure cry out in pain. Further application of the constant comparison method yielded a core theme: (4) the pressures faced by oncology nurses lead them to focus on the technical side of procedures at the expense of their young patients' communication needs. Conclusions: We suggest that hospital managers need to ensure that oncology nurses have sufficient training in communication skills and are confident in their ability to respect and respond to the communication preferences and needs of patients.

Factors Influencing Pediatric Hematology/Oncology Nurse Retention: A Scoping Review

Background: Nursing staff retention is an ongoing concern within pediatric hematology/oncology settings globally. Work-related stressors cause emotional burden, psychological distress, and burnout to which nurses respond by leaving their workplace. Consequently, workplace culture and functionality are negatively impacted, quality of care reduces, and potential harm to patients increases. This paper aims to identify the "most" influencing factors for intention to leave among pediatric hematology/oncology nurses. Methods: A systematic search was undertaken on 29 July 2021 across five electronic databases, Cumulative Index to Nursing and Allied Health Literature, Joanna Briggs Institute, MEDLINE, PubMed, and Web of Science, using MeSH and keywords related to pediatric hematology/oncology nurse retention. Results: The initial search yielded 283 articles. Following abstract and full-text review, nine articles met inclusion criteria. Across all studies, strong links between health service organizational factors (e.g., unit acuity and time constraints), clinician demographics (e.g., age, education, experience, and coping mechanisms), and nursing retention within pediatric hematology/oncology settings were observed. Direct patient care and long-term relationships with pediatric hematology/oncology patients were identified as the most frequent and intense stressors, while also presenting the most rewarding aspect of the nurse's work. Discussion: Clinician burnout and retention were found to be complex and multifaceted organizational and individual issues, which most importantly evolved from accumulative exposure to specialty-specific stressors. Interventions to prevent clinician burnout and improve staff retention, therefore, need to comprise individual and organizational level strategies specific to the healthcare context.

When and how do healthcare professionals introduce specialist palliative care to the families of children with life-threatening conditions in Taiwan? A qualitative study

BACKGROUND

Specialist palliative care (SPC) is often needed to manage complex or refractory problems in children with life-threatening conditions during end-of-life. This study explores the perceptions of healthcare professionals (HPs) to determine the triggers leading to and experiences with introducing SPC among families of children with life-threatening conditions.

METHODS

A secondary analysis of 13 semi-structured interviews with HPs conducted from September 2019-June 2020 was carried out in a pediatric ward and a neonatal and pediatric intensive care unit in Taiwan. A thematic analysis was conducted. Competence Theory was used to guide the research questions and the interpretive framework.

FINDINGS

Seven nurses, four pediatricians, one psychologist, and one respiratory therapist were interviewed. The need for shared knowledge regarding wishes for care and end-of-life decision-making were found to be the indicators for introducing SPC, along with having a fear of causing harm to the family-professional relationship and the patient. HPs value harmony in the form of clarifying misconceptions, building trust, and holding the moral bottom line. The theme of 'seeking the competent self' encompasses the values and expectations related to improving skills and creating a sense of fulfillment as HPs achieve good quality care.

DISCUSSION

Discussions about SPC facilitate better communication and decision-making. Careful attention should be paid to the needs related to clarifying misconceptions and protecting the child's right to life when SPC is suggested.

APPLICATION TO PRACTICE

Communication, empathy, and conflict resolution training may be helpful with developing HP competencies related to introducing SPC.

Palliative Cancer Care Stress and Coping Among Clinical Nurses Who Experience End-of-Life Care

The increasing number of cancer patients and prolonged periods of illness have led to an increase in nurses' stress and various other problems. This research aimed to identify the stress resulting from caring for cancer patients and the methods for coping with stress among cancer care nurses. The research subjects were 180 clinical nurses caring for cancer patients in a hospital in Korea. Stress caused by excessive workloads, inappropriate compensation, and interpersonal conflicts with physicians was high. There was a difference in stress according to age. Coping strategies differed according to religion, education, occupation, hospice education, job satisfaction, and leisure activities. The higher the stress, the greater the number of coping strategies used. Problem-related coping was associated with more diverse stressors. Stress characteristics differed according to various factors, whereas stress coping strategies depended on the stress characteristics of clinical nurses caring for cancer patients. Future research following a critical approach will be needed to elucidate the compassion fatigue related to the stress strategies of clinical nurses. These findings could contribute to the development of interventions to reduce stress in clinical nurses by providing evidence on the stress and coping methods of nurses who provide palliative care for cancer patients.

Ethical climate and moral distress in paediatric oncology nursing

BACKGROUND

Ethical climate and moral distress have been shown to affect nurses' ethical behaviour. Despite the many ethical issues in paediatric oncology nursing, research is still lacking in the field.

RESEARCH AIM

To investigate paediatric oncology nurses' perceptions of ethical climate and moral distress.

RESEARCH DESIGN

In this cross-sectional study, data were collected using Finnish translations of the Swedish Hospital Ethical Climate Survey-Shortened and the Swedish Moral Distress Scale-Revised. Data analysis includes descriptive statistics and non-parametric analyses.

RESPONDENTS AND RESEARCH CONTEXT

Ninety-three nurses, working at paediatric oncology centres in Finland, completed the survey.

ETHICAL CONSIDERATIONS

According to Finnish legislation, no ethical review was needed for this type of questionnaire study. Formal research approvals were obtained from all five hospitals. Return of the questionnaire was interpreted as consent to participate.

RESULTS

Ethical climate was perceived as positive. Although morally distressing situations were assessed as highly disturbing, in general they occurred quite rarely. The situations that did appear often reflected performing procedures on school-aged children who resist such treatment, inadequate staffing and lack of time. Perceptions of ethical climate and frequencies of morally distressing situations were inversely correlated.

DISCUSSION

Although the results echo the recurrent testimonies of busy work shifts, nurses could most often practise nursing the way they perceived as right. One possible explanation could be the competent and supportive co-workers, as peer support has been described as helpful in mitigating moral distress.

CONCLUSION

Nurturing good collegial relationships and developing manageable workloads could reduce moral distress among nurses.

Advocacia em saúde na enfermagem oncológica: revisão integrativa da literatura

RESUMO Objetivo Identificar a produção científica acerca do tema advocacia do paciente por enfermeiros no contexto da oncologia. Método revisão integrativa com busca e seleção dos estudos primários realizadas em fevereiro de 2020 em quatro bases de dados relevantes na área da saúde: Lilacs, SciELO, Cochrane e PubMed. A amostra foi composta por 11 estudos de um universo de 395 artigos. Os 11 estudos foram agrupados em duas categorias. Resultados A partir da síntese das evidências foi possível elaborar as categorias conforme as temáticas mais abordadas, são elas: “Situações vivenciadas pelos pacientes e enfermeiros em que é necessária a advocacy” e “Estratégias que aprimoram o exercício de advocacy” que foi subdividida em três subcategorias: Self-advocacy; Sistemas de apoio e advocacy para os pacientes; Comunicação centrada no paciente (CCP) e Tomada de decisão compartilhada (TDC). Conclusões e implicações para a prática A importância do exercício de advocacy pelos enfermeiros em oncologia é evidente nos estudos, pautando-se na necessidade da comunicação, educação, apoio e reconhecimento da necessidade para intervir quando necessário, considerando a ética como guia para auxiliar na tomada de decisões, reforçando a necessidade de reflexões sobre a temática fortalecendo e embasando tecnicamente a prática profissional.

Striving to reduce suffering: A Phenomenological Study of nurses experience in caring for children with cancer in Ghana

Aim

To provide insights into nurses lived experiences in caring for children with cancer.

Background

Little is known about the paediatric oncology nurses shared practices of caring for children with cancer in Ghana.

Design

A hermeneutic phenomenological qualitative study.

Methods

A semi-structured interview with 14 purposely sampled Ghanaian paediatric oncology nurses. Findings were analysed using Diekelman, Allen and Tanner's approach.

Results

The theme "Striving to reduce suffering" and three relational subthemes: "knowing children's needs," "Rendering a hopeful fight" and "Ensuring continuity and coordination of care" emerged. Increased awareness of this phenomenon for the nurses who care for these children is vital to ensure quality and holistic care that is meaningful and satisfying by nurses for children with cancer. Paediatric oncology nurses can use the result of the study to evaluate their caring practice and as an avenue to develop better caring practice.

Nurses' Communication With the Families of Patients at the End-of-Life

BACKGROUND

Effective communication is important in providing quality care to families at the end-of-life. In the end-of-life situations, the nurses' views on how to communicate with the family are not well understood.

AIM

This study was conducted to explore the nurses' experiences of their communication with families of patients at the end-of-life situations.

METHODS

The authors used standards for reporting qualitative research. The data were analyzed by conventional content analysis. Semi-structured interviews were conducted with 24 Iranian nurses who had the experiences of dealing with patients' families at the end-of-life.

RESULTS

Nurses' perceptions of communication with families emerged base on the main theme: "Disrupted communication" consisting of two categories: "restricted communication" and "abortive communication."

CONCLUSION

The results of this study highlight the need to increase the professional and ethical sensitivity of nurses in dealing with patients' families at the end-of-life.

An Innovative Application of End-of-Life Nursing Education Consortium Curriculum to Increase Clinical Nurses' Palliative Care Knowledge

Clinical nurses are in a crucial position to provide primary palliative care by advocating for patients and families at the end of life, collaborating with the health care team to optimize quality of life, and contributing to enhanced symptom management. Most clinical nurses, however, have not received the comprehensive palliative care education needed to provide high-quality palliative care. The End-of-Life Nursing Education Consortium curriculum can bridge this gap by providing nurses with the knowledge needed to promote palliative care. Following completion of an End-of-Life Education Consortium train-the-trainer program, 6 nurses from a large, metropolitan academic medical center designed and implemented a series of 20-minute educational sessions informed by a hospital-wide needs assessment and based on the End-of-Life Nursing Education Consortium curriculum. The educational sessions, Palliative Care Conversations, provide clinical nurses with the core palliative care knowledge and skills needed to advocate for and provide patient-/family-centered care throughout the serious illness trajectory and at end of life. This article describes the process, design, and content of the palliative care educational sessions.

Exploring the thinking, reasoning and clinical approach of expert child psychiatric nurses

BACKGROUND

Expert nurses are characterized by their deep knowledge of patient situations and understanding of patients in the context of their total situation. We know of no studies that have focused on the expert practice of child/adolescent (C/A) psychiatric mental health (PMH) advanced practice nurse.

OBJECTIVE

The purpose of this study was to gather information on how expert C/A advanced practice psychiatric nurses (APPNs) view their role and assess/treat children and adolescents with complex mental health issues.

METHOD

Expert C/A APPNs were interviewed by one of the two investigators using a semi-structured interview guide. All interviews were audiotaped and transcribed. This was a qualitative descriptive study and in line with that method, interview content was open-coded and examined for themes that were collapsed into categories.

RESULTS

Fifteen C/A PMH APPNs were interviewed. Initial categories that were distilled included descriptions of their commitment to the population, development of families as partners, an expanded approach to medication management, and how they demonstrate expertise.

CONCLUSION

Expert nurses adopt an invaluable approach to children and families-inherently patient and family-centered. They view the child/teen in terms of the multiple contexts of their lives.

Communication Training: Needs Among Oncology Nurses Across the Cancer Continuum

BACKGROUND

Oncology nurses are responsible for communication-aimed prognosis, patient education about cancer care and treatment, survivorship, and care coordination. Communication difficulties and uncomfortable communication topics put nurses at risk for compassion fatigue.

OBJECTIVES

Supporting nurse communication skills requires institutional policies and structures to foster patient-centered communication. This study reports on communication training needs for oncology nurses to inform future development of communication curricula and institutional training.

METHODS

A national survey of oncology nurse teams (N = 355) attending one of four communication training courses was used. Surveys were used to evaluate institutions' current patient-centered communication practices and to ascertain institutional communication training needs.

FINDINGS

Nurses' role in communicating prognosis remains unclear, and training is needed for discussing survivorship. Curriculum development should be congruent with institutionally defined roles for nurse communication.

Paediatric oncology providers' perspectives on early integration of paediatric palliative care

BACKGROUND

Healthcare providers' perceptions of palliative care in children with cancer influence care management, specifically that of its early integration. Thus, it is crucial to understand the perspectives of the providers on early integration of palliative care so that measures to create informed care decisions are based on reconciling their views.

AIMS

To explore the perceptions of paediatric oncology providers at the Children's Cancer Institute (CCI) in Lebanon regarding the integration of early paediatric palliative care (PPC) in the management of children with cancer.

METHODS

A qualitative descriptive research design with focus groups was used in a leading paediatric oncology setting.

FINDINGS

The thematic analysis yielded four themes: (1) healthcare providers understood palliative care as pain relief and psychological support mainly at the end of life; (2) the timing of integrating PPC is linked to end of life, advanced disease or treatment failure; (3) interdisciplinary collaboration is important for addressing patients' and families' needs effectively; and (4) communication with the child and family is one of the most difficult aspects of integrating PPC.

CONCLUSION

This study demonstrated the perceptions of healthcare providers about early palliative care in paediatric oncology in Lebanon. It also highlighted the importance of interdisciplinary collaboration and effective communication with the child and family for better management of PPC.

Emotional Bond: The Nature of Relationship in Palliative Care for Cancer Patients

Aim

Relationship between care providers and cancer patients is one of the main elements in providing healthcare to these patients. Understanding the characteristics and the nature of the relationship is a basis for further organization of palliative care and will enhance the performance of care providers. The purpose of this study was to investigate the nature of the relationship in palliative care for cancer patients.

Methods

In this qualitative study, 16 participants with rich experiences in the field of cancer patient's palliative care were selected by purposive sampling. A semi-structured face-to-face interview was conducted with each of the participants. After data collection, all interviews were transcribed and reviewed, and then primary codes, sub-categories, and categories were extracted.

Results

Data analysis emerged three categories; being alongside the patient, establishing and maintaining cordiality relationship, and mutual understanding with the patient. Moreover, an emotional bonding was the main theme that defined the nature of relationship between the care provider team and cancer patients in a palliative care approach.

Conclusion

Effective relationship based on emotional bonding is the foundation of palliative care in cancer patients. Considering the structures and palliative care settings in health systems, it is possible to provide training programs regarding the strategies related to establishing emotional bond for effective delivery of palliative care.

Important situations that capture moral distress in paediatric oncology

BACKGROUND

The paediatric Moral Distress Scale-Revised (MDS-R) was previously translated and adapted to Swedish paediatric oncology. Cognitive interviews revealed five not captured situations among the 21 items, resulting in five added items: 22) Lack of time for conversations with patients/families, 23) Parents' unrealistic expectations, 24) Not to talk about death with a dying child, 25) To perform painful procedures, 26) To decide on treatment/care when uncertain. The aim was to explore experiences of moral distress in the five added situations in the Swedish paediatric MDS-R, among healthcare professionals (HCPs) in paediatric oncology.

METHODS

In this national cross-sectional survey, the Swedish paediatric MDS-R, including five added items, were used. Descriptive statistics, non-parametric analysis of differences between professions and a MDS-R score for each item were calculated. Internal consistency was tested using Cronbach's alpha and inter-item correlation test. HCPs (n = 278) at all six Swedish paediatric oncology centres participated (> 89%). The Regional Ethical Review Board had no objections. Consent was assumed when the survey was returned.

RESULTS

Nursing assistants (NAs) reported higher intensity and lower frequency on all added items; registered nurses (RNs) reported a higher frequency on item 22-25; medical doctors (MDs) reported higher MDS-R score on item 26. On item 22, intensity was moderate for RNs and MDs and high for NAs, and frequency was high among all. Item 22, had the second highest MDS-R score of all 26 for all professional groups. On item 23, the level of disturbance was low but it occurred often. The 26-item version showed good internal consistency for the overall sample and for all professional groups. However, item 22 and 24 could be viewed as redundant to two of the original 21.

CONCLUSION

In accordance with other studies, the intensity was higher than the frequency, however, the frequency of the added items was higher than of the original items. In line with previous research, item 22 and 23 are important elements of moral distress. RNs experience the situations more often while NAs find them more disturbing. The results indicate that the added items are important in capturing moral distress in paediatric oncology.

Nurses' perspectives on the personal and professional impact of providing nurse-led primary palliative care in outpatient oncology settings

BACKGROUND:

Palliative care (PC) workforce shortages have led to a need for primary PC provided by non-specialists. The Care Management by Oncology Nurses (CONNECT) intervention provides infusion room oncology nurses with training and support to provide primary PC.

AIMS:

To describe nurses' perspectives on the personal and professional impact of training and provision of primary PC as part of CONNECT.

METHODS:

This qualitative study consisted of in-depth telephone interviews with 11 nurses at oncology practices in Pennsylvania. Data was analysed using qualitative content analysis.

FINDINGS:

Nurses reported a sense of personal and professional fulfillment from providing primary PC, while noting the risk of increased emotional attachment to patients. Participation improved nursing communication skills. A supportive workplace helped to minimise stress related to incorporating primary PC into busy treatment schedules.

CONCLUSION:

Providing primary PC challenges the task-oriented paradigm of nursing practice and will potentially alter the professional roles and workloads of infusion room nurses.

Parent and Child Preferences and Styles of Communication About Cancer Diagnoses and Treatment

Communication challenges frequently occur among families and health care providers of children with life-threatening conditions. These obstacles compound concerns related to children’s diagnoses and treatment, the family’s quality of life, and delivery of care. Developmentally appropriate and validated methods of addressing the communication preferences of families with chronically ill children are limited. This study used six focus groups to determine child and parent preferences and styles of communication centering on new diagnoses and changes in prognosis. Hypothetical situations were used to minimize feelings of self-consciousness among school-aged and adolescent participants. Qualitative analyses (interrater reliability 75%) of child and parent responses revealed 3 categories and 11 subcategories or themes. The category of Characteristics of Communication Exchange included (1) how to tell, (2) who should tell, (3) when to tell, (4) who should be included, and (5) what to tell. The Knowledge and Understanding category included themes of (1) side effects of treatment, (2) what children understand, and (3) questions when being diagnosed. The category of Feelings and Emotions included themes of (1) feelings about changes in prognosis, (2) children’s feelings on being informed, and (3) coping and emotional regulation. Results reveal a need for developmentally appropriate, evidence-based education to inform parents on how, what, and when to communicate information concerning their child’s disease, as well as instructions around facilitating those discussions. Moreover, a need for professional education and training programs for providers is demonstrated by some parental dissatisfaction with bedside manner and disclosure of information. The data collected from this study lay a foundation for future research in communication as a principal factor in quality of life for pediatric patients and their families.

End-of-life communication: a nationwide study of bereaved parents’ perceptions

Objective

To investigate bereaved parents’ perception of end-of-life communication with healthcare professionals after losing a child due to life-limiting diagnoses.

Methods

A national register identified the causes of death of 951 children aged 0–18 years during the period 2012–2014. A previously described classification of life-limiting diagnoses identified 402 children. A modified version of the self-administered questionnaire 'To Lose a Child' was distributed to the parents of these 402 children, capturing their perceptions of communication with the healthcare professionals throughout the child’s disease trajectory and imminent death.

Results

A total of 193 bereaved parents, representing 38% of the identified children, participated in the study. Overall, 98% of the parents expressed the view that physicians should immediately disclose when curatively intended treatment options were exhausted. Some 79% of parents reported that information about their child’s incurable illness was given in an appropriate manner; however, 42% said that information about the child's imminent death was given too late. Finally, 31% felt deprived of the option to say goodbye to their child in their preferred manner, and 56% said that their child’s death was “a shock”.

Conclusions

Parents request accurate and timely information. However, a substantial number of the parents surveyed reported that healthcare professionals communicated too late about palliative care and end-of-life issues. Even though healthcare professionals strive to communicate effectively with dying children and their parents, barriers were identified that may hinder even the best of intentions. National guidelines addressing communication issues and improved education of healthcare professionals should form part of any future agenda.

Oncology Nurse Managers' Perceptions of Palliative Care and End-of-Life Communication

The purpose of this study was to describe pediatric oncology nurse managers' (NMs) perspectives of palliative care/end-of-life (PC/EOL) communication. The study, guided by group-as-a-whole theory and empirical phenomenology, was part of a larger, multisite study aimed at understanding pediatric oncology nurses' experiences of PC/EOL communication. Nurses were assigned to focus groups based on length or type of experience (i.e., nurses with <1, 2-5, or >5 years' work experience and NMs). Eleven NMs from three Midwestern pediatric hospitals with large oncology programs participated in one focus group. The participants' mean years of experience was 15.8 in nursing and 12 in pediatric oncology; 90% had a BSN or higher degree; all had supervisory responsibilities. The authors identified 2,912 meaning statements, which were then analyzed using Colaizzi's method. Findings include NMs' overall experience of "Fostering a Caring Climate," which includes three core themes: (1) Imprint of Initial Grief Experiences and Emotions; (2) Constant Vigilance: Assessing and Optimizing Family-Centered Care; and (3) Promoting a Competent, Thoughtful, and Caring Workforce. Findings indicate that pediatric oncology NMs draw on their own PC/EOL experiences and their nursing management knowledge to address the PC/EOL care learning needs of nursing staff and patient/family needs. NMs need additional resources to support nursing staff's PC/EOL communication training, including specific training in undergraduate and graduate nursing programs and national and hospital-based training programs.

Conspiracy of Silence in Palliative Care: A Concept Analysis

BACKGROUND AND AIM

With chronic diseases on the rise, there is a growing demand for palliative care. The global landscape of the integration of palliative care into health-care systems is incipient, which leads to a lack of social awareness of this reality and consequently, to communication failures, particularly a conspiracy of silence. The aim of this study was to analyze the concept of conspiracy of silence in palliative care.

MATERIALS AND METHODS

Walker and Avant method of concept analysis was used. Review and synthesis of literature supported the analysis process. Forty-seven articles were analyzed.

RESULTS

Results showed that the conspiracy of silence in palliative care is a communication failure, typical of limited life expectancy prognosis, and involves patients, their families, and health-care teams. Lack of autonomy, overburden, family malfunctioning and coping, and health-care dehumanization are consequences of the conspiracy of silence in palliative care.

CONCLUSIONS

The present study had found that scales to measure this concept as well as interventions that consider important factors in the communication process in palliative care identified in this analysis are needed.

Pediatric oncology nurses' perceptions of prognosis-related communication

BACKGROUND

Disclosure of prognosis-related information is an essential aspect of communication with pediatric patients with cancer and their families. The nurse is believed to play an important role in this process, but nurse perceptions and experiences have not been well-described.

PURPOSE

Provide an exploration of pediatric oncology nurses' experiences with prognosis-related communication (PRC).

METHOD

Mixed-methods, multiphase design. This paper highlights the qualitative portion of the study.

FINDINGS

Three themes were identified: Importance of collaboration, impact of PRC, and delivery of prognostic information.

DISCUSSION

Collaboration is a critical element of PRC. Nurses are often not included in the disclosure process, which limits the ability of nurses to fully function in their roles, compromising patient, family, and nurse outcomes. A paradigm shift is required to empower nurses to be more active participants. More education of physicians and nurses is necessary to consistently engage nurses in PRC and prepare nurses for critical conversations.

Health Professionals Perceived Concerns and Challenges in Providing Palliative and End-of-Life Care: A Qualitative Analysis

Background:

The Institute of Medicine identifies that quality palliative/end-of-life (EOL) care should be provided to patients with serious, life-limiting illnesses and their families by competently prepared health professionals.

Purpose:

This study assessed perceived concerns of health professionals pertaining to the delivery of palliative/EOL care in the hospital setting. The specific aim was to determine thematic concerns in the delivery of palliative/EOL care which emerged from respondents’ impressions of a memorable palliative/EOL patient experience.

Methods:

Interdisciplinary health professionals at a large academic health system in the Midwest were surveyed to reflect upon a memorable palliative/EOL life care patient situation (positive or negative). A Thematic Analysis approach was used to code qualitative responses to 4 open-ended questions and then extract themes and subthemes from the coded data.

Results:

Concerns identified by participants (N = 425) emerged around 7 themes including communication (97%), decision-making/care planning (75%), education needs (60%), EOL care (48%), ethics (24%), satisfaction with care (9%), and spiritual/cultural sensitivity (6%).

Conclusion:

Challenges exist in the delivery of quality palliative/EOL care in the hospital setting which may be addressed through educational initiatives that focus on recognition of cultural influences on care preferences, improving communication between patients/families and providers, education about the differences between palliative and EOL care, and increased competency of health providers in having EOL/goals-of-care discussions. Health professionals must recognize the benefit of collaborative palliative care in order to meet patient and family needs holistically and comprehensively.

When Advocacy Extends Life: Age and Diagnosis Discrimination in Patients With Serious Illness

Despite education and professional preparation, age and diagnosis discrimination persists in health care. A case scenario describes discrimination that could have resulted in untimely death without advocacy and intervention by 1 informed professional. Nurses must identify their own attitudes and behaviors associated with age, diagnosis, and their role within the interprofessional team to identify when discrimination may be occurring and claim their responsibility as advocate to ethically intervene on behalf of patients and families when appropriate.

Critical care nurses' experiences of caring for a dying child: A qualitative evidence synthesis

AIM

To synthesize qualitative research examining the experience of critical care nurses caring for a dying child.

BACKGROUND

Caring for a dying child remains one of the most difficult aspects of nursing, potentially leading to personal and professional distress. A thorough understanding of this experience for critical care nurses allows for improved delivery of care and support for the nurse.

DESIGN

A qualitative evidence synthesis was undertaken, informed by Thomas and Harden's thematic synthesis methodology.

DATA SOURCES

Studies were retrieved from CINAHL Plus, Scopus, OVID Medline, and Embase, alongside hand-searching reference lists in February 2016.

REVIEW METHODS

Two reviewers independently assessed each study using a multistep screening process and performed critical appraisal of each included study. Data were extracted onto a predeveloped tool and analysed using thematic analysis.

RESULTS

There is a blurred line between the role of the nurse as a person or a professional while caring for the child and family throughout hospitalization and during and after the death. Each stage of care involves tasks and emotions that highlight the changing dominance of the nurse as either a person or professional.

CONCLUSION

Personal, interpersonal, and contextual factors affect delivery of care and impact of the death of the child on the critical care nurse. Reviewing individual and institutional practices could improve provision of care, interprofessional collaboration, and support provided to staff involved.

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.

Consult, Negotiate, and Involve: Evaluation of an Advanced Communication Skills Program for Health Care Professionals

Effective communication is central to children, young people, and their families’ experiences of health care. Most patient complaints in developed health care systems result from ineffective communication, including inadequate information provision, not feeling listened to, failure to value patients concerns, and patients not feeling involved in care decisions. Advanced communication skills training is now embedded within cancer care policy in the United Kingdom and now features prominently within cancer education in many countries. Here, we share findings from a research evaluation of an advanced communication skills training program dedicated to health professionals caring for children and young people with cancer. We evaluated participants’ (n = 59) perceptions of the program, impact on their skills, knowledge, competence, and confidence. An appreciative inquiry design was adopted; data included interviews, precourse-postcourse evaluations, e-mail blog survey, and 360-degree reflective work records. The framework approach underpinned data analysis and triangulation of data sets. Key findings highlighted good and poor practice in health professionals’ engagement with children, young people, and their families; the purpose of communicating effectively was not always consistent with collaborative working. Attending a program helped participants expand their knowledge of communication theories and strategies. Participants valued using simulated scenarios to develop their skills and were keen to use their new skills to enhance care delivery. Our emphasis within this evaluation, however, remained on what was communicated, when and how, rather than to what effect. The impact of programs such as these must now be evaluated in terms of patient benefit.

Phenomenology Study on Nurses' Experiences in Understanding the Comfort of Children at the End-of-Life

Context:

Patients' need for comfort at the end of their lives is rarely fulfilled. The comfort of patients at the end of their lives, especially children, is affected by nurses' understanding of what comfort means.

Aims:

This research aims to explore and to understand the meaning of children's comfort at the end of their life for nurses.

Setting and Design:

The research applied descriptive qualitative phenomenology design.

Subject and Methods:

The study was conducted at Jakarta. Nurses who have experience in caring the child at the end of their life were in-depth interview with an open-ended question. Data were then analyzed using the Colaizzi method.

Results:

This research identified six themes: striving to reduce children's suffering, realizing what children wanted, observing the children felt comfortable in their family's acceptance of their condition, facing internal and external conflict, experiencing mixed feelings knowing the children's condition, and requiring support from all parties.

Conclusion:

Nurses should provide information regarding children's end of life conditions to the family, to achieve family acceptances. Eventhough it was hard situation and rose internal conflict to nurses. It was found that children also felt comfortable at the end-of-life when they did not experience any suffering, and their wishes were granted. Subsequently, the nurses did not have mixed feelings when the children died. Therefore, evaluation of the training effectiveness that has been given to the nurses should be done to fulfill the need of the child's comfort at the end-of-life.

Research roundup

Synopses of a selection of recently published research articles of relevance to palliative care.