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Yu J, Soh KL, He L, Wang P, Soh KG, Cao Y. The Experiences and Needs of Hospice Care Nurses Facing Burnout: A Scoping Review. Am J Hosp Palliat Care 2023; 40:1029-1039. [PMID: 36400563 DOI: 10.1177/10499091221141063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/19/2023] Open
Abstract
AIM Explore the existing literature on the experience and needs of palliative nurses facing job burnout. BACKGROUND On a global scale, with the increase of aging, the number of people in need of palliative care has increased significantly, which has a huge impact on the professional pressure of palliative nurses. Existing literature focuses on examining palliative care from the perspective of patients, but palliative nurses also face the threats to physical and mental health caused by job burnout. EVALUATION A systematic literature search has been carried out in the following databases as of October 2021:PubMed, EMBASE, CINAHL, Web of Science, and Scopus. The Cochrane Library and Joanna Briggs Institute Library were also searched to confirm if there are any available systematic reviews on the subject. Manually searched the reference list of included papers. KEY ISSUES Seventeen studies were included in this review. Five key issues in the palliative care nurse's experience: (1) psychological harm, (2) physical symptoms, (3) negative emotions, (4) Burnout caused by communication barriers, and (5) Lack of experience. Two key issues in the needs of palliative care nurses: (1) social support, and (2) training and education. CONCLUSION The pressure of facing death for a long time and controlling the symptoms of patients has a very important impact on the mental and physical health of palliative nurses. Nursing staff have needed to be satisfied, and it is essential to provide support and help relieve the pressure on palliative nurses.
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Affiliation(s)
- Jiaxiang Yu
- Department of Nursing, University Putra Malaysia, Serdang, Malaysia
| | - Kim Lam Soh
- Department of Nursing, University Putra Malaysia, Serdang, Malaysia
| | - Liping He
- Department of Nursing, University Putra Malaysia, Serdang, Malaysia
| | - Pengpeng Wang
- Department of Nursing, University Putra Malaysia, Serdang, Malaysia
| | - Kim Geok Soh
- Department of Sport Studies, Faculty of Educational Studies, Putra Malaysia University, Serdang, Malaysia
| | - Yingjuan Cao
- Department of Nursing, Qilu Hospital of Shandong University, Jinan, China
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Loxton I, Oxlad M, Perry A. Consulting parents bereaved by childhood cancer: A qualitative study to improve bereavement services. DEATH STUDIES 2022; 47:891-901. [PMID: 36344115 DOI: 10.1080/07481187.2022.2142325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Twelve Australian parents bereaved by childhood cancer were interviewed about their experiences of, and preferences for, bereavement support, to inform recommendations to improve bereavement care. Reflexive thematic analysis resulted in five themes: Care, empathy, and connection assist with bereavement; Communication makes a difference; Early and ongoing support is desired; Gender matters when grieving the loss of a child; and The pull of peer support. Parents can be assisted through empathy, early and ongoing support, enhanced communication, peer support, and care that is inclusive of all genders. Parents in non-metropolitan areas require increased and flexible support options.
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Affiliation(s)
- Isabella Loxton
- School of Psychology, The University of Adelaide, Adelaide, Australia
| | - Melissa Oxlad
- School of Psychology, The University of Adelaide, Adelaide, Australia
| | - Anna Perry
- School of Psychology, The University of Adelaide, Adelaide, Australia
- Childhood Cancer Association, Adelaide, Australia
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van Kempen MM, Kochen EM, Kars MC. Insight into the content of and experiences with follow-up conversations with bereaved parents in paediatrics: A systematic review. Acta Paediatr 2022; 111:716-732. [PMID: 34995378 PMCID: PMC9304260 DOI: 10.1111/apa.16248] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Revised: 11/16/2021] [Accepted: 01/05/2022] [Indexed: 12/31/2022]
Abstract
Aim A follow‐up conversation with bereaved parents is a relatively well‐established intervention in paediatric clinical practice. Yet, the content and value of these conversations remain unclear. This review aims to provide insight into the content of follow‐up conversations between bereaved parents and regular healthcare professionals (HCPs) in paediatrics and how parents and HCPs experience these conversations. Methods Systematic literature review using the methods PALETTE and PRISMA. The search was conducted in PubMed and CINAHL on 3 February 2021. The results were extracted and integrated using thematic analysis. Results Ten articles were included. This review revealed that follow‐up conversations are built around three key elements: (1) gaining information, (2) receiving emotional support and (3) facilitating parents to provide feedback. In addition, this review showed that the vast majority of parents and HCPs experienced follow‐up conversations as meaningful and beneficial for several reasons. Conclusion An understanding of what parents and HCPs value in follow‐up conversations aids HCPs in conducting follow‐up conversations and improves care for bereaved parents by enhancing the HCPs' understanding of parental needs.
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Affiliation(s)
- Merel M. van Kempen
- Julius Center for Health Sciences and Primary Care University Medical Center Utrecht Utrecht University Utrecht The Netherlands
| | - Eline M. Kochen
- Julius Center for Health Sciences and Primary Care University Medical Center Utrecht Utrecht University Utrecht The Netherlands
| | - Marijke C. Kars
- Julius Center for Health Sciences and Primary Care University Medical Center Utrecht Utrecht University Utrecht The Netherlands
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4
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Moriconi V, Cantero-García M. Bereaved Families: A Qualitative Study of Therapeutic Intervention. Front Psychol 2022; 13:841904. [PMID: 35295402 PMCID: PMC8919973 DOI: 10.3389/fpsyg.2022.841904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Accepted: 01/13/2022] [Indexed: 11/13/2022] Open
Abstract
Background A child's death is the most stressful event and the most complex grief that families face. The process of psychological adaptation to the illness and death of a child is difficult due to a variety of emotional reactions. Parental grief had received the attention of researchers only in recent years when it became clear that this reality differs substantially from the general grief process. Objective This work aims to highlight the needs of bereaved parents; increase the specificity and effectiveness of the therapeutic approach to prevent complications in the process of loss-making; and find the recurrent thematic nuclei in the development of bereavement present in a therapeutic group of parents who have lost their child to an onco-hematological disease. Method Between 2011 and 2016, five therapeutic groups for the grief elaboration were made. The sample included a total of 50 parents of children who died from cancer between the ages of 0 and 21 years.Content analysis was carried out as a qualitative analysis method. The SAS® Text Miner software (SAS Institute Inc, 2004) was used to read, interpret, classify and integrate the data from numerous sources. Results The development and consecutive interpretation of the 5 clusters have been carried out to analyze the related topics using the node "Topic Analysis" and requesting the subdivision into five topics. Four topics have been well defined. Clear topics are reducible to categories of emotional relief, tools, legacy, and unfinished business. The topic analysis provides interesting indications about the different interpretive journeys of the bereavement situation and offers ideas regarding the different types of social responses. Conclusions After reviewing the existing bibliography, we have confirmed the lack of specific literature on the problem of grief in parents whose children have died from cancer. Much research has shown that parents who lose a child to cancer want support, and there are still few studies on the most effective interventions for this group.
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Affiliation(s)
- Valeria Moriconi
- Hospital Universitario Infantil Niño Jesús, Fundación Aladina, Madrid, Spain.,Department of Psychology, Faculty of Biomedical and Health Sciences, Universidad Europea de Madrid, Madrid, Spain
| | - María Cantero-García
- Department of Psychology, Faculty of Biomedical and Health Sciences, Universidad Europea de Madrid, Madrid, Spain.,Department of Psychology, Faculty of Health Sciences, Universidad Internacional de Valencia, Valencia, Spain
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Dias N, Boring E, Johnson LA, Grossoehme DH, Murphy S, Friebert S. Developing a theoretically grounded, digital, ecological momentary intervention for parental bereavement care using the ORBIT model-Phase 1. DEATH STUDIES 2021:1-10. [PMID: 33913789 DOI: 10.1080/07481187.2021.1914239] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Current models of bereavement care do not address all of bereaved parents' unique needs. Diverse challenges limit parents' ability to access certain bereavement services. A web-based intervention prototype for bereaved parents was developed. Using convenience and snowball techniques, 14 participants (pediatric providers, software developers, and bereaved parents) were enrolled in a descriptive, cross-sectional feasibility and usability study. While the intervention was generally considered acceptable, three themes were identified to enhance its usability and acceptability: timing; delivery; and revisions. Further intervention development is needed to improve both short- and long-term physical and psychological outcomes for bereaved parents.
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Affiliation(s)
- Nancy Dias
- Department of Nursing Science, College of Nursing, East Carolina University, Greenville, North Carolina, USA
| | - Elizabeth Boring
- Riley Hospital for Children, Indiana University Health, Indianapolis, Indiana, USA
| | - Lee Ann Johnson
- Department of Nursing Science, College of Nursing, East Carolina University, Greenville, North Carolina, USA
| | - Daniel H Grossoehme
- Haslinger Family Pediatric Palliative Care Center, Akron Children's Hospital, Akron, Ohio, USA
- Rebecca D. Considine Research Institute, Akron Children's Hospital, Akron, Ohio, USA
| | - Savannah Murphy
- Department of Nursing Science, College of Nursing, East Carolina University, Greenville, North Carolina, USA
| | - Sarah Friebert
- Haslinger Family Pediatric Palliative Care Center, Akron Children's Hospital, Akron, Ohio, USA
- Rebecca D. Considine Research Institute, Akron Children's Hospital, Akron, Ohio, USA
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6
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Kochen EM, Jenken F, Boelen PA, Deben LMA, Fahner JC, van den Hoogen A, Teunissen SCCM, Geleijns K, Kars MC. When a child dies: a systematic review of well-defined parent-focused bereavement interventions and their alignment with grief- and loss theories. BMC Palliat Care 2020; 19:28. [PMID: 32164668 PMCID: PMC7068872 DOI: 10.1186/s12904-020-0529-z] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Accepted: 02/19/2020] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND The availability of interventions for bereaved parents have increased. However, most are practice based. To enhance the implementation of bereavement care for parents, an overview of interventions which are replicable and evidence-based are needed. The aim of this review is to provide an overview of well-defined bereavement interventions, focused on the parents, and delivered by regular health care professionals. Also, we explore the alignment between the interventions identified and the concepts contained in theories on grief in order to determine their theoretical evidence base. METHOD A systematic review was conducted using the methods PALETTE and PRISMA. The search was conducted in MEDLINE, Embase, and CINAHL. We included articles containing well-defined, replicable, paediatric bereavement interventions, focused on the parent, and performed by regular health care professionals. We excluded interventions on pathological grief, or interventions performed by healthcare professionals specialised in bereavement care. Quality appraisal was evaluated using the risk of bias, adapted risk of bias, or COREQ. In order to facilitate the evaluation of any theoretical foundation, a synthesis of ten theories about grief and loss was developed showing five key concepts: anticipatory grief, working models or plans, appraisal processes, coping, and continuing bonds. RESULTS Twenty-one articles were included, describing fifteen interventions. Five overarching components of intervention were identified covering the content of all interventions. These were: the acknowledgement of parenthood and the child's life; establishing keepsakes; follow-up contact; education and information, and; remembrance activities. The studies reported mainly on how to conduct, and experiences with, the interventions, but not on their effectiveness. Since most interventions lacked empirical evidence, they were evaluated against the key theoretical concepts which showed that all the components of intervention had a theoretical base. CONCLUSIONS In the absence of empirical evidence supporting the effectiveness of most interventions, their alignment with theoretical components shows support for most interventions on a conceptual level. Parents should be presented with a range of interventions, covered by a variety of theoretical components, and aimed at supporting different needs. Bereavement interventions should focus more on the continuous process of the transition parents experience in readjusting to a new reality. TRIAL REGISTRATION This systematic review was registered in Prospero (registration number: CRD42019119241).
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Affiliation(s)
- Eline M Kochen
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Universiteitsweg 100, 3584 CG, Utrecht, The Netherlands.
| | - Floor Jenken
- Department Woman and Baby, Wilhelmina Childrens Hospital, Lundlaan 6, 3584 EA, Utrecht, The Netherlands
| | - Paul A Boelen
- Department of clinical psychology, Utrecht University, Heidelberglaan 1, 3584 CS, Utrecht, The Netherlands
- Arq Psychotrauma Expert Group, Nienoord 5, 1112 XE, Diemen, The Netherlands
| | - Laura M A Deben
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Universiteitsweg 100, 3584 CG, Utrecht, The Netherlands
| | - Jurrianne C Fahner
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Universiteitsweg 100, 3584 CG, Utrecht, The Netherlands
| | - Agnes van den Hoogen
- Department Woman and Baby, Wilhelmina Childrens Hospital, Lundlaan 6, 3584 EA, Utrecht, The Netherlands
| | - Saskia C C M Teunissen
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Universiteitsweg 100, 3584 CG, Utrecht, The Netherlands
| | - Karin Geleijns
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Universiteitsweg 100, 3584 CG, Utrecht, The Netherlands
| | - Marijke C Kars
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Universiteitsweg 100, 3584 CG, Utrecht, The Netherlands
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Eggly S, Meert KL, Berger J, Zimmerman J, Anand K, Newth CJ, Harrison R, Carcillo J, Dean JM, Willson DF, Nicholson C. Physicians’ conceptualization of “Closure” as A benefit of Physician-Parent Follow-Up Meetings after A Child's Death in the Pediatric Intensive Care Unit. J Palliat Care 2018. [DOI: 10.1177/082585971302900202] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
We examined physicians’ conceptualization of closure as a benefit of follow-up meetings with bereaved parents. The frequency of use and the meaning of the word “closure” were analyzed in transcripts of interviews with 67 critical care physicians affiliated with the Collaborative Pediatric Critical Care Research Network. In all, 38 physicians (57 percent) used the word “closure” at least once (median: 2; range: 1 to 7), for a total of 86 times. Physicians indicated that closure is a process or trajectory rather than an achievable goal. They also indicated that parents and physicians can move toward closure by gaining a better understanding of the causes and circumstances of the death and by reconnecting with, or resolving relationships between, parents and health professionals. Physicians suggested that a primary reason to conduct follow-up meetings is that such meetings offer parents and physicians an opportunity to move toward closure. Future research should attempt to determine whether follow-up meetings reduce the negative effects of bereavement for parents and physicians.
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Affiliation(s)
- Susan Eggly
- S Eggly (corresponding author) Department of Oncology, Wayne State University, 4100 John R Street, MM03CB, Detroit, Michigan, USA 48201
| | - Kathleen L. Meert
- Children's Hospital of Michigan, Detroit, Michigan, USA; J Berger: Critical Care Unit, Children's National Medical Center, Washington, DC, USA
| | - John Berger
- Seattle Children's Hospital, Seattle, Washington, USA
| | - Jerry Zimmerman
- Children's Hospital of Michigan, Detroit, Michigan, USA; J Berger: Critical Care Unit, Children's National Medical Center, Washington, DC, USA
| | - K.J.S. Anand
- Seattle Children's Hospital, Seattle, Washington, USA
| | - Christopher J.L. Newth
- University of Tennessee Health Science Center and Le Bonheur Children's Hospital, Memphis, Tennessee, USA; CJL Newth: Children's Hospital Los Angeles, Los Angeles, California, USA
| | - Rick Harrison
- Mattel Children's Hospital at University of California Los Angeles, Los Angeles, California, USA
| | - Joseph Carcillo
- Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - J. Michael Dean
- Department of Pediatrics, University of Utah, Salt Lake City, Utah, USA; DF Willson: University of Virginia Children's Hospital, Charlottesville, Virginia, USA
| | - Douglas F. Willson
- Pediatric Critical Care and Rehabilitation Program, National Institute of Child Health and Human Development, Bethesda, Maryland, USA
| | - Carol Nicholson
- Pediatric Critical Care and Rehabilitation Program, National Institute of Child Health and Human Development, Bethesda, Maryland, USA
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Abstract
OBJECTIVES To describe the health outcomes of bereaved parents and identify practical strategies for critical care providers as they support and provide anticipatory guidance to bereaved parents. DATA SOURCES PubMed and PsycInfo databases with search terms of bereavement, grief, with parent and pediatric or child complimented by personal experience and knowledge. STUDY SELECTION We sought studies describing parental health outcomes and needs of bereaved parents after the death of their child. DATA SYNTHESIS A narrative literature review was performed and framed from the perspective of PICU providers who care for bereaved parents. We aimed to describe experiences of grief and short- and long-term consequences and approaches to the care of parents and families in the immediate period and in the months after the death of a child. CONCLUSIONS The death of a child is a traumatic experience that can put parents at risk for adverse mental and physical health during bereavement. Health professionals working in PICUs can benefit from knowing these risks to best support bereaved parents, both during their child's hospitalization and in the early postdeath period. The bereavement experience of parents is an adaptive process, and ongoing professional support may be required for vulnerable families. After the child's hospitalization and death, a bereavement follow-up meeting with PICU physician(s) and staff may allow parents to gain additional information, emotional support, and provide an opportunity for parents to give feedback on their experiences.
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Nguyen MNR, Mosel C, Grzeskowiak LE. Interventions to reduce medication errors in neonatal care: a systematic review. Ther Adv Drug Saf 2017; 9:123-155. [PMID: 29387337 DOI: 10.1177/2042098617748868] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2017] [Accepted: 11/27/2017] [Indexed: 01/18/2023] Open
Abstract
Background Medication errors represent a significant but often preventable cause of morbidity and mortality in neonates. The objective of this systematic review was to determine the effectiveness of interventions to reduce neonatal medication errors. Methods A systematic review was undertaken of all comparative and noncomparative studies published in any language, identified from searches of PubMed and EMBASE and reference-list checking. Eligible studies were those investigating the impact of any medication safety interventions aimed at reducing medication errors in neonates in the hospital setting. Results A total of 102 studies were identified that met the inclusion criteria, including 86 comparative and 16 noncomparative studies. Medication safety interventions were classified into six themes: technology (n = 38; e.g. electronic prescribing), organizational (n = 16; e.g. guidelines, policies, and procedures), personnel (n = 13; e.g. staff education), pharmacy (n = 9; e.g. clinical pharmacy service), hazard and risk analysis (n = 8; e.g. error detection tools), and multifactorial (n = 18; e.g. any combination of previous interventions). Significant variability was evident across all included studies, with differences in intervention strategies, trial methods, types of medication errors evaluated, and how medication errors were identified and evaluated. Most studies demonstrated an appreciable risk of bias. The vast majority of studies (>90%) demonstrated a reduction in medication errors. A similar median reduction of 50-70% in medication errors was evident across studies included within each of the identified themes, but findings varied considerably from a 16% increase in medication errors to a 100% reduction in medication errors. Conclusion While neonatal medication errors can be reduced through multiple interventions aimed at improving the medication use process, no single intervention appeared clearly superior. Further research is required to evaluate the relative cost-effectiveness of the various medication safety interventions to facilitate decisions regarding uptake and implementation into clinical practice.
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Affiliation(s)
| | - Cassandra Mosel
- SA Pharmacy, Flinders Medical Centre, Bedford Park, SA, Australia
| | - Luke E Grzeskowiak
- Adelaide Medical School, Robinson Research Institute, University of Adelaide, Level 6, AHMS, Adelaide, SA 5000, Australia
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Jensen J, Weng C, Spraker-Perlman HL. A Provider-Based Survey To Assess Bereavement Care Knowledge, Attitudes, and Practices in Pediatric Oncologists. J Palliat Med 2017; 20:266-272. [PMID: 28072917 DOI: 10.1089/jpm.2015.0430] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Bereavement support is a core tenet of palliative care that may prove difficult for clinicians as it is time-consuming, emotionally charged, and not emphasized in pediatrics training. This project is intended to describe the opinions, knowledge, and practice of bereavement care among pediatric oncologists to identify gaps in clinical care. PROCEDURES An internet-based survey instrument was pilot tested, refined, and distributed to pediatric oncologists in the United States. Statistical analysis was performed using SAS 9.2. RESULTS Electronic surveys were distributed to 2,061 pediatric oncologists and 522 surveys (25%) were fully completed. Participants were asked how likely they are to engage in particular bereavement activities (phone calls, condolence cards, memorial services, family meetings, or referrals for counseling) following the death of a pediatric cancer patient. Eighty-two percent of participants, at least, sometimes engage in at least one of these activities. Being female, an attending physician, and increased time in clinical practice were predictive of active participation in bereavement care. Nearly all participants (96%) believe that bereavement care is part of good clinical care, while 8% indicate that bereavement support is not their responsibility. Lack of time and resources were the biggest barriers to providing bereavement support. CONCLUSIONS The majority of pediatric oncologists engage in clinical practices to support bereaved families. Lack of time and physical resources pose significant barriers to clinician's efforts. Additional supports should be explored to increase pediatric oncology physician uptake of bereavement care practices.
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Affiliation(s)
- Jasmin Jensen
- 1 Division of Pediatric Hematology-Oncology, Kapiolani Medical Center for Women and Children , Honolulu, Hawaii
| | - Cindy Weng
- 2 Study Design and Biostatistics Center, School of Medicine, University of Utah , Salt Lake City, Utah
| | - Holly L Spraker-Perlman
- 3 Division of Pediatric Hematology-Oncology, University of Utah , Primary Children's Hospital, Salt Lake City, Utah
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Aligning guidelines and medical practice: Literature review on pediatric palliative care guidelines. Palliat Support Care 2017; 15:474-489. [PMID: 28065197 DOI: 10.1017/s1478951516000882] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
OBJECTIVE Palliative care for children is becoming an important subspecialty of healthcare. Although concurrent administration of curative and palliative care is recommended, timely referral to pediatric palliative care (PPC) services remains problematic. This literature review aims to identify barriers and recommendations for proper implementation of palliative care for children through the looking glass of PPC guidelines. METHOD To identify studies on PPC guidelines, five databases were searched systematically between 1960 and 2015: Scopus, PubMed, PsycINFO, the Web of Science, and CINAHL. No restrictions were placed on the type of methodology employed in the studies. RESULTS Concerning barriers, most of the papers focused on gaps within medical practice and the lack of evidence-based research. Common recommendations therefore included: training and education of healthcare staff, formation of a multidisciplinary PPC team, research on the benefits of PPC, and raising awareness about PPC. A small number of publications reported on the absence of clear guidance in PPC documents regarding bereavement care, as well as on the difficulties and challenges involved in multidisciplinary care teams. SIGNIFICANCE OF RESULTS Our results indicate that a critical assessment of both the research guidelines and medical practice is required in order to promote timely implementation of PPC for pediatric patients.
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Shorey S, André B, Lopez V. The experiences and needs of healthcare professionals facing perinatal death: A scoping review. Int J Nurs Stud 2016; 68:25-39. [PMID: 28063339 DOI: 10.1016/j.ijnurstu.2016.12.007] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2016] [Revised: 12/13/2016] [Accepted: 12/15/2016] [Indexed: 12/01/2022]
Abstract
BACKGROUND Globally, perinatal death is on a decline. However, its impact on the healthcare profession is huge. The existing literature focuses on examining perinatal death from parents' perspectives and patient death from the perspectives of nurses and a few doctors in critical care, oncology, and neonatology in the West. Due to the unique setting of maternity units where death is not routinely anticipated, as well as distinctive socio-cultural views surrounding death, there is a need to comprehensively review literature examining the impact of perinatal death on the perspectives of healthcare professionals working in maternity units. OBJECTIVES To examine available literature on the needs and experiences of healthcare professionals working in maternity units who have experienced perinatal death. DESIGN A scoping review of published and unpublished data. DATA SOURCES A systematic literature search from 1st January 1996 to 5th August 2016 was made in the following databases: PubMed, CINAHL, Embase, PsycINFO, ScienceDirect, and Web of Science. Cochrane Library, Joanna Briggs Institute Library of Systematic Reviews, York Centre for Reviews and Dissemination, Open Grey, ProQuest Dissertation and Theses, and Mednar were reviewed for grey literature. A hand search of the reference lists of the included papers was performed. REVIEW METHODS Based on the pre-set inclusion criteria, 1519 articles were screened for their titles and abstracts. Eighty-five full-text papers were reviewed, resulting in 30 papers included for this review. The data were extracted and cross-checked between the reviewers. Any discrepancy between the authors' views would be discussed with a third reviewer until consensus was reached. Thematic analysis was used to categorise the results into themes. RESULTS Two major themes emerged from the review: the experiences and needs of healthcare professionals. Six subthemes emerged from the experiences of healthcare professionals: 1) psychological impact, 2) physical impact, 3) positive feelings, 4) coping strategies, 5) personal factors influencing the experience, and 6) cultural factors influencing the experience. Three subthemes including 1) social support, 2) training and education, and 3) other needs explained the needs of healthcare professionals. Studies focusing on the experiences and needs of physicians were scarce. CONCLUSIONS Perinatal death has a profound impact on the psychological and physical wellbeing of healthcare professionals. They have unmet needs that need to be addressed. Though they use internal and external resources to combat their stress, institutional support acknowledging their stress and their needs is essential. Culturally-sensitive education and training are needed to provide support to these professionals.
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Affiliation(s)
- Shefaly Shorey
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, National University Health System, Level 2, Clinical Research Centre, Block MD 11, 10 Medical Drive, Singapore.
| | - Beate André
- Faculty of Nursing- Centre for Health Promotion Research, NTNU- Norwegian University of Science and Technology, 7491 Trondheim, Norway.
| | - Violeta Lopez
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, National University Health System, Level 2, Clinical Research Centre, Block MD 11, 10 Medical Drive, Singapore.
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13
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Brink HL, Thomsen AK, Laerkner E. Parents' experience of a follow-up meeting after a child's death in the Paediatric Intensive Care Unit. Intensive Crit Care Nurs 2016; 38:31-39. [PMID: 27526626 DOI: 10.1016/j.iccn.2016.06.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2015] [Revised: 06/20/2016] [Accepted: 06/25/2016] [Indexed: 11/17/2022]
Abstract
OBJECTIVE 'To identify parents' experience of a follow up meeting and to explore whether the conversation was adequate to meet the needs of parents for a follow-up after their child's death in the Paediatric Intensive Care Unit (PICU). DESIGN AND SETTING Qualitative method utilising semi-structured interviews with six pairs of parents 2-12 weeks after the follow-up conversation. The interviews were held in the parents' homes at their request. Data were analysed using a qualitative, descriptive approach and thematic analysis. FINDINGS Four main themes emerged: (i) the way back to the PICU; (ii) framework; (iii) relations and (iv) closure. CONCLUSION The parents expressed nervousness before the meeting, but were all pleased to have participated in these follow-up meetings. The parents found it meaningful that the follow-up meeting was interdisciplinary, since the parents could have answers to their questions both about treatment and care. It was important that the staff involved in the follow-up meeting were those who had been present through the hospitalisation and at the time of the child's death. Parents experienced the follow-up meeting as being a closure of the course in the PICU, regardless the length of the hospitalisation.
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Affiliation(s)
- Helle L Brink
- Department of Anesthesiology and Intensive Care, Odense University Hospital, Sdr. Boulevard 29, DK-5000 Odense C, Denmark.
| | - Anja K Thomsen
- Department of Anesthesiology and Intensive Care, Odense University Hospital, Sdr. Boulevard 29, DK-5000 Odense C, Denmark
| | - Eva Laerkner
- Department of Anesthesiology and Intensive Care, Odense University Hospital, Sdr. Boulevard 29, DK-5000 Odense C, Denmark
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Lichtenthal WG, Sweeney CR, Roberts KE, Corner GW, Donovan LA, Prigerson HG, Wiener L. Bereavement Follow-Up After the Death of a Child as a Standard of Care in Pediatric Oncology. Pediatr Blood Cancer 2015; 62 Suppl 5:S834-69. [PMID: 26700929 PMCID: PMC4692196 DOI: 10.1002/pbc.25700] [Citation(s) in RCA: 77] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2015] [Accepted: 07/13/2015] [Indexed: 11/11/2022]
Abstract
After a child's death to cancer, families commonly want continued connection with the healthcare team that cared for their child, yet bereavement follow-up is often sporadic. A comprehensive literature search found that many bereaved parents experience poor psychological outcomes during bereavement and that parents want follow-up and benefit from continued connection with their child's healthcare providers. Evidence suggests that the standard of care should consist of at least one meaningful contact between the healthcare team and bereaved parents to identify those at risk for negative psychosocial sequelae and to provide resources for bereavement support.
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Affiliation(s)
- Wendy G. Lichtenthal
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Corinne R. Sweeney
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Department of Psychology, Fairleigh Dickinson University, Teaneck, NJ
| | - Kailey E. Roberts
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Geoffrey W. Corner
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Department of Psychology, University of Southern California, Los Angeles, CA, USA
| | - Leigh A. Donovan
- School of Women’s and Children’s Health, University of New South Wales, Sydney, Australia
| | - Holly G. Prigerson
- Department of Medicine, Weill Cornell Medical College, New York, NY, USA
| | - Lori Wiener
- Pediatric Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
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Meert KL, Eggly S, Kavanaugh K, Berg RA, Wessel DL, Newth CJL, Shanley TP, Harrison R, Dalton H, Dean JM, Doctor A, Jenkins T, Park CL. Meaning making during parent-physician bereavement meetings after a child's death. Health Psychol 2015; 34:453-61. [PMID: 25822059 DOI: 10.1037/hea0000153] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Our goal was to identify and describe types of meaning-making processes that occur among parents during bereavement meetings with their child's intensive care physician after their child's death in a pediatric intensive care unit. METHODS Fifty-three parents of 35 deceased children participated in a bereavement meeting with their child's physician 14.5 ± 6.3 weeks after the child's death. One meeting was conducted per family. Meetings were video recorded and transcribed verbatim. Using a directed content analysis, an interdisciplinary team analyzed the transcripts to identify and describe meaning-making processes that support and extend extant meaning-making theory. RESULTS Four major meaning-making processes were identified: (1) sense making, (2) benefit finding, (3) continuing bonds, and (4) identity reconstruction. Sense making refers to seeking biomedical explanations for the death, revisiting parents' prior decisions and roles, and assigning blame. Benefit finding refers to exploring positive consequences of the death, including ways to help others, such as giving feedback to the hospital, making donations, participating in research, volunteering, and contributing to new medical knowledge. Continuing bonds refers to parents' ongoing connection with the deceased child manifested by reminiscing about the child, sharing photographs and discussing personal rituals, linking objects, and community events to honor the child. Identity reconstruction refers to changes in parents' sense of self, including changes in relationships, work, home, and leisure. CONCLUSIONS Parent-physician bereavement meetings facilitate several types of meaning-making processes among bereaved parents. Further research should evaluate the extent to which meaning making during bereavement meetings affects parents' health outcomes.
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Affiliation(s)
| | - Susan Eggly
- Department of Oncology, Karmanos Cancer Institute/Wayne State University
| | | | - Robert A Berg
- Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia
| | - David L Wessel
- Department of Pediatrics, Children's National Medical Center
| | - Christopher J L Newth
- Department of Anesthesiology and Critical Care Medicine, Children's Hospital Los Angeles
| | - Thomas P Shanley
- Department of Pediatrics and Communicable Diseases, C.S. Mott Children's Hospital
| | - Rick Harrison
- Department of Pediatrics, Mattel Children's Hospital at University of California Los Angeles
| | - Heidi Dalton
- Department of Pediatrics, Phoenix Children's Hospital
| | | | - Allan Doctor
- Department of Pediatrics, St. Louis Children's Hospital
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Eggly S, Manning MA, Slatcher RB, Berg RA, Wessel DL, Newth CJL, Shanley TP, Harrison R, Dalton H, Dean JM, Doctor A, Jenkins T, Meert KL. Language Analysis as a Window to Bereaved Parents' Emotions During a Parent-Physician Bereavement Meeting. JOURNAL OF LANGUAGE AND SOCIAL PSYCHOLOGY 2015; 34:181-199. [PMID: 26726278 PMCID: PMC4696603 DOI: 10.1177/0261927x14555549] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Parent-physician bereavement meetings may benefit parents by facilitating sense making, which is associated with healthy adjustment after a traumatic event. Prior research suggests a reciprocal relationship between sense making and positive emotions. We analyzed parents' use of emotion words during bereavement meetings to better understand parents' emotional reactions during the meeting and how their emotional reactions related to their appraisals of the meeting. Parents' use of positive emotion words increased, suggesting the meetings help parents make sense of the death. Parents' use of positive emotion words was negatively related to their own and/or their spouse's appraisals of the meeting, suggesting that parents who have a positive emotional experience during the meeting may also have a short-term negative reaction. Language analysis can be an effective tool to understand individuals' ongoing emotions and meaning making processes during interventions to reduce adverse consequences of a traumatic event, such as a child's death.
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Affiliation(s)
- Susan Eggly
- Karmanos Cancer Institute, Wayne State University, Detroit, MI, USA
| | - Mark A. Manning
- Karmanos Cancer Institute, Wayne State University, Detroit, MI, USA
| | | | - Robert A. Berg
- Children’s Hospital of Philadelphia, Philadelphia, PA, USA
| | | | | | | | - Rick Harrison
- Mattel Children’s Hospital at University of California Los Angeles, Los Angeles, CA, USA
| | | | | | - Allan Doctor
- St. Louis Children’s Hospital, St. Louis, MO, USA
| | - Tammara Jenkins
- National Institute of Child Health and Human Development, Bethesda, MD, USA
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Granek L, Barrera M, Scheinemann K, Bartels U. When a child dies: pediatric oncologists' follow-up practices with families after the death of their child. Psychooncology 2015; 24:1626-31. [DOI: 10.1002/pon.3770] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2014] [Revised: 01/06/2015] [Accepted: 01/15/2015] [Indexed: 11/06/2022]
Affiliation(s)
- Leeat Granek
- Department of Public Health, Faculty of Health Sciences; Ben-Gurion University of the Negev; Beer Sheva Israel
| | - Maru Barrera
- Department of Psychology and Hematology/Oncology Program; SickKids Hospital; Toronto ON Canada
- Dalla Lana School of Public Health; University of Toronto; Toronto ON Canada
| | - Katrin Scheinemann
- Division of Haematology/Oncology; McMaster Children's Hospital/McMaster University; Hamilton ON Canada
- Children's Hospital; Cantonal Hospital; Lucerne Switzerland
| | - Ute Bartels
- Division of Haematology/Oncology, NeuroOncology Program; SickKids Hospital; Toronto ON Canada
- University of Toronto; Toronto ON Canada
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18
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Feasibility and perceived benefits of a framework for physician-parent follow-up meetings after a child's death in the PICU. Crit Care Med 2014; 42:148-57. [PMID: 24105453 DOI: 10.1097/ccm.0b013e3182a26ff3] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To evaluate the feasibility and perceived benefits of conducting physician-parent follow-up meetings after a child's death in the PICU according to a framework developed by the Collaborative Pediatric Critical Care Research Network. DESIGN Prospective observational study. SETTING Seven Collaborative Pediatric Critical Care Research Network-affiliated children's hospitals. SUBJECTS Critical care attending physicians, bereaved parents, and meeting guests (i.e., parent support persons, other health professionals). INTERVENTIONS Physician-parent follow-up meetings using the Collaborative Pediatric Critical Care Research Network framework. MEASUREMENTS AND MAIN RESULTS Forty-six critical care physicians were trained to conduct follow-up meetings using the framework. All meetings were video recorded. Videos were evaluated for the presence or absence of physician behaviors consistent with the framework. Present behaviors were evaluated for performance quality using a 5-point scale (1 = low, 5 = high). Participants completed meeting evaluation surveys. Parents of 194 deceased children were mailed an invitation to a follow-up meeting. Of these, one or both parents from 39 families (20%) agreed to participate, 80 (41%) refused, and 75 (39%) could not be contacted. Of 39 who initially agreed, three meetings were canceled due to conflicting schedules. Thirty-six meetings were conducted including 54 bereaved parents, 17 parent support persons, 23 critical care physicians, and 47 other health professionals. Physician adherence to the framework was high; 79% of behaviors consistent with the framework were rated as present with a quality score of 4.3 ± 0.2. Of 50 evaluation surveys completed by parents, 46 (92%) agreed or strongly agreed the meeting was helpful to them and 40 (89%) to others they brought with them. Of 36 evaluation surveys completed by critical care physicians (i.e., one per meeting), 33 (92%) agreed or strongly agreed the meeting was beneficial to parents and 31 (89%) to them. CONCLUSIONS Follow-up meetings using the Collaborative Pediatric Critical Care Research Network framework are feasible and viewed as beneficial by meeting participants. Future research should evaluate the effects of follow-up meetings on bereaved parents' health outcomes.
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Abstract
Patient-centered and family-centered care (PFCC) has been endorsed by many professional health care organizations. Although variably defined, PFCC is an approach to care that is respectful of and responsive to the preferences, needs, and values of individual patients and their families. Research regarding PFCC in the pediatric intensive care unit has focused on 4 areas including (1) family visitation; (2) family-centered rounding; (3) family presence during invasive procedures and cardiopulmonary resuscitation; and (4) family conferences. Although challenges to successful implementation exist, the growing body of evidence suggests that PFCC is beneficial to patients, families, and staff.
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Affiliation(s)
- Kathleen L. Meert
- Department of Pediatrics, Critical Care Medicine, Children’s Hospital of Michigan, 3901 Beaubien Boulevard, Detroit, MI 48201, USA, Corresponding author.
| | - Jeff Clark
- Department of Pediatrics, Critical Care Medicine, Children’s Hospital of Michigan, 3901 Beaubien Boulevard, Detroit, MI 48201, USA
| | - Susan Eggly
- Department of Internal Medicine, Karmanos Cancer Institute, Wayne State University, 4100 John R MMO3CB, Detroit, MI 48201, USA
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Eggly S, Meert KL, Berger J, Zimmerman J, Anand KJS, Newth CJL, Harrison R, Carcillo J, Dean JM, Willson DF. Physicians' conceptualization of "closure" as a benefit of physician-parent follow-up meetings after a child's death in the pediatric intensive care unit. J Palliat Care 2013; 29:69-75. [PMID: 23923469 PMCID: PMC3817557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
We examined physicians' conceptualization of closure as a benefit of follow-up meetings with bereaved parents. The frequency of use and the meaning of the word "closure" were analyzed in transcripts of interviews with 67 critical care physicians affiliated with the Collaborative Pediatric Critical Care Research Network. In all, 38 physicians (57 percent) used the word "closure" at least once (median: 2; range: 1 to 7), for a total of 86 times. Physicians indicated that closure is a process or trajectory rather than an achievable goal. They also indicated that parents and physicians can move toward closure by gaining a better understanding of the causes and circumstances of the death and by reconnecting with, or resolving relationships between, parents and health professionals. Physicians suggested that a primary reason to conduct follow-up meetings is that such meetings offer parents and physicians an opportunity to move toward closure. Future research should attempt to determine whether followup meetings reduce the negative effects of bereavement for parents and physicians.
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Affiliation(s)
- Susan Eggly
- Department of Oncology, Wayne State University, 4100 John R Street, MM03CB, Detroit, Michigan 48201, USA.
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MacConnell G, Aston M, Randel P, Zwaagstra N. Nurses' experiences providing bereavement follow-up: an exploratory study using feminist poststructuralism. J Clin Nurs 2012; 22:1094-102. [PMID: 23039194 DOI: 10.1111/j.1365-2702.2012.04272.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
AIMS AND OBJECTIVES To describe the experiences of nurses who provided bereavement follow-up with families after the death of a child or a pregnancy loss and explore facilitators, barriers and challenges. BACKGROUND Bereavement follow-up after the death of a child has been identified as an indicator of quality end of life care by families and health care professionals. Research suggests communication with bereaved families can be challenging and intimidating for nurses, particularly those who have had limited experience. In-depth information about the personal, professional and institutional experiences of nurses providing this care is lacking. DESIGN Eight registered nurses with experience in providing bereavement follow-up to families were interviewed. Purposive sampling provided information rich cases. METHODS Feminist poststructuralism was the guiding theory and methodology used to uncover underlying discourses. This methodology uses the concepts of discourse analysis, subjectivity and agency to enable a critical understanding of the relationships. RESULTS The nurses described complex interactions between themselves, the families, hospital practices and policy, and social norms around the discourses of death and professionalism. The importance of relationship, self-care and closure, professional boundaries, invisible nature of the practice and institutional support were prominent themes. Insights into the challenges and rewards of providing bereavement follow-up are discussed in the context of power relations, and recommendations for change are offered. CONCLUSIONS Nurses in the study were strongly committed to providing ongoing care to families who had experienced the death of a child or a pregnancy loss. Relationships were important to bereavement follow-up care, and the connections with families were often emotional for the nurses. RELEVANCE TO CLINICAL PRACTICE Nurses and other health professionals would benefit from increased support and education related to bereavement and communication with grieving families. Clarity related to institutional policies to support bereavement care is paramount in helping nurses and others in this work.
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Affiliation(s)
- Grace MacConnell
- Pediatric Palliative Care Service, IWK Health Centre, Halifax, Nova Scotia and Adjunct Professor, Dalhousie University, Halifax, Nova Scotia, Canada.
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Carnevale FA, Farrell C, Cremer R, Canoui P, Séguret S, Gaudreault J, de Bérail B, Lacroix J, Leclerc F, Hubert P. Struggling to do what is right for the child: pediatric life-support decisions among physicians and nurses in France and Quebec. J Child Health Care 2012; 16:109-23. [PMID: 22247181 DOI: 10.1177/1367493511420184] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This study examined (a) how physicians and nurses in France and Quebec make decisions about life-sustaining therapies (LSTs) for critically ill children and (b) corresponding ethical challenges. A focus groups design was used. A total of 21 physicians and 24 nurses participated (plus 9 physicians and 13 nurses from a prior secondary analysis). Principal differences related to roles: French participants regarded physicians as responsible for LST decisions, whereas Quebec participants recognized parents as formal decision-makers. Physicians stated they welcomed nurses' input but found they often did not participate, while nurses said they wanted to contribute but felt excluded. The LST limitations were based on conditions resulting in long-term consequences, irreversibility, continued deterioration, inability to engage in relationships and loss of autonomy. Ethical challenges related to: the fear of making errors in the face of uncertainty; struggling with patient/family consequences of one's actions; questioning the parental role and dealing with relational difficulties between physicians and nurses.
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A framework for healing. Pediatr Crit Care Med 2011; 12:221-2. [PMID: 21646945 DOI: 10.1097/pcc.0b013e3181f268ae] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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