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Clancy M, Bradbury-Jones C, Phillimore J, Taylor J. Exploring the experiences of children's palliative care for forced migrant families in the United Kingdom: an interpretative phenomenological study. Front Pediatr 2025; 12:1494938. [PMID: 39834494 PMCID: PMC11743524 DOI: 10.3389/fped.2024.1494938] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Academic Contribution Register] [Received: 09/11/2024] [Accepted: 12/04/2024] [Indexed: 01/22/2025] Open
Abstract
Introduction This study focused on understanding the experiences of forced migrant families and the health care professionals who care for them within palliative care. Palliative care for children requires an active, holistic approach to care, with a focus upon improving quality of life. Forced migrant families encounter a range of additional challenges including the loss of family, belongings, and all sources of familiarity and support. The difficulties of navigating complex bureaucratic systems can confound access and communication difficulties. Methods Interpretative Phenomenological Analysis methodology was used in this study to privilege participant perspectives and apply an active in-depth cyclical process of reflection and reflexivity. Advisory group members provided expertise in childhood illness, palliative care and forced migration, throughout the study. The Silences Framework offered novel theoretical and philosophical concepts, which helped to situate and prioritise the "silences" within the marginalised discourses of forced migration and palliative care. Seven family members and seven health care professional participants were interviewed from hospital, hospice and community palliative care settings in the UK. Results Four overarching themes were identified related to experiences of loss and grief, communication, faith and coping strategies and alienation and discrimination. Compassionate, empathetic, family-centred care which valued family belief systems and coping strategies, optimised care. Learning with and from families was described by all participants, which enhanced understanding and fostered mutual respect. However, barriers included poor access to services and resources, protocol-led care, limited time with families, communication barriers and staff burnout. Discussion The findings suggest the need for a specific educational pathway for palliative care professionals to include spiritual care provision, cultural humility, and moral reasoning. Interdisciplinary education including the use of lived-experience expert insights is also advocated. Sufficient time to build relationships, the importance of interpreter support and the need for better access to hospice care for forced migrant families is also recommended.
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Affiliation(s)
- Marie Clancy
- Academy of Nursing, Department of Health and Care Professions, Faculty of Health and Life Sciences, University of Exeter, Exeter, United Kingdom
| | - Caroline Bradbury-Jones
- Department of Nursing and Midwifery, School of Health Sciences, College of Medicine and Health Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Jenny Phillimore
- School of Social Policy, Sociology and Criminology, University of Birmingham, Birmingham, United Kingdom
| | - Julie Taylor
- Department of Nursing and Midwifery, School of Health Sciences, College of Medicine and Health Sciences, University of Birmingham, Birmingham, United Kingdom
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Lee JH, Lee SY, Cha KM. An Evolutionary Concept Analysis of Pediatric Hospice and Palliative Care. JOURNAL OF HOSPICE AND PALLIATIVE CARE 2024; 27:51-63. [PMID: 38863564 PMCID: PMC11163181 DOI: 10.14475/jhpc.2024.27.2.51] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Academic Contribution Register] [Received: 05/11/2023] [Revised: 05/05/2024] [Accepted: 05/07/2024] [Indexed: 06/13/2024]
Abstract
Purpose This study aimed to clarify the concept of pediatric hospice and palliative care through conceptual analysis. It also sought to identify the differences between related concepts such as pediatric death care and pediatric spiritual care, in order to provide foundational data for the development of nursing theory and knowledge. Methods A conceptual analysis of pediatric hospice and palliative care was conducted using Rodgers' evolutionary method. Out of 5,013 papers identified, 28 were selected for detailed reading and analysis. Results Pediatric hospice and palliative care encompasses physical, psychological, social, mental, spiritual, and family care for children with acute and chronic diseases with uncertain prognoses ahead of death, as well as their families. Effective pediatric hospice and palliative care will require multidisciplinary team nursing, effective communication, and supportive policies. Conclusion The findings of this study suggest that providing pediatric hospice and palliative care will lead to improvements in pain relief for children and families, the efficiency of responses to death in children, and the quality of life for children and families. The significance of this study is that it clearly clarifies the concept by analyzing pediatric hospice and palliative care using an evolutionary method.
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Affiliation(s)
- Jung Hwa Lee
- Department of Nursing Science, Choonhae College of Health Sciences, Ulsan, Korea
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Malcolm C, McGirr D. Educational needs and preferred learning approaches of the paediatric palliative care workforce: A qualitative exploratory study. NURSE EDUCATION TODAY 2020; 89:104417. [PMID: 32320847 DOI: 10.1016/j.nedt.2020.104417] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Academic Contribution Register] [Received: 07/09/2019] [Revised: 12/09/2019] [Accepted: 03/21/2020] [Indexed: 06/11/2023]
Affiliation(s)
- Cari Malcolm
- School of Health and Social Care, Edinburgh Napier University, Room 4.B.38 Sighthill Campus, Edinburgh, Scotland EH11 4BN, UK.
| | - Debbie McGirr
- School of Health and Social Care, Edinburgh Napier University, Room 4.B.38 Sighthill Campus, Edinburgh, Scotland EH11 4BN, UK
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Song W, Li H, Ding N, Zhao W, Shi L, Wen D. Psychometrics properties of the Team Interaction Scale and influencing factors of team interaction of tertiary hospital physicians in China: a cross-sectional study. BMJ Open 2019; 9:e026162. [PMID: 31420382 PMCID: PMC6701648 DOI: 10.1136/bmjopen-2018-026162] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Academic Contribution Register] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVES To administer a cross-cultural adaptation of the Team Interaction Scale (TIS), test its psychometric properties and investigate influencing factors of team interactions in a physician population in Chinese tertiary hospitals. DESIGN Cross-sectional survey. SETTINGS Two rounds of surveys, a pilot and a large sampling survey, were conducted in two and nine tertiary hospitals, respectively, in Liaoning Province, China. PARTICIPANTS In the pilot survey, 363 of 390 physicians sampled were included in the analysis, resulting in an effective response rate of 93.08%. In the large sampling survey, the effective response rate was 89.10% (3653 of 4100 physicians). OUTCOME MEASURES The TIS and a short version of a burn-out scale were administrated to assess the physician's team interaction and burn-out. Psychometric properties of TIS were tested by confirmatory factor analysis (CFA), exploratory factor analysis (EFA) and internal consistency analysis. Gender, age, discipline, education level, professional title, hospital scale and burn-out were explored as influencing factors with independent sample t-tests, one-way analyses of variance and a correlation analysis. RESULTS Based on CFA, a 17-item modified scale was developed following the pilot survey. In the large sampling survey, EFA was conducted with half of the samples, producing six dimensions: 'Communication', 'Coordination', 'Mutual help', 'Team goals', 'Work norms' and 'Cohesion and conflict resolution'. Fit of the modified model was confirmed by CFA with the other half of the samples (root mean square error of approximation=0.067, Comparative Fit Index=0.98, Normed Fit Index=0.97, Goodness of Fit Index=0.94, Adjusted Goodness of Fit Index=0.92). A high Cronbach's α coefficient of 0.98 demonstrated reliability of the modified scale. The Team Interaction Score was significantly lower in younger physicians, in men, in paediatricians and in physicians from larger-scale tertiary hospitals. Team Interaction Scores were negatively associated with burn-out. CONCLUSIONS The adapted TIS, containing 17 items and six dimensions, was reliable and valid for Chinese tertiary hospital physicians. To address physician burn-out, team interaction should be highlighted.
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Affiliation(s)
- Wenwen Song
- Institute for International Health Professions Education and Research, China Medical University, Shenyang, Liaoning, China
| | - Honghe Li
- Institute for International Health Professions Education and Research, China Medical University, Shenyang, Liaoning, China
| | - Ning Ding
- Institute for International Health Professions Education and Research, China Medical University, Shenyang, Liaoning, China
| | - Weiyue Zhao
- Institute for International Health Professions Education and Research, China Medical University, Shenyang, Liaoning, China
| | - Lin Shi
- Medical Insurance Department, Shenyang Tenth People’s Hospital, Shenyang, Liaoning, China
| | - Deliang Wen
- Institute for International Health Professions Education and Research, China Medical University, Shenyang, Liaoning, China
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Contro N, Sourkes BM. Opportunities for Quality Improvement in Bereavement Care at A Children's Hospital: Assessment of Interdisciplinary Staff Perspectives. J Palliat Care 2018. [DOI: 10.1177/082585971202800105] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Academic Contribution Register] [Indexed: 11/16/2022]
Abstract
This study examined the current state of bereavement care at a university-based children's hospital from the perspective of the interdisciplinary staff. In all, 60 staff members from multiple disciplines participated in in-depth interviews. In at least two-thirds of the interviews, issues related to the bereavement experience of both staff and families emerged and were consistently identified. Themes included: disparities in bereavement care based on relationship factors; logistics of time and space; geographical distances; the different cultures and languages of families; continuity in family follow-up; needs of siblings and other family members; staff communication, cooperation, and care coordination; staff suffering; and education, mentoring, and support for staff. This evidence-based needs assessment furnishes an empirical basis for the design and implementation of bereavement services for both families and staff. It can serve as a template for evaluation at other children's hospitals and thus contribute to the sound and creative development of the field of pediatric palliative care.
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Affiliation(s)
- Nancy Contro
- BM Sourkes (corresponding author): Stanford University School of Medicine, Lucile Packard Children's Hospital at Stanford, 725 Welch Road, Room 2129, Palo Alto, California, USA 94304–5731
| | - Barbara M. Sourkes
- N Contro: Lucile Packard Children's Hospital at Stanford, Palo Alto, California, USA
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Kaasalainen S, Sussman T, Bui M, Akhtar-Danesh N, Laporte RD, McCleary L, Wickson Griffiths A, Brazil K, Parker D, Dal Bello-Haas V, Papaioannou A, O'Leary J. What are the differences among occupational groups related to their palliative care-specific educational needs and intensity of interprofessional collaboration in long-term care homes? BMC Palliat Care 2017; 16:33. [PMID: 28521799 PMCID: PMC5437548 DOI: 10.1186/s12904-017-0207-y] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Academic Contribution Register] [Received: 08/09/2016] [Accepted: 05/03/2017] [Indexed: 11/27/2022] Open
Abstract
Background The purpose of this study was to compare the differences across occupational groups related to their end-of-life care-specific educational needs and reported intensity of interprofessional collaboration in long-term care (LTC) homes. Methods A cross-sectional survey, based on two questionnaires, was administered at four LTC homes in Ontario, Canada using a modified Dilman’s approach. The first questionnaire, End of Life Professional Caregiver Survey, included three domains: patients and family-centered communication, cultural and ethical values, effective care delivery. The Intensity of Interprofessional Collaboration Scale included two subscales: care sharing activities, and interprofessional coordination. In total, 697 LTC staff were given surveys, including personal support workers, support staff (housekeeping, kitchen, recreation, laundry, dietician aids, office staff), and registered staff (licensed nurses, physiotherapists, social workers, pharmacists, physicians). Results A total of 317 participants completed the survey (126 personal support workers, 109 support staff, 82 registered staff) for a response rate of 45%. Significant differences emerged among occupational groups across all scales and subscales. Specifically, support staff rated their comfort of working with dying patients significantly lower than both nurses and PSWs. Support staff also reported significantly lower ratings of care sharing activities and interprofessional coordination compared to both registered staff and personal support workers. Conclusions These study findings suggest there are differing educational needs and sense of interprofessional collaboration among LTC staff, specific to discipline group. Both the personal support workers and support staff groups appeared to have higher needs for education; support staff also reported higher needs related to integration on the interdisciplinary team. Efforts to build capacity within support staff related to working with dying residents and their families are needed. Optimal palliative care may require resources to increase the availability of support for all staff involved in the care of patients.
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Affiliation(s)
- S Kaasalainen
- Faculty of Health Sciences, 3N25F, McMaster University, 1280 Main Street West, Hamilton, ON, L8N 3Z5, Canada. .,Queen's University Belfast, Belfast, UK.
| | - T Sussman
- McGill University, Montreal, QC, Canada
| | - M Bui
- Faculty of Health Sciences, 3N25F, McMaster University, 1280 Main Street West, Hamilton, ON, L8N 3Z5, Canada
| | - N Akhtar-Danesh
- Faculty of Health Sciences, 3N25F, McMaster University, 1280 Main Street West, Hamilton, ON, L8N 3Z5, Canada
| | | | - L McCleary
- Brock University, St. Catharines, ON, Canada
| | | | - K Brazil
- Queen's University Belfast, Belfast, UK
| | - D Parker
- Deborah Parker, University of Western Sydney, Sydney, Australia
| | - V Dal Bello-Haas
- Faculty of Health Sciences, 3N25F, McMaster University, 1280 Main Street West, Hamilton, ON, L8N 3Z5, Canada
| | - A Papaioannou
- Faculty of Health Sciences, 3N25F, McMaster University, 1280 Main Street West, Hamilton, ON, L8N 3Z5, Canada
| | - J O'Leary
- Faculty of Health Sciences, 3N25F, McMaster University, 1280 Main Street West, Hamilton, ON, L8N 3Z5, Canada
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McConnell T, Scott D, Porter S. Healthcare staff 's experience in providing end-of-life care to children: A mixed-method review. Palliat Med 2016; 30:905-919. [PMID: 27129677 DOI: 10.1177/0269216316647611] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Academic Contribution Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Staff who provide end-of-life care to children not only have to deal with their own sense of loss but also that of bereaved families. There is a dearth of knowledge on how they cope with these challenges. AIM The aim of this review is to explore the experiences of healthcare professionals who provide end-of-life care to children in order to inform the development of interventions to support them, thereby improving the quality of paediatric care for both children and their families. DATA SOURCES Searches included CINAHL, MEDLINE, Web of Science, EMBASE, PsychINFO and The Cochrane Library in June 2015, with no date restrictions. Additional literature was uncovered from searching reference lists of relevant studies, along with contacting experts in the field of paediatric palliative care. DESIGN This was a systematic mixed studies review. Study selection, appraisal and data extraction were conducted by two independent researchers. Integrative thematic analysis was used to synthesise the data. RESULTS The 16 qualitative, 6 quantitative and 8 mixed-method studies identified included healthcare professionals in a range of settings. Key themes identified rewards and challenges of providing end-of-life care to children, the impact on staff's personal and professional lives, coping strategies and key approaches to help support staff in their role. CONCLUSION Education focusing on the unique challenges of providing end-of-life care to children and the importance of self-care, along with timely multidisciplinary debriefing, are key strategies for improving healthcare staff's experiences, and as such the quality of care they provide.
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Affiliation(s)
- Tracey McConnell
- School of Nursing and Midwifery, Queen's University Belfast, Belfast, UK
| | - David Scott
- School of Nursing and Midwifery, Queen's University Belfast, Belfast, UK
| | - Sam Porter
- School of Nursing and Midwifery, Queen's University Belfast, Belfast, UK
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Abstract
AbstractObjective:This study analyzes symptom perception by parents and healthcare professionals and the quality of symptom management in a pediatric palliative home care setting and identifies which factors contribute to a high quality of palliative and end-of-life care for children.Methods:In this retrospective, cross-sectional study, parents were surveyed at the earliest three months after their child's death. All children were cared for by a specialized home pediatric palliative care team that provides a 24/7 medical on-call service. Questionnaires assessed symptom prevalence and intensity during the child's last month of life as perceived by parents, symptom perception, and treatment by medical staff. The responses were correlated with essential palliative care outcome measures (e.g., satisfaction with the care provided, quality-of-life of affected children and parents, and peacefulness of the dying phase).Results:Thirty-eight parent dyads participated (return rate 84%; 35% oncological disorders). According to parental report, dyspnea (61%) and pain (58%) were the dominant symptoms with an overall high symptom load (83%). Pain, agitation, and seizures could be treated more successfully than other symptoms. Successful symptom perception was achieved in most cases and predicted the quality of symptom treatment (R2, 0.612). Concordant assessment of symptom severity between parents and healthcare professionals (HCPs) improved the satisfaction with the care provided (p = 0.037) as well as the parental quality-of-life (p = 0.041). Even in cases with unsuccessful symptom control, parents were very satisfied with the SHPPC team's care (median 10; numeric rating scale 0–10) and rated the child's death as highly peaceful (median 9).Significance of the results:The quality and the concordance of symptom perception between parents and HCPs essentially influence parental quality-of-life as well as parental satisfaction and constitute a predictive factor for the quality of symptom treatment and palliative care.
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Reid FC. Lived experiences of adult community nurses delivering palliative care to children and young people in rural areas. Int J Palliat Nurs 2013; 19:541-7. [DOI: 10.12968/ijpn.2013.19.11.541] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Academic Contribution Register] [Indexed: 11/11/2022]
Affiliation(s)
- Fiona Cathryn Reid
- Paediatric Oncology/Haematology Nurse Specialist for NHS Highland, Scotland
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Abstract
OBJECTIVE To compare characteristics of family conferences at the bedside vs. the conference room in the PICU. DESIGN Single-site, cohort survey study. SETTING Thirty-three bed academic PICU in an urban setting. PARTICIPANTS Ten PICU physicians (90.9%) providing care to 29 patients whose families participated in 58 family conferences. MEASUREMENTS AND MAIN RESULTS Family conferences, defined as a meeting involving the parent(s) of a PICU patient and the critical care attending physician to discuss a treatment decision, redirection of care from curative to palliative, or deliver bad news, occurred most commonly among families of the sickest patients. Conferences were conducted at the bedside 20 times out of 58 (33%). Although physicians stated a general preference to discuss withdrawal or withholding care in the conference room, there was no difference in location during actual conferences. Physicians preferred the bedside when they wanted the patient to participate (p = 0.01) or because it was perceived to be easier (p < 0.0005) or faster (p = 0.016) to conduct, while the conference room was preferred when additional space was needed (p < 0.0005). Family conferences at the bedside were less likely to include a social worker (p < 0.0005), consultant physicians (p = 0.043), or father of the patient (p = 0.006) as compared with conferences in a conference room. Family conferences convened to discuss a treatment were followed by a decision within 24 hours (42% of the time) and a change in code status (32% of the time). In 32 of 58 family conferences (55%), the attending physician did not have a prior relationship with the family. CONCLUSION Family conferences in the PICU are common both at the bedside and in conference rooms in a subpopulation of the most critically ill children and frequently result in a treatment decision or change in code status.
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Cook KA, Mott S, Lawrence P, Jablonski J, Grady MR, Norton D, Liner KP, Cioffi J, Hickey P, Reidy S, Connor JA. Coping while caring for the dying child: nurses' experiences in an acute care setting. J Pediatr Nurs 2012; 27:e11-21. [PMID: 22703689 DOI: 10.1016/j.pedn.2011.05.010] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Academic Contribution Register] [Received: 10/01/2010] [Revised: 05/17/2011] [Accepted: 05/24/2011] [Indexed: 11/17/2022]
Abstract
The aim of this study was to describe and understand behavior and coping strategies used by pediatric nurses caring for dying children on an inpatient acute care cardiology unit. Qualitative descriptive methods consisting of semistructured questions were presented to acute care nurses participating in focus groups. The nurses who participated in the focus groups had cared for an acutely ill child who died. Conventional content analysis was used to analyze data and organize results. The categories that emerged included the following: boundaries, memories, disconnecting, and labeling. Colleague support, institutional resources, and nurses' experience level were critical to the process of coping. Coping and grieving are facilitated by colleague and unit resources. Studies exploring job dissatisfaction, stress, and burnout from an inadequate grieving process are required.
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Affiliation(s)
- Katherine A Cook
- Nursing/Patient Services, Children's Hospital Boston, Boston, MA, USA.
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Hinds PS, Oakes LL, Hicks J, Powell B, Srivastava DK, Spunt SL, Harper J, Baker JN, West NK, Furman WL. "Trying to be a good parent" as defined by interviews with parents who made phase I, terminal care, and resuscitation decisions for their children. J Clin Oncol 2009; 27:5979-85. [PMID: 19805693 PMCID: PMC2793041 DOI: 10.1200/jco.2008.20.0204] [Citation(s) in RCA: 191] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Academic Contribution Register] [Received: 09/07/2008] [Accepted: 06/18/2009] [Indexed: 11/20/2022] Open
Abstract
PURPOSE When a child's cancer progresses beyond current treatment capability, the parents are likely to participate in noncurative treatment decision making. One factor that helps parents to make these decisions and remain satisfied with them afterward is deciding as they believe a good parent would decide. Because being a good parent to a child with incurable cancer has not been formally defined, we conducted a descriptive study to develop such a definition. METHODS In face-to-face interviews, 62 parents who had made one of three decisions (enrollment on a phase I study, do not resuscitate status, or terminal care) for 58 patients responded to two open-ended questions about the definition of a good parent and about how clinicians could help them fulfill this role. For semantic content analysis of the interviews, a rater panel trained in this method independently coded all responses. Inter-rater reliability was excellent. RESULTS Among the aspects of the definition qualitatively identified were making informed, unselfish decisions in the child's best interest, remaining at the child's side, showing the child that he is cherished, teaching the child to make good decisions, advocating for the child with the staff, and promoting the child's health. We also identified 15 clinician strategies that help parents be a part of making these decisions on behalf of a child with advanced cancer. CONCLUSION The definition and the strategies may be used to guide clinicians in helping parents fulfill the good parent role and take comfort afterward in having acted as a good parent.
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Affiliation(s)
- Pamela S Hinds
- School of Medicine, Department of Pediatrics, George Washington University, Washington, DC, USA.
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