Awakening the Spiritual Identity in Adolescents With Cancer: A Phenomenological Study

BACKGROUND

Awakening the spiritual identity in adolescents with cancer is a phenomenon that has not been fully explored. Nevertheless, empirical research shows that spirituality is associated with positive health outcomes for adolescents with cancer. This finding indicates that awakening the spiritual identity can serve as a coping mechanism in health contexts.

OBJECTIVE

In this study, we (1) describe the essential structure of the process of awakening the spiritual identity as experienced and perceived by adolescents with cancer and (2) explore factors that facilitate or hinder the process.

METHODS

We used a qualitative empirical phenomenological approach to explore the process of awakening the spiritual identity of adolescents with cancer. Ten adolescents completed a graphing-timeline activity and participated in semistructured interviews. We analyzed the data with an adapted version of Colaizzi's method.

RESULTS

Regarding the process of awakening the spiritual identity, we identified 4 theme categories corresponding to 12 themes. The essential structure of the process is cyclical and ongoing: once a triggering moment initiates the awakening, adolescents navigate it through connectedness with the transcendent while drawing strength from preexisting spiritual foundations and family.

CONCLUSIONS

We reveal the essential structure of the process of awakening the spiritual identity among adolescents with cancer and highlight factors affecting the process.

IMPLICATIONS FOR PRACTICE

Expanding our understanding of the phenomenon of awakening the spiritual identity among adolescents may support nurses in addressing and fostering adolescents' use of spirituality as a coping mechanism during cancer treatment.

The utility and feasibility of incorporating death cafes in undergraduate education: A qualitative exploration of medical and nursing students' perspectives

BACKGROUND

The current medical and nursing curricula place little emphasis on palliative and end-of-life care. Consequently, students are less comfortable in communicating about topics related to death and dying when providing palliative and end-of-life care. Death cafés utilizes a facilitator-led small group to encourage conversations about death and dying to take place alongside food and beverages in a safe environment. In light of the presence of death taboos, there is a need to understand how medical and nursing students perceive the incorporation of a death café within the undergraduate program.

OBJECTIVES

This study aimed to explore the perceptions of medical and nursing students regarding the utility and feasibility of incorporating death cafés into their undergraduate education.

DESIGN

A qualitative study was conducted.

METHODS

This study was conducted in one medical school in a university in Singapore. Participants above the ages of 18 years, pursuing a full time undergraduate medical or nursing program were invited. A purposive sampling approach using the maximum variation sampling technique to enhance representativeness was used to select the participants based on their sociodemographic and academic variables. A total of 32 medical and nursing students were included in the study. Online individual interviews were conducted. The interviews were then transcribed and analyzed using qualitative content analysis.

RESULTS

Three main categories were developed from the content analysis: (1) Perceptions of death cafés, (2) Features of a death café, and (3) Contents of a death café conversation. Participants viewed the death café as a platform for conversations surrounding death and dying. Several features such as the presence of a facilitator and discussions to be held in small groups were surfaced. The proposed topics to be discussed ranged from communication skills, coping with death encounters, and understanding more about the concepts of palliative care.

CONCLUSION

Medical and nursing students view death cafes as a feasible and potential approach in learning pallative and end-of-life care. The use of a faciliator-guided small group discussion on topics such as coping with death, communication techniques and concepts of palliative care are proposed. Further work is needed to examine how the death café method can potentially impact students' confidence and skills in managing palliative and end-of-life care.

Fundamentals of end-of-life communication as part of advance care planning for older people: An interview study with nursing staff

This exploratory interview study investigated nursing staff members' perspectives on the fundamentals of end-of-life communication with older people as part of advance care planning in home care, nursing home, and hospital settings. Separate semi-structured interviews were conducted with 17 nursing staff members about their experiences, opinions, and preferences before, during, and after end-of-life conversations. Overall themes clustering the fundamentals include preconditions such as feeling comfortable talking about the end of life and creating space for open communication. Fundamentals related to the actual conversation-such as using senses and applying associative communication techniques (e.g., using understandable language), following conversation phases, and being aware of interprofessional collaboration-were also considered important. This study emphasizes the importance of moving along with the older person as well as connecting, adapting, and letting go of control over the conversation's outcome. Many fundamentals can be traced back to the basics of nursing and the humanity of conversation.

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.

Nurses' experiences of providing palliative care for children with life-limiting conditions

BACKGROUND

Paediatric palliative care (PPC) has evolved in response to the increased prevalence of children who have been diagnosed with life-limiting conditions. Nursing care is a fundamental aspect of PPC and understanding nurses' experiences is imperative to the provision and development of quality holistic child-centred services.

AIM

To review nurses' experiences of providing palliative care for children with life-limiting conditions.

METHOD

A systematic database search of the Cumulative Index to Nursing and Allied Health Literature (CINAHL) Complete, Ovid Medline and Scopus was undertaken. Key words consisted of 'palliative care' or 'terminal care' or 'dying' or 'end-of-life care' and children* or paediatric* or pediatric* and 'nurs* experience*' or 'nurs* view*' or 'nurs* perspective*' or 'nurs* feeling*'. Inclusion criteria included peer-reviewed studies published between 2016-2023 in the English language.

FINDINGS

A thematic approach was adopted with the 11 papers selected for the review and each study critically analysed to identify three recurring themes. The themes included: 'a broken wreck', 'makes a life worth living' and 'challenges in doing 100%'. Findings point to mixed feelings among nurses in providing PPC and suggest that nurses experience emotional distress when caring for dying children. With appropriate supports and inspiration from their paediatric patients, nurses are determined to provide a 'good death' for the children in their care. Nevertheless, the perceived lack of knowledge and experience, communication struggles and personal dilemmas can be predisposing factors in triggering negative experiences among nurses when providing palliative care for children with life-limiting conditions.

RECOMMENDATIONS

Education and policy development is required to meet the practice needs and support the emotional needs of nurses engaged in PPC. Further research is required to generate PPC evidence-based nursing interventions. In doing so, high quality PPC practice will be promoted, thereby ensuring high quality PPC for the children and their families.

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.

Taboo words in pediatric oncology: Communication experiences of nurses and physicians with dying children and their families

PURPOSE

Despite the numerous benefits of effective communication between patients, families, and healthcare professionals, there are still substantial barriers and communication challenges. This study investigated the experiences of nurses and doctors working in different pediatric hematology-oncology units in Turkey communicating with children and their parents about end-of-life issues.

METHOD

This qualitative study was conducted with twenty-four physicians and nurses. A descriptive phenomenological approach was used. Data were analyzed using Braun and Clarke's six-step reflexive thematic analysis. The MAXQDA software was used to facilitate data management.

RESULTS

The findings revealed three main themes describing end-of-life communication experiences of physicians and nurses: Avoiding communication with a dying child, Everyone knows but nobody talks, and Complicating aspects of the setting.

CONCLUSIONS

Communication with dying children and their families is essential. However, multiple barriers remain for healthcare providers to do so. That issue burdens the child and their family more during the end-of-life, which is already a challenging experience to handle. Healthcare professionals need urgent training in communication with the dying children and their families.

Registered Nurses' attitudes towards end-of-life care: A sequential explanatory mixed method study

AIMS

To examine registered nurses' attitudes about end-of-life care and explore the barriers and facilitators that influence the provision of high-quality end-of-life care.

DESIGN

A sequential explanatory mixed methods research design was used.

METHODS

An online cross-sectional survey was distributed to 1293 registered nurses working in five different hospitals in the Kingdom of Saudi Arabia. The Frommelt Attitudes Towards Care of the Dying Scale was used to assess nurses' attitudes towards end-of-life care. Following the survey, a subset of registered nurses were interviewed using individual semi-structured interviews.

RESULTS

Four hundred and thirty-one registered nurses completed the online survey, and 16 of them participated in individual interviews. Although nurses reported positive attitudes towards caring for dying patients and their families in most items, they identified negative attitudes towards talking with patients about death, their relationship with patients' families and controlling their emotions. The individual interview data identified the barriers and facilitators that registered nurses experience when providing end-of-life care. Barriers included a lack of communication skills and family and cultural and religious resistance to end-of-life care. The facilitators included gaining support from colleagues and patients' families.

CONCLUSION

This study has identified that while registered nurses hold generally favourable attitudes towards end-of-life care, they have negative attitudes towards talking with patients and families about death and managing their emotional feelings.

RELEVANCE TO CLINICAL PRACTICE

Education providers and leaders in healthcare settings should consider developing programmes for undergraduate nurses and nurses in clinical practice to raise awareness about the concept of death in a cross-section of cultures. Nurses' attitudes towards dying patients will be enhanced with culture-specific knowledge which will also enhance communication and coping methods.

REPORTING METHOD

This study used the Mixed Methods Article Reporting Standards (MMARS).

The effect of death education course utilizing constructivist learning theory on first grade undergraduate nursing student attitudes and coping abilities towards death: A mixed study design

Inadequate clinical preparation for palliative care is often reflected in inadequate education about death. Nursing students as nurses of the future, it is necessary to make them aware of death and overcome fear of it so that they can cope with their future careers and provide qualified and warmly care service.

OBJECTIVES

To determine the effect of death education course using constructivist learning theory on first grade undergraduate nursing student attitudes and coping abilities towards death.

DESIGN

This study was designed using a mixed-methods design.

SETTING

Two campuses of a university school of nursing in China.

PARTICIPANTS

First grade Bachelor of Nursing Science students (n = 191).

METHODS

Data collection includes questionnaires and reflective writing as after class task. Quantitative data were analyzed using descriptive statistics, the Wilcoxon Signed Rank test, and the Mann-Whitney U test. As for reflective writing, content analysis was hired to analysis.

RESULTS

The intervention group's attitude towards death tended to be neutral acceptance. The intervention group's ability to deal with death (Z = -5.354, p < 0.001) and expression of thoughts about death (Z = -3.89 b, p < 0.001) greater than that of the control group. Four themes (Awareness of death before class, Knowledge, The meaning of palliative care, New cognition) were identified from reflecting writing.

CONCLUSION

Compared with the conventional teaching, death education course utilizing constructivist learning theory was found to be a more effective method for developing students' death coping skills and reducing fear of death.

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

PURPOSE

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

CLINICAL RELEVANCE

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

Live Well, Die Well: The Development of an Online, Arts-Based Palliative Care Programme in the Shadow of the COVID-19 Pandemic

The Covid-19 crisis led to an increase in the 'total pain' of many terminally ill patients who faced a reduction in support, due to the temporary closure of front-line palliative day therapy services. A hospice volunteer, I instigated an online day therapy programme for patients previously attending face-to-face day therapy. Participant feedback revealed the importance of providing a space for ongoing peer support for participants' changing sense of identity, an issue for time-limited day therapy programmes. An exploration of key concepts associated with palliative care established the multiple connections between such changing identity and arts-based approaches to living well. This article charts how I used this understanding to develop an alternative, online arts-based support programme, Live well, die well. It explores the links between ongoing mutual support, arts-based activity and the reactions to a shifting identity in patients with a life-limiting illness.

Pediatric Goals of Care Communication: A Socioecological Model to Guide Conversations

The purpose of this article is to explore factors that influence pediatric patients and their parents during provider-led goals-of-care conversations. Our framework can help providers enhance holistic communication by approaching difficult topics (ie, quality of life, end of life) with an understanding of the multilayered external influences that affect patient/parent decision making. A 5-layer model is presented that describes facilitators to conversations about quality goals of care and advance directives. Each year, complex health conditions (a) affect approximately 500 000 children in the United States, 8600 of whom meet current palliative care criteria, and (b) account for over 7 million child deaths globally. Nurses can use knowledge of the unique values and culture of families with children who have complex health conditions to support them by providing high quality, ongoing goals-of-care conversations, especially if their access to pediatric palliative care is limited.

Compassion Fatigue in Oncology Nurses in Turkey: A Qualitative Study

Nurses working in oncology clinics, where terminal patients are frequently cared for, face the risk of compassion fatigue, and, therefore, it is important to understand their experiences of this condition. Accordingly, this study aimed to identify compassion fatigue among nurses working in oncology clinics. The findings led to the identification of 5 themes: empathy, sadness, despair, depersonalization, and not suffering from death.

Improving Nursing Student Resilience Using Online Simulation and Resilience-Based Content in a Pediatric Course

BACKGROUND

New graduate nurse job satisfaction persistently decreases at 6 months postgraduation. To prepare future nurses for career resilience, schools of nursing are implementing resilience into their curriculum.

METHOD

A large Midwestern school of nursing developed and instituted small group discussions, individual assignments, and online simulations to foster career resilience in a required specialty course. The course, offered in the last year of nursing school, included 93 nursing students and a comparison group of 93 nursing students.

RESULTS

The intervention showed an increase in Connor-Davidson Resilience Scale (CD-RISC) scores. Online simulations were useful for classroom learning, helped students discover new ways of thinking, and increased understanding of course content. Differences in simulation techniques were found, and students reported benefitting more from faculty-guided simulations than self-guided simulations.

CONCLUSION

Nurse educators implementing resilience simulation programs can increase new graduate nurse resilience using online simulation, which is an effective technique for teaching nursing students. [J Nurs Educ. 2022;61(6):348-351.].

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

BACKGROUND

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

OBJECTIVE

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

DESIGN

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

DATA SOURCES

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

RESULTS

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

CONCLUSION

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

Decision-Making Process for the Implementation of the Child Therapeutic Support Limitation Plan: Nurses' Experiences

Aim: To present nurses’ experience in the decision-making process for implementing a therapeutic support limitation plan in the PICU. Method: Qualitative exploratory research was conducted through semi-structured interviews with 25 intensive care nurses from January to June 2019. The textual corpus was then submitted for content analysis. Results: Two categories emerged: the nurse and decision-making process of the TSLP and ambivalence of the participating nurse’s feelings in implementing the TSLP. These categories are interrelated in that the decision-making process mobilizes the ambivalence of the participating nurses’ feelings. Final considerations and implications for practice: The starting point of communication between the health teams consists of acquiring information about the concerned child’s end-of-life care plan with no prospect of cure and with some form of therapeutic limit admitted to the PICU. Therefore, this study helps to map possible research gaps on the topic and mobilize researchers to build educational materials, protocols, and tools for comprehensive care that can be used by nurses when faced with ethical dilemma, such as decision-making through TSLP.

Factors associated with critical care nurses' acute stress disorder after patient death

BACKGROUND

In intensive care units, patient death can have a negative psychological influence on the patient's nurse. However, how the frequency of events and factors contributed to acute stress among nurses remains unknown.

OBJECTIVE

The objective of this study was to explore the prevalence of and the factors affecting acute stress disorder among intensive care unit nurses after their patient death.

METHODS

Nurses from five adult intensive care units whose patient had died during the nurses' working shift were recruited from July 2018 to April 2019. Bryant's Acute Stress Disorder Scale, the Beck Anxiety Inventory, and the Beck Depression Inventory-II were used to measure acute stress, depression, and anxiety. Descriptive statistics, chi-square tests, independent sample t-tests, and stepwise logistic regression were used for data analysis.

RESULTS

In total, 119 nurses were enrolled. Nearly one in three nurses (29.4%) had suffered from acute stress disorder after their patient had died. Nurses experienced a higher risk of acute stress disorder when their patients underwent cardiopulmonary resuscitation before death (odds ratio [OR] = 13.75, 95% confidence interval [CI]: 2.59-72.95), when their patients died unexpectedly (OR = 4.88, 95% CI: 1.16-20.56), and when they experienced verbal abuse from the patient family at the patient death (OR = 4.61, 95% CI: 1.18-18.05) compared with their counterparts.

CONCLUSION

Intensive care unit nurses often experience acute stress disorder after their patient death. The nurses of patients who underwent cardiopulmonary resuscitation before death and/or who died unexpectedly and/or nurses who were subjected to verbal abuse by the patient's family were at higher risk of acute stress disorder. A comprehensive program aimed at improving the knowledge, skills, and resilience of nurses is needed.

Translation and Validation of the Arabic Version of the Caring Nurse-Patient Interaction Scale-Patient Version (CNPI-23P)

BACKGROUND

Importantly, little is known about the cancer patients' perceptions about nurses' caring behaviors in Arab countries (Jordan specifically). This is mainly related to a lack of short Arabic instruments that measure nurse-patient interaction from a caring perspective.

OBJECTIVE

To translate and validate an Arabic version of the Caring Nurse-Patient Interaction Scale-Patient Version (CNPI-23P).

METHODS

The CNPI-23 was translated into Arabic using Brislin's model of translation. A cross-cultural adaptation and psychometric testing were used to collect the data from patients with cancer through a self-administered questionnaire, which included the Arabic version of CNPI-23P and demographic characteristics. Descriptive statistics, inferential statistics, and exploratory factor analysis were used.

RESULTS

One hundred fifty patients were recruited. A content validity involving experts and 20 patients indicated that the statements were clear, understandable, and in logical and easy order. Reliability analysis of CNPI-23P subscales ranged between 0.71 to 0.91 and 0.95 for the total Arabic version of CNPI-23P. Results of the exploratory factor analysis showed that the 23-item scale score reflecting 4 caring domains with Kaiser-Meyer-Olkin was 0.896, and Bartlett test of sphericity was significant (P < .001).

CONCLUSION

The Arabic version of CNPI-23P is reliable and valid and can be used in research, clinical, and educational settings in Arabic countries.

IMPLICATIONS FOR PRACTICE

The Arabic version of CNPI-23P may increase our understanding of cancer patients' perceptions about nurses' caring behaviors in Arab countries.

The effect of peer support approach on communication skills of nursing students in pediatric clinical setting

Peer support is a valuable teaching-learning approach to enhance deep learning in the clinical environment. The purpose of the present study was to investigate the effect of peer support on the communication skills of undergraduate nursing students when interacting with hospitalized children and their parents. This was a pre-and post-test quasi-experimental study with two groups. Through the cluster random sampling method, six practical groups of students who undertook a 3-week pediatric practicum were selected. Three groups were allocated to the experimental (n = 51) and control groups (n = 52). Two volunteer post-graduate students in pediatric nursing formed the peer group. First, the peers participated in three 45-min sessions using different scenarios about communication skills. They then tutored the intervention group to improve their communication skills. The communication skills with 5 children and 5 parents were observed for each undergraduate student via the checklist. The experimental group demonstrated significantly higher mean scores of the communication skills than the control groups in post-test (P < 0.001). Moreover, the mean scores of communication skills was significantly higher in post-test than pre-test in both the experimental and control groups (p < 0.001). Peer support approach promoted the communication skills of undergraduate nursing students in pediatric clinical setting.

Nurses' moral distress in end-of-life care: A qualitative study

BACKGROUND

Moral distress is a neglected issue in most palliative education programmes, and research has largely focused on this phenomenon as an occupational problem for nursing staff.

RESEARCH QUESTION

The primary outcome of this study was to explore the causes of morally distressing events, feelings experienced by nurses and coping strategies utilised by a nursing population at an Italian teaching hospital. A secondary outcome of this qualitative study was to analyse whether palliative care or end-of-life care education may reduce morally distressing events.

RESEARCH DESIGN

A hermeneutic-phenomenological qualitative study was performed.

PARTICIPANTS AND RESEARCH CONTEXT

Participants were recruited through snowball sampling. The interviews were conducted and recorded by one interviewer and transcribed verbatim.

ETHICAL CONSIDERATIONS

Ethical approval was obtained from the Institutional Review Hospital Board.

FINDINGS

Six main themes emerged from the interview analyses: (1) the causes of moral distress; (2) feelings and emotions experienced during morally distressing events; (3) factors that affect the experience of moral distress; (4) strategies for coping with moral distress; (5) recovering from morally distressing events; and (6) end-of-life accompaniment. Varying opinions regarding the usefulness of palliative care education existed. Some nurses stated that participation in end-of-life courses did not help them cope with morally distressing events in the ward, and they believe that existing courses should be strengthened and better structured.

DISCUSSION

In this study, moral distress was often associated with poor communication or a lack of communication between healthcare professionals and the patients and/or their relatives and with the inability to satisfy the patients' last requests. According to our findings, the concept of 'good' end-of-life accompaniment was extremely important to our sample for the prevention of morally distressing events.

CONCLUSION

Nurses who work in the onco-haematological setting frequently experience moral distress. Determining the causes of moral distress at early stages is of paramount importance for finding a solution.

An End-of-Life Care Educational Series to Improve Staff Knowledge and Comfort Levels

Nursing staff play a key role in enhancing a patient's quality of life during end of life; however, they perceive lack of knowledge to be the largest barrier in providing quality end-of-life (EOL) care. Literature suggests that implementation of palliative and EOL care education can improve nursing EOL care practices. In order to address the gap in nursing knowledge and comfort, a quasi-experimental study was conducted; this study included the implementation of a multimodal EOL care educational series on an inpatient pediatric hematology oncology floor over 6 months. Prior to implementation, nursing staff completed a survey to measure perceived knowledge and comfort level regarding EOL care. The series included didactic sessions, in-services, case studies, practice exercises, and interactive discussions led by an interprofessional team of nurses, child-life specialists, and social workers. Educational topics included EOL symptom management, child-life services, supportive care resources, COMFORT communication, and an End-of-Life Nursing Education Consortium course. Following the educational series, the survey was repeated. Results of the survey demonstrated an increase in nursing knowledge and comfort levels. Significant improvements were observed across several items including medication management of dyspnea (χ1,83 =5.1, P = .023), comfort with implementing interventions (χ1,93 = 3.9, P = .049), and knowledge of hospital resources (χ1,93 = 6.1, P = .014). These results suggest that while EOL education strategies can vary, a combination of learner engagement tactics can increase knowledge and comfort regarding EOL concepts and potentially positively impact nursing practice.

Clinicians' accounts of communication with patients in end-of-life care contexts: A systematic review

OBJECTIVE

Communication between patients and end-of-life care providers requires sensitivity given the context and complexity involved. This systematic review uses a narrative approach to synthesise clinicians' understandings of communication in end-of-life care.

METHODS

A systematic, narrative synthesis approach was adopted given the heterogeneity across the 83 included studies. The review was registered prospectively on PROSPERO (ID: CRD42019125155). Medline was searched for all articles catalogued with the MeSH terms "palliative care," "terminal care" or "end-of-life care," and "communication". Articles were assessed for quality using a modified JQI-QARI tool.

RESULTS

The findings highlight the centrality and complexity of communication in end-of-life care. The challenges identified by clinicians in relation to such communication include the development of skills necessary, complexity of interpersonal interactions, and ways in which organisational factors impact upon communication. Clinicians are also aware of the need to develop strategies for interdisciplinary teams to improve communication.

CONCLUSION

Training needs for effective communication in end-of-life contexts are not currently being met.

PRACTICE IMPLICATIONS

Clinicians need more training to address the lack of skills to overcome interactional difficulties. Attention is also needed to address issues in the organisational contexts in which such communication occurs.

Development of an Instrument to Measure Stress in Korean Nurses Performing End-of-Life Care for Children

PURPOSE

This study aims to develop a scale to assess the stress of nurses caring for terminally ill children and to test the validity and reliability of the scale.

BACKGROUND

Nurses caring for children experience various stressors that are different from those experienced by nurses caring for adult patients. It is important to understand the level of stress of nurses caring for dying children and their families. Instruments to measure these stress levels, however, are not available.

DESIGN

This study used a methodological approach.

METHOD

The initial items were identified through literature reviews and in-depth interviews. Content validation of the items was evaluated by seven experts. Participants were 357 pediatric nurses working at 11 institutions in six cities. Data were analyzed using item analysis, exploratory and confirmatory factor analysis, internal consistency, and test-retest. This study followed the STROBE checklist.

FINDINGS

The final scale consisted of 22 items chosen and classified into 5 factors (psychological difficulties, conflict with parents, difficulties in communication, lack of end-of-life care knowledge, and restricted working environment), which explained 61.13% of the total variance. The 5-subscale model was validated by confirmatory factor analysis. Cronbach's alpha for the total item was 0.90, and the intra-class correlation coefficient was 0.89.

CONCLUSION

This scale can be used to contribute toward the assessment of stress among nurses performing end-of-life care for children.

PRACTICE IMPLICATIONS

This scale will contribute to the improvement of the quality of life of not only nurses, but also children and their families in pediatric settings.

Hospital Nurses' Perception of Death and Self-Reported Performance of End-of-Life Care: Mediating Role of Attitude towards End-of-Life Care

Few studies have explored how nurses in acute care hospitals perceive and perform end-of-life care in Korea. Therefore, this study aimed to evaluate the influence of nurses' perceptions of death on end-of-life care performance and analyze the mediating role of attitude towards end-of-life care among hospital nurses. This cross-sectional study included a total of 250 nurses who have had experience with end-of-life care from four general hospitals in Korea. We used the Korean validated tools with the View of Life and Death Scale, the Frommelt Attitudes Toward Care of the Dying (FATCOD) scale, and the performance of end-of-life care. Hierarchical linear regression and mediation analysis, applying the bootstrapping method. The results of hierarchical linear regression showed that nurses' positive perceptions of death and attitude towards end-of-life care were significantly associated with their performance of end-of-life care. A mediation analysis further revealed that nurses' attitude towards end-of-life care mediates the relationship between the perceptions of death and performance of end-of-life care. Our findings suggest that supportive and practical death educational programs should be designed, based on nurses' professional experience and work environment, which will enable them to provide better end-of-life 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.

Pediatric Palliative Care: A Literature Review of Best Practices in Oncology Nursing Education Programs

Palliative care as a foundation for patient-centered care is not adequately covered in nursing curricula. This gap in education means that pediatric oncology nurses may lack necessary palliative care competencies to provide comprehensive care to patients. A literature review was performed to determine if nurses believe that they are prepared to provide clinical palliative care to pediatric patients and how pediatric palliative care best practices can be better integrated into nursing education programs. According to the literature review, studies suggest that providing pediatric palliative care education in nursing programs can build nurses' confidence and better prepare them to competently care for patients and families.

Integration of a Hospice Clinical Experience: Nursing Students' Perceptions

Prelicensure nursing programs have been slow to integrate end-of-life care into their curricula. In those prelicensure nursing programs that do offer courses on end-of-life care, student outcomes include positive attitudes toward dying patients. This mixed-method study had 2 purposes: first to compare 2 teaching strategies, hospice simulation and hospice clinical. The second purpose of this study was to strengthen understanding of the attitudes and perceptions of nursing students caring for dying patients and their families in both simulated and hospice clinical settings. Fourth-year nursing students enrolled in a Medical-Surgical Nursing III course participated in the study (n = 134). Participants were placed in an inpatient hospice clinical setting or a hospice simulation. Students completed the Frommelt Attitudes Toward Care of the Dying Scale and a reflection journal, before and after the assigned clinical or hospice day. Thematic analysis of the reflection journals was conducted. Key phrases and themes were identified, and the major themes were described. Prior to the hospice clinical or simulated educational experience, students reported feeling anxious caring for a dying patient or a patient who has just died. After the hospice clinical or simulation, students reported feeling more comfortable discussing end-of-life preferences with the patient and interdisciplinary team.

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.

The experiences of physicians, nurses, and social workers providing end-of-life care in a pediatric acute-care hospital

This qualitative study explored the experiences of social workers, nurses, and physicians providing end-of-life care to children in a pediatric acute-care hospital setting. Findings demonstrated that participants experienced both professional and personal impacts of their work and employed various coping strategies under each of these domains. The acute-care setting was found to create unique challenges in providing end-of-life care. Implications for policy and practice include promotion of both individual and institutional-level coping strategies and supports that meet the various needs of staff. Implications for future research include a nuanced examination of differences in experiences among nurses, social workers, and physicians.

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.

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

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

Competence and Compassion: Key Elements of Professional Care at the End of Life From Caregiver's Perspective

In the act of caring for and helping people in the end-of-life process, the professional who provides care and assistance must know how to maintain a relationship of closeness, empathy, and compassion for the pain and suffering of the person who is going to die. The objective was to understand, elaborate on, and characterize the key elements of end-of-life care of patients from a caregiver's perspective through a qualitative phenomenological multicenter study. Participants were caregivers who had lost a family member at least 2 months but less than 2 years in the past. The techniques used were 5 discussion groups and 41 in-depth interviews, which included a total of 81 participants. To analyze the information, a protocol developed by Giorgi was followed. Two dimensions or units of meaning, with subdimensions, emerged: (1) Technical competence, with the subdimensions "Control of symptoms" and "Continuity of care," and (2) Compassion, with the subdimensions "Effective/affective communication," "Attitudes of kindness and closeness toward the patient and the family," and "Generosity and personalized flexibility of care." Assistance at the end of life requires the proper preparation of professionals who care for these patients, in addition to a compassionate attitude on the part of professionals and the people accompanying the dying person, that fosters a more humanized and dignified treatment in the dying process.

Perceived challenges in pediatric palliative care among doctors and nurses in Hong Kong

This study aims to examine perceived challenges, including knowledge, skills, self, and work environment, of professionals in providing pediatric palliative care (PPC) in Hong Kong and the differences in perceived challenges between groups. A total of 680 pediatric doctors and nurses participated in the survey. They tended to perceive the provision of PPC as difficult and considered "advanced skills" (those dealing with death-related issues) challenging. Findings indicate that nurses, professionals who are less experienced, do not have children, and have not received palliative care training perceived a higher level of challenges in providing PPC. Implications for training and support are discussed.

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.

Undergraduate students' perspectives of healthcare professionals' use of shared decision-making skills

Essential for future healthcare professionals (HCPs) to delivering ethical and empathetic patient-centred care (PCC) as a team is the understanding of appropriate shared decision-making (SDM) responses when facilitating discussions with patients and family members. The purpose of this study was to evaluate undergraduate students' perspectives about HCPs' use of SDM as described in a case-study reflection assignment. An exploratory qualitative approach was used to analyse student-reflection assignments. The sample included 42 undergraduate students enrolled in an interprofessional education (IPE) course at a Midwest university based in the United States. Data consisted of student responses in a course reflection assignment that captured their perspectives about recommended SDM responses by HCPs. Student assignments were randomly selected using stratified sampling to provide representation of eight HCP roles. Analysis revealed two themes related to students' use of SDM responses. Results provide evidence supporting the tenet that through IPE, healthcare students can develop an understanding of SDM and ethical principles related to PCC.

End-of-Life Communication: Nurses Cocreating the Closing Composition With Patients and Families

Communication is imperative for end-of-life decision-making; however, descriptions of key strategies used by nurses are missing. A phenomenological approach was used to interpret interviews from 10 hospice/palliative nurses. The overarching pattern is the closing composition. Key communication strategies/patterns include establishing context, acknowledging through attentive listening, making it safe for them to die, planning goals of care, and being honest. Essential is the awareness that nurse, patient, and family all hold expertise in the subject matter. It is imperative that pre-/postnursing licensure curriculum be expanded to include training in mutual influence communication practices and mentoring in the skill of orchestration.

Essential Professional Behaviors of Nursing Students and New Nurses: Hospital Nurse Leader Perspectives Survey

AIM

This two-part study was conducted to determine which professional behaviors hospital nurse leaders believe are essential for nursing students to learn in the classroom.

BACKGROUND

Nursing students need to be educated to lead high-quality care in complex health care environments. Little is known regarding the professional behaviors deemed essential for novice nurses.

METHOD

Hospital leaders were surveyed (n = 221) using the Hospital Nurse Leader Perspectives survey. This survey, developed from interviews, includes 41 items in change, communication, conflict, leadership, and self-awareness.

RESULTS

The highest-ranked category was communication (n = 159, 72 percent), followed by self-awareness (n = 32, 14.4 percent). The highest items in each category were patient communication, prioritization, expect change, learning from failure, and conflict resolution.

CONCLUSION

The results provide practical information to inform curricula and prepare leaders.