Pediatric nurses' grief experience, burnout and job satisfaction

PA and NP burnout in orthopedic surgery

OBJECTIVE

To quantify the burnout rate among physician associates/assistants (PAs) and NPs in a large orthopedic surgery practice affiliated with an academic institution.

METHODS

The Maslach Burnout Inventory (MBI) and original research questions were given to all PAs and NPs in orthopedics at the facility. Burnout was defined as a high level of emotional exhaustion or depersonalization on the MBI subscale.

RESULTS

Of the 129 PAs and NPs in orthopedics at our institution, 91 (70.5%) completed all survey items. Nearly 42% of respondents were burned out, as defined by high depersonalization or emotional exhaustion. PAs and NPs who met the burnout criteria were significantly older than those who did not (41.8 ± 10 versus 36.5 ± 7.71 years, P = .007) and spent longer in practice (12.4 ± 6.66 versus 9.35 ± 6.41 years, P = .01).

CONCLUSIONS

The prevalence of burnout is high among PAs and NPs in orthopedics who practice in an academic setting.

Intensive Care Nurses' Experiences Related to Dying Patients: A Qualitative Study

OBJECTIVE

To describe intensive care nurses' experiences of caring for dying patients.

METHOD

This study was carried out between July 15, 2019, and September 15, 2019, in a university hospital's intensive care unit. We conducted in-depth semi-structured interviews with a purposive sample of 14 intensive care nurses to describe their experiences related to patient deaths. Qualitative thematic analysis was used to identify, analyse and report the identified themes.

RESULTS

Four themes were identified: (I) Emotions experienced the first time their patient passed away; (II) feelings and thoughts on impact of death; (III) difficulties encountered when providing care and (IV) coping methods with this situation.

CONCLUSION

Despite the passage of time, nurses are unable to forget their death experiences when they first encountered. They oftentimes use ineffective methods of coping and were negatively affected physically and emotionally.

Short-term professional bereavement reactions and their links with the meaning of patient death: Evidence from network analyses

OBJECTIVES

Taking a dimensional view, this study aims to understand, among professional caregivers after patient deaths, the symptom distribution and development of the short-term bereavement reaction (SBR) network and the node-level links between the meaning of patient death (MPD) and the SBR network.

METHODS

A cross-sectional secondary analysis was conducted with existing data from 220 Chinese urban hospital nurses and physicians who experienced the most recent patient death within a month. MPD was measured by the 10 formative items of the meaning of patient death model, and SBR was measured by the Short-term Bereavement Reactions Subscale of the Professional Bereavement Scale. Both Gaussian graphical network analysis and Bayesian network analysis were applied to the SBR network, and Gaussian graphical network analysis was used to estimate the MPD-SBR network.

RESULTS

Frustrated and guilty are central nodes in the regularized partial correlation SBR network. Meanwhile, a traumatic event and failure at work are important bridge nodes between the MPD network and the SBR network. In the Bayesian SBR network, moved by the family's understanding, moved by the family's gratitude and sad mainly drive other nodes.

CONCLUSION

After a patient death, nurses' and physicians' SBR networks feature professional-dimension symptoms at their core, while they follow 'personal to professional' and 'concrete to abstract' symptom development patterns. The personal meaning of a traumatic event and the professional meaning of a failure at work play key roles in bridging the MPD and SBR networks, and meanings of both the personal and the professional dimensions can link to professional-dimension reactions.

REPORTING METHOD

The manuscript followed the STROBE checklist for reporting cross-sectional studies.

PATIENT OR PUBLIC CONTRIBUTION

No patient or public contribution.

Investigation of grief and posttraumatic growth related to patient loss in pediatric intensive care nurses: a cross-sectional study

BACKGROUND AND AIM

Pediatric Intensive Care Units (PICUs) are clinical settings where patient loss is frequently experienced. A sense of professional grief and posttraumatic growth in nurses who have experienced patient loss has a significant impact on psychological and physical health, work satisfaction, turnover rates, as well as on personal and professional relations, and employee loyalty. The aim of this study was to investigate grief and posttraumatic growth in PICU nurses and to examine related factors.

METHODS

The study is of cross-sectional design and was conducted with 200 nurses who were working in 87 PICU's around Turkey during the period March 30 - June 30, 2021. Data were collected with a Descriptive Information Form, the Texas Revised Inventory of Grief (TRIG), the Posttraumatic Growth Inventory (PTGI), and an open-ended question asking for suggestions as to how nurses can cope with loss. Online questionnaires were used in the data collection. Descriptive statistics, the student t-test, one-way analysis of variance, and post-hoc tests were employed in the analysis of the data.

RESULTS

The nurses' mean scores were 49.425 ± 10.868 on TRIG and 61.450 ± 24.934 on PTGI. A negative weak correlation was found between the intensity of the nurses' grief and their posttraumatic growth (r = 0.144, p = 0.041). Receiving training on dealing with a patient's terminal stage (t=-2.688, p = 0.001), feeling comfortable about providing the patient's care (t = 2.624, p = 0.009) and providing the family with emotional support during patient care (t = 1.979, p = 0.049), and the presence of supporting health professionals reduced levels of grief (t = 2.797, p = 0.000). Being a woman (t = 3.299, p = 0.001), willingness to work in the unit (t=-3.219, p = 0.002), and being given enough time to accept the loss (t = 3.986, p = 0.000) were correlated with higher levels of posttraumatic growth. The nurses most commonly wanted more time allotted to recuperate after a loss (n = 35) and professional support (n = 22).

CONCLUSIONS

Nurses experience a moderate sense of grief after a patient's loss. As levels of grief decrease, posttraumatic growth increases. Healthcare administrators and future researchers can benefit from these findings when planning supportive interventions to help nurses cope with their feelings of grief and achieve posttraumatic growth.

STRENGTHS AND LIMITATIONS

A limitation of the study is that it was conducted only with nurses who were Association members.

The Resilience of Pediatric Nurses in Context: A Mixed Methods Study

BACKGROUND

Resilience, an individual's ability to cope with and recover from stressors, is supported by contextually specific factors. Factors in the work environment may support or hinder nurses' resilience to the specific stressors present in pediatric nursing, an understudied population.

OBJECTIVE

We aimed to explore the contextual factors in the work environment of pediatric nurses with varying levels of resilience, including social support, the work environment, and opportunities for coping from an individual approach.

METHODS

This study is a secondary mixed-methods analysis using ordinal logistic regression and a meta-matrix of survey responses and semi-structured interview transcripts from 30 pediatric nurses.

RESULTS

5 themes, 3 supporting and 2 hindering resilience, emerged from the interviews. Nurses described their resilience as supported by sharing the burden, support from administration, and taking a break. Participants described resilience as hindered when they found it challenging to provide quality nursing care and when they felt unappreciated or undervalued. No theme significantly changed the odds of having higher resilience.

CONCLUSIONS

Our findings suggest that nurses recognize resources and conditions within their work environment as influencing their resilience. However, workplace resources and conditions are only one contributor to pediatric nurse resilience. Encouraging breaks and informal opportunities for nurses to support each other may support resilience in pediatric nurses. In addition, nursing leaders can support pediatric nurse resilience by regularly spending time connecting with nurses. Finally, health care organizations should consider how changes in the work environment may hinder nurse resilience by adding stress or changing access to supportive factors.

Non-Qualified Staff's Experience of Suicidal Behaviour in Adult Mental Health Inpatient Services

Suicide and attempted suicide of people receiving care in Adult Mental Health Inpatient Services (AMHIS) leads to significant emotions amongst mental health professionals, characterised by guilt and shame. A sense of responsibility occurs due to hospital being seen as a safe place. However, little is known about what it is like for 'non-qualified' staff. This study explored experiences of suicide and attempted suicide on 'non-qualified' staff in AMHIS. Semi-structured interviews explored ten staff's experiences. Participants were recruited online and transcripts were analysed using Reflexive Thematic Analysis. Four themes were identified; 'Direct personal impact', 'Unrealistic expectations', 'Attempting to contain the impact' and 'Acclimatisation'. Ten sub-themes outlined; responsibility for assessing risk, shame and protective strategies to aid acceptance. The results provide insight into the unique experience of non-qualified staff in AMHIS experiencing suicidal behaviour.

Grief Support and Coping Mechanism Mediate the Effect of Grief on Burnout Among Intensive Care Unit Nurses: A Structural Equation Modeling Analysis

BACKGROUND

Patients' death caused the intensive care unit (ICU) nurses to grieve, which led to their burnout. Intensive care unit nurses use various coping mechanisms and need support to overcome grief.

OBJECTIVE

The aim of this study was to identify the mediation effects of coping mechanisms and grief support on the impact of grief on burnout.

METHOD

This cross-sectional study among 660 ICU nurses from 9 hospitals used 4 self-reported instruments to collect data, apart from the sociodemographic and employment-related variables. A final model was developed through structural equation modeling after establishing the construct validities of the measures through confirmatory factor analysis.

RESULTS

The representation of ICU nurses from each hospital was greater than 50%, with the majority being female (90.8%) with a mean age of 27.27 years. Most nurses perceived the absence of grief, low burnout, and moderate to low grief support. The nurses use various coping mechanisms. Grief support significantly mediated the relationship between grief and burnout using a bootstrapping method with a mediation strength using the variance counted for (VAF) of 34.95%. The final model fit indices with acceptable values validated the direct and indirect relationships of grief, grief support, and coping mechanisms on burnout.

DISCUSSION

The significant influence of grief support in mediating the effect of grief on burnout is an important finding. The nursing and hospital management can use this finding to provide grief support to ICU nurses, enhance the grief support resources, and promote future studies to test the model's validity and applicability to health care professionals who frequently face patients' death.

Relationships Between Lifestyle, Quality of Life, Organizational Culture and Job Satisfaction Among Nurses Related to Health Promoting Hospital (HPH) Standards

Providing quality healthcare services through health promotion activities to patients, hospital-based professionals and the wider community is the goal of the health promoting hospital (HPH). There is, however, no formal structured pathway for "universally" providing health promotion services in hospitals. Accordingly, this study was conducted with the aim of presenting a model designed to promote and increase health-related satisfaction of hospital-professionals in health-promoting hospitals (HPHs) in Iran-as a potential tool to guide international HPH standards. Lifestyle, quality of life, organizational culture, and job satisfaction were measured using standardized questionnaires in specialized hospitals in Hamadan, Iran. A structural equation model (SEM) using partial least squares (PLS) software (version 2) was used to determine the validity and fit of the conceptual framework/model. The study revealed that several factors were identified as strong predictors of job satisfaction and wellbeing, including various dimensions of lifestyle such as spiritual health, physical activity, stress management, and interpersonal communication, dimensions of quality of life including physical and mental aspects, and organizational culture. The values of predictive relevance (Q2) for physical and psychological dimension of life quality, organizational culture, and job satisfaction were estimated to be 0.101, 0.250, and 0.040 and 0.251, respectively. Conclusively, the study found a goodness of fit (GOF) value of 0.415, indicating that the model had a high predictive power and fit well. Based on these results, it is suggested that implementing HPH interventions that focus on the outcomes of this model could lead to increased job satisfaction and wellbeing in hospitals. Additionally, the model could serve as a useful indicator of HPHs.

Hospital-Based Interventions to Address Provider Grief: A Narrative Review

CONTEXT

Provider grief, i.e., grief related to the death of patients, often forms an ongoing and profound stressor impacting healthcare providers' ability to maintain their sense of well-being, avoid feeling overwhelmed, and sustain quality and compassionate patient care over time.

OBJECTIVES

This narrative review presents findings on the types of interventions hospitals have offered to physicians and nurses to address provider grief.

METHODS

Searches of PubMed and PsycINFO were conducted for articles (e.g., research studies, program descriptions and evaluations) focused on hospital-based interventions to help physicians and nurses cope with their own grief.

RESULTS

Twenty-nine articles met inclusion criteria. The most common adult clinical areas were oncology (n = 6), intensive care (n = 6), and internal medicine (n = 3), while eight articles focused on pediatric settings. Nine articles featured education interventions, including instructional education programs and critical incident debriefing sessions. Twenty articles discussed psychosocial support interventions, including emotional processing debriefing sessions, creative arts interventions, support groups, and retreats. A majority of participants reported that interventions were helpful in facilitating reflection, grieving, closure, stress relief, team cohesion, and improved end-of-life care, yet mixed results were found related to interventions' effects on reducing provider grief to a statistically significant degree.

CONCLUSION

Providers largely reported benefits from grief-focused interventions, yet research was sparse and evaluation methodologies were heterogenous, making it difficult to generalize findings. Given the known impact provider grief can have on the individual and organizational levels, it is important to expand providers' access to grief-focused services and to increase evidence-based research in this field.

An accumulation of distress: Grief, loss, and isolation among healthcare providers during the COVID-19 pandemic

This article draws on the journal entries of 62 healthcare professionals (HCP) in the United States and Canada who participated in the Pandemic Journaling Project (PJP) during 2020–2021. The HCP in this article represented healthcare fields including medicine, nursing, physical therapy, social work, and clinical psychology. In their journal entries, HCP provided accounts of witnessing the death and bereavement of their patients and loved ones; experiencing their own loss of loved ones and important milestones; facing isolation from their networks and places of meaning; and juggling increasing workloads and caregiving activities. I illustrate how these four areas were impacted by guilt, duty, ethical deliberations, and gender disparities. I argue that HCP face an accumulation of distress when they witness grief and face loss without space to process these experiences.

Introducing a Resiliency Bundle for Home Care Nurses

Home healthcare (HHC) nurses are experiencing stress and burnout related to high workloads, isolation on the job, and COVID-19 restrictions. A literature review found numerous interventions effective in reducing nurse burnout through building resiliency and decreasing moral distress. The purpose of this evidence-based project was to improve resiliency and decrease the risk of burnout in HHC nurses through the introduction of a resiliency bundle. The following resiliency bundle interventions were implemented: a) gratitude strategies, b) connecting with co-workers, c) storytelling, and d) resiliency training. Duffy's Quality-Caring Model and Neal's Theory of Home Health Nursing Practice framed the project. The interventions were implemented in an HHC department at a large Midwestern pediatric hospital. Outcomes were measured using a pre- and postimplementation resiliency and burnout survey, which used a Likert scale to allow for quantitative analysis. Fourteen nurses completed the presurvey, 11 completed the postsurvey, and 10 completed both pre- and postsurveys. Results showed no statistically significant change in resiliency or burnout after implementation; however, nurses expressed desire to continue using the bundle pieces, especially the gratitude strategies, connecting with co-workers, and sharing stories. Leadership should take burnout risk in HHC nurses seriously and look for innovative ways to promote resiliency.

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.].

S. V. Supporting Resilience and the Management of Grief and Loss among Nurses: Qualitative Themes from a Continuing Education Program

Caring for patients with cancer is highly stimulating and rewarding, attracting health professionals to the field who enjoy the challenge of managing a complex illness. Health professionals often form close bonds with their patients as they confront ongoing disease or treatment impacts, which may be associated with multiple losses involving function and/or eventual loss of life. Ongoing exposure to patient loss, along with a challenging work setting, may pose significant stress and impact health professionals' well-being. The prevalence rates of burnout and compassion fatigue (CF) are significant, yet health professionals have little knowledge on these topics. A 6-week continuing education program consisting of weekly small-group video-conferencing sessions, case-based learning, and an online community of practice was delivered to health care providers providing oncology care. Program content included personal, organization and team-related risk and protective factors associated with CF, grief models, and strategies to mitigate against CF. Content analysis was completed as part of the program evaluation. In total, 189 participants (93% nurses) completed the program, which was associated with significant improvements in confidence and knowledge of CF and strategies to support self and team resilience. Qualitative themes and vignettes from experiences with the program are presented. Key themes included knowledge gaps, a lack of support related to CF and strategies to support resilience, organization- and team-based factors that can inhibit expression about the impacts of clinical work, the health professional as a "person" in caregiving, and the role of personal variables, self-skill practices, and recommendations for education and support for self and teams.

Understanding what wellbeing means to medical and nursing staff working in paediatric intensive care: an exploratory qualitative study using appreciative inquiry

AIMS AND OBJECTIVES

To explore what wellbeing means to medical and nursing staff working in a large paediatric intensive care (PIC).

DESIGN

Exploratory qualitative design using an appreciative inquiry framework.

SETTING

PIC unit; primary, secondary and tertiary.

PARTICIPANTS

46 nurses and doctors working on PIC.

INTERVENTIONS

A set of images were used together with open-ended questions to prompt staff to discuss what wellbeing means to them. Interviews were audiorecorded and transcribed. Data were analysed thematically.

RESULTS

Images depicting nature, children and groups of adults were selected most. Meanings of wellbeing for PIC staff can be understood through three themes: (1) Being nurtured and supported at work, (2) Importance of nature and (3) Social support independent of work. The first theme considered the importance of being listened to at work as well as staff highlighting the value of being in control at work. Within the second theme, being active in nature and outdoors as well as the importance of being in the present moment was illustrated. Within the final theme, staff expressed the value of having support independent of work and highlighted the importance of spending time with family.

CONCLUSIONS

This study provides a unique insight into how individuals working in PIC experience wellbeing and what wellbeing means to them. Understanding how healthcare professionals in PIC settings experience wellbeing and what wellbeing means to them will enable researchers to develop interventions designed to enhance staff wellbeing based on lived experience.

Systematic Review of Burnout in US Nurses

Nurses experience high levels of burnout, and this has become a major factor in recruitment and retention of nurses. Several factors have been associated with burnout, but it is not clear which factors are the most significant predictors. Understanding the most prevalent factors that are associated with burnout will allow for the development and implementation of interventions to ameliorate and/or reduce burnout in the nursing workforce.

A Continuing Educational Program Supporting Health Professionals to Manage Grief and Loss

Health professionals working in oncology face the challenge of a stressful work environment along with impacts of providing care to those suffering from a life-threatening illness and encountering high levels of patient loss. Longitudinal exposure to loss and suffering can lead to grief, which over time can lead to the development of compassion fatigue (CF). Prevalence rates of CF are significant, yet health professionals have little knowledge on the topic. A six-week continuing education program aimed to provide information on CF and support in managing grief and loss and consisted of virtual sessions, case-based learning, and an online community of practice. Content included personal, health system, and team-related risk factors; protective variables associated with CF; grief models; and strategies to help manage grief and loss and to mitigate against CF. Participants also developed personal plans. Pre- and post-course evaluations assessed confidence, knowledge, and overall satisfaction. A total of 189 health professionals completed the program (90% nurses). Reported patient loss was high (58.8% > 10 deaths annually; 12.2% > 50). Improvements in confidence and knowledge across several domains (p < 0.05) related to managing grief and loss were observed, including use of grief assessment tools, risk factors for CF, and strategies to mitigate against CF. Satisfaction level post-program was high. An educational program aiming to improve knowledge of CF and management of grief and loss demonstrated benefit.

Meta-Analysis of Factors Associated with Occupational Therapist Burnout

Burnout, a reaction to chronic emotional stress, affects health and reduces the quality of service. Reportedly, healthcare professionals are especially vulnerable to burnout. This meta-analysis is aimed at examining the factors associated with occupational therapists' burnout. The results of 2,430 occupational therapists, across 17 peer-reviewed English articles, the most recent published in 2020, were analysed. Results revealed significant associations between related variables and burnout. Marital status, work field, and work hours, job challenges, patient age, position, turnover intention, working type, and work addiction showed significant positive correlation effect sizes in relation to burnout, whereas age, education, engagement, job satisfaction, personal identity, professional identity, rewards, and feeling valued showed significant negative correlation effect sizes. The results of this meta-analysis suggest that strategies to reduce occupational therapists' burnout need to consider organizational as well as psychological aspects.

Are emotional intelligence and compassion associated with nursing safety and quality care? A cross-sectional investigation in pediatric settings

PURPOSE

To assess and compare the perceptions of emotional intelligence, compassion, and safety and quality care held by parents of hospitalized children and nurses, and to examine the association between emotional intelligence, compassion, and safety and quality care among nurses.

DESIGN AND METHODS

This cross-sectional study comprised 80 parents whose children were hospitalized for at least three days, and 71 nurses who treated these children. The data were collected during April-June 2018 using a self-administered questionnaire addressing socio-demographic characteristics, safety and quality care in the ward, emotional intelligence, and compassion. A hierarchical multiple regression model was used to assess whether emotional intelligence and compassion could be associated with safety and quality care among pediatric nurses.

RESULTS

Parents considered the safety and quality care in the ward to be significantly (p = .003) higher (M = 4.23 ± 0.61) than did nurses (M = 3.97 ± 0.46). Compassion had a significant positive effect on safety and quality of care (β = 0.260; p = .041), while seniority in nursing had a significant negative effect on safety and quality care (β = -0.289;p = .021). Null effect was found between emotional intelligence and safety and quality care.

CONCLUSION

Compassionate care should be targeted to improve the safety and quality of nursing care delivered to children and their parents.

PRACTICE IMPLICATIONS

Nurse ward managers should promote procedures and guidelines concerning safety and quality care processes among older nurses. Specifically, we recommend nurse ward managers to leverage the results and dedicate efforts to continue to provide compassionate care in pediatric settings as an integral part of safety and quality care.

A Qualitative Study of the Role of Palliative Care During the COVID-19 Pandemic: Perceptions and Experiences Among Critical Care Clinicians, Hospital Leaders, and Spiritual Care Providers

Background

Palliative care offers a unique skill set in response to challenges posed by the COVID-19 pandemic, with expertise in advance care planning, symptom management, family communication, end-of-life care, and bereavement. However, few studies have explored palliative care’s role during the pandemic and changes in perceptions and utilization of the specialty among health and spiritual care providers and hospital leaders.

Objective

To explore the utilization, perceptions, and understanding of palliative care among critical care clinicians, hospital leaders, and spiritual care providers during the pandemic.

Design

We conducted a qualitative study employing semi-structured, in-depth interviews.

Setting/participants

We conducted the study at a tertiary academic medical center in Boston, Massachusetts, USA. Between August and October 2020, we interviewed 25 participants from 3 informant groups: (1) critical care physicians, (2) hospital leaders, and (3) spiritual care providers.

Results

Respondents recognized that palliative care’s role increased in importance during the pandemic. Palliative care served as a bridge between providers, patients, and families; supported provider well-being; and contributed to hospital efficiency. The pandemic reinforced participants’ positive perceptions of palliative care, increased their understanding of the scope of the specialty’s practice, and inspired physicians to engage more with palliative care. Respondents indicated the need for more palliative care providers and advocated for their role in bereavement support and future pandemic response.

Conclusion

Findings highlight evolving and increased utilization of palliative care during the pandemic, suggesting a need for greater investment in palliative care programs and for palliative care involvement in public health emergency preparedness and response.

The Relationships of End-of-life Care Stress with Compassionate Competence and Attitudes toward End-of-life Care among Pediatric Nurses

Purpose

This study aimed to provide basic data for developing interventions to relieve the end-of-life care stress experienced by pediatric nurses by examining the relationships of end-of-life care stress with compassionate competence and attitudes toward end-of-life care.

Methods

Data were collected via a survey that was conducted from September 10 to September 30, 2018 and administered to 113 nurses who had worked for more than 6 months in a pediatric unit at a tertiary hospital in Seoul, South Korea. The data were analyzed for frequency, percentage, mean, and standard deviation, and the independent t-test, one-way analysis of variance, and Pearson correlation analysis were conducted using SPSS version 25.0.

Results

End-of-life care stress among pediatric nurses had a weak positive correlation (r=0.216, P<0.05) with compassionate competence and had no significant correlation with attitudes toward end-of-life care. Among the sub-factors of end-of-life care stress, psychological difficulties had a weak positive correlation with sensitivity (r=0.309, P<0.01) and communication (r=0.230, P<0.05), which are aspects of compassionate competence. Lack of knowledge about end-of-life care had a weak positive correlation with communication (r=0.209, P<0.05) as an aspect of compassionate competence.

Conclusion

To improve the quality of end-of-life care provided by pediatric nurses, it is necessary to improve their compassionate competence and reduce their end-of-life care stress by developing education and support programs tailored to the characteristics of children and specific communication methods.

Effectiveness of a One Day Self-Compassion Training for Pediatric Nurses' Resilience

BACKGROUND

Resilience is a critical skill for nurses and other healthcare professionals, especially during the COVID-19 pandemic, yet few nurses receive training that promotes emotional awareness and regulation, resilience, and self-compassion.

PURPOSE

The purpose of this study was to understand if attending a one-day workshop format of the Self Compassion for Healthcare Communities (SCHC) program would improve pediatric nurses' resilience, well-being, and professional quality of life.

DESIGN AND METHODS

Following a quasi-experimental design, pre, post, and follow-up surveys were acquired from 22 nurses who attended the training and 26 nurses who did not attend the training. In a linear mixed models regression analysis, changes in self-compassion, mindfulness, compassion, resilience, job engagement, professional quality of life (compassion satisfaction, burnout, and secondary traumatic stress), depression, anxiety and stress were analyzed between groups.

RESULTS

Participants in the intervention exhibited significant increases in self-compassion, mindfulness, compassion to others, resilience and compassion satisfaction, and significant decreases in burnout, anxiety, and stress compared to the non-intervention group.

CONCLUSIONS

A one-day SCHC training program provides nurses with knowledge and skills to increase their resilience and support their emotional well-being and professional quality of life.

PRACTICE IMPLICATIONS

Nurses' schedules may hamper their ability to attend lengthy resilience trainings, yet the skills needed for resilience are crucial to decreasing burnout, empathy fatigue, and turnover. Offering an effective, one-day training provides an accessible alternative for nurses to gain knowledge and skills that increase resilience.

Paediatric oncology ward nurses' experiences of patients' deaths in China: A qualitative study

BACKGROUND

Considering cancer death is second only to accidental death in the number of lives claimed each year,nurses in paediatric oncology wards often experience helplessness, sadness, frustration and such other adverse emotions when they witness children's death due to cancer.However,there is a lack of qualitative studies on nurses who witness the death of children in paediatric oncology wards in China.

METHOD

A qualitative study was conducted using a semi-structured interview guide with 22 paediatric oncology ward nurses. Interviews were recorded and simultaneously translated and transcribed. Thematic analysis was used to analyse the data.

RESULTS

The analysis resulted in the identification of three main thematic categories: Different emotional expression, Different copingstrategies, A weak support system. Nursing managers should pay attention to problems faced by nurses in paediatric oncology wards, and take targeted measures in terms of continuing training courses, improving the psychological adaptability of oncology professional nurses, and providing them substantive support.

CONCLUSION

Nurses in paediatric oncology wards have strong stress responses to facing the death of children. They reported experiencing complex psychological feelings and have different coping attitudes. Healthcare authorities should recognise and understand the needs of paediatric oncology ward nurses, who often witness the death of children. Appropriate and effective support measures should be planned and implemented for these nurses to maintain their mental health, thus enabling them to better serve patients.

Factors Associated With Burnout in Trauma Nurses

BACKGROUND

Burnout is a psychological syndrome resulting from repeated stressors experienced in the workplace that centers on emotional exhaustion, detachment from the job, and a sense of ineffectiveness. It has been previously demonstrated that burnout exists in the health care workforce, but there has been limited investigation of burnout in nurses who primarily provide care for patients who have been traumatically injured. The purpose of this study was to explore factors associated with burnout reported by trauma nurses.

METHODS

This was a secondary analysis of a cross-sectional survey distributed at a large, academic Level I trauma center that serves both adult and pediatric patients. For this analysis, only the Burnout subscale of the Professional Quality of Life scale Version 5 (ProQOL) was used. Multivariate hierarchical regression was used to determine factors associated with burnout reported by trauma nurses.

RESULTS

Protective factors included being female, being married, and better quality of sleep. Risk factors included having a mental health diagnosis and working with adult populations.

CONCLUSIONS

These results provide an important contribution to the burnout risk profile for trauma nurses and may provide insight into future investigations as well as development and testing of tailored interventions to mitigate burnout in trauma nurses.

Psychometric Properties of Grief Traits and State Scale for Nurses to Measure Levels of Grief

Frequent exposure to patient deaths prompts nurses to experience grief. Unresolved grief leads to harmful consequences of nurses' mental health and quality of nursing care. A cross-sectional study using an online survey was conducted to determine the psychometric properties of the Grief traits and State Scale for Nurses. Exploratory factor analysis revealed two factors measuring the level of nurses' grief traits (Cronbach's alpha: 0.84) and two factors in grief state (Cronbach's alpha: 0.86). Nurses' feelings of unable to provide good care were associated with a higher risk of grief (odds ratio (OR): 4.30, 95% confidence interval (CI): 1.45-12.75), uncomfortable feeling toward deaths (OR: 11.29, 95%CI: 1.48-85.91), and emotional exhaustion (OR: 7.12, 95%CI: 1.63-30.99). Results indicated that the scale was reliable in determining the levels of their grief. Nurse managers can use the scale to identify their nurses' levels of grief, creating opportunities to influence the resolution of the grief experiences.

Analysis of how nurses cope facing the death of a paediatric patient

AIMS

To evaluate how nurses cope with the death of a paediatric patient, relate it to the different sociodemographic variables, and to describe personal coping strategies used by nurses in managing the process and accepting the death of the patient.

METHODOLOGY

An observational, descriptive and cross-sectional study, carried out from January to June 2018 with nurses from the palliative care area, intensive care unit, neonatology and oncohaematology area of a tertiary paediatric hospital in Barcelona city. An ad hoc questionnaire was applied, divided into three parts: socio-demographic data, the Bugen Scale of coping with death and two open questions.

RESULTS

31.37% of the respondents faced the process of death of the paediatric patient adequately, while 33.33% did not cope well. The best coping was in paediatric palliative care, followed by paediatric oncohaematology, neonatology and, finally, the intensive care unit. In addition, the variables related to this coping are the work shift, the death of a loved one in less than 3 years and previous training. On the other hand, the age of the respondents, experience in the unit and having children are not related to coping. Moreover, the professionals surveyed demand more training to improve their coping in this area, as well as interdisciplinary sessions to discuss cases of deceased patients.

Factors Influencing the Levels of Grief Among Indonesian Nurses

This study aimed to develop the Grief State Scale for Nurses to measure the level of nurses' grief and to identify items influencing grief levels among Indonesian nurses. A total of 267 questionnaires were analyzed and interpreted. Statistical analyses were performed using descriptive statistics and exploratory factor analysis. Items influential in increasing nurses' grief were relating death with personal loss; patient's age/illness similar to nurse's family members; and having rapport with patients. Time and place to express grief, allocation of grieving time, and sharing collegial emotional expressions were items found to decrease levels of nurses' grief.

Examination of job satisfaction and burnout status of pediatric nurses: A cross-sectional and correlational study using online survey research in Turkey

PURPOSE

The aim of this study is to determine the job satisfaction and burnout of Turkish pediatric nurses.

DESIGN AND METHODS

An online survey of pediatric nurses was conducted between January 2018 and March 2019, enrolled 326 participants. Minnesota Job Satisfaction Scale and Maslach Burnout Inventory were used as data collection tools. Descriptive statistics were used to analyze.

FINDINGS

Job satisfaction of younger and more inexperienced pediatric nurses was lower, while their burnout was higher. Negative relationship between job satisfaction, age, pediatric nursing experience, and burnout level was observed.

PRACTICE IMPLICATIONS

Young and inexperienced nurses should be supported by pediatric nurse managers to increase job satisfaction and reduce burnout. Aspects of new nurses that need improvement should be identified and orientation programs should be planned.

The Influencing Factors of Gender Differences on Mental Burdens in Young Physiotherapists and Occupational Therapist

Background: Gender differences in personal discrimination experience, burnout, and job stress among physiotherapists and occupational therapists are considered as associated factors of job loss, poor job quality, high turnover, and economic losses due to the outflow of medical personnel. Thus, the purpose of this study is to analyze the level of burnout, personal discrimination experience, and job stress according to gender differences for young physiotherapists and occupational therapists. Furthermore, we used regression analyses to determine the contribution of gender differences in personal discrimination experience and job stress to self-reported burnout, considering gender and two age groups (younger than 30 years old vs. 30 years old and over). Methods: A total of 325 professional physiotherapists and occupational therapists were part of this study (n = 325; male n = 131; female n = 194. Age: 20–29 years old, n = 178; ≥30 years old, n = 147). Data were collected using a questionnaire including our three study variables (scales: the Maslach Burnout Inventory (MBI), a modified version of the gender section of the Medical School Graduation Questionnaire from the Association of American Medical Colleges; and the Korean version of the Job Content Questionnaire (JCQ)). Further, data on socio-demographic factors, job-related factors, health-related factors, and subjective job satisfaction were also collected. Results: There were significant positive correlations between job stress and gender differences in personal discrimination experience and job stress and burnout in women 30 years old and over. Personal experience of gender discrimination (β = 0.179, p = 0.015) and job stress (β = 0.162, p = 0.028) explained a significant 42.4% of the variance in burnout in the case of younger female participants (20–29 years old). However, this model did not explain a significant amount of the variance in burnout in the case of younger male participants (R² = 0.156, p = 0.072). Regarding participants aged 30 years and over, our results showed that only job stress (but no personal experience of gender discrimination) was a relevant predictor for both males (β = 0.471, p < 0.001) and females (β = 0.373, p = 0.001). Conclusion: In this study, female therapists showed higher levels of burnout than male therapists. In particular, personal discrimination experience and job stress significantly contributed to burnout in younger female therapists while job stress was the most relevant predictor variable of burnout for both males (under 30 years old and 30 years old and over) and females in their thirties and beyond. For young female physiotherapists and occupational therapists, safe working environments should be created to reduce work-related mental burdens. It is also necessary to consider policies and regulations that can prevent job stress for therapists and measures that can positively resolve the unavoidable job stress.

Burnout Syndrome in Paediatric Nurses: A Multi-Centre Study

Background: Burnout syndrome is an increasingly prevalent problem, characterised by emotional exhaustion (EE), depersonalization (D), and low personal accomplishment (PA), feelings that appear with prolonged exposure to stress-inducing situations. The syndrome alters physical well-being and endangers the quality of services provided. Among nurses working in the paediatric area, the association between burnout and the corresponding risk profile has received little research attention, despite the highly stressful nature of this work. Materials and Methods: The study population was composed of 95 nurses working in four hospitals in the province of Granada. Data were collected using the Maslach Burnout Inventory, the NEO Personality Inventory, and the Educational-Clinical Questionnaire: Anxiety and Depression. Results: According to the results obtained, 22.0% of the nurses working in the paediatric area present high levels of EE, 18.5% present high levels of D, and 39.6% had feelings of low PA. These burnout levels do not depend on sociodemographic or labour variables, but the three domains of the syndrome are related to the psychological factors analysed. Conclusions: Among the nurses who participated in this study, 38.6% presented high levels of burnout, especially regarding feelings of low personal accomplishment. Personality factors play an important role in the development of this syndrome. This study shows the impact of burnout in paediatric nurses as well as the risk factors, providing information for the development of strategies to prevent it.

Emotional Responses of Neonatal Intensive Care Nurses to Neonatal Death

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

Burnout Syndrome in Paediatric Oncology Nurses: A Systematic Review and Meta-Analysis

Purpose: To determine levels of burnout among paediatric oncology nurses, and the risk factors that may influence its development. Method: A literature review with meta-analysis was conducted, via a search in the PubMed, CINHAL, Scopus, ProQuest (Health and Medical Complete), Scielo and PsycINFO databases, using the search equation: "Nurs* AND burnout AND oncology AND pediatric". Results: The final sample of selected studies was of eight articles. All were quantitative studies of paediatric oncology nurses, using the Maslach Burnout Inventory, written in English or Spanish. No search restrictions were established on the year of publication. The eight studies reported moderate-high levels of burnout in each of its three dimensions. These dimensions were all related to the characteristics of the profession, in terms of complexity, shifts and workload, and to sociodemographic variables such as marital status, work experience, age and gender. The prevalence meta-analytical estimation for a sample of n = 361 nurses were 37% for high emotional exhaustion, 16% for high depersonalisation and 27% for low personal fulfilment. Conclusions: Most paediatric oncology nurses present moderate-high levels of burnout. Therefore, strategies and interventions should be identified and implemented to protect these workers from the syndrome.

Burnout Syndrome and Work-Related Stress in Physical and Occupational Therapists Working in Different Types of Hospitals: Which Group Is the Most Vulnerable?

Because of the nature of their work, physical and occupational therapists are at high risk of burnout, which is associated with decreased job satisfaction, medical errors, and mental wellbeing in healthcare professionals. To well manage and minimize potential impact of burnout, risk factors should be determined. This study examined burnout and job stress in physical and occupational therapists in various Korean hospital settings. Physical and occupational therapists from several rehabilitation facilities in South Korea completed a survey between March-May 2019. A set of questionnaires, including the Maslach Burnout Inventory and Job Content Questionnaire, were distributed to all participants. In total, 325 professionals (131 men and 194 women) were recruited. Burnout and work-related stress differed significantly according to several factors. Hospital size, gender, and age were the main contributory factors affecting at least two dimensions of the questionnaires. The more vulnerable group consisted of female therapists in their 20s at small- or medium-sized hospitals with low scores for quality of life. High levels of job stress and burnout were observed in female therapists in their 20s at small- or medium-sized hospitals. Hospitals and society should create suitable environments and understand the nature of therapists' work to improve healthcare.

Impact of Exposure to Patient Death or Near Death on Compassion Fatigue in Pediatric Intensive Care Nurses

BACKGROUND

Compassion fatigue affects up to 40% of health care professionals who work in intensive care settings. Frequent exposure to the death of patients, particularly children, may put nurses at risk for compassion fatigue, but the relation between these is unclear among those working in pediatric intensive care units.

OBJECTIVES

To examine the relationship between exposure to the death or near death of a pediatric patient and compassion fatigue, specifically the outcomes of compassion satisfaction, burnout, and secondary traumatic stress.

METHODS

Pediatric and neonatal intensive care nurses were surveyed about their exposure to patient death and near-death experiences. They were asked to respond to the Professional Quality of Life Scale, which has 3 subscales that measure compassion satisfaction, burnout, and secondary traumatic stress. Bivariate and multivariate linear regression modeling was used to identify correlates of these outcomes.

RESULTS

Of the 65 respondents, 94% were female, 41% were aged 31 to 45 years, and 71% had a bachelor's degree. No significant relationship was found between nurses' experiences of patient death or near death and their compassion satisfaction, burnout, or secondary traumatic stress. Significant correlates of compassion satisfaction and burnout included educational level and an age-experience interaction.

CONCLUSIONS

No relationship seems to exist between nurses' experiences of patient death or near death and their compassion satisfaction, burnout, or secondary traumatic stress. Further research is needed to evaluate the impact of educational attainment on nurse outcomes and determine how best to support nurses who are at risk for compassion fatigue.

Related Factors of Turnover Intention Among Pediatric Nurses in Mainland China: A Structural Equation Modeling Analysis

PURPOSE

Pediatric nurses are at high risk for turnover. Turnover intention strongly predicts the actual voluntary turnover. Currently, no nationwide study has examined turnover intention among pediatric nurses in mainland China since the universal two-child policy implementation. Related factors associated with pediatric nurse turnover intention have not yet been identified. This study aims to understand factors related to turnover intention among pediatric nurses in mainland China.

DESIGN AND METHODS

A cross-sectional on-line questionnaire survey was conducted among 6673 pediatric nurses across mainland China. Structural equation modeling (SEM) was used to examine the relationships between job satisfaction, work stress, job burnout, organizational commitment, work-family support and turnover intention.

RESULTS

Six hundred and sixty-three (9.93%) nurses reported high turnover intention. Work stress and job burnout were directly and indirectly associated with turnover intention positively. Job satisfaction was related to turnover intention negatively with both direct effect and indirect effect through the mediations of job burnout and organizational commitment. Organizational commitment had a negative direct effect on turnover intention. Work-family support had indirect effects on turnover intention through the mediating role of burnout, job satisfaction, and organizational commitment.

CONCLUSION

Turnover intention among pediatric nurses was associated with job satisfaction, work stress, job burnout, organizational commitment and work-family support.

PRACTICE IMPLICATIONS

Attention to pediatric nurses' job burnout and work stress is important to improve job satisfaction and organizational commitment and to provide them with support in order to alleviate the turnover intention.

Grief among Neonatal Intensive Care Nurses

BACKGROUND

Nurses working in the high-stress environment of the neonatal intensive care unit (NICU) are at high risk of experiencing grief after death of a baby.

DESIGN

Using a quantitative cross-sectional design, a convenience sample of nurses working in a Level IV NICU in Northern California, United States completed online surveys. Level of grief among NICU nurses, perceptions of grief support available at their institution, and past and future grief coping methods were assessed.

PARTICIPANTS

A diverse sample of 55 NICU nurses, mean age 45.5 (SD = 11.7) years.

SETTING

A high-acuity NICU in one large Northern California hospital.

METHODS

Participant demographic data and the Revised Grief Experience Inventory were completed online.

RESULTS

Total grief scores ranged between 22 and 82 with a mean of 46.9 (SD = 17.4). Sixty percent (n = 33) moderately/strongly disagreed on adequacy of current grief support services at their institution and 81% (n = 45) reported hospital staff could benefit from additional grief support. Nurses' past grief support included family, friends, and church. Future grief resources would include family, friends, and co-workers. Participants indicated need for debriefing and additional nurse staffing resources at the time of a patient death.

CONCLUSIONS

Neonatal intensive care unit nurses in our study reported experiencing grief. Debriefing and bereavement support may be helpful for nurses working in high-stress environments where there is a higher likelihood of patient death.

Physical Effects of Maternal Deaths on Midwives' Health: A Qualitative Approach

Grief does not only affect human emotions but also impacts their physical health. Understanding physical grief of people can bring to bear the grip of its daunting nature, a situation where routines become challenging. A qualitative explorative descriptive research method was used. A purposive sample of 18 ward supervisors and 39 ward midwives was used to ascertain the physical effects of maternal deaths on these caregivers in the Ashanti Region of Ghana. Data were collected through semistructured and focus group discussions. Data analysis was done parallel with data collection till saturation was reached. Ethics was obtained from the University of the Western Cape, South Africa, and Ghana Health Service. The findings indicated that generally, as a result of grieving over the deaths of their patients, midwives experienced physical health sufferings. Therefore, reported depression is expressed as insomnia, appetite loss, exhaustion, and social isolation. There is the need to reduce the physical effects of patients' death on caregivers in Ghana and therefore, the study recommends that all hospitals in Ghana utilize employee assistance programmes, a workplace intervention programme designed for such purposes.

Physician assistant burnout, job satisfaction, and career flexibility in Minnesota

OBJECTIVES

This study explores associations between job satisfaction, career flexibility, and burnout among physician assistants (PAs) in Minnesota.

METHODS

A survey comprising the Maslach Burnout Inventory (a validated burnout tool) and original questions was emailed to PAs practicing in Minnesota. Spearman rank correlation coefficients were used to assess associations between variables and burnout.

RESULTS

PAs (response rate = 31.4%, N = 312) reported moderate levels of burnout. Working in primary care and being female were independently associated with higher rates of burnout. Satisfaction with one's career and one's current position were both high (95.9% and 87.8%, respectively) and independently associated with lower rates of burnout.

CONCLUSIONS

Despite high levels of career and job satisfaction, PAs in Minnesota report moderate levels of burnout, particularly women in primary care. Further research should examine a broader population and the effect of burnout on patient care.

What is known about paediatric nurse burnout: a scoping review

Burnout in healthcare providers has impacts at the level of the individual provider, patient, and organization. While there is a substantial body of literature on burnout in healthcare providers, burnout in pediatric nurses has received less attention. This subpopulation may be unique from adult care nurses because of the specialized nature of providing care to children who are typically seen as a vulnerable population, the high potential for empathetic engagement, and the inherent complexities in the relationships with families. Thus, the aim of this scoping review was to investigate, among pediatric nurses, (i) the prevalence and/or degree of burnout, (ii) the factors related to burnout, (iii) the outcomes of burnout, and (iv) the interventions that have been applied to prevent and/or mitigate burnout. This scoping review was performed according to the PRISMA Guidelines Scoping Review Extension. CINAHL, EMBASE, MEDLINE, PsycINFO, ASSIA, and The Cochrane Library were searched on 3 November 2018 to identify relevant quantitative, qualitative, and mixed-method studies on pediatric nurse burnout. Our search identified 78 studies for inclusion in the analysis. Across the included studies, burnout was prevalent in pediatric nurses. A number of factors were identified as impacting burnout including nurse demographics, work environment, and work attitudes. Similarly, a number of outcomes of burnout were identified including nurse retention, nurse well-being, patient safety, and patient-family satisfaction. Unfortunately, there was little evidence of effective interventions to address pediatric nurse burnout. Given the prevalence and impact of burnout on a variety of important outcomes, it is imperative that nursing schools, nursing management, healthcare organizations, and nursing professional associations work to develop and test the interventions to address key attitudinal and environmental factors that are most relevant to pediatric nurses.

Effectiveness of a Staff Resilience Program in a Pediatric Intensive Care Unit

BACKGROUND

Compassion fatigue (CF) and secondary traumatic stress (STS) is prevalent in intensive care nurses, especially in pediatric intensive care nurses (PICU). CF, which includes STS and burnout, leads to reduced employee engagement and nursing turnover.

PURPOSE

The purpose of this project was to evaluate the impact of a staff resilience program on nursing turnover, employee engagement and compassion satisfaction among nurses in a PICU.

DESIGN AND METHODS

A retrospective pre-test and post-test design was used to evaluate the impact of a staff resilience program on turnover, engagement, and Professional Quality of Life (ProQOL), which measured compassion satisfaction and compassion fatigue.

RESULTS

RN turnover was reduced and employee engagement was improved, although the differences were not statistically significant. The aggregate scores of the ProQOL indicated the RN's had low levels of CF with high levels of compassion satisfaction post implementation of the resilience program. Years of work experience was positively associated with compassion satisfaction and work engagement.

CONCLUSIONS

Education regarding the prevention of CF and burnout coupled with interventions designed to promote resilience can be effective in reducing CF and in building compassion satisfaction.

PRACTICE IMPLICATIONS

Doing an assessment of compassion fatigue and following up with the implementation of interventions to build staff resilience and promote psychological health can lead to positive outcomes, as demonstrated by the increase in work engagement and compassion satisfaction when burnout and CF decreased.

The voice of paediatric oncology nurses: A longitudinal diary study of professional development

PURPOSE

There is a limited amount of studies with results on professional development of paediatric oncology nurses. This study seeks to increase the understanding of the factors associated with the professional development of paediatric oncology nurses through the continuous education programme from the paediatric nurses' perspective.

METHOD

The descriptive, qualitative study used the text of participants' electronic diaries as data during a two-year continuing professional education programme in 2016-2018. The sample consisted of 17 paediatric oncology nurses who were working in three different university hospitals. The data were analysed with the inductive content analysis method.

RESULTS

Professional development is linked with a strong knowledge base in nursing, which involves the use of nursing methods and up-to-date nursing practices. Professional development is also linked with the use of medical knowledge, which manifests as a deep understanding of cancers and their treatment.

CONCLUSIONS

Research results show that a strong knowledge base in nursing alone is not sufficient for the professional development of paediatric oncology nurses. They also need to use their medical knowledge in order to gain an adequately deep understanding of children's cancers and their treatment. Nursing must be organised so that nurses have the opportunity to compare, share, question and argue for the methods they use with their colleagues in their own unit and other hospitals. Further research is needed on the professional development of paediatric oncology nurses and factors affecting it in order for a career development model to be created for this specific yet demanding area of nursing.

Bereavement care in Japanese pediatrics: Pediatrician awareness in practice

BACKGROUND

A child's death affects not only family members but also the health-care professionals involved in patient care. The education system for bereavement care in Japan, however, is not set up in a systematic way, and the care provided is based on the individual experience of the health-care professional. The aim of this study was to investigate pediatrician awareness of and actual circumstances involved in bereavement care in Japan.

METHODS

A qualitative descriptive study was conducted at four facilities in Japan. Data collected using semi-structured interviews of 11 pediatricians were assessed using inductive qualitative analysis.

RESULTS

Pediatrician recognition of the elements of bereavement care was categorized as follows: (i) developing relationships with families before a child's death is important in bereavement care; (ii) after the child dies, family involvement is left to the doctor's discretion; (iii) coping with a child's death myself through past experience is essential; (iv) doctors involved in a child's death also experience mental burden; and (v) a system for the family's bereavement care must be established. Two categories were established according to actual circumstances involved in bereavement care: (i) attention must be given to the emotions of the families who lost a child; and (ii) doctor involvement with bereaved families depends on doctor awareness and expertise.

CONCLUSION

Japanese pediatricians provided bereavement care to families who lost their children in a non-systematic manner. This is necessitates improvement of the self-care of health-care professionals with regard to grief by improving bereavement care-related education. Additionally, health-care professionals must be trained, and a national-level provision system must be established to provide high-quality bereavement care to families who lose a child.

"It Could Have Been Me": An Interpretive Phenomenological Analysis of Health Care Providers' Experiences Caring for Adolescents and Young Adults with Terminal Cancer

Purpose: Adolescents and young adults (AYAs) with terminal cancer are a marginalized population with unique medical and psychosocial needs. AYAs commonly report challenges with their health care experiences, however, little is known about the experiences of the health care providers (HCPs) who deliver this specialized care. The purpose of the current study was to understand HCPs' experiences caring for AYAs with terminal cancer. Methods: Nine HCPs (four nurses and five physicians) took part in in-depth semistructured interviews. Participants were eligible if they were a nurse or physician in Atlantic Canada; cared for at least one AYA patient with terminal cancer in the past 3 years; and were able to speak and understand English. Data were analyzed using interpretive phenomenological analysis. Results: Analyses revealed four superordinate themes present in the data: (1) many unknowns and uncertainties associated with providing care for AYAs compounded by minimal or no training specifically concerning this population; (2) an intense emotional experience compared with caring for patients with terminal cancer of other ages; (3) personal identification with patients and their families; and (4) attempts to make sense of the circumstance thwarted by feelings of injustice and unfairness. Conclusions: HCPs experienced unique emotional and logistical challenges when caring for AYAs with terminal cancer, which can influence the care they provide. HCPs' experiences highlight the need for training to support clinicians in caring for AYAs with terminal cancer to optimize their own well-being and delivery of health care services to this population.