Healthcare staff 's experience in providing end-of-life care to children: A mixed-method review

BACKGROUND

Staff who provide end-of-life care to children not only have to deal with their own sense of loss but also that of bereaved families. There is a dearth of knowledge on how they cope with these challenges.

AIM

The aim of this review is to explore the experiences of healthcare professionals who provide end-of-life care to children in order to inform the development of interventions to support them, thereby improving the quality of paediatric care for both children and their families.

DATA SOURCES

Searches included CINAHL, MEDLINE, Web of Science, EMBASE, PsychINFO and The Cochrane Library in June 2015, with no date restrictions. Additional literature was uncovered from searching reference lists of relevant studies, along with contacting experts in the field of paediatric palliative care.

DESIGN

This was a systematic mixed studies review. Study selection, appraisal and data extraction were conducted by two independent researchers. Integrative thematic analysis was used to synthesise the data.

RESULTS

The 16 qualitative, 6 quantitative and 8 mixed-method studies identified included healthcare professionals in a range of settings. Key themes identified rewards and challenges of providing end-of-life care to children, the impact on staff's personal and professional lives, coping strategies and key approaches to help support staff in their role.

CONCLUSION

Education focusing on the unique challenges of providing end-of-life care to children and the importance of self-care, along with timely multidisciplinary debriefing, are key strategies for improving healthcare staff's experiences, and as such the quality of care they provide.

A Proposed Model of Health Professionals' Grieving Process

This article proposes a model that conceptualizes health professionals' reactions to the multiple deaths of their patients, in terms of loss and grief. It suggests that grieving is both an individual and a social-interactive process that may be understood in terms of an ongoing fluctuation between experiencing grief reactions by focusing on the loss experience, and repressing or avoiding grief reactions by moving away from it. This fluctuation allows professionals to attribute meaning to the death of individual patients, and to transcend these losses by investing in life and living. The interaction between individual idiosyncratic factors (“life style”) and environmental factors (“work style”) is described in terms of how they affect the grieving process. Special consideration is given to the individual and collective forms of grieving, and to the role of team support.

Pediatric oncologists' coping strategies for dealing with patient death

This research examined pediatric oncologists coping strategies when their patients died of cancer. Twenty-one pediatric oncologists at 2 Canadian pediatric academic hospitals were interviewed about their coping strategies when patients died or were in the process of dying. The grounded theory method of data collection and data analysis were used. Line-by-line coding was used to establish codes and themes and constant comparison was used to establish relations among emerging codes and themes. Pediatric oncologists used engagement coping strategies with primary and secondary responses including emotional regulation (social support and religion), problem solving (supporting families at end of life), cognitive restructuring (making a difference and research), and distraction (breaks, physical activity, hobbies and entertainment, spending time with own children). They also used disengagement coping strategies that included voluntary avoidance (compartmentalization and withdrawing from families at end of life). Given the chronic nature of patient death in pediatric oncology and the emotionally difficult nature of this work, medical institutions such as hospitals have a responsibility to assist pediatric oncologists in coping with this challenging aspect of their work. Future research is needed to evaluate how best to implement these changes on the institutional level to help oncologists cope with patient death and the effect of using these strategies on their quality of life.

Peer-Supported Storytelling for Grieving Pediatric Oncology Nurses

Telling stories about deceased patients to supportive peers is frequently mentioned as an activity used for meaning-making in anecdotal reports of clinical practice and the literature addressing nurses' experiences caring for dying children. This study examines peer-supported storytelling for grieving pediatric oncology nurses using a mixed methods single-group descriptive repeated measures design. Participants were 6 registered nurses from a tertiary care pediatric hospital inpatient oncology unit who self-identified as experiencing grief. Participants met in self-selected dyads for 2 storytelling sessions. Questionnaires were completed at baseline, midpoint, and study end. Sessions were audio-recorded. Participants reported (1) receiving and providing support during sessions; (2) that sessions had an impact on their grief; (3) that sessions had an impact on their meaning-making, and the explicit session focus on making sense of and identifying benefit in their experiences was particularly helpful. There was a significant positive correlation between participant report of number of special patient deaths during career and impact of sessions on grief.

Paediatric palliative care: challenges and emerging ideas

Paediatric palliative care is an emerging subspecialty that focuses on achieving the best possible quality of life for children with life-threatening conditions and their families. To achieve this goal, the individuals working in this field need to: clearly define the population served; better understand the needs of children with life-threatening conditions and their families; develop an approach that will be appropriate across different communities; provide care that responds adequately to suffering; advance strategies that support caregivers and health-care providers; and promote needed change by cultivating educational programmes. Despite these challenges, advances in paediatric palliative care have been achieved in a short period of time; we expect far greater progress as the field becomes more formalised and research networks are established.

Providing a children's palliative care service in the community through fixed-term grants: the staff perspective

BACKGROUND

Children's palliative care services have recently been awarded fixed-term grants, aimed at improving the provision of care for children with life-limiting conditions in the community. We report findings of a qualitative study to investigate the experience of a cohort of community children's nurses from teams involved in setting up or extending community-based children's palliative care services. The purpose of the study was to identify factors that affect service delivery, from the staff perspective, and to suggest ways of promoting their sustainable development.

METHODS

Semi-structured telephone interviews were conducted with 21 nurses from 12 different teams providing palliative care for children at home and in hospices. Participants were questioned about the services they provided and their own roles in that provision. NVIVO qualitative data analysis software was used to explore themes arising from the transcribed recorded interviews.

FINDINGS

Key findings were the importance of physical location in facilitating multidisciplinary communication, the importance of defining role boundaries between existing and new providers of children's palliative care, and the potentially detrimental impact of insecure funding on referral patterns and recruitment to posts. Staff named the opportunity to offer direct 'hands-on' care to families, access to work-based support and networking opportunities as important factors in helping them cope with the stresses involved in managing finite resources and the emotional challenges of their work.

CONCLUSIONS

The maintenance of a mixed caseload with a significant proportion of direct care, provision of ongoing support and clearly defined roles are recommended as means of bolstering the ability of staff to develop their services. The deliberate locating of services to enhance communication between staff and guidance on the preparation of funding applications may further contribute to the sustainability of these services.

Caregivers in death, dying, and bereavement situations

This document examines issues related to the work of both formal and informal caregivers as they are involved in caring for dying and/or bereaved individuals. The examination is organized around five central questions: what brings individuals to this work?; what enables them to develop effective caregiving relationships?; what sustains them in their work?; what responsibilities do they have to themselves and to others?; and how are they are influenced by the social context of their work? The goal of this article is to help individuals and teams improve the care they provide in death-related situations, while also assisting educators, managers, and administrators to prepare and support these caregivers in more effective ways.

Death education: what should student children's nurses be taught?

Children's nursing has developed rapidly over the last 50 years and continues to be a dynamic process. In many respects children's nursing educators, together with their practice colleagues, have been central to these developments. There is concordance that all children have the right to the highest standards of care and this especially applies to the small numbers who die; however, the management of dying children continues to challenge all involved. The reasons for this may relate in part to deficiencies in death education for student children's nurses. This paper reports on a qualitative study that explored delivery of death education by a small number of UK children's nursing lecturers. The results and recommendations presented here may help to inform death education, and ultimately help to facilitate high-quality care for dying and bereaved children and their families.

Caring for dying children: a comparative study of nurses' experiences in Greece and Hong Kong

The purpose of this transcultural descriptive study was to explore the subjective experiences of 63 oncology and critical care nurses who provide care to dying children in Greece and Hong Kong. Semistructured interviews were conducted with 39 Greek and 24 Chinese nurses who described their experiences and responses to the dying process and death of children. The data were analyzed qualitatively and quantitatively, and nurses' responses were compared for their work setting (oncology versus critical care) and their ethnic background (Greek versus Chinese). Findings revealed that most nurses experience a sense of helplessness when caring for a dying patient and difficulties in their communication with the child and parents during the terminal phase of the disease. The large majority acknowledge that the impending or actual death of a patient elicits a grieving process, which is characterized by a fluctuation between experiencing and avoiding loss and grief. Greek and Chinese nurses differ in their expression of their grief and how they attribute meaning to childhood death. Despite the suffering caused by multiple deaths, nurses report significant rewards from caring for chronically and acutely ill children, and the majority are satisfied with their job, despite the difficulties they encounter, in both countries, mostly as a result of shortage in personnel and cooperation problems with physicians.