Parents' experience of extended viewing in a paediatric hospice: a qualitative study

BACKGROUND

The rising prevalence of life-limiting conditions in children and young people warrants an evaluation of paediatric palliative care, hospice services and delivered care.

AIM

First, this study aimed to develop a deeper understanding of how extended viewing is experienced by the parents of a deceased child (or young person) with a life-limiting condition, based in Australia. Second, this study aimed to evaluate the quality of bereavement care delivered during the first few days after death.

FINDINGS

A total of 17 bereaved parents of 13 children completed an interview. In-depth interviews were audio-recorded, transcribed verbatim and thematically analysed. While the authors acknowledge the complexity and individual nature of grief, four broad themes were identified, namely the importance of the 'physical environment' being conducive to spending time with their child; 'seeing their child'; 'time to say goodbye'; and 'supportive care'.

CONCLUSION

The findings of this study reinforce that extended viewing can provide therapeutic benefits for parents, as well as the importance of a skilled palliative care nursing workforce in assisting with grief management.

Metaphors that shape parents' perceptions of effective communication with healthcare practitioners following child death: a qualitative UK study

OBJECTIVES

To offer an interpretation of bereaved parents' evaluations of communication with healthcare practitioners (HCPs) surrounding the death of a child.

DESIGN

Interpretative qualitative study employing thematic and linguistic analyses of metaphor embedded in interview data.

SETTING

England and Scotland.

PARTICIPANTS

24 bereaved parents (21 women, 3 men).

METHODS

Participants were recruited through the True Colours Trust website and mailing list, similar UK charities and word of mouth. Following interviews in person or via video-conferencing platforms (Skype/Zoom), transcripts first underwent thematic and subsequently linguistic analyses supported by NVivo. A focused analysis of metaphors used by the parents was undertaken to allow in-depth interpretation of how they conceptualised their experiences.

RESULTS

The findings illuminate the ways parents experienced communication with HCPs surrounding the death of a child. Key findings from this study suggest that good communication with HCPs following the death of a child should acknowledge parental identity (and that of their child as an individual) and offer opportunities for them to enact this; taking account their emotional and physical experiences; and accommodate their altered experiences of time.

CONCLUSIONS

This study suggests that HCPs when communicating with bereaved parents need to recognise, and seek to comprehend, the ways in which the loss impacts on an individual's identity as a parent, the 'physical' nature of the emotions that can be unleashed and the ways in which the death of a child can alter their metaphorical conceptions of time.

Compassionate Design: Utilizing Design Thinking to Preserve Sanctity, Dignity, and Personhood When Children Die

Introduction

Greater than 70% of children who die in our institution annually die in an intensive care unit (ICU) setting. Family privacy, visitation policies, and an inability to perform religious rituals in the ICU are barriers to provide children with culturally competent, family-centered care when a child dies. The goal of this project was to profoundly understand family and staff experiences surrounding pediatric death in our institution to identify unique opportunities to design improved, novel delivery models of pediatric end of life (EOL) care.

Methods

This project utilized a structured process model based on the Vogel and Cagan's 4-phase integrated new product development process model. The 4 phases are identifying, understanding, conceptualizing, and realizing. We utilized an adaptation of this process model that relies on human-centered and design thinking methodologies in 3 phases: research, ideation, and refinement of a process or product opportunity.

Results

There were 2 primary results of this project: 5 process and opportunity areas to improve the EOL experience across the hospital, and a set of criteria and considerations for a dedicated EOL space.

Discussion

Sometimes, the best outcome we can provide for a child and their family is a peaceful, dignified death. This project utilized human-centered design to create improved process outcomes and to design a dedicated EOL space for children who die in the hospital. Offering grieving families quiet, private time with their child in a beautiful, dignified, peaceful location enables the beginning of improved bereavement outcomes for the family and staff.

Personhood: An evolutionary concept analysis for nursing ethics, theory, practice, and research

BACKGROUND

The purpose of this concept analysis was to examine how the concept of personhood has been used in the nursing literature. The person is central to nursing, as the object of nursing work, or care, and a key element of theory. Health and illness confront conventional notions of personhood based on the Western philosophy, in delineating boundaries of life and death, and grappling with pathophysiological changes and alterations in capacities that challenge our understandings of what makes a person whole.

METHODS

Rodgers' evolutionary method was selected; it emphasizes the relationship between concepts, language, and communities of users. A literature search between 1950 and 2017 generated 760 articles; 54 were retained for analysis.

RESULTS

Four themes were identified: (1) personhood and nursing ethics, emphasizing scientific advances, and establishing criteria; (2) personhood as a morally significant, relational process realized through nursing care; (3) personhood lost (or neglected); (4) interventions aimed at understanding, recognizing, and enhancing personhood. Related terms, antecedent concepts, and consequences are explored.

CONCLUSIONS

This preliminary view of personhood in the nursing literature demonstrated how the concept has been developed, used, and understood. Areas for future research include nursing ethics, theory, and clinical practice, as well as links with other academic disciplines.

Communication Coaching: A Case Study of Family Caregiver Burden

BACKGROUND

Problematic communication among providers, patients, and their family members can affect the quality of patient care, causing stress to all parties involved and decreased opportunities for collaborative decision making.
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OBJECTIVES

The purpose of this article is to present one case from a pilot study of a family caregiver intervention focused on communication. 
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METHODS

The nurse-delivered communication intervention includes a written communication guide for family caregivers, as well as a one-time nurse communication coaching call. The call is aimed at identifying caregiver communication concerns, providing communication education, and role playing problematic communication.
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FINDINGS

Psychological distress and caregiver confidence in communication were improved for the caregiver. Data presented from the case study demonstrate the need for family caregiver communication support and training and the potential benefits of such training.

Bringing Home to the Hospital: Development of the Reflection Room and Provider Perspectives

BACKGROUND

Alternative locations for children near end of life (EOL) are lacking in the United States with deaths largely occurring within intensive care units (ICUs). The reflection room (RR) was implemented as a relevant space for providing this care in our hospital.

OBJECTIVE

We hypothesized staff would report a positive experience in providing EOL and/or postmortem (PM) care here and would recommend this to peers.

DESIGN

This explorative study summarized room use data and evaluated staff experiences using a voluntary qualitative and quantitative survey.

SUBJECTS

The survey was administered to the inpatient interdisciplinary team.

RESULTS

From 2011 to 2014, 116 children used the RR, 64% for PM care, and 34% for EOL care. A total of 201 staff responded to the survey. Of them, 90% described the space as a valuable resource to families, 90% reported a preference for using this location versus a hospital unit, and 93% stated they would encourage their peers to do the same. Advantages listed were increased privacy, allowance for more visitors, and a quieter, calmer environment. Challenges included distance from the unit of transfer, managing assignments in two hospital locations, and medication transportation. Overall, there was a measureable decrease in the number of deaths pronounced in the ICU as the number pronounced in the RR increased, illustrating a significant change in practice.

CONCLUSION

This study demonstrated an overwhelmingly positive experience in providing EOL and/or PM care to children in the RR and staff would recommend this to peers. This model of care should be a serious consideration for hospitals in the United States.

Nurses' Experiences of Spiritual Communication with Seriously III Children

OBJECTIVE

The goal of this study was to explore nurse experiences in communication with children about spiritual topics in order to develop training in this area.

BACKGROUND

Although spiritual care is essential in pediatric palliative care, few providers receive training about communication with ill children about spirituality.

METHODS

Researchers developed a brief survey to prompt nurses to reflect on pediatric palliative care experiences that included spiritual discussions. Nurses attending training courses voluntarily submitted stories. Qualitative data were thematically analyzed by members of the research team, consisting of two researchers with expertise in palliative care, spirituality, and communication and two expert pediatric palliative care clinicians.

RESULTS

Nurses' spiritual conversations with children revealed that children question God and the reason for their illness, have a desire to talk about the afterlife as a way of understanding their limited lifespan, and to share descriptions of an afterlife, in these cases described as heaven. Nurses conveyed the importance of being present and engaging in spiritual communication with children.

DISCUSSION

Communication training is needed and should prepare providers to respond to a child's spiritual questioning, assist parents when the child initiates discussion about the afterlife, and help parent and child understand the spiritual meaning of their illness. Chaplains serve as spiritual care experts and can help train nurses to screen for spiritual distress, have greater competence in spiritual communication, and to collaborate with chaplains in care. Quality palliative care is incomplete without attention to spiritual care.

Managing Bodies, Managing Persons: Postmortem Care and the Role of the Nurse

This paper addresses how interactions between UK palliative care nursing staff and the bodies of the deceased they care for function as a mechanism to help them make sense of death in line with their work as carers. Through an analysis of postmortem care rituals, I will argue that nurses play an integral role in the 'making of the dead', and look at how this functions in relation to their role as carers of bodies in line with associated states of personal wellbeing. Further to this, there is an argument to be made for the recognition of the nurse's place in biomedical models as managers of the transient body; as the constructors of the well, sick, living and dead body.