Caring for Pediatric Patients' Families at the Child's End of Life

Difficulties Experienced by Turkish Parents With Children in Pediatric Palliative Care: An Exploratory Qualitative Study

We aimed to identify the difficulties of the parents of pediatric palliative care patients and how they cope with these problems in this qualitative study in Turkey. This study was carried out with 20 parents by in-depth interviews. Content analysis was used for data analysis. Four themes were identified: The problems in the process of acceptance, the difficulties of being at the hospital, the expectations from the health staff, the coping strategies. The families had difficulties in coping with the end-of-life of their children. Future researches may focus on the effectiveness of family-centered care and the experience of parents with its implementation. The findings suggest that social support resources and coping strategies can play an important role in the acceptance of the child's disease process and maintenance of palliative care effectively.

The elements of end-of-life care provision in paediatric intensive care units: a systematic integrative review

BACKGROUND

Deaths in paediatric intensive care units (PICUs) are not uncommon. End-of-life care in PICUs is generally considered more challenging than other settings since it is framed within a context where care is focused on curative or life-sustaining treatments for children who are seriously ill. This review aimed to identify and synthesise literature related to the essential elements in the provision of end-of-life care in the PICU from the perspectives of both healthcare professionals (HCPs) and families.

METHODS

A systematic integrative review was conducted by searching EMBASE, CINAHL, MEDLINE, Nursing and Allied Health Database, PsycINFO, Scopus, Web of Science, and Google Scholar databases. Grey literature was searched via Electronic Theses Online Service (EthOS), OpenGrey, Grey literature report. Additionally, hand searches were performed by checking the reference lists of all included papers. Inclusion and exclusion criteria were used to screen retrieved papers by two reviewers independently. The findings were analysed using a constant comparative method.

RESULTS

Twenty-one studies met the inclusion criteria. Three elements in end-of-life care provision for children in the PICUs were identified: 1) Assessment of entering the end-of-life stage; 2) Discussion with parents and decision making; 3) End of life care processes, including care provided during the dying phase, care provided at the time of death, and care provided after death.

CONCLUSION

The focus of end-of-life care in PICUs varies depending on HCPs' and families' preferences, at different stages such as during the dying phase, at the time of death, and after the child died. Tailoring end-of-life care to families' beliefs and rituals was acknowledged as important by PICU HCPs. This review also emphasises the importance of HCPs collaborating to provide the optimum end-of-life care in the PICU and involving a palliative care team in end-of-life care.

An Evolutionary Concept Analysis of Pediatric Hospice and Palliative Care

Purpose

This study aimed to clarify the concept of pediatric hospice and palliative care through conceptual analysis. It also sought to identify the differences between related concepts such as pediatric death care and pediatric spiritual care, in order to provide foundational data for the development of nursing theory and knowledge.

Methods

A conceptual analysis of pediatric hospice and palliative care was conducted using Rodgers' evolutionary method. Out of 5,013 papers identified, 28 were selected for detailed reading and analysis.

Results

Pediatric hospice and palliative care encompasses physical, psychological, social, mental, spiritual, and family care for children with acute and chronic diseases with uncertain prognoses ahead of death, as well as their families. Effective pediatric hospice and palliative care will require multidisciplinary team nursing, effective communication, and supportive policies.

Conclusion

The findings of this study suggest that providing pediatric hospice and palliative care will lead to improvements in pain relief for children and families, the efficiency of responses to death in children, and the quality of life for children and families. The significance of this study is that it clearly clarifies the concept by analyzing pediatric hospice and palliative care using an evolutionary method.

Experiences of nursing students providing end of life care for children and young people: A focus group study

BACKGROUND

End of life care for Children and Young People (CYP) is known to be an emotive area of practice. Previous studies involving qualified nurses have demonstrated that nurses feel they need more end-of-life care education, as well as a platform for sharing experiences and discussing them with others. Evidence relating to nursing students remains limited despite being widely acknowledged as a difficult aspect of nursing education.

AIMS

This study aims to help improve understanding of the lived experiences of children's nursing students who have cared for a patient at, during, or immediately following end-of-life. The study describes the emotions experienced by children's nursing students and explores the student nurses' perceptions of education and support needs around caring for CYP during end-of-life care.

METHODOLOGY

A qualitative inquiry methodology allowed for a pragmatic approach to design this focus group study. Nine undergraduate student children's nurses participated in two focus groups. Ethical approval was granted by the host university. Thematic data analysis using Braun and Clarke's (2019) thematic analysis was conducted.

FINDINGS

Six themes emerged from the data; Emotional practice (1), the heart of the care (2), a lasting impact (3), hierarchy of grief (4), experience, knowledge and understanding (5), and the value of support (6). End of life care for children and young people is recognised by students as a sad but important part of the job role, which can have a lasting impact and which students required improved education and support for.

IMPLICATIONS FOR PRACTICE

Improved education on end-of-life care is required. This should be introduced early, encompassing practical approaches to the varied nature of end-of-life care, normalising a range of emotions and delayed responses. Furthermore, improved support is required for both student nurses and qualified staff, who are supporting students caring for CYP at the end of life.

Vicarious learning and communication self-efficacy: A pediatric end-of-life simulation for pre-licensure nursing students

BACKGROUND

End-of-life clinical experiences, particularly in pediatrics, are quite limited for pre-licensure nursing students. Though effective, end-of-life simulations can be costly, require facilitators trained in palliative and end-of-life care, and are restricted by limited space and time availability. Such barriers prompt the question as to whether there is an effective alternative to simulation by which students can gain improved self-efficacy in therapeutic communication during pediatric end-of-life situations.

PURPOSE

Bandura's Social Cognitive Theory and work exploring self-efficacy posits that vicarious learning provides learners opportunities to gain experience and knowledge through observation of peers in simulated settings. This study evaluated the effectiveness of vicarious versus active learning on pre-licensure nursing students' perceived self-efficacy in providing therapeutic communication during a pediatric end-of-life situation.

METHOD

Data were collected over three time points - pre-simulation, post-simulation, and post-debriefing - using a modified Self-Efficacy in Communication Scale.

RESULTS

Learners in both groups had significant improvement in self-efficacy across all time points. Only two items had significant differences between vicarious and active learner groups, but the effect was minor.

CONCLUSION

Vicarious learning presents as a viable pedagogical approach for providing pre-licensure nursing students important learning opportunities related to pediatric end-of-life simulations during both the scenario and debriefing.

Parent's Lived Experience of Memory Making With Their Child at or Near End of Life

BACKGROUND

Memory making is the process of creating mementos of a child with a life limiting condition, who may be at or near end of life, providing a tangible and visual connection to the child who has died.

AIM

This study explored the lived experience a memory making process had on parents of children who were at or near end-of-life.

DESIGN

A qualitative approach was used. Hermeneutic phenomenology methods provided guidance to the data collection, with a more limited interpretative phenomenological analysis conducted.

SETTING

A purposive selected sample of 6 parents whose child had died and who had engaged in memory making participate. The sample was drawn from parents whose child had received care from a children's hospice.

RESULTS

Individual interviews were conducted with 6 parents, all mothers. Three main themes emerged: Making the memories; the impact of memory making; and the end-of-life care journey. Parents experienced an overwhelmingly positive impact from memory making, as well as tangible and precious mementos that were created. The positive impact the process had on coping with grief and loss was also demonstrated, as well as the effect of helping to keep the deceased child's memory alive and include them in conversation.

CONCLUSIONS

The importance of skilled and sensitive staff with the ability to introduce the concept of memory making, and choice at end of life were highlighted by the parents who took part. Clinicians may benefit from understanding how memory making can positively impact the bereavement experience of parents whose child has died.

Parental bereavement - impact of death of neonates and children under 12 years on personhood of parents: a systematic scoping review

BACKGROUND

Losing a child tragically impacts the well-being and functioning of parents. With these effects extending beyond emotional, physical morbidity and compromising self-perceptions, appropriate, longitudinal, timely and personalised support is key to effective care of bereaved parents. However, in the absence of a comprehensive understanding of parental bereavement, effective support of bereaved parents remains suboptimal. To address this gap, we scrutinise prevailing data on the effects of a child's death, aged 0-12 years, through the lens of the Ring Theory of Personhood (RToP).

METHODS

To study prevailing accounts of bereaved parents following the death of a child, we adopt Krishna's Systematic Evidence Based Approach (SEBA) to structure our Systematic Scoping Review (SSR in SEBA).

RESULTS

Three thousand seventy-four abstracts were reviewed, 160 full text articles were evaluated, and 111 articles were included and analysed using thematic and content analysis. Four themes/categories were identified relating to the four rings of the RToP. Findings reveal that static concepts of protective and risk factors for grief are misplaced and that the support of healthcare professionals is key to assisting bereaved parents.

CONCLUSION

In the absence of consistent support of bereaved parents, this study highlights the need for effective training of healthcare professionals, beginning with an appreciation that every aspect of an individual parent's personhood is impacted by the loss of their child. Acknowledging grief as a complex, evolving and personalised process subjected to parental characteristics, settings, context and available support, this SSR in SEBA calls attention to effective nurturing of the relationship between parents and healthcare professionals, and suggests use of the RToP to assess and direct personalised, timely, specific support of parents in evolving conditions. We believe the findings of this review also call for further studies to support healthcare professionals as they journey with bereaved parents.

Seeking an Adjustment from the Unnatural to the Supernatural: The Experience of Losing a Child from Cancer in Colombia

Aims

The death of a child with cancer can be devastating for his or her parents. This study sought to understand the way in which the process of parental grief develops after the death of a child with cancer.

Methods

The research used a grounded theory approach, in which 18 participants were enrolled including parents whose child died from cancer 5 months to 5 years before. In-depth interviews were conducted, which were analyzed using constant comparisons until theoretical saturation was reached.

Results

Fifteen subcategories were identified and grouped into three categories that explain what the grieving process represents to the parents over time (a) crossing a desert, (b) dying while alive, and (c) coming back to life. From the emerging relationships among the categories, the core category "seeking adjustment from the unnatural to the supernatural" arises. The results show that grief begins from the moment of diagnosis until long after the child's death. For parents, it entails understanding the disruption in the natural course of life, going through indescribable pain, and being spiritually reconnected with their child.

Conclusions

These results enable nurses to design comprehensive interventions that meet the described needs of these parents.

Contingency Help: The Main Strategy of Iranian Nurses in Dealing With the Family of the End-of-Life Patients

Families are struggling with many challenges in the final stages of patient life. It is important to understand what actions nurses do for the family of the end-of-life (EOL) patients. This study aimed to explain the main strategy of nurses' dealing with the family of the EOL patients. Data were analyzed using conventional content analysis. Semistructured interviews were conducted on 32 nurses from hospitals in Tehran. Nurses used six measures of explaining the bitter reality, effective communication, management of violence, referral, consolation, and reinforcement. "Contingency help" was conceptualized as the main strategy. Nurses through "contingency help" were involved in solving the emotional, physical, financial, and spiritual needs of the family. Nurses will be able to apply the results of this study to the development of care policies for the family of the EOL patients.

Duelo en el cuidador del niño fallecido por cáncer: revisión exploratoria

El objetivo de esta revisión fue sintetizar el abordaje metodológico de estudio e integrar los hallazgos del proceso de duelo en cuidadores de niños fallecidos por cáncer. Se realizó una revisión exploratoria de literatura de 19 estudios publicados en revistas indexadas entre el 2010 y 2017. Los hallazgos fueron tratados con técnicas de codificación abierta inductiva. Los resultados evidenciaron un abordaje mayormente cualitativo, con participación de padre y madre, con un año entre la muerte del niño y el ingreso al estudio. Los resultados de los estudios revelaron que debido a que el duelo se vive como respuesta a la ruptura física del vínculo con el niño, es a través del trabajo sobre vínculos que el duelo puede superarse. Los vínculos clave son los que se tienen con el niño fallecido, con los hijos vivos, con el cónyuge, con la familia y el equipo de salud. Por lo que se requiere acompañamiento continuo y compasivo al cuidador desde el momento del diagnóstico del niño con cáncer, que permita construir vínculos asertivos. Posterior a la muerte del niño, es necesario mantener la continuidad del cuidado y propender por que el cuidador participe en grupos de apoyo.

Families in Paediatric Oncology Nursing: Critical Incidents From the Nurses' Perspective

PURPOSE

Paediatric oncology nurses encounter challenges with families on a daily basis. This study explores how nurses describe significant incidents when encountering families and family members during the child's hospitalisation in the paediatric oncology unit.

DESIGN AND METHODS

A qualitative study with a phenomenological approach in which 17 paediatric oncology nurses from three different hospitals described critical incidents related to families. The participants' written descriptions were analysed using inductive content analysis.

RESULTS

The results indicate three domains where critical incidents occur: 1) Families' capability and resources, 2) parents' behaviour and 3) emotional labour in paediatric oncology nursing.

CONCLUSION

The results indicate that paediatric oncology nurses face situations with patients' parents that can cause them stress and uncertainty, as well as burden them emotionally. Some of the incidents dealt with difficult ethical questions. Because of the challenges that families are facing, as described in the study, nurses need to focus more on helping families identify their resources and empower themselves in order to adapt to a new situation in their lives.

IMPLICATIONS

The results provide important information not only for paediatric nursing but also for education and management. Since the quality of family nursing does not only depend on the competence of nurses or available resources, support from management concerning the work with families of severely sick children would be beneficial to the nurses. In addition, educational interventions need to be developed in order to strengthen the capability of nurses to successfully respond to challenging situations with families.

Improving the Quality of End-of-Life Care in Pediatric Oncology Patients Through the Early Implementation of Palliative Care

Providing end-of-life care to children with cancer is most ideally achieved by initiating palliative care at the time of diagnosis, advocating for supportive care throughout the treatment trajectory, and implementing hospice care during the terminal phase. The guiding principles behind offering palliative care to pediatric oncology patients are the prioritization of providing holistic care and management of disease-based symptoms. Pediatric hematology-oncology nurses and clinicians have a unique responsibility to support the patient and family unit and foster a sense of hope, while also preparing the family for the prognosis and a challenging treatment trajectory that could result in the child’s death. In order to alleviate potential suffering the child may experience, there needs to be an emphasis on supportive care and symptom management. There are barriers to implementing palliative care for children with cancer, including the need to clarify the palliative care philosophy, parental acknowledgement and acceptance of a child’s disease and uncertain future, nursing awareness of services, perception of availability, and a shortage of research guidance. It is important for nurses and clinicians to have a clear understanding of the fundamentals of palliative and end-of-life care for pediatric oncology patients to receive the best care possible.

The Relationship between Anxiety and Coping Strategies in Family Caregivers of Patients with Trauma

INTRODUCTION

Traumatic events are of high incidence and affect not only the patient but also their family members, causing psychological problems such as stress and anxiety for caregivers of these patients. Therefore, the application of appropriate coping strategies by them seems necessary in order to promote mental health.

AIM

To study the relationship of anxiety with coping strategies in family caregivers of trauma patients.

MATERIALS AND METHODS

The present research was a descriptive-correlational study which was carried out on 127 family caregivers of patients with trauma in intensive care unit, surgery ward and emergency unit of Amir al-Mu'minin Hospital of Zabol, Sistan and Baluchestan Province. The respondents were selected based on the convenience sampling method. Demographics questionnaire, DASS-21, and Coping Strategies questionnaire were used for data collection. The obtained data were statistically analysed using descriptive statistics, Analysis of Variance (ANOVA), t-test, and Pearson correlation coefficient in statistical package for the Social Sciences (SPSS) version 21.0.

RESULTS

Based on the results, 89.9% of family caregivers suffer from mild to severe anxiety. The most common type of coping strategy used by the respondents was emotion-focused. The results showed no relationship between anxiety and emotion-centrism, but an inverse relationship was found between problem-centrism and anxiety.

CONCLUSION

The majority of family caregivers had anxiety. Given, the inverse relationship between the level of anxiety and the use of problem-based coping strategy, in addition to identifying and reducing the causes of anxiety in caregivers. It is recommended that appropriate coping strategies should be trained to them.

A family nursing educational intervention supports nurses and families in an adult intensive care unit

The family experience of critical illness is filled with distress that may have a lasting impact on family coping and family health. A nurse can become a source of comfort that helps the family endure. Yet, nurses often report a lack of confidence in communicating with families and families report troubling relationships with nurses. In spite of strong evidence supporting nursing practice focused on the family, family nursing interventions often not implemented in the critical care setting. This pilot study examined the influence of an educational intervention on nurses' attitudes towards and confidence in providing family care, as well as families' perceptions of support from nurses in an adult critical care setting. An academic-clinical practice partnership used digital storytelling as an educational strategy. A Knowledge to Action Process Framework guided this study. Results of pre-intervention data collection from families and nurses were used to inform the educational intervention. A convenience sample of family members completed the Iceland Family Perceived Support Questionnaire (ICE-FPSQ) to measure perception of support provided by nurses. Video, voice, and narrative stories of nurses describing their experiences caring for family members during a critical illness and family members' experiences with a critically ill family member also guided education plans. When comparing the pre and post results of the Family Nurse Practice Scale (FNPS), nurses reported increased confidence, knowledge, and skill following the educational intervention. Qualitative data from nurses reported satisfaction with the educational intervention. Findings suggest that engaging nurses in educational opportunities focused on families while using storytelling methods encourages empathic understandings. Academic-clinician teams that drive directions show promise in supporting families and nurses in critical care settings. Plans are moving forward to use this study design and methods in other critical care settings.