Personal and Professional Experiences of Pediatric Residents Concerning Death (original) (raw)
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Illness, Crisis, & Loss, 2003
Many health care professionals have to deal regularly with their patients' deaths and relatives' bereavement, but frequently they have not been trained in this area, and therefore the psychological cost is very high. The authors' principal aim in this work is to describe health care professionals' perceptions about death. A group of health care professionals who worked with children was compared with a group who worked with elderly people. Results showed that emotional aspects were perceived as more important than biomedical aspects in the death process. Between the groups, some differences were detected relating to the perception of the proximity of members' own deaths, and the authors could also observe that the death of a loved one was perceived as more important than their own death. These results
Thematic analysis of interprofessional provider perceptions of pediatric death
Journal of Pediatric Nursing, 2019
Though provider and patient perceptions of death are characterized in the adult population literature, there is limited information related to providers' perceptions in pediatric and neonatal patients. The purpose of this study was to better understand how interprofessional care team members perceive and experience neonatal and pediatric end-of-life situations. Design and methods: This survey questionnaire was administered to interprofessional providers following their participation in an institutional workshop, as part of an ongoing institutional effort to improve end-of-life experiences for patients/family and providers. Interprofessional care providers completed an electronic survey consisting of closed-ended and one open-ended question to elicit their perceptions of their participation in end of life care for a recent neonatal/pediatric patient in the period before the child's death. Results: The qualitative analysis of 306 free-text responses commenting on the deaths of 138 patients, contained within 880 completed mixed-method surveys, is described. Thematic analysis of the free text discovered three primary themes from the data: favorable aspects of the death experience, unfavorable aspects of the experience, and combined favorable and unfavorable aspects. Four subthemes contributed to the themes; namely, language, parental presence, trust/rapport in provider relationships and inclusion in decision-making, communication, and culture. Conclusions: Multiple factors contribute to how interprofessional care providers perceive end-of-life care experiences for neonatal/pediatric patients. The same death may be perceived differently by different providers. Practice implications: Understanding favorable and unfavorable aspects of providing end-of-life care will support strategies to provide resources, education and support to facilitate coping and resiliency in care providers.
Assessing Palliative and End-of-Life Educational Needs of Pediatric Health Care Professionals
Journal of Hospice & Palliative Nursing, 2017
Children with serious, complex medical or life-threatening conditions and their families often fail to receive effective, consistent, timely, and competent care that meets their physical, emotional, and spiritual needs. Enhancing both basic education and advanced skills in pediatric palliative and end-of-life care education is recommended so that health care providers will enter practice with some form of formal preparation. In this quantitative descriptive study, we used the End-of-Life Professional Caregiver Survey to assess unmet palliative and end-of-life educational needs of pediatric health care providers in the state of Connecticut. Participants who received palliative care education in the past 5 years had higher mean scores on all 3 factors of the End-of-Life Professional Caregiver Survey, which may reflect the evolvement and depth of current pediatric palliative care education. Future palliative educational programs for pediatric providers in Connecticut should include sharing pediatric palliative care principles and national guidelines, describing services provided by pediatric hospice and timing of referral, developing systems to ensure continuity of care crossing all settings, addressing request for assisted suicide, meeting needs of staff and providers caring for the dying child (self-care), and describing cultural and ethical values specific to diverse populations in Connecticut.
The Impact of Pediatric Palliative Care Training on the Death Attitudes of Health Professionals
Background: It is increasingly recognised that comprehensive training in pediatric palliative care cannot be achieved only through the acquisition of knowledge and skills but requires the cultivation of self awareness and acknowledgment of personal attitudes to death and dying. Aim of the study: This study aimed to explore the impact of a pediatric palliative care training program on the death attitudes of a multidisciplinary team of health professionals. Methodology: A sample of 83 health professionals (nurses, physicians, psychologists and others) participated in a quasi-experimental study. Participants in the intervention group (IG) (N=34) attended a 150-hour training program on pediatric palliative care, whereas the control group (CG) (N=49) received no training. All participants completed a questionnaire on demographics and the Death Attitude Profile–Revised (DAP-R) before (T1) and after (T2) the training program. A repeated measure analysis of variance (ANOVA) was used to identify any main or two-way interaction effects on the DAP-R subscale scores. Results: A two-way interaction was found in the Escape Acceptance subscale, with both groups having similar scores at T1, whereas at T2 the IG showed higher scores compared to the CG. A group difference was evident in the Neutral Acceptance subscale, with the IG showing higher scores than the CG at both T1 and T2. Moreover, time difference was found in this subscale, with scores at T2 being higher than at T1 for both groups. Νo statistical significant effects were detected for the other DAP-R subscales. Conclusions: Pediatric palliative care training influenced trainees' death attitudes. Results indicated that confrontation with children's incurable illness and unavoidable death may generate mixed attitudes to death. Further research is needed to explore the process by which changes in death attitudes occur over time. Implications on designing and assessing the impact of pediatric palliative care educational programs are also discussed.
Pediatric Palliative, End-of-Life, and Bereavement Care
Pediatric Clinics of North America, 2005
Each year in the United States, approximately 50,000 children die, mostly in hospitals, and many more confront life-threatening conditions. Most-if not allof these children and their families would benefit from timely, comprehensive, compassionate, continuous, and developmentally appropriate supportive care services, including a mixture of palliative, end-of-life, and bereavement care. Palliative care aims to relieve suffering and improve quality of life for patients with advanced illnesses and their families. Effective palliative care includes communicating with patients and family members, managing pain and other symptoms, providing psychosocial, spiritual, and bereavement support, and 0031-3955/05/$ -see front matter D
Pediatric Nurses' Individual and Group Assessments of Palliative, End-of-Life, and Bereavement Care
Journal of Palliative Medicine, 2011
Background: Although pediatric nurses working in children's hospitals often provide care to dying children, little is known about their palliative care beliefs and experiences as individuals or members of groups within the hospital. Objective: To describe pediatric nurses' ratings of palliative care goals and problems, as individuals and members of clusters of nurses with similar views, and nurses' degree of collaboration with an inpatient palliative care team across hospital units. Method: A cross-sectional survey of nurses at a freestanding children's hospital in 2005. Results: Nurses rated the most important goals as managing pain, maintaining the child's quality of life, and improving communication. Commonly cited problems were lack of opportunity to debrief after a patient's death, uncertainty about the goals of care, and the health care team's reluctance to discuss hospice with family. Based on individual views about goals and problems, nurses clustered into 5 groups that differed in terms of the adamancy of their views and the scope of the goals and problems they considered important or significant. The hospital unit was the most important factor in predicting nurses' degree of collaboration with the palliative care team even after accounting for individual characteristics. Conclusions: Pediatric nurses broadly endorse both the importance of palliative care goals and the presence of problems yet perceive the importance of these goals and problems differently. Further, they vary in their level of collaborative practice with a palliative care team in ways that should be accounted for when planning and implementing palliative care programs.
2019
Background: There is lack of a standardized residency curriculum for the emerging field of Pediatric Palliative Care (PPC). Available evidence suggests that few resident physicians acquire the requisite knowledge and essential skills needed to develop competency in PPC during their postgraduate education and training [1]. Methods: A pediatric end-of-life resident physician assessment survey was utilized to evaluate self-reported competence and concerns / interests about PPC. Results: Self-reported competence increased with each year of residency training. With regards to their communication skills, only 40 % of the residents felt competent to perform with minimal supervision or independently as compared to 65 % when it comes to their symptoms management skills. Residents also felt less prepared with the psychosocial aspects of caring for pediatric patients (e.g., when to initiate hospice referral, communicating to the family the shift from curative to comfort care measures, discussing donotresuscitate orders, conducting family conferences for end-of-life decisions, using adjuvant analgesics, and giving bad news to the patient or family members). Conclusion: The survey results showed differing levels of competence among pediatric interns and residents. The feedback from this study further supports that not only is PPC in postgraduate medical training necessary, it should also address the full experience of the terminally-ill pediatric patient, encompassing both physical and non-physical (psychosocial) aspects.
Journal of Palliative Medicine, 2017
Background: Bereavement support is a core tenet of palliative care that may prove difficult for clinicians as it is time-consuming, emotionally charged, and not emphasized in pediatrics training. This project is intended to describe the opinions, knowledge, and practice of bereavement care among pediatric oncologists to identify gaps in clinical care. Procedures: An internet-based survey instrument was pilot tested, refined, and distributed to pediatric oncologists in the United States. Statistical analysis was performed using SAS 9.2. Results: Electronic surveys were distributed to 2,061 pediatric oncologists and 522 surveys (25%) were fully completed. Participants were asked how likely they are to engage in particular bereavement activities (phone calls, condolence cards, memorial services, family meetings, or referrals for counseling) following the death of a pediatric cancer patient. Eighty-two percent of participants, at least, sometimes engage in at least one of these activities. Being female, an attending physician, and increased time in clinical practice were predictive of active participation in bereavement care. Nearly all participants (96%) believe that bereavement care is part of good clinical care, while 8% indicate that bereavement support is not their responsibility. Lack of time and resources were the biggest barriers to providing bereavement support. Conclusions: The majority of pediatric oncologists engage in clinical practices to support bereaved families. Lack of time and physical resources pose significant barriers to clinician's efforts. Additional supports should be explored to increase pediatric oncology physician uptake of bereavement care practices.