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Living with Dying in the Pediatric Intensive Care Unit: A Nursing Perspective
Debbie Stayer1, Joan Such Lockhart2
1Debbie Stayer is an assistant professor, Department of Nursing, Bloomsburg University of Pennsylvania, Bloomsburg, Pennsylvania. Joan Such Lockhart is a professor, Duquesne University School of Nursing, Pittsburgh, Pennsylvania. dstayer@bloomu.edu.
Insights
Pediatric intensive care unit nurses face complex challenges providing palliative care to children with life-threatening illnesses. Despite difficulties, nurses find professional satisfaction and collegial support in this critical role.
Area of Science:
- Pediatric Nursing
- Palliative Care
- Intensive Care
Background:
- Limited research exists on nurses' experiences with pediatric palliative care in intensive care settings.
- Nurses in pediatric intensive care units (PICUs) face unique challenges caring for children with life-threatening illnesses.
Purpose of the Study:
- To explore and interpret the lived experiences of PICU nurses providing palliative care to critically ill children and their families.
Main Methods:
- Hermeneutic phenomenology utilized.
- 12 PICU nurses in the northeastern United States participated.
- Data collected through face-to-face interviews and field notes.
Main Results:
- Five major themes emerged: journey to death, lifelong burden, challenges in care delivery, self-maintenance, and boundary crossing.
- 12 subthemes detailed emotional impacts, grief, hope, pain management, communication, and respect for parental wishes.
- Nurses reported professional satisfaction and collegial support despite care complexities.
Conclusions:
- Palliative care for critically ill children is complex for PICU nurses.
- Nurses derive satisfaction from their role and collegial support.
- Further research needed to identify resources supporting staff coping with death and dying.
Background:
Despite reported challenges encountered by nurses who provide palliative care to children, few researchers have examined this phenomenon from the perspective of nurses who care for children with life-threatening illnesses in pediatric intensive care units.
Objectives:
To describe and interpret the essence of the experiences of nurses in pediatric intensive care units who provide palliative care to children with life-threatening illnesses and the children's families.
Methods:
A hermeneutic phenomenological study was conducted with 12 pediatric intensive care unit nurses in the northeastern United States. Face-to-face interviews and field notes were used to illuminate the experiences.
Results:
Five major themes were detected: journey to death; a lifelong burden; and challenges delivering care, maintaining self, and crossing boundaries. These themes were illuminated by 12 subthemes: the emotional impact of the dying child, the emotional impact of the child's death, concurrent grieving, creating a peaceful ending, parental burden of care, maintaining hope for the family, pain, unclear communication by physicians, need to hear the voice of the child, remaining respectful of parental wishes, collegial camaraderie and support, and personal support.
Conclusion:
Providing palliative care to children with life-threatening illnesses was complex for the nurses. Findings revealed sometimes challenging intricacies involved in caring for dying children and the children's families. However, the nurses voiced professional satisfaction in providing palliative care and in support from colleagues. Although the nurses reported collegial camaraderie, future research is needed to identify additional supportive resources that may help staff process and cope with death and dying.
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