Strategies and Tools Used by Pediatric Nurses and Nurse Practitioners in Guiding Families From Curative to Comfort...

The timeframe from delivery of critical care and the transition to comfort care for the dying child can occur over minutes, days, weeks, or months. During this transition from curative to comfort care, nurses can play an active role in the management of vulnerable dying children and their families.

The aims of this study were (1) to explore the actions, communication techniques, and interventions utilized by morally resilient registered nurses (RNs) and nurse practitioners (NPs) as they guide families through the transition from curative to comfort care and (2) to understand how pediatric intensive care RNs and NPs utilize strategies such as self-awareness and self-regulation to remain morally resilient providers.

RNs and NPs from 4 neonatal/pediatric intensive care units completed the Rushton Moral Resiliency Scale (RMRS) to assess moral resiliency. Nurses with an RMRS ≥3 were invited to participate in a Zoom interview to discuss their strategies of caring for patients and families they helped transition from curative to comfort care and for remaining morally resilient.

Twenty-one RNs and NPs completed the RMRS. Seven RNs and 13 NPs participated in interviews lasting between 22 minutes 56 seconds and 65 minutes 6 seconds. The 6 RN themes were curative to comfort care transition toolbox, communication facilitators and barriers, advocacy, model of care, patient- and parent-focused comfort care activities, and morally resilient facilitators and barriers. The 4 NP themes were curative to comfort care transition toolbox, role definition, cultivating resiliency, and organizational structures influence care delivery.

Findings from this research may assist RNs and NPs in identifying strategies they can implement to facilitate the transition from curative to comfort care for the benefit of patients and families, while remaining morally resilient providers.