Paediatric death and dying: exploring coping strategies of health professionals and perceptions of support provision
Abstract
Without question a child's death is a devastating event for parents and families. Health professionals working with the dying child and family draw upon their expertise and experience to engage with children, parents and families on this painful journey. This is a delicate and sensitive area of practice and has strong and penetrating effects on health professionals. They employ physical, emotional, spiritual and problem solving strategies to continue to perform this role effectively and to protect their continued sense of wellbeing.
Aim:
To explore health professionals' perceptions of bereavement support surrounding the loss of a child.
Methods:
The research was underpinned by social constructionism. Semi-structured interviews were held with 10 health professionals including doctors, nurses and social workers who were directly involved in the care of the dying child and family in 7 cases of paediatric death. Health professional narratives were analysed consistent with Charmarz's (2006) approach.
Results:
For health professionals, constructions around coping emerged as peer support, personal coping strategies, family support, physical impact of support and spiritual beliefs. Analysis of the narratives also revealed health professionals' perceptions of their support provision.
Conclusion:
Health professionals involved in caring for dying children and their families use a variety of strategies to cope with the emotional and physical toll of providing support. They also engage in self-assessment to evaluate their support provision and this highlights the need for self-evaluation tools in paediatric palliative care.
References
- (2012) Mapping children's palliative care around the world: an online survey of children's palliative care services and professionals' educational needs. J Palliat Med 15(6): 646–52 Crossref, Medline, Google Scholar
Australian Institute of Health and Welfare (2012) A picture of Australia's children 2012. http://tinyurl.com/lokutvp (accessed 20 May 2015 ) Google Scholar- (2009) Interventions to manage compassion fatigue in oncology nursing. Clin J Oncol Nurs 13(2): 183–91 Crossref, Medline, Google Scholar
- (2005) A descriptive study of coping strategies used by medical intensive care unit nurses during transitions from cure- to comfort-oriented care. Heart Lung 34(1): 63–8 Crossref, Medline, Google Scholar
- (2006) Relationships between stressors, work supports, and burnout among cancer nurses. Cancer Nurs 29(4): 338–45 Crossref, Medline, Google Scholar
- (1966) The Social Construction Of Reality: A Treatise In The Sociology Of Knowledge. Anchor Books, New York Google Scholar
- (2010) Moral distress experienced by health care professionals who provide home-based palliative care. Soc Sci Med 71(9): 1687–91 Crossref, Medline, Google Scholar
- (2008) Effect of social support and coping strategies on the relationship between health care-related occupational stress and health. J Res Nurs 13(6): 498–524 Crossref, Google Scholar
- (2008) Stillbirth and the couple: A gender-based exploration. Journal of Family and Social Work 11(4): 351–72 Crossref, Google Scholar
- (2006) Constructing Grounded Theory: A Practical Guide Through Qualitative Analysis. Sage, London Google Scholar
- (2012) The power and potential of grounded theory. Medical Sociology Online 6(3): 2–15 Google Scholar
- (2011) Perceptions of the long-term influence of mindfulness training on counselors and psychotherapists: a qualitative inquiry. The Journal of Humanistic Psychology 51(3): 318–49 Crossref, Google Scholar
- (2007) Coping strategies, emotional outcomes and spiritual quality of life in palliative care nurses. Int J Palliat Nurs 13(6): 291–300 Link, Google Scholar
- (2011) Development of the palliative care nursing self-competence scale. J Hospice Palliat Nurs 13(4): 230–41 Crossref, Google Scholar
- (2006) An evaluation of a support group for junior doctors working in palliative medicine. Am J Hosp Palliat Care 23(4): 287–96 Crossref, Medline, Google Scholar
- (2010) Creating a curtain of protection: nurses' experiences of grief following patient death. J Nurs Scholarsh 42(2): 122–9 Crossref, Medline, Google Scholar
- (1999) Workload and social support: Effects on performance and stress. Human Performance 12(2): 155–76 Crossref, Google Scholar
- (2013) Assessing the validity and reliability of an Arabic version of desbiens palliative care nursing self-competence scale with arabic speaking postgraduate nurses. Unpublished Masters thesis. Queensland University of Technology, Brisbane Australia Google Scholar
- (2004). Job stress and coping strategies in health care professionals working with cancer patients. Eur J Oncol Nurs 8(3): 234–44 Crossref, Medline, Google Scholar
- (2008) A qualitative study of oncologists' approaches to end-of-life care. J Palliat Med 11(6): 893–906 Crossref, Medline, Google Scholar
- (2010) Bereavement debriefing sessions: an intervention to support health care professionals in managing their grief after the death of a patient. Pediatr Nurs 36(4): 185–90 Medline, Google Scholar
- (2010) Frontline grief: the workplace support needs of community palliative care nurses after the death of a patient. J Hospice Palliat Nurs 12(4): 225–35 Crossref, Google Scholar
- (2005) Role of peer support and emotional expression on posttraumatic stress disorder in student paramedics. J Trauma Stress 18(2): 171–9 Crossref, Medline, Google Scholar
- (2000) Improving management of bereavement in general practice based on a survey of the recently bereaved in a single general practice. Br J Gen Pract 50(460): 863–6 Medline, Google Scholar
- (2002) Management of relatives of patients who are dying. J Clin Nurs 11(6): 794–801 Crossref, Medline, Google Scholar
- (2013). Experiences and perceptions of nurses caring for dying patients and families in the acute medical admission setting. Int J Palliat Nurs 19(9): 423–31 Link, Google Scholar
- (2008) Preparing for palliative medicine; evaluation of an education programme for fourth year medical undergraduates. Palliat Med 22(6): 687–92 Crossref, Medline, Google Scholar
- (2010) Undergraduate training in palliative medicine: is more necessarily better? Palliat Med 24(3): 306–9 Crossref, Medline, Google Scholar
- (2014) Caring for children who die unexpectedly: Patterns that emerge out of chaos. J Pediatr Nurs 29(1): 23–8 Crossref, Medline, Google Scholar
- (2007) Memorable patient deaths: Reactions of hospital doctors and their need for support. Med Educ 41(10): 942–6 Crossref, Medline, Google Scholar
- (2009) Improved competence after a palliative care course for internal medicine residents. Palliat Med 23(4): 360–8 Crossref, Medline, Google Scholar
Palliative Care Curriculum for Undergraduates (2013) Learning Module. http://www.pcc4u.org/ (accessed 20 May 2015 ) Google Scholar- (1986) Coping in stressful episodes: the role of individual differences, environmental factors, and situational characteristics. J Pers Soc Psychol 51(6):1277–92 Crossref, Medline, Google Scholar
- (2008) Reflecting peer-support groups in the prevention of stress and burnout: randomized control trial. J Adv Nurs 63(5): 506–16 Crossref, Medline, Google Scholar
- (2010) Where do nurses go for help? a qualitative study of coping with death and dying. Int J Palliat Nurs 16(9): 432–8 Link, Google Scholar
- (2003) Doctors' emotional reactions to recent death of a patient: cross sectional study of hospital doctors. BMJ 327(7408): 185 Crossref, Medline, Google Scholar
- (1984) Toward a theory of social support: closing conceptual gaps. Journal of Social Issues 40(4): 11–36 Crossref, Google Scholar
- (2013) Understanding compassion satisfaction, compassion fatigue and burnout: a survey of the hospice palliative care workforce. Palliat Med 27(2): 172–8 Crossref, Medline, Google Scholar
- (2011) Bereaved family members' assessments of the quality of end-of-life care: what is important? J Palliat Care 27(4): 261–9 Medline, Google Scholar
- (2000) Communication with police supervisors and peers as a buffer of work-related traumatic stress. Journal of Organizational Behavior 21(4): 407–24 Crossref, Google Scholar
- (2006) Time of change? The spiritual challenges of bereavement and loss. Omega 53(1–2): 105–16 Google Scholar
- (2013) International multiprofessional course in pediatric palliative care: benefits and challenges. J Palliat Med 16(1): 96–9 Crossref, Medline, Google Scholar
- (1998) A survey of competencies and concerns in end-of-life care for physician trainees. J Pain Symptom Manage 15(2): 82–90 Crossref, Medline, Google Scholar
- (2007) Developing the primary palliative care workforce in Australia. Cancer Forum 31(1): 12–5 Google Scholar
- (2014) The experiences, coping mechanisms and impact of death and dying on palliative medicine specialists. Palliat Support Care 12(4): 309–16 Crossref, Medline, Google Scholar



