Child/Adolescent Health

Pediatric nurses express differing perspectives on palliative care

Pediatric nurses play a crucial role in providing palliative, end-of-life, and bereavement (PEOLB) care to dying children and their families. A survey of 410 nurses working in a children's hospital revealed how nurses perceive PEOLB care. It found that nurses individually endorsed managing pain, maintaining the quality of life, and improving communication as the most important goals of palliative care. The leading problems facing optimal palliative care, the nurses believed, were the lack of opportunity to debrief after a patient's death, uncertainty about the goals of care, and the team's reluctance to discuss hospice with the family.

The researchers found that with respect to both the importance of particular goals of palliative care and the problems facing palliative care, nurses' opinions clustered into 5 groups. Large clusters of nurses reported that all goals were important (25 percent) and all problems were significant (30 percent). With regard to palliative care goals, each group endorsed pain control, while rejecting one particular type of goal: spiritual care and hospice (26 percent), symptom management (19 percent), hospice (13 percent), or psychosocial and communication support (17 percent). Three groups differed regarding what they perceived as the most significant problems: unaddressed spirituality concerns (28 percent); inadequate clarifications of treatment goals, poor communication, and nondiscussion of hospice (9 percent); and a cultural bias against pediatric palliative care and underuse of do-not-resuscitate orders (22 percent). A final group viewed no specific problem as especially 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. The researchers conclude that by raising awareness of differing perspectives among nurses and hospital units, surveys can allow educational outreach programs to better hone their messages to different groups of nurses, and hopefully to greater effect. This study was supported in part by the Agency for Healthcare Research and Quality (T32 HS00002).

See "Pediatric nurses' individual and group assessments of palliative, end-of-life, and bereavement care," by Heather L. Tubbs-Cooley, Ph.D., R.N., Gina Santucci, M.S.N., Tammy I. Kang, M.D., and others in the Journal of Palliative Medicine 14(5), pp. 631-637, 2011.

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