"At Least I Can Push this Morphine":PICU Nurses' Approaches to Suffering Among Dying Children

Authors

Elizabeth G. Broden, Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston MA; National Clinician Scholars Program, Yale Schools of Medicine and Public Health, New Haven, CT. Electronic address: Elizabeth.broden@yale.edu.
Ijeoma Julie Eche-Ugwu, Phyllis F. Cantor Center for Research in Nursing and Patient Care Services, Dana-Farber Cancer Institute, Boston, MA.
Danielle D. DeCourcey, Department of Pediatrics, Harvard Medical School Boston, MA; Division of Medical Critical Care, Boston Children's Hospital, Boston, MA.
Joanne Wolfe, Department of Pediatrics, Harvard Medical School Boston, MA; Department of Pediatrics, Massachusetts General Hospital and Department of Pediatrics, Brigham and Women's Hospital, Boston, MA.
Pam Hinds, Department of Nursing Science, Professional Practice and Quality, Children's National Hospital, Washington, DC; Department of Pediatrics, The George Washington University, Washington, DC.
Jennifer Snaman, Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston MA; Department of Pediatrics, Harvard Medical School Boston, MA.

Document Type

Journal Article

Publication Date

4-26-2024

Journal

Journal of pain and symptom management

DOI

10.1016/j.jpainsymman.2024.04.018

Keywords

nursing; pediatric; pediatric intensive care; qualitative research

Abstract

CONTEXT: Parents of children who die in the pediatric intensive care unit (PICU) carry memories of their child's suffering throughout a lifelong grieving experience. Given their prolonged time at the bedside, PICU nurses are poised to attend to dying children's suffering. OBJECTIVES: We aimed to explore how PICU nurses identify, assess, and attend to EOL suffering. METHODS: Interpretive descriptive qualitative study with thematic analysis of virtual focus groups from a geographically diverse sample of PICU nurses. RESULTS: Nurses participated in 5 focus groups (N=19). Most identified as White (89%) females (95%) with a range of 1-24 years of PICU experience and involvement in >10 EOL care cases (89%). Nurses described approaches to suffering within five themes: 1) Identifying and easing perceptible elements; 2) Recognizing and responding to subtleties moment-to-moment; 3) Acclimating to family interdependence; 4) Synchronizing nurse in-the-room insight with systemic complexity; and 5) Accounting for ambiguity. Nurses detailed elements of suffering they could "fix" with straightforward, external interventions (e.g., pain medication). More complex tasks like optimizing care within familial and interprofessional team relationships while navigating psychosocial responses from children and families challenged nurses. Nurses attempted to minimize EOL suffering amidst ambiguity and complexity using internal processes including managing the environment and titrating moment-to-moment care. CONCLUSIONS: While physical suffering may be remedied with direct nursing care, holistically attending to EOL suffering in the PICU requires both bolstering external processes and strengthening PICU nurses' internal resources. Improving psychosocial training and optimizing interprofessional care systems could better support dying children and their families.

APA Citation

Broden, Elizabeth G.; Eche-Ugwu, Ijeoma Julie; DeCourcey, Danielle D.; Wolfe, Joanne; Hinds, Pam; and Snaman, Jennifer, ""At Least I Can Push this Morphine":PICU Nurses' Approaches to Suffering Among Dying Children" (2024). GW Authored Works. Paper 4669.
https://hsrc.himmelfarb.gwu.edu/gwhpubs/4669

Department

Pediatrics