scholarly journals Pediatric palliative care in the intensive care unit and questions of quality: a review of the determinants and mechanisms of high-quality palliative care in the pediatric intensive care unit (PICU)

2018 ◽  
Vol 7 (4) ◽  
pp. 326-343 ◽  
Author(s):  
Sara Rhodes Short ◽  
Rachel Thienprayoon
Keyword(s):  
Intensive Care Unit ◽  
Palliative Care ◽  
Intensive Care ◽  
Pediatric Intensive Care Unit ◽  
Pediatric Intensive Care ◽  
Pediatric Palliative Care ◽  
High Quality

Living with Dying in the Pediatric Intensive Care Unit: A Nursing Perspective

2016 ◽  
Vol 25 (4) ◽  
pp. 350-356 ◽  
Author(s):  
Debbie Stayer ◽  
Joan Such Lockhart
Keyword(s):  
Intensive Care Unit ◽  
Palliative Care ◽  
Intensive Care ◽  
Intensive Care Units ◽  
Pediatric Intensive Care Unit ◽  
Pediatric Intensive Care ◽  
Emotional Impact ◽  
Pediatric Intensive Care Units ◽  
Personal Support ◽  
Life Threatening

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.

scholarly journals Speaking a Different Language: A Qualitative Analysis Comparing Language of Palliative Care and Pediatric Intensive Care Unit Physicians

2017 ◽  
Vol 35 (3) ◽  
pp. 384-389 ◽  
Author(s):  
Anne G. Ciriello ◽  
Zoelle B. Dizon ◽  
Tessie W. October
Keyword(s):  
Quality Of Life ◽  
Intensive Care Unit ◽  
Palliative Care ◽  
Intensive Care ◽  
Pediatric Intensive Care Unit ◽  
Medical Information ◽  
Pediatric Intensive Care ◽  
Icu Physicians ◽  
Pediatric Icu

Background: Family conferences in the pediatric intensive care unit (ICU) often include palliative care (PC) providers. We do not know how ICU communication differs when the PC team is present. Aim: To compare language used by PC team and ICU physicians during family conferences. Design: A retrospective cohort review of ICU family conferences with and without the PC team. Setting: Forty-four bed pediatric ICU in a tertiary medical center. Participants: Nine ICU physicians and 4 PC providers who participated in 18 audio-recorded family conferences. Results: Of the 9 transcripts without the PC team, we identified 526 ICU physician statements, generating 10 thematic categories. The most common themes were giving medical information and discussing medical options. Themes unique to ICU physicians included statements of hopelessness, insensitivity, and “health-care provider challenges.” Among the 9 transcripts with the PC team, there were 280 statements, generating 10 thematic categories. Most commonly, the PC team offered statements of support, giving medical information, and quality of life. Both teams promoted family engagement by soliciting questions; however, the PC team was more likely to use open-ended questions, offer support, and discuss quality of life. Conclusion: Pediatric ICU physicians spend more time giving medical information, whereas the PC team more commonly offers emotional support. The addition of the PC team to ICU family conferences may provide a balanced approach to communication.

scholarly journals End-of-life care in a pediatric intensive care unit: the impact of the development of a palliative care unit

2020 ◽  
Vol 19 (1) ◽  
Author(s):  
Sara Bobillo-Perez ◽  
Susana Segura ◽  
Monica Girona-Alarcon ◽  
Aida Felipe ◽  
Monica Balaguer ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Palliative Care ◽  
Intensive Care ◽  
End Of Life ◽  
Pediatric Intensive Care Unit ◽  
End Of Life Care ◽  
Pediatric Intensive Care ◽  
Palliative Care Unit ◽  
Life Care ◽  
The Impact

A Mixed-Methods Quasi-Experimental Study on Perspectives Among Physicians and Nurses Regarding Use of Palliative Care Teams in the Pediatric Intensive Care Unit After Out-of-Hospital Cardiac Arrest

2020 ◽  
Vol 38 (2) ◽  
pp. 130-137
Author(s):  
Alia Broman ◽  
Cydni Williams ◽  
Robert Macauley ◽  
Patricia A. Carney
Keyword(s):  
Intensive Care Unit ◽  
Experimental Study ◽  
Palliative Care ◽  
Intensive Care ◽  
Pediatric Intensive Care Unit ◽  
Psychosocial Support ◽  
Pediatric Intensive Care ◽  
Palliative Care Teams ◽  
Quasi Experimental ◽  
Hospital Cardiac Arrest

Background: Nationally, only one-third of children survive to hospital discharge after initial presentation with out-of-hospital cardiac arrest (OHCA). Of those children who survive, less than 25% leave the hospital at their functional baseline. Given these poor outcomes, such patients could benefit from palliative care involvement. Aims: To characterize the existing use and identify barriers to seeking palliative care consults in children admitted to the Pediatric Intensive Care Unit (PICU) with OHCA. Design: Mixed-methods quasi-experimental study. Participants: Physicians (MD/DO), nurse practitioners, and registered nurses who provide care in the PICU. Results: Overall, nurses felt palliative care was consulted “not nearly enough” (43%), while the majority of physicians (53.9%) perceived palliative care services are requested either “just the right amount” (30.8%) or “too often” (23.1%). The top 3 desired palliative services were (1) patient and family psychosocial support, (2) assistance with determining goals of care, and (3) counseling and education. Barriers to consults were forgetting/not thinking about consulting, and family refusal of palliative care consult. No statistical differences among participant groups were found for likelihood to consult palliative care, unless the patient faced imminent death. Conclusions: Pediatric Intensive Care Unit providers desire assistance from palliative care teams for help with identifying goals of care, providing psychosocial support, as well as education to the patients and their families. Unfortunately, there remains a large discrepancy between physicians and nurses when it comes to how often palliative care is, and should, be consulted.

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