Nurses’ experience of grief following paediatric patient death in the critical care setting

Abstract

Background: Paediatric death is widely regarded as one of the most distressing losses, and its impact extends beyond families to the nurses who care for critically ill children. Despite the emotional intensity of this work, nurses are often expected to maintain composure and continue providing high-quality care. Grief within nursing is frequently unacknowledged, particularly in critical care settings where exposure to death is recurrent and time for emotional processing is limited. In Malta, paediatric patients are treated together with adult patients in the Intensive Therapy Unit. Moreover, no research has explored this issue in the local setting. Objectives: This study aimed to explore how critical care nurses experience and interpret grief following the death of a paediatric patient, both at the time of death and in the period that follows. It sought to examine the short- and long-term effects of grief on nurses’ well-being, identify the coping mechanisms and support systems they use, and elicit the common factors shaping their grief experiences within the critical care setting. Design: A qualitative, phenomenological study, using Interpretative Phenomenological Analysis as the research approach. Participants: Seven ITU nurses working in Malta’s only Intensive Therapy Unit were recruited; all had direct experience of caring for paediatric patients who died in the unit. Methods: Data were collected through in-depth semi-structured interviews (four female, three male), each with more than three years of ITU experience. Participants were purposively sampled based on their involvement in caring for paediatric patients who died in the unit. Interviews were audio-recorded, transcribed verbatim, and analysed using Interpretative Phenomenological Analysis following the stages outlined by Smith et al. (2022). Ethical approval was obtained before data collection. Results: Three Group Experiential Themes emerged. These included “The Experience and Impact of Grief”, “Emotional and Relational Responses to Loss” and “Coping and Support Mechanisms for Nurses”. These themes capture how nurses make sense of paediatric loss, how these experiences shape their emotional worlds, and how they attempt to cope within a demanding environment. Findings are interpreted through two complementary frameworks: Worden’s (2009) Tasks of Mourning and Tonkin’s (1996) Growing Around Grief Model. Conclusion: This study has revealed significant emotional and professional challenges faced by nurses following paediatric death in the ITU, showing how grief affects their well-being, identity, and capacity to provide compassionate care. These findings emphasise the urgent need for structured psychological support and organisational measures that acknowledge and address nurses’ grief, ultimately safeguarding staff well-being and improving the quality of ITU care.