The nurse's experience of the death of patients on the paediatric wards

Abstract

This qualitative study set out to explore the nurses' experiences after the death of their patients on the acute paediatric wards in Malta. The study has three main objectives, firstly to explore nurses' personal reflections on death and how it has changed through time. Secondly to identify the interventions that nurses' carry out in preparation for and following a child's death. Thirdly, to describe the coping strategies and the support that the nurses have previously found helpful and to shed light on any alternative support desired. To select key informants or information-rich case, random purposive sampling was employed, whereby 12 nurses currently working on paediatric wards were selected. Data was gathered using a semi-structured interview and was analyzed and sorted manually using thematic analysis. The main themes that emerged from this analysis are "Perceiving death and dying'', "facilitating a good death", "experiencing a mixture of feelings" and "curtailing and counterbalancing the negative feelings". The results of this study confirmed findings of previous studies (Feldstein and Gemma, 1995; Davies et al., 1996; Kaunonen et al., 2000; Wakefield, 2000; Papadatou et al., 2002) suggesting that nurses grieve over the death of a child particularly over children to whom they are "emotionally attached". Results from this study confirm that the way the nurses classifies a death, affects the extent of their grief after the death. In an attempt to control their grief, nurses strive to facilitate a good death, however, when struggles prove futile, feelings such as helplessness, frustration and anger are triggered. Apart from coping with their own grief, these nurses are faced with the demanding task of supporting the grieving family. Despite the challenges inherent in this type of work, nurses taking part in this study seemed to derive considerable satisfaction from successfully contributing to a good death. Common responses to the impact of death fluctuated between experiencing and avoiding grief. From these results it has been found that peer support is very important to the nurses who took part in this study. With regards to the supporting these nurses, it appears that educational sessions based on the needs of the nurses and a more specialized approach when is comes to support are deemed beneficial to increase the staff's capacity to act as supporter to the family and to each other. To support better these nurses it is recommended that the people responsible for offering and organizing support services, will appreciate and take in consideration these nurses' suggestions and offer them educational sessions and a more specialized support system. Apart from providing these nurses with adequate educational sessions the management should enable and encourage attendance to these sessions by providing time off and assistance to the staff. To counteract the limiting factor presented in this study of the small sample size, it is recommended that similar studies are carried out with a much greater sample, possibly including the acute general hospital in Gozo to enhance the geographical variation.