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Searching for "the dying point:" providers' experiences with palliative care in pediatric acute care
To improve care of children who die in acute care settings there is a need to develop a clearer understanding of the barriers to provision of palliative care. The purpose of this study was to describe the experiences and views of health care providers in giving care to children who have undergone in...
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Published in: | Pediatric nursing 2007-07, Vol.33 (4), p.335-341 |
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description | To improve care of children who die in acute care settings there is a need to develop a clearer understanding of the barriers to provision of palliative care. The purpose of this study was to describe the experiences and views of health care providers in giving care to children who have undergone intensive therapies for life-threatening illnesses. A qualitative, descriptive design was conducted in the intensive care nursery, pediatric intensive care unit, and pediatric blood and marrow transplant unit at a southeastern US medical center. Purposive sampling with variation on role, years of experience, ethnicity, and gender was used to select the 17 health care providers. Findings were organized into three broad categories: (a) Palliative Care as an Added Dimension in the Illness Trajectory, (b) Palliative Care Moves Away From Curative Treatment, and (c) Professional Issues. Relevant themes were identified within each category. Most participants viewed palliative care as a changed dimension of care that is instituted once it is known that a child is dying. Three challenges in employing palliative care to acutely ill infants and children were identified: (a) finding the true dying point, (b) making the transition to palliative care, and (c) turning care over to an outside palliative care team at a critical juncture of caring. Professional issues in providing palliative care included inadequate preparation and, especially for nurses, the crossing of professional boundaries. An integrated model of palliative care is needed that is initiated at diagnosis and allows for the bidirectional transitioning across the illness and treatment trajectories. |
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The purpose of this study was to describe the experiences and views of health care providers in giving care to children who have undergone intensive therapies for life-threatening illnesses. A qualitative, descriptive design was conducted in the intensive care nursery, pediatric intensive care unit, and pediatric blood and marrow transplant unit at a southeastern US medical center. Purposive sampling with variation on role, years of experience, ethnicity, and gender was used to select the 17 health care providers. Findings were organized into three broad categories: (a) Palliative Care as an Added Dimension in the Illness Trajectory, (b) Palliative Care Moves Away From Curative Treatment, and (c) Professional Issues. Relevant themes were identified within each category. Most participants viewed palliative care as a changed dimension of care that is instituted once it is known that a child is dying. Three challenges in employing palliative care to acutely ill infants and children were identified: (a) finding the true dying point, (b) making the transition to palliative care, and (c) turning care over to an outside palliative care team at a critical juncture of caring. Professional issues in providing palliative care included inadequate preparation and, especially for nurses, the crossing of professional boundaries. An integrated model of palliative care is needed that is initiated at diagnosis and allows for the bidirectional transitioning across the illness and treatment trajectories.</description><identifier>ISSN: 0097-9805</identifier><identifier>PMID: 17907734</identifier><language>eng</language><publisher>United States: Jannetti Publications, Inc</publisher><subject>Acute Disease ; Adaptation, Psychological ; Adult ; Attitude of Health Personnel ; Care and treatment ; Child ; Continuity of Patient Care - organization & administration ; Critical Care - organization & administration ; Critical Care - psychology ; Critically ill children ; Evaluation ; Female ; Health care ; Health Knowledge, Attitudes, Practice ; Health Services ; Health Services Needs and Demand ; Hospice care ; Hospices (Terminal Care) ; Hospitals ; Humans ; Intensive Care Units, Pediatric - organization & administration ; Male ; Middle Aged ; Models, Organizational ; Nursing ; Nursing Education ; Nursing Methodology Research ; Organizational Objectives ; Palliative care ; Palliative Care - organization & administration ; Palliative Care - psychology ; Palliative treatment ; Pediatric nursing ; Pediatrics ; Pediatrics - organization & administration ; Personnel, Hospital - education ; Personnel, Hospital - psychology ; Professional Competence ; Professional Role ; Qualitative Research ; Self Efficacy ; Southeastern United States</subject><ispartof>Pediatric nursing, 2007-07, Vol.33 (4), p.335-341</ispartof><rights>COPYRIGHT 2007 Jannetti Publications, Inc.</rights><rights>Copyright Anthony J. Jannetti, Inc. Jul/Aug 2007</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.proquest.com/docview/199429995/fulltextPDF?pq-origsite=primo$$EPDF$$P50$$Gproquest$$H</linktopdf><linktohtml>$$Uhttps://www.proquest.com/docview/199429995?pq-origsite=primo$$EHTML$$P50$$Gproquest$$H</linktohtml><link.rule.ids>314,780,784,21378,21394,33611,33612,33877,33878,43733,43880,74221,74397</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/17907734$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Docherty, Sharron L</creatorcontrib><creatorcontrib>Miles, Margaret S</creatorcontrib><creatorcontrib>Brandon, Debra</creatorcontrib><title>Searching for "the dying point:" providers' experiences with palliative care in pediatric acute care</title><title>Pediatric nursing</title><addtitle>Pediatr Nurs</addtitle><description>To improve care of children who die in acute care settings there is a need to develop a clearer understanding of the barriers to provision of palliative care. The purpose of this study was to describe the experiences and views of health care providers in giving care to children who have undergone intensive therapies for life-threatening illnesses. A qualitative, descriptive design was conducted in the intensive care nursery, pediatric intensive care unit, and pediatric blood and marrow transplant unit at a southeastern US medical center. Purposive sampling with variation on role, years of experience, ethnicity, and gender was used to select the 17 health care providers. Findings were organized into three broad categories: (a) Palliative Care as an Added Dimension in the Illness Trajectory, (b) Palliative Care Moves Away From Curative Treatment, and (c) Professional Issues. Relevant themes were identified within each category. Most participants viewed palliative care as a changed dimension of care that is instituted once it is known that a child is dying. Three challenges in employing palliative care to acutely ill infants and children were identified: (a) finding the true dying point, (b) making the transition to palliative care, and (c) turning care over to an outside palliative care team at a critical juncture of caring. Professional issues in providing palliative care included inadequate preparation and, especially for nurses, the crossing of professional boundaries. An integrated model of palliative care is needed that is initiated at diagnosis and allows for the bidirectional transitioning across the illness and treatment trajectories.</description><subject>Acute Disease</subject><subject>Adaptation, Psychological</subject><subject>Adult</subject><subject>Attitude of Health Personnel</subject><subject>Care and treatment</subject><subject>Child</subject><subject>Continuity of Patient Care - organization & administration</subject><subject>Critical Care - organization & administration</subject><subject>Critical Care - psychology</subject><subject>Critically ill children</subject><subject>Evaluation</subject><subject>Female</subject><subject>Health care</subject><subject>Health Knowledge, Attitudes, Practice</subject><subject>Health Services</subject><subject>Health Services Needs and Demand</subject><subject>Hospice care</subject><subject>Hospices (Terminal Care)</subject><subject>Hospitals</subject><subject>Humans</subject><subject>Intensive Care Units, Pediatric - organization & administration</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Models, Organizational</subject><subject>Nursing</subject><subject>Nursing Education</subject><subject>Nursing Methodology Research</subject><subject>Organizational Objectives</subject><subject>Palliative care</subject><subject>Palliative Care - organization & administration</subject><subject>Palliative Care - psychology</subject><subject>Palliative treatment</subject><subject>Pediatric nursing</subject><subject>Pediatrics</subject><subject>Pediatrics - organization & administration</subject><subject>Personnel, Hospital - education</subject><subject>Personnel, Hospital - psychology</subject><subject>Professional Competence</subject><subject>Professional Role</subject><subject>Qualitative Research</subject><subject>Self Efficacy</subject><subject>Southeastern United States</subject><issn>0097-9805</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2007</creationdate><recordtype>article</recordtype><sourceid>ALSLI</sourceid><sourceid>CJNVE</sourceid><sourceid>M0P</sourceid><recordid>eNptkU1PxCAQhnvQuH79BUP2oKc10FIK3ozxKzHxoJ4bFqZbNixUoOr-e9msJmpkDoQ3zwxPMjvFPsaimQmO60lxEOMS58Mx2ysmpBG4aSq6X-gnkEH1xi1Q5wOaph6QXm-egzcuXUzREPyb0RDiGYKPAYIBpyCid5N6NEhrjUzmDZCSAZBxaACdk2AUkmpM2_yo2O2kjXD8dR8WLzfXz1d3s4fH2_ury4fZoqxFyqa0rLgoCTBOObCq1FmT8U4RKDVlwLs5pRKk0EQyMscdVlU573DDCRc1rQ6L0-3c7Pw6QkztykQF1koHfowt41VFalpncPoHXPoxuOzWEiFoKYTYQLMttJAWWuM6n4JUC3AQpPUOOpPjS8J4TRvONr-f_8Pn0rAy6t-G0x8NPUib-ujtmIx38Td48qU7zleg2yGYlQzr9nuN1SdDZZWq</recordid><startdate>200707</startdate><enddate>200707</enddate><creator>Docherty, Sharron L</creator><creator>Miles, Margaret S</creator><creator>Brandon, Debra</creator><general>Jannetti Publications, Inc</general><general>Anthony J. 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organization & administration</topic><topic>Critical Care - organization & administration</topic><topic>Critical Care - psychology</topic><topic>Critically ill children</topic><topic>Evaluation</topic><topic>Female</topic><topic>Health care</topic><topic>Health Knowledge, Attitudes, Practice</topic><topic>Health Services</topic><topic>Health Services Needs and Demand</topic><topic>Hospice care</topic><topic>Hospices (Terminal Care)</topic><topic>Hospitals</topic><topic>Humans</topic><topic>Intensive Care Units, Pediatric - organization & administration</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Models, Organizational</topic><topic>Nursing</topic><topic>Nursing Education</topic><topic>Nursing Methodology Research</topic><topic>Organizational Objectives</topic><topic>Palliative care</topic><topic>Palliative Care - organization & administration</topic><topic>Palliative Care - psychology</topic><topic>Palliative treatment</topic><topic>Pediatric nursing</topic><topic>Pediatrics</topic><topic>Pediatrics - organization & administration</topic><topic>Personnel, Hospital - education</topic><topic>Personnel, Hospital - psychology</topic><topic>Professional Competence</topic><topic>Professional Role</topic><topic>Qualitative Research</topic><topic>Self Efficacy</topic><topic>Southeastern United States</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Docherty, Sharron L</creatorcontrib><creatorcontrib>Miles, Margaret S</creatorcontrib><creatorcontrib>Brandon, Debra</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>ProQuest Social Sciences Premium Collection</collection><collection>ProQuest Central (Corporate)</collection><collection>University Readers</collection><collection>Career & Technical Education Database</collection><collection>Nursing & Allied Health Database</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Education Database (Alumni Edition)</collection><collection>Medical Database (Alumni Edition)</collection><collection>Education Periodicals</collection><collection>ProQuest Pharma Collection</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>Research Library (Alumni Edition)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>Social Science Premium Collection</collection><collection>British Nursing Index</collection><collection>ProQuest Central Essentials</collection><collection>eLibrary</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>Education Collection</collection><collection>ProQuest Central Korea</collection><collection>British Nursing Index (BNI) (1985 to Present)</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Central Student</collection><collection>Research Library Prep</collection><collection>British Nursing Index</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Database (Alumni Edition)</collection><collection>Education Database</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Research Library</collection><collection>Research Library (Corporate)</collection><collection>Nursing & Allied Health Premium</collection><collection>ProQuest One Education</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>ProQuest Central Basic</collection><collection>SIRS Editorial</collection><collection>MEDLINE - Academic</collection><jtitle>Pediatric nursing</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Docherty, Sharron L</au><au>Miles, Margaret S</au><au>Brandon, Debra</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Searching for "the dying point:" providers' experiences with palliative care in pediatric acute care</atitle><jtitle>Pediatric nursing</jtitle><addtitle>Pediatr Nurs</addtitle><date>2007-07</date><risdate>2007</risdate><volume>33</volume><issue>4</issue><spage>335</spage><epage>341</epage><pages>335-341</pages><issn>0097-9805</issn><abstract>To improve care of children who die in acute care settings there is a need to develop a clearer understanding of the barriers to provision of palliative care. The purpose of this study was to describe the experiences and views of health care providers in giving care to children who have undergone intensive therapies for life-threatening illnesses. A qualitative, descriptive design was conducted in the intensive care nursery, pediatric intensive care unit, and pediatric blood and marrow transplant unit at a southeastern US medical center. Purposive sampling with variation on role, years of experience, ethnicity, and gender was used to select the 17 health care providers. Findings were organized into three broad categories: (a) Palliative Care as an Added Dimension in the Illness Trajectory, (b) Palliative Care Moves Away From Curative Treatment, and (c) Professional Issues. Relevant themes were identified within each category. Most participants viewed palliative care as a changed dimension of care that is instituted once it is known that a child is dying. Three challenges in employing palliative care to acutely ill infants and children were identified: (a) finding the true dying point, (b) making the transition to palliative care, and (c) turning care over to an outside palliative care team at a critical juncture of caring. Professional issues in providing palliative care included inadequate preparation and, especially for nurses, the crossing of professional boundaries. An integrated model of palliative care is needed that is initiated at diagnosis and allows for the bidirectional transitioning across the illness and treatment trajectories.</abstract><cop>United States</cop><pub>Jannetti Publications, Inc</pub><pmid>17907734</pmid><tpages>7</tpages></addata></record> |
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subjects | Acute Disease Adaptation, Psychological Adult Attitude of Health Personnel Care and treatment Child Continuity of Patient Care - organization & administration Critical Care - organization & administration Critical Care - psychology Critically ill children Evaluation Female Health care Health Knowledge, Attitudes, Practice Health Services Health Services Needs and Demand Hospice care Hospices (Terminal Care) Hospitals Humans Intensive Care Units, Pediatric - organization & administration Male Middle Aged Models, Organizational Nursing Nursing Education Nursing Methodology Research Organizational Objectives Palliative care Palliative Care - organization & administration Palliative Care - psychology Palliative treatment Pediatric nursing Pediatrics Pediatrics - organization & administration Personnel, Hospital - education Personnel, Hospital - psychology Professional Competence Professional Role Qualitative Research Self Efficacy Southeastern United States |
title | Searching for "the dying point:" providers' experiences with palliative care in pediatric acute care |
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