The Lived Experiences of Nurses Caring For Dying Pediatric Patients

The Lived Experiences of Nurses Caring For Dying Pediatric Patients The Lived Experiences of Nurses Caring For Dying Pediatric Patients I’m trying to study for my Nursing course and I need some help to understand this question. *****************2 full pages (1 page per article)**************************** (cover or reference page not included) ¨¨¨¨¨¨¨¨¨¨¨¨APA norms¨¨¨¨¨¨¨¨¨¨¨¨¨¨¨¨¨¨ ++++++++++++++++ ?? It will be verified by Turnitin and SafeAssign?? References from the last 5 years The questions don’t be must copied in the work. It must be identified by numbers. For example 1. this study quantitative because………………………….. 2. the population is……………………………… ___________________________________________- Read both articles provided and answer the following questions in brief paragraph format for each article. The articles are labeled: Article 1 : 1. Is this study quantitative or qualitative? Provide rationale for your choice. 2. What is the population of interest in the study? 2. Identify and discuss the clinical problem being investigated 3. Is there an intervention in the study? 4. Is there a comparison? 5. What is the outcome or finding of the study? Provide a PICO statement for this article from your answers above. P=population I=Intervention C= Comparison (every study may not have a comparison) O=outcome Article 2 : 1. Is this study quantitative or qualitative? Provide rationale for your choice. 2. What is the population of interest in the study? 2. Identify and discuss the clinical problem being investigated 3. Is there an intervention in the study? 4. Is there a comparison? 5. What is the outcome or finding of the study? Provide a PICO statement for this article from your answers above. The Lived Experiences of Nurses Caring For Dying Pediatric Patients P=population I=Intervention C= Comparison (every study may not have a comparison) O=outcome article_2.pdf article_1.pdf ORDER NOW FOR CUSTOMIZED AND ORIGINAL ESSAY PAPERS Continuing Nursing Education Learning outcome, instructions for completing the evaluation, and statements of disclosure can be found on page 13. The Lived Experiences of Nurses Caring For Dying Pediatric Patients Danna L. Curcio T hroughout the course of their careers, nurses care for patients who are sick, suffering, and in the process of dying (Maeve, 1998). Caring for dying children is a unique type of nursing practice and perceived as contrary to the natural process of life (Papadatou, Martinson, & Chung, 2001). Nurses who care for terminally ill patients of all ages fear burnout and the creation of psychological barriers between the patient and themselves, including the inability to become aware of death (Davies et al., 1996). Therefore, caring for children who are dying becomes an important topic in helping the nurse transition through the child’s dying process. Nurses may have difficulty making meaning and ultimately adjusting to when a child’s life ends, thus creating the potential to interfere with patient care (Papadatou et al., 2001). Barriers created by nurses who care for dying pediatric patients may be due to severe grief, and may even result in withdrawal from patients and families (Davies et al., 1996). Unfortunately, the topic of the meaning and essence of nurses’ lived experiences in the caring for dying pediatric patients has barely been explored (Davis et al., 1996; TubbsCooley et al., 2011). The lack of investigation and exploration in this subject matter may be due to the emotional sensitivity of both the nurses and bereaved families. Death and dying at the end of a long life are understood as part of a natural process, and observed as an occurrence when the patient is at the end of a long and fulfilled life (Mukherjee, Beresford, Glaser, & Sloper, 2009). Conversely, the death of a child is Danna L. Curcio, PhD, RNC, FNP, is a Lecturer, College of Staten Island, City University of New York, Staten Island, NY. 8 Nurses and healthcare professionals may have difficulty adjusting to and comprehending their experiences when a patient’s life ends. This has the potential to interfere with patient care. Reflection on past events and actions enables critical discovery of strategies to benefit both nurses and patients. This qualitative phenomenological study explores the lived experiences of nurses caring for dying pediatric patients. The philosophical underpinning of Merleau-Ponty (2008), in combination with the research method of van Manen (1990), was used for this study. The Roy Adaptation Model (RAM) (Roy, 2009; Roy & Andrews, 1991) was the nursing model that guided the study to help understand that nurses are an adaptive system, using censoring as a compensatory adaptive process to help function for a purposeful cause. Nine female nurse participants with one to four years of experience were interviewed. The context of the experiences told by nurses caring for dying pediatric patents uncovered seven essential themes of empathy, feelings of ambivalence, inevitability, inspiration, relationship, self-preservation, and sorrow, and these themes demonstrated a connection formed between the nurse and the patient. Key Words: End-of-life care, death, dying, pediatric, censoring, adaptive process, burnout, psychological barriers, grief. The Lived Experiences of Nurses Caring For Dying Pediatric Patients considered to be unnatural and brings on a much different perspective when it happens (Dawson, 1995). It is essential that nurses understand the care needed during this time, especially when care includes facilitating the process of dying and giving support during the last moments of life. These last moments of life are extremely critical because the moment of death is a finite point in time in which each action becomes a permanent fixture in the caregiver’s memory. In discovering nurses’ lived experiences of caring for dying pediatric patients, we are able to understand the importance of knowing how to interact with the dying child. This discovery of knowing how to interact may be due, in part, to personal knowledge, which comes from the inner experience of becoming aware of one’s own self and the self of others (Chinn & Kramer, 2008). The purpose of this study was to explore, describe, and understand the lived experiences of nurses caring for dying pediatric patients, and to gather information that may help future nurses when caring for the dying child. Specifically, this study sought to answer questions concerned with 1) nurses’ interactions with pediatric patients and their families, 2) thoughts processed by nurses as their young patients approached death, 3) ways in which nurses cope with these thoughts, and 4) ways nurses integrate these issues into patient care. Additional questions that emerged and were addressed concerned the actions, feelings, and emotions of pediatric patients during the final stages of life, and how nurses were able to identify these cues. Themes and essences that emerged from the interviews provided insight into understanding the ways in which nurses “nurse,” as well as information on nurses’ essential tasks in caring for dying pediatric patients. This article will focus on how nurses interacted with the dying pediatric patients. Methods The phenomenon of this study was the lived experiences of nurses PEDIATRIC NURSING/January-February 2017/Vol. 43/No. 1 caring for dying pediatric patients. In conducting this study, the methodology of van Manen (1990) was used to explore the phenomenon of nurses’ experiences in caring for dying pediatric patients. According to van Manen (1990), the purpose of phenomenological research is to establish a reconnection of recollection with the original experience, and give individuals an opportunity to look at the world and re-examine the meaning of the event. Experiences, feelings, and actions create behaviors that guide individuals to interact with situations within a specific environment (Dobratz, 2002). Once identified, these experiences, feelings, and actions provide the basis for important nursing education and nursing theory to enhance patient care interactions. Reflection on these interactions help to discover critical concepts that affect the way nurses perform when a pediatric patient is dying for the benefit of both the nurse and patient. This discovery also provides insight into the nurses’ thought processes, including emotional responses, nursing actions, nursing interpretation of the dying pediatric patient’s actions, and family concerns. Through these interactions, nurses make a difference, for the better, in patients’ lives (Dobratz, 2002). Sample After the City University of New York (CUNY) Institutional Review Board (IRB) approval was obtained, registered nurses who worked on pediatric units and cared for dying pediatric patients were selected through networking and purposeful sampling, and were chosen on the basis of availability and likelihood of voluntary participation in this study. Purposeful sampling allowed the selection of individuals who had similar experiences within the phenomenon and then permitted the researcher to understand the phenomenon in question (Polit & Beck, 2004). The Lived Experiences of Nurses Caring For Dying Pediatric Patients The researcher had no prior relationships with the nurse participants; however, participants were selected by word-ofmouth snowballing recruitment. All participants needed to have a minimum of one to four years of pediatric nursing experience, allowing for a timely recall of pediatric death. Exclusion criteria included nurses who had their own child die or had experienced a child within their immediate family die from terminal illness. Formal consent was obtained from each participant prior to interviews and data collection. The study sample consisted of nine participants who were all female, registered nurses, actively employed on pediatric units, and had between one and four years of experience. Participants’ ages ranged from 24 to 37 years. Three participants were married, six were single, four were mothers, and five did not have children of their own. Of the nine participants, eight lived in a suburban area, and one lived in a metropolitan area in a large city in the northeast states. All nine were actively employed at large metropolitan hospitals. Nurses’ names were withheld, and pseudonym names were assigned to protect their identities. The nurses were referred to as follows: Abby, Betty, Conny, Dotty, Eddy, Fanny, Gabby, Heidy, and Ivy. Data Collection The researcher conducted semistructured interviews, asking nurse participants open-ended, non-judgmental, and non-leading questions, while encouraging them to share their stories. Interviews were conducted face to face and were digitally voice recorded for transcription purposes. Interviews lasted approximately 35 to 45 minutes, and questions were asked, such as: “Tell me what it is like to care for dying pediatric patients.” Subsequent clarifying interview questions were also asked, such as: “What does that mean?” or “Can you give me an example?” Exploration of the experience was unique to each participant and absent of uniformity. However, properties and dimensions of the interviews developed into categories of data, and when no new categories or relevant themes in the data emerged, saturation and determination of sample size was then said to have been achieved (Corbin & Strauss, 2008). Data Analysis From a qualitative perspective, exploration was used to study the phenomenon of the lived experiences of nurses caring for dying pediatric patients. Qualitative research proposes to discover the perceptions of individuals within a particular phenomenon, and give an opportunity to look at the world and re-examine the meaning of a particular event. The qualitative research process used for this study was inspired by the philos- PEDIATRIC NURSING/January-February 2017/Vol. 43/No. 1 ophy of Merleau-Ponty (2008). The philosophical underpinnings of Merleau-Ponty (2008), focus on the human in the “lived experience, embodiment, and the meshing of the individual and the world,” allowing for pediatric nurses to tell their own stories by providing representation through examples of their experiences and describing their experiences as they lived them. To clarify, “lived experience” is the personal daily practice and reactions each nurse encounters through caring for a dying child. This philosophical approach, in combination with the research method of van Manen (1990), provided the six activities or steps the qualitative researcher needed to follow (see Table 1). These six activities guided the collection and analysis of data that explored and described meanings that comprised the lived experiences of the nurse caring for the dying pediatric patient. Results Interviews clarified nurses’ passion in caring for dying children, providing a greater understanding of why these nurses continue to practice within the realm of pediatric nursing. The Lived Experiences of Nurses Caring For Dying Pediatric Patients They all felt their presence with the dying child was needed to help ease suffering. Several nurses expressed selfdoubt regarding the care they gave, but the overall feeling was that they were there to help support, comfort, and guide the child and family. Seven themes emerged to describe the phenomenon of nurses caring for dying pediatric patients: a) empathy, b) feelings of ambivalence, c) inevitability, d) inspiration, e) relationship, f) self-preservation, and g) sorrow. These themes were discussed and identified throughout the nine interviews in relation to the dying pediatric patient and were brought to light by the qualitative research process of van Manen (1990). This phenomenon would not exist without these themes and their examples. Empathy The nurses spoke about several experiences that captured the meaning of the theme of “empathy,” and was illustrated with descriptions of the innocence in children and the notion that death is not supposed to happen in childhood. Abby described the feelings she experienced concerning pediatric patients when she 9 Steps Table 1. Research Method of van Manen (1990) Description of the Steps First Step Identify a phenomenon of interest, turning to the nature of the lived experience, expressing reflection by the participants to make sense of the meaningful experience. Third Step Reflect on illuminated essential themes that characterize the phenomenon through listening to, transcribing, and reflecting on the interviews to allow the phenomena to arise. Second Step Fourth Step Fifth Step Sixth Step Conduct an investigation of the phenomenon as the lived experience, not as it is conceptualized, and provide the opportunity for participants to describe their experiences from their own perceptions. Write and rewrite in order to describe the phenomenon through the use of coding, memos, and diagramming. Maintain a strong relation to the phenomenon in terms of pedagogy to provide the rigor of the research process. Balance the context by considering the parts as well as the whole by stepping back and evaluating the wholeness in context to its parts to see how the parts contribute to the whole. said: “It’s someone’s baby. It’s a child. You know, they’re not supposed to die. They’re supposed to be healthy, you know. It’s sad.” This was further enhanced by Betty, who said: “You have those kids, and you have those times with them where you think that they’re not going to make it.” Conny conferred with empathy felt toward children when she stated: “Because it’s a child. Because it’s an innocent human that hasn’t had a chance to live.” This was also described by Heidy, who stated: “I’m not saying that a child losing a father isn’t just as sad, because I do. But I think what differentiates is just that this person (is a child), who knows what their life could have been.” Fanny also expressed empathy when she described her feelings toward the dying child: “He was a person, and he just was suffering the entire time. And it was very, very hard for me to deal with.” Gabby expressed empathy when she talked about dignity in dying, and how creating a dignified setting for pediatric death is important for peace and comfort during the process: “It’s just too hard to wrap your head around a child dying. It’s not the natural order of things.” Empathy can be thought of as an individual’s identification with and response to an event (Wilson & Kirshbaum, 2011).The Lived Experiences of Nurses Caring For Dying Pediatric Patients Empathetic reactions may be a result of understanding and compassion felt toward the patient and family. As with other research studies (Dawson, 1995; Morgan, 2009), nurses felt it was not a natural process to see a child in the throes of dying and death, and not congruent with the way the life 10 process should unfold. Nurses perceived children as individuals who should be living productive, healthy, happy lives. When children die, the potential for the future of the child’s life is lost, leaving parents and nurses to grieve (Morgan, 2009). Empathy can further be viewed as an emotion felt by nurses when they place themselves in the patient’s situation, personifying the experience and treating the patient as they would want to be treated. When empathy involves alleviation of pain, avoidance of suffering, and promotion of a new level of health (Mattsson, Forsner, Castren, & Arman, 2013), nurses will try to deliver patient care so these concepts can be achieved. This was evident when the nurse participants discussed their feelings of empathy, describing their reactions to the pain inflicted on the children, making the children more presentable to the family, making the children feel better, bringing on a peaceful death, and even placing themselves in the parents’ shoes. As one nurse stated: ”I don’t want to remember seeing my child like that,” reflecting as if the patient was her own child. Stayt (2009) found that empathy toward patients and families contributes to the emotions of caring provided by nurses. Feelings of Ambivalence Nurses discussed struggling with their feelings during their experiences of caring for dying pediatric patients. Betty described her feelings of ambivalence by questioning why the children were subjected to the treatments and drawn-out lifeprolonging procedures when she stated: “I’m sure a nurse said like, ‘What are we doing here?’ Like you can’t even feel good that you literally saved someone’s life because [pauses, voice waivers] it was for no reason.” Dotty spoke about her experience when caring for a dying child of Chinese culture, explaining that in this culture, they do not speak about death and dying with the patient because it is taboo. Her feelings of ambivalence were illuminated when she said: “I find, in the Chinese culture, they don’t want to let the patient know they’re dying or they have a risk of dying. So there’s also that aspect of the nurse, of separating your beliefs. So that’s a struggle.” Ambivalence is defined as the state of having mixed feelings, mixed beliefs, or contradictions of thoughts and feelings (Petty & Krosnick, 2014). When discussing ambivalence in patient care, nurses described a sense of doubt as to whether or not the care rendered was appropriate for the situation. Each nurse participant discussed similar issues related to ambivalence, whether the issues were concerned with the healthcare prescribed for the dying children or the struggles nurses faced with their own emotions. The nurses spoke about the care they gave, and questioned whether their care caused pain and suffering.The Lived Experiences of Nurses Caring For Dying Pediatric Patients In relation to this, Morgan (2009) found that ambivalence may be emotionally distressing when nurses are asked to behave in a manner contradictory to their beliefs. It may be feelings of “disquiet” or listening to the “conscience” concerning nursing actions that create ambivalent feelings about what is PEDIATRIC NURSING/January-February 2017/Vol. 43/No. 1 experienced (Lee & Dupree, 2008), concurring with reports of nurse participants in the current study of ambivalence in the type of care rendered, specifically comfort measures and curative treatment. Inevitability Nurses spoke of how they had “seen so much” and that they could “predict how things were going to go,” describing their experiences of inevitability. Abby discussed the inevitability of death as expressed by the child. She described how the children know they are dying and how they understand their inevitable future. She stated: One child, he had three friends die in about a two-month period, and he’s like, ‘Well if they’re dying, I’m next, and there’s no way that I’m not next. I can feel it.’ And within, I would say about three months, that he passed away. Betty described inevitability when monitoring the dying pediatric patient’s status: “The oxygen desaturations are lasting longer. And longer. And longer. You just see things start taking longer. Like he’s not coming back up as quickly as he usually does.” Conny clarified inevitability when she described the experience through the eyes of the dying child: “I know it sounds a little bad to say, but sometimes, you just need to let them go. In a way, it’s like you’re just prolonging their suffering.” This statement described prolonging the suffering of the dying pediatric patient and knowing what would happen despite all efforts. Heidy described her experience by this description of what a patient said to her: “This is what I want. I just want it to be over.” Ivy reinforced this when describing one dying child: “She had fought her fight, and knew what was happening to her, and was okay with what was going to happen.” Inevitability is defined as a situation that is unavoidable and an event that is certain, but is yet to come (Peach, 2000). Death is sometimes an inevitable outcome for patients despite technology, increasing survival rates, and cures for illnesses (Lehto & Stein, 2009). Pedi … Purchase answer to see full attachment Student has agreed that all tutoring, explanations, and answers provided by the tutor will be used to help in the learning process and in accordance with Studypool’s honor code & terms of service . Get a 10 % discount on an order above $ 100 Use the following coupon code : NURSING10