Pediatric Nurses’ Perceptions of Obstacles and Supportive Behaviors in End-of-Life Care

By Renea L. Beckstrand, RN, PhD, CCRN, CNE, Nicole L. Rawle, RN, MS, APRN,
Lynn Callister, RN, PhD, and Barbara L. Mandleco, RN, PhD
Background Each year 55 000 children die in the United States,
and most of these deaths occur in hospitals. The barriers and
supportive behaviors in providing end-of-life care to children
should be determined.
Objective To determine pediatric intensive care unit nurses’
perceptions of sizes, frequencies, and magnitudes of selected
obstacles and helpful behaviors in providing end-of-life care
to children.
Method A national sample of 1047 pediatric intensive care
unit nurses who were members of the American Association
of Critical-Care Nurses were surveyed. A 76-item questionnaire
adapted from 3 similar surveys with critical care, emergency,
and oncology nurses was mailed to possible participants.
Nurses who did not respond to the first mailing were sent a
second mailing. Nurses were asked to rate the size and fre-
quency of listed obstacles and supportive behaviors in caring
for children at the end of life.
Results A total of 474 usable questionnaires were received
from 985 eligible respondents (return rate, 48%). The 2 items
with the highest perceived obstacle magnitude scores for size
and frequency means were language barriers and parental
discomfort in withholding and/or withdrawing mechanical
ventilation. The highest supportive behavior item was allowing
time alone with the child when he or she has died.
Conclusions Pediatric intensive care unit nurses play a vital
role in caring for dying children and the children’s families.
Overcoming language and communication barriers with chil-
dren’s families and between interdisciplinary team members
could greatly improve the end-of-life experience for dying
children. (American Journal of Critical Care. 2010;19:543-552)
PEDIATRIC NURSES’
PERCEPTIONS OF OBSTACLES
AND SUPPORTIVE BEHAVIORS
IN END-OF-LIFE CARE
E nd-of-Life Care
©2009 American Association of Critical-Care Nurses
doi: 10.4037/ajcc2009497
www.ajcconline.org AAJJ CC CC AMERICAN JOURNAL OF CRITICAL CARE, November 2010, Volume 19, No. 6 543
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