Child Health Nursing Research

Korean Academy of Child Health Nursing (한국아동간호학회)
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Withdrawal of Life-Sustaining Treatment from Children: Experiences of Nurses Caring for the Children

간호사의 연명치료중단아동 돌봄경험

  • Received : 2017.06.20
  • Accepted : 2017.07.12
  • Published : 2017.07.31
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Abstract

Purpose: The purpose of this study was to describe feelings and actions of nurses following withdrawal of life-sustaining treatment from children being cared for by the nurses. Methods: Data were collected by in-depth interviews with 7 nurses from different hospitals where children receiving nursing care had life-sustaining treatment withdrawn. The interviews were conducted from August 2016 to February 2017 when all data were saturated. Interviews lasted 30~90 minutes and were conducted 2~3 times per participant. Data were analyzed using Giorgi's phenomenological research methodology. Results: The following factors constituted experiences of nurses working in pediatric wards when life-sustaining treatment was withdrawn from children: "agony and conflict in the aspects of care", "heavy mind and regret for exhausting care", "intentionally avoiding parents' sadness", "comforting sadness in the heart" and "orientation in the role of caring for children undergoing withdrawal of life-sustaining treatment." Conclusion: Findings indicate that support systems and intervention programs need to be developed so that nurses can understand and wisely deal with experiences of withdrawal of life-sustaining treatment from children who receive care from nurses.

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References

  1. Kwon BG, Koh YS, Yun YH, Heo DS, Seo SY, Kim HC, et al. A study of the attitudes of patients, family members, and physicians toward the withdrawal of medical treatment for terminal patients in Korea. Korean Journal of Medical Ethics. 2010;13(1):1-16.
  2. Heo DS. Patient autonomy and advance directives in Korea. Journal of the Korean Medical Association. 2009;52(9):865-870. https://doi.org/10.5124/jkma.2009.52.9.865
  3. Meyer C. Allow natural death - Alternative to DNR? [Internet]. Rockford: Hospice patients alliance; 2016 [cited 2016 December 31]. Available from: http://www.hospicepatients.org/and.html.
  4. Lee YB. Nurses' and doctors' perceptions, experiences and ethical attitudes on DNR. Journal of Korean Clinical Nursing Research. 2007;13(2):73-85.
  5. Moore P, Kerridge I, Gillis J, Jacobe S, Isaacs D. Withdrawal and limitation of life sustaining treatments in a paediatric intensive care unit and review of the literature. Journal of Paediatrics and Child Health. 2008 ;44(7-8):404-408. https://doi.org/10.1111/j.1440-1754.2008.01353.x
  6. Jan Mohammed MS. The decision of "do not resuscitate" in pediatric practice. Saudi Medical Journal. 2011;32(2):115-122.
  7. Seoul National University Hospital. Loss of life-sustaining treatment of pediatric cancer patients [Internet]. Seoul: Seoul National University Hospital Korea; 2014 [cited 2017 April 20]. Available from: https://www.snuh.org/pub/snuh/sub02/sub01/1183505_3957.jsp
  8. Kang KA, Kim SJ. The Difficulties for Parents of Children with Terminal Cancer. Korean Journal of Child Health Nursing. 2005;11(2):229-239.
  9. Burns JP, Mitchell C. Is there any consensus about end-of-life care in pediatrics?. Archives of Pediatrics & Adolescent Medicine. 2005;159 (9):889-891. https://doi.org/10.1001/archpedi.159.9.889
  10. Bellini S, Damato EG. Nurses' knowledge, attitudes/beliefs, and care practices concerning do not resuscitate status for hospitalized neonates. Journal of Obstetric, Gynecologic & Neonatal Nursing. 2009;38(2):195-205. https://doi.org/10.1111/j.1552-6909.2009.01009.x
  11. Adwan JZ. Pediatric nurses' grief experience, burnout and job satisfaction. Journal of Pediatric Nursing. 2014;29(4):329-336. https://doi.org/10.1016/j.pedn.2014.01.011
  12. Yi MS, Oh SE, Choi EO, Kwon IG, Kwon SB, Cho KM, et al. Hospital nurses' experience of do-not-resuscitate in Korea. Journal of Korean Academy of Nursing. 2008;38(2):298-309. https://doi.org/10.4040/jkan.2008.38.2.298
  13. Wenzel J, Shaha M, Klimmek R, Krumm S. Working through grief and loss: Oncology nurses' perspectives on professional bereavement. Oncology Nursing Forum. 2011;38(4):272-282. https://doi.org/10.1188/11.onf.e272-e282
  14. Newton J, Waters V. Community palliative care clinical nurse specialists' descriptions of stress in their work. International Journal of Palliative Nursing. 2001;7(11):531-540. https://doi.org/10.12968/ijpn.2001.7.11.9293
  15. Breen CM, Abernethy AP, Abbott KH, Tulsky JA. Conflict associated with decisions to limit life sustaining treatment in intensive care units. Journal of General Internal Medicine. 2001;16(5):283-289. https://doi.org/10.1046/j.1525-1497.2001.00419.x
  16. Im MS, Lee YE. Factors affecting turnover intention in pediatric nurses. Child Health Nursing Research. 2016;22(1):37-44. https://doi.org/10.4094/chnr.2016.22.1.37
  17. Jo KH. Nurse's conflict experience toward end-of-life medical decision-making. Korean Journal of Adult Nursing. 2010;22(5):488-498.
  18. Woo MK, Kim MY. Nurses' experiences of Do-Not-Resuscitate (DNR) by the narrative inquiry. Korean Journal of Adult Nursing. 2013;25(3):322-331. https://doi.org/10.7475/kjan.2013.25.3.322
  19. Kang HJ, Bang KS. Neonatal intensive care unit nurses' experience in caring for infants who are dying. Child Health Nursing Research. 2013;19(4):252-261. https://doi.org/10.4094/chnr.2013.19.4.252
  20. Giorgi A. The descriptive phenomenological method in psychology: A modified Husserlian approach. Pittsburgh, PA: Duquesne University Press; 2009. p. 9-10.
  21. Guba EG, Lincoln YS. Fourth generation evaluation. Sage: Newbury Park; California; 1989. p. 294.
  22. Haut CM, Michael M, Moloney-Harmon P. Implementing a program to improve pediatric and pediatric ICU nurses' knowledge of and attitudes toward palliative care. Journal of Hospice & Palliative Nursing. 2012;14(1):71-79. https://doi.org/10.1097/njh.0b013e318236df44
  23. Kang KA, Kim HS, Kwon SH, Nam MJ, Bang KS, Yu SJ, et al. Nurses' knowledge of and attitudes toward pediatric palliative care of Korea. Korean Journal of Hospice and Palliative Care. 2014:17(4):289-300. https://doi.org/10.14475/kjhpc.2014.17.4.289
  24. Liu SM, Lin HR, Lu FL, Lee TY. Taiwanese parents' experience of making a "Do-Not-Resuscitate" decision for their child in pediatric intensive care unit. Asian Nursing Research. 2014:8(1):29-35. https://doi.org/10.1016/j.anr.2013.12.002
  25. Sanderson A, Zurakowski D, Wolfe J. Clinician perspectives regarding the do-not-resuscitate order. JAMA Pediatrics. 2013;167(10):954-958. https://doi.org/10.1001/jamapediatrics.2013.2204
  26. Papadatou D, Bellali T, Papazoglou I, Petraki D. Greek nurse and physician grief as a result of caring for children dying of cancer. Pediatric Nursing. 2002:28(4):345-353.
  27. Morgan D. Caring for dying children: Assessing the needs of the pediatric palliative care nurse. Pediatric Nursing. 2009;35(2):86-90.
  28. Sung MH, Park JH, Jung KE, Han HR. ICU nurses' awareness and attitudes to the ethical dilemma associated with DNR. Clinical Nursing Research. 2007;13:109-122.
  29. Chang HA, An empirical review of complicated grief. Korean Journal of Psychology: General. 2009;28(2):303-317.
  30. Keene EA, Hutton N, Hall B, Rushton C. Bereavement debriefing sessions: an intervention to support health care professionals in managing their grief after the death of a patient. Pediatric Nursing. 2010;36 (4):185-189.

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