A nurse is caring for a preschool-age child who is dying

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Background: The majority of in-hospital deaths of children occur in paediatric and neonatal intensive care units. For nurses working in these settings, this can be a source of significant anxiety, discomfort and sense of failure.

Objectives: The objectives of this study were to explore how NICU/PICU nurses care for families before and after death; to explore the nurses' perspectives on their preparedness/ability to provide family care; and to determine the emotional content of language used by nurse participants.

Methods: Focus group and individual interviews were conducted with 22 registered nurses from neonatal and paediatric intensive care units of two major metropolitan hospitals in Australia. All data were audio recorded and transcribed verbatim. Transcripts were then analysed thematically and using Linguistic Inquiry to examine emotional content.

Results: Four core themes were identified: preparing for death; communication challenges; the nurse-family relationship and resilience of nurses. Findings suggested that continuing to provide aggressive treatment to a dying child/infant whilst simultaneously caring for the family caused discomfort and frustration for nurses. Nurses sometimes delayed death to allow families to prepare, as evidenced in the Linguistic Inquiry analysis, which enabled differentiation between types of emotional talk such as anger talk, anxiety talk and sadness talk. PICU nurses had significantly more anxiety talk (p=0.018) than NICU nurses.

Conclusion: This study provided rich insights into the experiences of nurses who are caring for dying children including the nurses' need to balance the often aggressive treatments with preparation of the family for the possibility of their child's death. There is some room for improvement in nurses' provision of anticipatory guidance, which encompasses effective and open communication, focussed on preparing families for the child's death.

Keywords: Death; Dying; Emotional talk; End of life care; Linguistic Inquiry; Neonatal intensive care unit (NICU); Paediatric intensive care unit (PICU).

8.The nurse is caring for a preschool-age child who is aware of impending death. Whatbehavior should the nurse expect the child to demonstrate at this time?A)Outbreaks of angerB)Verbalization of feelingsC)Bargaining for another chanceD)Fear of being separated from parentsAns:DFeedback:Preschoolers fear separation. If able to grasp the concept of dying, this child's majorworry is being alone and separated. These children may need someone to stay with themconstantly to reassure them that they are loved and people are caring for them. Anger,verbalization of feelings, and bargaining are not behaviors typically associated with apreschool age-child who is facing death.

9.The mother of a terminally ill child stays with the child day and night. Which statementindicates that the mother is in the chronic sorrow of depression stage?

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