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Positively Charged Nurses, Best in Nursing Dying Children

Nurses endowed with high levels of positive attitude are happy and confident in caring for dying children and their families//. Researchers at The Children's Hospital of Philadelphia conducted a survey of several hundreds of pediatric nurses. The findings of the survey showed that, nurses who were positive and confident about their skills, most often were recipients of focused training in palliative care. The study appears in the January issue of Pediatrics.

"Very few researchers have analyzed whether healthcare providers' underlying beliefs and feelings are associated with their ability to care for dying children and their families," said study authors Chris Feudtner, M.D., Ph.D., M.P.H.; and Gina Santucci, M.S.N., of The Children's Hospital of Philadelphia. "This study may help educators develop programs to help nurses and other healthcare providers to address difficult situations."

A pediatrician and a nurse, respectively, Dr. Feudtner and Ms. Santucci are experts on pediatric palliative care and members of the Hospital's Pediatric Advanced Care Team, which provides palliative, end-of-life and bereavement services.

The study team analyzed responses from 410 pediatric nurses at Children's Hospital in spring 2005 with a web-based, written survey. The survey asked the nurses whether they were comfortable working with dying children and their families and inquired about their knowledge, attitudes, practices and experiences regarding aspects of palliative and end-of-life care. The team also used questions from a standardized measuring tool called the Adult Dispositional Hope Scale.

The Hope Scale measures attitudes about goal-setting and problem-solving, asking people whether they agree with statements such as, "I meet the goals I set for myself," "I can think of many ways to get out of a jam," and "I can think of many ways to get things in life that are most important to me."

Overall, the nurses in the survey said they felt most competent in managing pain for patients and least competent in talking with children and families about dying. The researchers found that nurses with higher levels of hopefulness rated themselves as more comfortable with and competent in palliative care tasks, even when adjusted for each nurse's years of nursing experience and their exposure to education in palliative care.

"Our most substantial finding," said Dr. Feudtner, "is that the more hours of palliative care education that a nurse receives, the more comfortable the nurse is in providing palliative care and in talking about death and dying with patients and families. We interpret this finding in the framework of 'hope theory' formulated by our co-author, Dr. Rick Snyder. Education enlarges the set of pathway thoughts a person may have when considering how to achieve a goal, and may expand the range of potentially desired goals."

"For instance, in palliative care, a nurse who is hopeful and confident may be better able to collaborate with a dying patient and the patient's family in formulating meaningful goals, such as being at home with loved ones receiving hospice care."

The current research, said Ms. Santucci, suggests the need for further investigation into the role of personal hopefulness and the relevance of nursing education in helping nurses be more effective in providing palliative care.


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