Children's Hospital Nurses Perceptions of Pediatric Palliative Care Team Support: A Mixed-Methods Study

Abstract

Nurses who care for children who are seriously ill, suffering, or dying are at increased risk of developing burnout. Pediatric palliative care (PPC) teams may play a role in addressing nurse burnout. However there remains a gap in the literature understanding the ways PPC teams support nurses, and how nurses prioritize different types of support. Our study aimed to 1) explore what interactions with PPC teams are perceived as providing support to children’s hospital nurses, and 2) to develop a survey instrument using discrete choice methodology with maximum difference scaling to assess how children’s hospital nurses value and prioritize actions of nurse support from PPC teams. Nurses were recruited from four children’s hospitals in the United States. Thirty nurses participated in focus group interviews, leading to the confirmation of ten types of support from PPC teams. These types of support were revised over four rounds resulting in 13 types of support for use in the discrete choice experiment survey instrument. Two hundred sixty-five nurses completed the survey instrument. Helping families with coping and decision making, facilitating communication and coordinating care for families and guiding care at the end of life had the highest mean importance scores, while checking in with me/asking how I’m doing and acknowledging my feelings or experiences when situations are difficult were rated lowest. Nurse perspectives showed the multitude of ways PPC teams support them, including through primarily patient-oriented and primarily nurse-oriented support. Support from the PPC team served as a job resource to nurses that in turn may reduce exhaustion or disengagement.