Pediatric intensive care nurses and their grief experiences: a phenomenological study.

OBJECTIVE: To describe the grief experience of pediatric intensive care nurses when their patients die. DESIGN: Heideggerian phenomenological approach; nonprobability, purposive sampling; semistructured interviews; data analyzed using Colaizzi's method of phenomenology. SETTING: Pediatric intensive care unit within a Canadian pediatric metropolitan university teaching hospital. PARTICIPANTS: Six registered nurses, currently working in the pediatric intensive care unit, who had experienced the death of at least three children for whom they had cared. Nursing experience ranged from 2 to 20 years, intensive care nursing experience from 9 months to 19 years, and tenure on the unit from 9 months to 15 years. RESULTS: Data were analyzed for recurring themes according to the procedure outlined by Colaizzi. These nurses acknowledged they suffered multiple exposures to children's death and experienced grief. The interviews revealed eight themes that included one about their grief responses--hurting; two that described the influencing contextual factors--nurse-family unit relationship and dissonance; and five that related to coping strategies used to manage their feeling of grief--self-expression, self-nurturance, termination of relationship activities, engaging in control-taking activities, and self-reflection. Further analysis revealed that managing grief effectively was an experiential learning process for the participants. CONCLUSIONS: These results demonstrate that pediatric intensive care nurses' grief is different from that of surviving family member grief. Further research is required to document in further depth the experiential learning process to coping with multiple, accumulated losses for these professional caregivers. The findings of this study also could encourage further research that examines interventions designed to enhance the type of education and support needed in relation to the grief experience of nurses.

The evolution and implementation of a PICU standard nursing care plan. A nursing process.

The staff of an intensive care unit in a Pediatric Hospital in Ottawa believed in the philosophy of nursing care plans. They decided to develop a pediatric critical care standard nursing care plan that would be useful for care giving and user friendly. This article describes the evolution and implementation of their plan.

Pediatric heart transplants.

Interest in pediatric heart transplantation has increased since the early 1980's in large part due to the improvement in immunosuppression. At the University of Ottawa Heart Institute, Ottawa Civic Hospital/Children's Hospital of Eastern Ontario, Ottawa, six children between the ages of ten days and twelve years have received heart transplants between January 1988 and April 1990. Intensive care nursing staff synthesized their knowledge in areas of transplant and cardiovascular nursing to develop a plan of care for these children. The purpose of this article is to share the knowledge the nurses have gained through our clinical experience with these patients.

Acute bacterial meningitis. The pathophysiological sequence of events.

Despite the availability of a new vaccine, acute bacterial meningitis continues to be a potentially life-threatening childhood disease. The mortality rate is approximately 5% and research suggests that many of the survivors suffer from various forms of morbidity. The pediatric intensive care nurse must immediately recognize the signs and symptoms of impending complications so that interventions can be implemented before it becomes impossible to reverse a critical situation and/or to prevent longterm sequelae. Therefore nursing care requires a thorough understanding of the pathophysiological sequence of events of this disease process.