Nurses’ experiences of the death of a child in the Emergency Department

A/Prof. Bev Copnell1, Prof Lisa McKenna1, Dr Kaori Shimoinaba2

1School of Nursing and Midwifery, La Trobe University, Melbourne, Australia, 2Nursing and Midwifery, Monash University, Melbourne, Australia

Background: Nurses’ experiences of childhood death have been studied in various settings, but never in the Emergency Department, a setting with several unique challenges. Understanding these experiences is crucial in determining how well prepared nurses are to manage the situation and to provide quality nursing care to dying children and their families.

Aims: to explore nurses’ experiences of the death of a child in the Emergency Department

Methods: A qualitative descriptive design was utilised. Participants (n=24) were recruited via email through the College of Emergency Nursing Australasia. The only inclusion criterion was that they must have cared for a child who died in their department; there were no exclusion criteria. Data were collected via audiorecorded individual interview. Interviews were transcribed verbatim and analysed using thematic analysis.

Findings: Three main themes were identified: ‘the nature of emergency department work’, ‘working with families’ and ‘coping and support’. The relative rarity of child death, and lack of specific education, made it difficult to develop expertise; this was an overarching theme. The pace and pressure of work was seen to allow little time for reflection and recovery, with patients’ physical needs dominating. Family presence during resuscitation of a child was universally practised, but working with families was often challenging. Most participants found child death traumatising; some described unresolved distress persisting for some time, or manifesting long after the event. The most common individual coping mechanism was seeking reassurance that everything possible had been done for the child. Support from nurse managers varied considerably and was related to departmental culture. Differences between metropolitan and rural settings, and between paediatric and adult departments, were evident.

Conclusion: Most participants were insufficiently supported in caring for patients, families and themselves when a child died in their department. Departmental culture and lack of education were the main modifiable factors.


Biography:

Dr Kaori Shimoinaba is a registered nurse in both Japan and Australia with extensive experiences in palliative care. Since joining Nursing and Midwifery, Monash University, Kaori has focused on teaching undergraduate programs and Japanese nursing student programs.

Kaori’s professional interests and research areas are palliative care, loss and grief, resilience, and cross-cultural nursing/education. Currently, she is the chief investigator of a research project which focuses on undergraduate students’ experiences of death and dying during clinical placements and their support needs. Kaori is supervising a PhD student who is focusing on acute care nurses’ experience providing care for patients at their end-of-life.