Personal and professional experiences of pediatric residents concerning death
ABSTRACT The American Academy of Pediatrics (AAP) statement on Pediatric Palliative Care has emphasized the importance of identifying barriers and facilitators to effective palliative care.
To survey pediatric residents about their personal and professional experiences concerning death and determine factors associated with guilt (a potential barrier) and attendance at patient funerals (a potential facilitator).
PL-2 residents were surveyed midway through pediatric residency. Both personal and professional attitudes and experiences about death were solicited.
Seventy-nine (90%) PL-2 residents completed the survey from 1997-2000. While 91% reported that a close family member or friend had died, 75% recalled that their family had not openly discussed issues of death. Thus far in their career, residents reported encountering a mean of 9.4 patients who had died (+/-6.4; range, 0-30 deaths) and 39% expressed guilt about a death. Those who felt guilt about a death were more likely to state they felt responsible (p<0.01) but less likely to think about their own death (p<0.01). While 23% had attended a patient's funeral, 42% expressed fear of attending. The mean number of times a resident informed a family of a patient's death was slightly higher in those who attended a patient's funeral, and approached statistical significance.
By midresidency, these pediatric residents have had many personal and professional experiences with death. Residency training programs must provide venues for residents to address bereavement, facilitate the integration of these experiences, and provide time to attend funerals.
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ABSTRACT: Health care professionals report a lack of skills in the psychosocial and spiritual aspects of caring for dying people and high levels of moral distress, grief, and burnout. To address these concerns, the "Being with Dying: Professional Training Program in Contemplative End-of-Life Care" (BWD) was created. The premise of BWD, which is based on the development of mindfulness and receptive attention through contemplative practice, is that cultivating stability of mind and emotions enables clinicians to respond to others and themselves with compassion. This article describes the impact of BWD on the participants. Ninety-five BWD participants completed an anonymous online survey; 40 completed a confidential open-ended telephone interview. Four main themes-the power of presence, cultivating balanced compassion, recognizing grief, and the importance of self-care-emerged in the interviews and were supported in the survey data. The interviewees considered BWD's contemplative and reflective practices meaningful, useful, and valuable and reported that BWD provided skills, attitudes, behaviors, and tools to change how they worked with the dying and bereaved. The quality of presence has the potential to transform the care of dying people and the caregivers themselves. Cultivating this quality within themselves and others allows clinicians to explore alternatives to exclusively intellectual, procedural, and task-oriented approaches when caring for dying people. BWD provides a rare opportunity to engage in practices and methods that cultivate the stability of mind and emotions that may facilitate compassionate care of dying patients, families, and caregivers.Palliative and Supportive Care 12/2009; 7(4):405-14. DOI:10.1017/S1478951509990411 · 0.98 Impact Factor
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ABSTRACT: The discrepancy between what is taught in formal educational settings and what is learned by practitioners in the informal flow of everyday practice has been called the hidden curriculum. In this article, the authors apply a well-documented range of concerns about the hidden curriculum and the erosion of professionalism to the arena of pediatric palliative care education. The authors propose that educational initiatives must always be grounded in the charged existential space of relationships among children, families,and practitioners, because the learning that matters most occurs within these relationships. The authors present an educational approach, which they call relational learning, and offer some preliminary strategies educators may wish to foster this kind of learning in their own health care organizations.Child and Adolescent Psychiatric Clinics of North America 08/2006; 15(3):795-815. DOI:10.1016/j.chc.2006.03.002 · 2.60 Impact Factor
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ABSTRACT: Paediatric palliative care is an emerging subspecialty that focuses on achieving the best possible quality of life for children with life-threatening conditions and their families. To achieve this goal, the individuals working in this field need to: clearly define the population served; better understand the needs of children with life-threatening conditions and their families; develop an approach that will be appropriate across different communities; provide care that responds adequately to suffering; advance strategies that support caregivers and health-care providers; and promote needed change by cultivating educational programmes. Despite these challenges, advances in paediatric palliative care have been achieved in a short period of time; we expect far greater progress as the field becomes more formalised and research networks are established.The Lancet 04/2008; 371(9615):852-64. DOI:10.1016/S0140-6736(07)61203-3 · 45.22 Impact Factor