Abstract：
BACKGROUND: Parents of children who die in the pediatric intensive care unit (PICU) carry memories of their child\'s suffering throughout a lifelong grieving experience. Given their prolonged time at the bedside, PICU nurses are poised to attend to dying children\'s suffering.
OBJECTIVE: We aimed to explore how PICU nurses identify, assess, and attend to EOL suffering.
METHODS: Interpretive descriptive qualitative study with thematic analysis of virtual focus groups from a geographically diverse sample of PICU nurses.
RESULTS: Nurses participated in five focus groups (N = 19). Most identified as White (89%) females (95%) with a range of 1-24 years of PICU experience and involvement in >10 EOL care cases (89%). Nurses described approaches to suffering within five themes: 1) Identifying and easing perceptible elements; 2) Recognizing and responding to subtleties moment-to-moment; 3) Acclimating to family interdependence; 4) Synchronizing nurse in-the-room insight with systemic complexity; and 5) Accounting for ambiguity. Nurses detailed elements of suffering they could \"fix\" with straightforward, external interventions (e.g., pain medication). More complex tasks like optimizing care within familial and interprofessional team relationships while navigating psychosocial responses from children and families challenged nurses. Nurses attempted to minimize EOL suffering amidst ambiguity and complexity using internal processes including managing the environment and titrating moment-to-moment care.
CONCLUSIONS: While physical suffering may be remedied with direct nursing care, holistically attending to EOL suffering in the PICU requires both bolstering external processes and strengthening PICU nurses\' internal resources. Improving psychosocial training and optimizing interprofessional care systems could better support dying children and their families.
OBJECTIVE: We aimed to explore how PICU nurses identify, assess, and attend to EOL suffering.
METHODS: Interpretive descriptive qualitative study with thematic analysis of virtual focus groups from a geographically diverse sample of PICU nurses.
RESULTS: Nurses participated in five focus groups (N = 19). Most identified as White (89%) females (95%) with a range of 1-24 years of PICU experience and involvement in >10 EOL care cases (89%). Nurses described approaches to suffering within five themes: 1) Identifying and easing perceptible elements; 2) Recognizing and responding to subtleties moment-to-moment; 3) Acclimating to family interdependence; 4) Synchronizing nurse in-the-room insight with systemic complexity; and 5) Accounting for ambiguity. Nurses detailed elements of suffering they could \"fix\" with straightforward, external interventions (e.g., pain medication). More complex tasks like optimizing care within familial and interprofessional team relationships while navigating psychosocial responses from children and families challenged nurses. Nurses attempted to minimize EOL suffering amidst ambiguity and complexity using internal processes including managing the environment and titrating moment-to-moment care.
CONCLUSIONS: While physical suffering may be remedied with direct nursing care, holistically attending to EOL suffering in the PICU requires both bolstering external processes and strengthening PICU nurses\' internal resources. Improving psychosocial training and optimizing interprofessional care systems could better support dying children and their families.
摘要：
背景：在儿科重症监护病房（PICU）中死亡的儿童的父母在一生的悲伤经历中都带有对孩子痛苦的记忆。鉴于他们在床边的时间很长，PICU护士准备好照顾垂死儿童的痛苦。
目的：我们旨在探讨PICU护士如何识别，评估,并参加EOL的痛苦。
方法：对来自不同地域的PICU护士样本的虚拟焦点组进行专题分析的解释性描述性定性研究。
结果：护士参加了5个焦点小组（N=19）。大多数确定为白人（89％）女性（95％），具有1-24年的PICU经验和参与>10例EOL护理病例（89％）。护士描述了五个主题中的痛苦方法：1）识别和缓解可感知的元素；2）时刻识别和应对微妙之处；3）适应家庭相互依存；4）使护士在房间中的洞察力与系统复杂性同步；5）考虑歧义。护士详细说明了他们可以直接“修复”的痛苦要素，外部干预(例如，止痛药）。更复杂的任务，如优化家庭和跨专业团队关系中的护理，同时导航儿童和家庭的心理社会反应，挑战护士。护士试图使用内部流程，包括管理环境和滴定即时护理，以最大程度地减少歧义和复杂性中的EOL痛苦。
结论：虽然身体上的痛苦可以通过直接护理来补救，全面关注PICU中的EOL痛苦需要加强外部流程和加强PICU护士的内部资源。改善心理社会培训和优化跨专业护理系统可以更好地支持垂死的儿童及其家庭。
目的：我们旨在探讨PICU护士如何识别，评估,并参加EOL的痛苦。
方法：对来自不同地域的PICU护士样本的虚拟焦点组进行专题分析的解释性描述性定性研究。
结果：护士参加了5个焦点小组（N=19）。大多数确定为白人（89％）女性（95％），具有1-24年的PICU经验和参与>10例EOL护理病例（89％）。护士描述了五个主题中的痛苦方法：1）识别和缓解可感知的元素；2）时刻识别和应对微妙之处；3）适应家庭相互依存；4）使护士在房间中的洞察力与系统复杂性同步；5）考虑歧义。护士详细说明了他们可以直接“修复”的痛苦要素，外部干预(例如，止痛药）。更复杂的任务，如优化家庭和跨专业团队关系中的护理，同时导航儿童和家庭的心理社会反应，挑战护士。护士试图使用内部流程，包括管理环境和滴定即时护理，以最大程度地减少歧义和复杂性中的EOL痛苦。
结论：虽然身体上的痛苦可以通过直接护理来补救，全面关注PICU中的EOL痛苦需要加强外部流程和加强PICU护士的内部资源。改善心理社会培训和优化跨专业护理系统可以更好地支持垂死的儿童及其家庭。
