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How Pediatric Critical Care Nurses Manage Their Work-Related Grief: A Focused Ethnography

Herrle, Sarah
http://orcid.org/0000-0002-7716-4367
http://rave.ohiolink.edu/etdc/view?acc_num=ucin1491818265095913

Abstract Details

2017, PhD, University of Cincinnati, Nursing: Nursing - Doctoral Program.
Background: In 2013, over 39,000 children in the United States died, with approximately 80 percent of deaths occurring in a pediatric critical care unit. The death rate for critically ill children treated in pediatric critical care units decreased by half in the last two decades, yet remains at 2.39 percent. There is a small body of current knowledge which examines the lived experience of nurses who care for dying children, the grief they experience, and how they individually or with the aid of organizational interventions resolve their grief. No current studies have examined the culture nurses create that helps them collectively manage work-related grief. Purpose: The purpose of this study was to explore how nurses in two pediatric critical care units use shared behaviors to help manage work-related grief and continue providing care in the stressful pediatric critical care environment. Method: Focused ethnography was the method used to examine the shared culture nurses create that helps them manage work-related grief. Thirty-three informants were interviewed, 20 from the pediatric intensive care unit (PICU) and 13 from the cardiac intensive care unit (CICU). Data were comprised of interviews, and researcher reflections, with themes and domains abstracted from the data. Findings: Study findings demonstrated that PICU and CICU nurses had very different strategies for grief management. These differences were explicated in the five domains abstracted from the research data. The five domains were further broken down into themes. Domain I: Values and Beliefs reviewed shared values and beliefs held by critical care nurses in both units. Themes which comprised this Domain are: Always Learning – Always New, Dignity in Life – Dignity in Death, Bringing Comfort, and Meaning in Work. Domain II: Causes of Grief, was comprised of the themes: Hyper-Responsibility, Prevented from Bringing Comfort, Bonding, Alive One Day, Dead the Next, and Acuity of the Unit. This theme described the causes of grief for pediatric critical care nurses. Domain III: The Turning Point, was the point at which the units no longer had common attributes, but where the cultures began to shift away from each other. Domain IV: Managing Grief depicted strategies the nurses in the PICU and CICU use to manage work-related grief. Themes included: Building a Protective Shell, Staying Open, Crying Etiquette, Supporting One Another, and Bringing in New Nurses. Lastly, Domain V: Organizational Expectations, described perceived organizational expectations regarding grief expression and organizational support. Themes include: Organizational Support, Disrespecting Death, and Debriefing. All domains and their corresponding themes are discussed in detail in this document. Implications: Nurses who are unable to manage work-related grief are at risk for unresolved secondary traumatic stress, compassion fatigue, and burnout. Burnout contributes to attrition, resulting in less experienced staff caring for patients. Increased falls, hospital acquired infections, and mortality are negative patient outcomes directly related to inexperienced nursing staff. Supporting nurses by helping them manage work-related grief may increase retention of experienced nurses, and improve patient outcomes.
Donna Shambley-Ebron, Ph.D. (Committee Chair)
Erynn Casanova, Ph.D. (Committee Member)
Carolyn Smith, Ph.D. (Committee Member)
189 p.
Nursing
pediatric critical care; grief; pediatric nurse; grief management; registered nurse

Recommended Citations

Citations

  • Herrle, S. (2017). How Pediatric Critical Care Nurses Manage Their Work-Related Grief: A Focused Ethnography [Doctoral dissertation, University of Cincinnati]. OhioLINK Electronic Theses and Dissertations Center. http://rave.ohiolink.edu/etdc/view?acc_num=ucin1491818265095913

    APA Style (7th edition)

  • Herrle, Sarah. How Pediatric Critical Care Nurses Manage Their Work-Related Grief: A Focused Ethnography. 2017. University of Cincinnati, Doctoral dissertation. OhioLINK Electronic Theses and Dissertations Center, http://rave.ohiolink.edu/etdc/view?acc_num=ucin1491818265095913.

    MLA Style (8th edition)

  • Herrle, Sarah. "How Pediatric Critical Care Nurses Manage Their Work-Related Grief: A Focused Ethnography." Doctoral dissertation, University of Cincinnati, 2017. http://rave.ohiolink.edu/etdc/view?acc_num=ucin1491818265095913

    Chicago Manual of Style (17th edition)

ucin1491818265095913
488
© 2017, some rights reserved.Creative Commons License How Pediatric Critical Care Nurses Manage Their Work-Related Grief: A Focused Ethnography by Sarah Herrle is licensed under a Creative Commons Attribution-NonCommercial-NoDerivs 3.0 Unported License. Based on a work at etd.ohiolink.edu.
This open access ETD is published by University of Cincinnati and OhioLINK.