Hopeful Nurses are More Comfortable, Confident in Caring for Dying Children, Finds The Children's Hospital of Philadelphia


PHILADELPHIA, Jan. 9 /PRNewswire/ -- Nurses with higher levels of hopefulness are more likely to report feeling confident and competent in their ability to care for dying children and their families. Researchers at The Children's Hospital of Philadelphia, reporting on a survey of hundreds of pediatric nurses, said that nurses who were more confident about their skills also were more likely to have received education in palliative care
- the practice of providing high-quality, responsive care to patients with a life- threatening illness.

The study appears in the January issue of "Pediatrics."

"Very few researchers have analyzed whether healthcare providers' underlying beliefs and feelings are associated with their ability to care for dying children and their families," said study authors Chris Feudtner, M.D., Ph.D., M.P.H.; and Gina Santucci, M.S.N., of The Children's Hospital of Philadelphia. "This study may help educators develop programs to help
nurses and other healthcare providers to address difficult situations."

A pediatrician and a nurse, respectively, Dr. Feudtner and Ms. Santucci are experts on pediatric palliative care and members of the Hospital's Pediatric Advanced Care Team, which provides palliative, end-of-life and bereavement services.

The study team analyzed responses from 410 pediatric nurses at Children's Hospital in spring 2005 with a web-based, written survey. The survey asked the nurses whether they were comfortable working with dying children and their families and inquired about their knowledge, attitudes, practices and experiences regarding aspects of palliative and end-of-life care. The team also used questions from a standardized measuring tool called the Adult Dispositional Hope Scale.

The Hope Scale measures attitudes about goal-setting and problem-solving, asking people whether they agree with statements such as, "I meet the goals I set for myself," "I can think of many ways to get out of a jam," and "I can think of many ways to get things in life that are
most important to me."

Overall, the nurses in the survey said they felt most competent in managing pain for patients and least competent in talking with children and families about dying. The researchers found that nurses with higher levels of hopefulness rated themselves as more comfortable with and competent in palliative care tasks, even when adjusted for each nurse's years of nursing experience and their exposure to education in palliative care.

"Our most substantial finding," said Dr. Feudtner, "is that the more hours of palliative care education that a nurse receives, the more comfortable the nurse is in providing palliative care and in talking about death and dying with patients and families. We interpret this finding in the framework of 'hope theory' formulated by our co-author, Dr. Rick
Snyder. Education enlarges the set of pathway thoughts a person may have
when considering how to achieve a goal, and may expand the range of potentially desired goals.

"For instance, in palliative care, a nurse who is hopeful and confident
may be better able to collaborate with a dying patient and the patient's family in formulating meaningful goals, such as being at home with loved ones receiving hospice care."

The current research, said Ms. Santucci, suggests the need for further investigation into the role of personal hopefulness and the relevance of nursing education in helping nurses be more effective in providing palliative care.

The Agency for Healthcare Research and Quality provided grant support for this study. Co-authors with Dr. Feudtner and Ms. Santucci were Tammy I. Kang, M.D.; James A. Feinstein, B.A.; and Mary T. Rourke, Ph.D.; all of The Children's Hospital of Philadelphia, and the late C. Rick Snyder, Ph.D., of the University of Kansas.
"Hopeful Thinking and Level of Comfort Regarding Providing Pediatric
Palliative Care: A Survey of Hospital Nurses," Pediatrics, vol. 119, number 1, January 2007, pp. 186-192.

Note to reporters: The Pediatric Advanced Care Team at Children's Hospital includes physicians, advanced-practice nurses, a social worker, an art therapist, a bereavement counselor and psychologists. The team supports
children with life-threatening conditions, the child's family, and the physicians and nurses providing the care. To arrange an interview with Ms. Santucci or Dr. Feudtner, contact Gina Marchiondo at 267-426-6054 or marchiondo@email.chop.edu.

About The Children's Hospital of Philadelphia: The Children's Hospital
of Philadelphia was founded in 1855 as the nation's first pediatric hospital. Through its longstanding commitment to providing exceptional patient care, training new generations of pediatric healthcare professionals and pioneering major research initiatives, Children's
Hospital has fostered many discoveries that have benefited children worldwide. Its pediatric research program is among the largest in the country, ranking third in National Institutes of Health funding. In
addition, its unique family-centered care and public service programs have brought the 430-bed hospital recognition as a leading advocate for children and adolescents. For more information, visit http://www.chop.edu.

Contact: Gina Marchiondo
The Children's Hospital of Philadelphia
Phone: (267) 426-6054