Peak and nadir experiences and their consequences described by pediatric oncology nurses

Abstract

Pediatric oncology nurses experience role-related stressors, some of which are inherent to the speciality, and their consequences. Despite these difficulties, nurses continue in the specialty. One variable that helps to explain their continued commitment is "meaning", or what pediatric oncology nurses find to be most significant and satisfying in their roles. One technique for determining meaning in a role is to inquire about the peak (significant and positive) and nadir (significant and negative) role-related experiences and the consequences of both kinds of experiences. The purpose of this study was to identify the peak and nadir experiences of pediatric oncology nurses and the short- and long-term consequences of those experiences. Using an interview format that consisted of four open-ended questions and a convenience sampling plan, five nurses interviewed 26 nurses from one pediatric cancer center and 38 nurses from a national sample. The interviewers completed an initial training session on interviewing and repeated that training two more times during data collection. Written or taped oral consent was obtained at the time of each interview. Using a content analytical technique (Krippendorff, 1980), four nurses independently coded each interview. Agreement ratings ranged from 75% to 100% per coded theme for an overall agreement level of 92%. Training for the coding process occurred initially and periodically throughout the analysis period. Fifteen different themes for peak experiences were identified, the majority of which reflect the nurses' experience with patients dying, or with patients recovering and living normal lives, or with the close relationships that develop between nurses and patients. Multiple short- and long-term consequences were identified and included changes in (1) values (becoming less judgmental), (2) behaviors (giving more empathic care), and (3) perspective (accepting limitations of care). Twenty-three different nadir themes were identified. A shared characteristic of several of these themes is the nurses' regret over a perceived inadequacy in handling a situation. Another common element is witnessing patient suffering and feeling unable to adequately relieve the suffering or provide comfort to the patient. The short-term consequences of nadir experiences tend to be negative and include guilt, anger, or dread. The long-term consequences tend to be positive and similar to the long-term consequences of peak experiences. Study findings indicate that pediatric oncology nurses do find meaning in their roles and that those who continue in the speciality are able to experience positive long-term consequences. Study findings will be used to develop a new scale to measure role-related meaning and to develop interventions designed to assist nurses in finding meaning in their roles even during particularly stressful periods.

Nurses' experiences of caring for children in pain

“…The opening questions were: 'Please describe one or more peak experiences you have had when caring for children in pain' and 'Please describe one or more nadir experiences you have had when caring for children in pain' (Olson et al 1998). During the interview, probing was used in order to encourage the nurse to respond to the questions as comprehensively as possible.…”

Missing life stories. The narratives of palliative patients, parents and physicians in paediatric oncology

“…Childhood cancer is a distressing experience both for family and healthcare professionals. Various studies have explored parents’ experiences in terms of marital and parental quality of life during and after their child's treatment (Bally et al., ; Barling, Stevens, & Davies, ; Bishop, Stedmon, & Dallos, ; Brody & Simmons, ; Robert et al., ; Wong & Chan, ) and an increasing number of studies have examined the lived experience of work‐related stress and grief among paediatric oncology nurses and physicians (Conte, ; Enskär, ; Olson et al, ; Stenmarker, Palmérus, & Màrky, ). With some notable exceptions, children's perspective is rarely ever discussed.…”

Maintaining Integrity: How Nurses Navigate Boundaries in Pediatric Palliative Care

“…Often due to their emotional involvement with families at a child's end of life, nurses experienced grief and feelings of loss from their patients' deaths and from bearing witness to families' suffering (Davis et al, 1996;Papadatou, Bellali, Papazoglou, & Petraki, 2002;Papadatou, Martinson, & Chung, 2001;Rushton et al, 2006;Yam, Rossiter, & Cheung, 2001). Despite contributing to their grief, nurses in these studies viewed emotional support to families as an essential aspect of their practice and constitutive to their work being rewarding and meaningful Engler et al, 2001;Olson et al, 1998;Papdatou, Bellali, et al;Papadatou, Martinson, et al;Rashotte, Fothergill-Bourbannais, & Chamberlain, 1997). These nurses experienced personal costs from the intensity of their work, such as feeling distress, forming close attachments, and grieving the loss of a child.…”

“…Families report a higher quality of care when they are given emotional support and individualized attention from health care providers caring for their child at the end of life (Heller & Solomon, 2005;Macdonald et al, 2005). Studies found that nurses derived meaning from their work through their emotional involvement with families (Davies et al, 1996;Olson et al, 1998;Papadatou et al, 2001;Rashotte et al, 1997;Yam et al, 2001). Nurses view their emotional support as integral to their role caring for children at the end-of-life and their families Engler et al, 2001;Olson et al;Papdatou et al, 2001;Rashotte et al).…”

“…Studies found that nurses derived meaning from their work through their emotional involvement with families (Davies et al, 1996;Olson et al, 1998;Papadatou et al, 2001;Rashotte et al, 1997;Yam et al, 2001). Nurses view their emotional support as integral to their role caring for children at the end-of-life and their families Engler et al, 2001;Olson et al;Papdatou et al, 2001;Rashotte et al). However, little is known about how nurses manage to give emotional support to families during such sensitive times and simultaneously maintain boundaries between their personal and professional selves.…”