title: Pediatric nurses' perceptions of obstacles and supportive behaviors in end-of-life care.
abstract: BACKGROUND
  Each year 55 000 children die in the United States, and most of these deaths occur in hospitals. The barriers and supportive behaviors in providing end-of-life care to children should be determined.
  
  
  OBJECTIVE
  To determine pediatric intensive care unit nurses' perceptions of sizes, frequencies, and magnitudes of selected obstacles and helpful behaviors in providing end-of-life care to children.
  
  
  METHODS
  A national sample of 1047 pediatric intensive care unit nurses who were members of the American Association of Critical-Care Nurses were surveyed. A 76-item questionnaire adapted from 3 similar surveys with critical care, emergency, and oncology nurses was mailed to possible participants. Nurses who did not respond to the first mailing were sent a second mailing. Nurses were asked to rate the size and frequency of listed obstacles and supportive behaviors in caring for children at the end of life.
  
  
  RESULTS
  A total of 474 usable questionnaires were received from 985 eligible respondents (return rate, 48%). The 2 items with the highest perceived obstacle magnitude scores for size and frequency means were language barriers and parental discomfort in withholding and/or withdrawing mechanical ventilation. The highest supportive behavior item was allowing time alone with the child when he or she has died.
  
  
  CONCLUSIONS
  Pediatric intensive care unit nurses play a vital role in caring for dying children and the children's families. Overcoming language and communication barriers with children's families and between interdisciplinary team members could greatly improve the end-of-life experience for dying children.
authors.affiliation: College of Nursing, Brigham Young University, Provo, Utah 84602-5432, USA. renea@byu.edu
authors.forename: Renea L
authors.initials: RL
authors.lastname: Beckstrand
authors.forename: Nicole L
authors.initials: NL
authors.lastname: Rawle
authors.forename: Lynn
authors.initials: L
authors.lastname: Callister
authors.forename: Barbara L
authors.initials: BL
authors.lastname: Mandleco
mesh_terms: D000328:Adult; D000368:Aged; D001291:Attitude of Health Personnel; D005260:Female; D019538:Health Care Surveys; D006801:Humans; D008297:Male; D008875:Middle Aged; D009726:Nurses / Q000523:psychology*; D010371:Pediatric Nursing; D011368:Professional-Family Relations; D012944:Social Support; D013727:Terminal Care; D014481:United States; D055815:Young Adult