title: An Order Protocol for Respiratory Distress/Acute Pain Crisis in Pediatric Palliative Care Patients: Medical and Nursing Staff Perceptions.
abstract: BACKGROUND
  An order protocol for distress (OPD), including respiratory distress and acute pain crisis, has been established for pediatric palliative care patients at Sainte-Justine Hospital (SJH). After discussion with the patient/his or her family, the OPD is prescribed by the attending physician whenever judged appropriate. The OPD can then be initiated by the bedside nurse when necessary; the physician is notified after the first dose is administered.
  
  
  OBJECTIVE
  The study objectives were to evaluate the perceptions and experience of the medical/nursing staff towards the use of the OPD.
  
  
  METHODS
  A survey was distributed to all physicians/nurses working on wards with pediatric palliative care patients. Answers to the survey were anonymous, done on a voluntary basis, and after consent of the participant.
  
  
  RESULTS
  Surveys (258/548) were answered corresponding to a response rate of 47%. According to the respondents, the most important motivations in using the OPD were the desire to relieve patient's distress and the speed of relief of distress by the OPD; the most important obstacles were going against the patient's/his or her family's wishes and fear of hastening death. The respondents reported that the OPD was frequently (56%) or always (36%) effective in relieving the patient's distress. The respondents felt sometimes (16%), frequently (34%), or always (41%) comfortable in giving the OPD. They thought the OPD could never (12%), rarely (32%), sometimes (46%), frequently (8%), or always (1%) hasten death. Physicians were less favorable than nurses with the autonomy of bedside nurses to initiate the OPD before notifying the physician (p = 0.04). Overall, 95% of respondents considered that they would use the OPD in the future.
  
  
  CONCLUSIONS
  Data from this survey shows that respondents are in favor of using the OPD at SJH and find it effective. Further training as well as support for health care professionals are mandatory in such palliative care settings.
authors.affiliation: 1 Palliative Care Unit, Department of Pediatrics, Sainte-Justine Hospital , Montréal, Québec, Canada .
authors.forename: Gwenaëlle
authors.initials: G
authors.lastname: Bidet
authors.affiliation: 1 Palliative Care Unit, Department of Pediatrics, Sainte-Justine Hospital , Montréal, Québec, Canada .
authors.forename: Lysanne
authors.initials: L
authors.lastname: Daoust
authors.affiliation: 2 Hemato-Oncology Service, Department of Pediatrics, Sainte-Justine Hospital , Montréal, Québec, Canada .
authors.forename: Michel
authors.initials: M
authors.lastname: Duval
authors.affiliation: 3 Applied Clinical Research Unit, Department of Pediatrics, Sainte-Justine Hospital , Montréal, Québec, Canada .
authors.forename: Thierry
authors.initials: T
authors.lastname: Ducruet
authors.affiliation: 4 Pediatric Critical Care Unit, Department of Pediatrics, Sainte-Justine Hospital , Montréal, Québec, Canada .
authors.forename: Baruch
authors.initials: B
authors.lastname: Toledano
authors.affiliation: 1 Palliative Care Unit, Department of Pediatrics, Sainte-Justine Hospital , Montréal, Québec, Canada .
authors.forename: Nago
authors.initials: N
authors.lastname: Humbert
authors.affiliation: 1 Palliative Care Unit, Department of Pediatrics, Sainte-Justine Hospital , Montréal, Québec, Canada .
authors.forename: France
authors.initials: F
authors.lastname: Gauvin
mesh_terms: D059787:Acute Pain / Q000628:therapy*; D000293:Adolescent; D000328:Adult; D016223:Advance Directives; D000368:Aged; D001291:Attitude of Health Personnel; D002170:Canada; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008505:Medical Staff, Hospital / Q000523:psychology*; D008875:Middle Aged; D009741:Nursing Staff, Hospital / Q000523:psychology*; D010166:Palliative Care / Q000592:standards*; D010371:Pediatric Nursing / Q000592:standards*; D017410:Practice Guidelines as Topic; D012128:Respiratory Distress Syndrome / Q000628:therapy*; D011795:Surveys and Questionnaires; D055815:Young Adult