Introduction
With thousands of children dying from cancer every year, the need for experienced nurses qualified in both ethical and medical aspects of palliative care remains acute. In their qualitative study, Suryani, Allenidekania, and Rachmawati (2018) aimed at examining “the meaning of children’s comfort at the end of their life for nurses” (p.162). For the population of interest, the researchers took health care professionals from the Rachel Home Foundation, who met the following criteria. Respondents had to give voluntary consent for participation, speak Indonesian, receive proper training and professional certification in palliative care, as well as be currently involved in the nursing care at the end-of-life (Suryani et al., 2018). With an easily located problem statement at the end of the introduction, appropriate research methods, and conducive discussion of the findings, this article provides a persuasive argument for further study.
Methods
Research Tradition
The type of research tradition used for this qualitative study is phenomenology. The model chosen by Suryani et al. (2018) is entirely consistent with the analytical approach, research methods, and data sources utilized. Since the article aims at exploring the essence of children’s comfort as a phenomenon, this type helps researchers to address the primary goal of the study through the usage of in-depth interviews. In phenomenological studies like this one, interviews usually consist of open-ended questions that allow the participants to describe their experience with minimum wording limitations. After collecting the data, researchers took an analytical approach to organize the information by breaking it down, identifying running themes, and generalizing it to a broader population. The small sample of ten respondents used in the research is also congruent with the research tradition. The study does not include evidence of reflexivity in its design, except for the fact that interview transcripts might be analyzed by multiple researchers (Suryani et al., 2018). Patterns mentioned above are consistent throughout the article and easily identifiable in the methods, results, and discussion sections.
Ethical Aspects of a Study
Before the beginning of the study, researchers received approval from the Ethical Committee of the Nursing Faculty of Universitas, Indonesia. Suryani et al. (2018) do not outline any specific steps taken to maintain the confidentiality of the participants, except for the generic statement confirming that the necessary ethical principles apply to the whole research. Additionally, when quoted, respondents were labeled as Participant 1-10. No vulnerable groups, according to the article, were involved in the study (Suryani et al., 2018). Though not described in detail, the process of data analysis provides sufficient evidence to argue that the ethical aspects of the research were satisfactory.
Data Collection
As mentioned before, methods used to collect data are congruent with the research tradition, thus allow to capture study phenomenon fully. In their study, Suryani et al. (2018) used interviews with open-ended questions, which lasted from 40 minutes to 1 hour and 50 minutes. The answers given were tape-recorded, using the Sony Voice Recorder ICD-PX440, and then transcribed verbatim for better analysis (Suryani et al., 2018). The same way of data collection is integrated into the related researches by Hendricks-Ferguson et al. (2015) and Sawin et al. (2019), demonstrating the high effectiveness of the method in such research. Since the usage of focus group interviews in such in-depth conversations would not allow respondents to share their experiences thoroughly, only by interviewing respondents individually could researchers draw conclusive data?
Data Analysis Approach
To answer the research question and analyze the data collected, the Colaizzi method was used. For the research tradition chosen, Suryani et al. (2018) applied an appropriate qualitative approach to identify essential claims and further organize them into proper categories and themes in the discussion section. The article mentions no qualitative software was utilized for the data interpretation.
Results
Divided into six main themes, the results of the findings are effectively presented in the article. All themes are satisfactorily conceptualized in the data, with each category adequately describing the meaning of the information, encompassing several perspectives, such as medical, spiritual, and moral, in the quotes provided from the interviews. Major topics identified by Suryani et al. (2018) include reduction of the child’s pain, the realization of the kid’s wants and needs, emotional support of the family, mixed feelings, and internal conflicts experienced by nurses. Previous research conducted by Hendricks-Ferguson et al. (2015) supports the findings of the study, suggesting that one of the prominent features in nursing practices at the end of life is creating nurturing environment for the family of a dying child. Sawin et al. (2019) also wrote about the internal struggles of the health professional associated with the conversations with the patient’s caregivers. Both in the original and related researches, nurses consider a child’s physical and psychological comfort of great value, trying to achieve it through various techniques: talking, playing, encouraging family conversations, and others.
Discussion
Findings
A brief overview of the major themes present in the study is analyzed in detail in the discussion section. Interpretations for the data provided by Suryani et al. (2018) are congruous with the related researches in the field. Hendricks-Ferguson et al. (2015) reported similar nurse’s debilitative feelings of anger, hopelessness, and anxiety when faced with a child’s death, as described in the original article. Furthermore, the researchers determined nursing experience in managing pain symptoms as one of the primary goals in pediatric palliative care (Hendricks-Ferguson et al., 2015). Sawin et al. (2019) also wrote about the significance of the nurse’s interpersonal skills, meaning that a health professional should be able to recognize the child’s wants and provide emotional support when needed. Finally, all three studies by Suryani et al. (2018), Hendricks-Ferguson et al. (2015), and Sawin et al. (2019) highlighted the urgent need for the nurse’s education and emotional support. In other words, conducting training, organizing support groups, and counseling sessions for the health professionals could help them process grief easier and provide better medical assistance for the other patients.
Clinical Practice
Though the discussion of this qualitative study is mostly based on the results of the original research, it contains evidence from earlier studies to support drawn conclusions. Apart from creating a meaningful explanation of the studied phenomenon, Suryani et al. (2018) also included further implications of the research for the clinical practice. The authors highlighted the need for nurses to learn specific coping strategies to overcome the negative emotions associated with attending to a dying child. The article also covered aspects of further professional education in the forms of lectures, group discussions, and provisional training (Suryani et al., 2018). While the study has many practical implications for clinical practice, there is no inference for further research.
Conclusion
Qualified palliative care for children who have cancer presents medical, ethical, and psychological challenges for health care professionals. Considering the patient’s comfort of utmost importance, nurses frequently struggle to overcome their internal conflicts and deal with debilitative emotions when attending to the dying individual. Lack of interpersonal skills and failure to interpret cues of the child may prevent them from choosing the best pain management therapy. To help nurses recover from their patient’s loss better and increase their skills in pediatric palliative care, clinics should incorporate support groups, training, and education sessions for their employees.
References
Hendricks-Ferguson, V. L., Sawin, K. J., Montgomery, K., Dupree, C., Phillips-Salimi, C. R., Carr, B., & Haase, J. E. (2015). Novice nurses’ experiences with palliative and end-of-life communication. Journal of Pediatric Oncology Nursing, 32(4), 240-252. Web.
Sawin, K. J., Montgomery, K. E., Dupree, C. Y., Haase, J. E., Phillips, C. R., & Hendricks-Ferguson, V. L. (2019). Oncology nurse managers’ perceptions of palliative care and end-of-life communication. Journal of Pediatric Oncology Nursing, 36(3), 178-190. Web.
Suryani, R. L., Allenidekania, A., & Rachmawati, I. N. (2018). Phenomenology study on nurse’s experiences in understanding the comfort of children at the end-of-life. Indian Journal of Palliative Care, 24(2), 162-166. Web.