Purpose/Objectives:
The aim of this study was to describe the role of the clinical nurse specialist (CNS) in perinatal bereavement services for development of standards of practice and sensitive care for child death in the emergency department.
Significance:
Staff nurses identified the need to provide improved end-of-life care for children and their families in the emergency department. Although the organization had a well-established program of perinatal bereavement services, there was no program addressing the needs of families experiencing the deaths of children.
Design/Background/Rationale:
Often, the death of a child is a sudden event. Even when the death is anticipated, the impacts of child death on families and staff are significant. A child death is often a coroner's case, with the child's clothing and possessions removed as evidence. Families leave the hospital not only without their child but also without any of his possessions. Staff related feelings of powerlessness at their inability to provide sensitive care and support to families due to procedural and regulatory requirements.
Methods/Description:
An interdisciplinary group, led by the CNS for perinatal bereavement services, met to describe current management of families having a child die in the emergency department, to identify barriers to providing sensitive care to families, and to develop initiatives to improve the care to this population.
Findings/Outcomes:
There is a need for the establishment of standards of care/revision of emergency department policies/procedures; communication and care work sheet; pastoral care support; list of community resources for families; written materials for families; mementos that had contact with child; follow-up contact with families; staff education regarding pediatric end-of-life care and services provided through initiative; caregiver support; resources for parents of critically ill children sent to tertiary care referral centers.
Conclusions:
Families have received sensitive support, information, and the opportunity to have tangible mementos of their child in an environment of compassion and hope. Staff members have felt supported by having clear guidelines for care and the ability to offer mementos, support, and follow-up to families having a critically ill child or a child who has died.
Implications for Practice:
A model of a standard of care that provides support, mementos, and follow-up to parents at time of loss, and support and education to emergency department staff is needed.
Section Description
The 2009 NACNS National Conference will be held in St Louis, Missouri, on March 5 to 7. More than 350 clinical nurse specialists (CNSs), graduate faculty, nurse administrators, nurse researchers, and graduate students are registered. This year's theme, "Clinical Nurse Specialists: Vision, Value, Voice," demonstrates the essential leadership skills of the CNS as well as the CNS role in implementing evidence-based practice.
Seventy abstracts were selected for either podium or poster presentations. Again, this year, there is a CNS student poster session. The abstracts addressed CNS practice in 3 practice domains (spheres of influence), emphasizing patient safety and quality care outcomes, leadership, evidence-based practice, and new ways to shape CNS practice. Topics include CNS work activities incorporated into 3 spheres of influence-patients, nursing practice, organization/system-including the development of clinical inquiry skills among staff nurses, use of simulation technology, strategies to maintain clinical excellence, CNS practice in end-of-life care decisions, and many new and thoughtful ideas to support CNS education, practice, and research. Collectively, the abstracts represent the breadth, depth, and richness of the CNSs' contribution to the well-being of individuals, families, communities, as well as to the advancement of the nursing profession.
The conference abstracts were published here to facilitate sharing this emerging new knowledge with those who were unable to attend the conference. As you read each abstract, appreciate the intellectual talent and clinical scholarship of your CNS colleagues who are advancing the practice of nursing and contributing to the health of society through improved outcomes for patients and healthcare organizations. We encourage you to contact individual presenters to network, collaborate, consult, or share your thoughts and ideas on the conference topics. Watch out for next year's call for abstracts and consider submitting for presentation at NACNS' next annual conference in Portland, Oregon, on March 4 to 6, 2010.