Pediatric Palliative Care

Abstract

To the Editor.—As a nurse working in an intensive care nursery, I have dealt with children who have chronic illnesses and sometimes face death. This is why I found the article by Feudtner et al entitled “Hopeful Thinking and Level of Comfort Regarding Providing Pediatric Palliative Care: A Survey of Hospital Nurses” very enlightening.1 I have learned about palliative care through experience and from our hospital's Pediatric Advanced Comfort Care Team (PACCT). There are still situations in which I am not comfortable speaking about the death of a child, which is why the level of comfort that nurses have regarding palliative care is extremely important. I commend your efforts in providing awareness about pediatric palliative care and agree with the authors' conclusion that many nurses feel proficient regarding pain management and inadequate when talking with children and families about dying. This article showed that there is a need for more education in patient care settings regarding palliative care. By increasing knowledge related to palliative care, a positive effect could be obtained for both patients/families and nurses.Feudtner et al found that “[n]urses' level of hope is associated with their self-reported comfort and competence regarding palliative care.” To increase comfort levels of nurses, hospitals should be encouraged to implement courses like the End-of-Life Nursing Education Consortium, which was developed in September 2001. The End-of-Life Nursing Education Consortium is a training course that informs nurses about communication skills, ethics, cultural considerations, pain/symptom management, care at the time of death, grief, and bereavement.2 Hospitals should also be encouraged to create a pediatric supportive care team like the one my hospital, Children's Mercy, implemented (the Pediatric Advanced Comfort Care Team). These teams can enhance the “quality of life in the face of an ultimately terminal condition.”3New research and education can provide nurses with useful information about palliative care. Interventions should be studied in clinical trials to determine the effectiveness in achieving better patient, family, and health care provider outcomes.1 Because nurses have a distinctive role in promoting and providing care for terminal children and their families, education and teamwork are imperative to provide pediatric nurses the confidence that is needed in these situations. I hope that Pediatrics will continue to support the efforts of palliative care education and look forward to reading more literature regarding this important topic.