Balancing Needs: Pediatric Nurses' Experiences With Exposure to the Traumatic Events of Children

Purpose: Pediatric nurses care for some of the most vulnerable and innocent members of society.  Many children and families experiencing serious pediatric illness and injury are left traumatized by their healthcare experience.  In theses situations, nurses often must meet the needs of multiple individuals simultaneously.  This repeated witnessing of patient suffering and selflessly giving of oneself can lead to emotional exhaustion in nurses.  Nurses' perceptions of being unable to provide quality patient care can increase nurse turnover and their desire to leave the nursing profession.  Most of the literature focuses on the experiences of oncology and intensive care nurses.  However, it is believe that all pediatric nurses are exposed to the traumatic events of children and that the definition of trauma is unique to each individual.  Therefore, the purpose of this study was to describe and find meaning in the experiences of pediatric nurses who are exposed to and participate in the suffering and traumatic events of children.

Methods: A qualitative, interpretive description design was used to examine the experiences of nurses in witnessing and participating in the suffering and traumatic experiences of their patients.  A maximum variation, purposive sampling techniques was used to recruit 17 participants with a wide range of years of experience and from a variety of pediatric specialties and settings.  Participants were recruited through snowballing.  The researcher interviewed each participant using a semi-structured interview guide.  Constant comparative data analysis was utilized to analyze and interpret the data.

Results: Although the participants represented a diverse group in regards to their years of experience as a pediatric nurse, their educaiton level, and their pediatric specialty and practice setting; their answers to the research questions were relatively similar.  The analysis of the descriptions of traumatic expereinces revealed that in the realm of pediatric nursing, traumatic experiences not only involve the child, but also the parents/family of the child and the healthcare providers.  The experiences of each of these groups influenced the experiences of the other groups.  Analysis of the interview data revealed an overarching theme of Balancing the Needs of the Child, Parent, and Nurse.  Four themes were identified: Defining Traumatic Experiences, Managing the Burden of Professional Responsibility and Other Conflicting Emotions, Preventing Further Traumatization, and Making a Difference.  Three of these themes included several subthemes.  From the theme Defining Traumatic Experiences, three subthemes emerged: bearing withness to the pain, coping with unexpected events and self-doubt, and feeling powerless to make it better.  The theme Preventing Further Traumatization included the subthemes: meeting the needs of parents, being strong for the child and parent, and protecting oneself from trauma.  The Making a Difference theme included the subthemes: making difficult situations a little better, fulfilling the nurse's emotional needs, reframing the nurse's worldview, and growing professionally as a nurse.  All participants attributed making a difference not only in the lives of the children and their parents, but also in the lives of the nurses as the meaning associated with their exposure to and participation in the traumatic experiences of their patients.  The participants who reported feeling like they made a difference also reported that despite the stress, they had no desire to leave their current jobs or the profession.  However, the two participants who reported no longer feeling like they made a difference also discussed their plans for leaving the profession in the near future.  Additional findings included the difficult nature of talking about experiences and the associated emotions and that experience could be helpful or detrimental in coping with work-related emotional stress.

Conclusion: The results of this study have significance for advancing nursing science, research, education, practice, and administration.  This research adds to the body of knowledge regarding the role of the pediatric registered nurse in caring for children who have experinced traumatic events and the consequences, both positive and negative, of assuming this practice role.  A preliminary model Balancing Needs: Pediatric Nurses' Experiences with Exposure to the Traumatic Events of Children depicting the inter-relationship among factors that affect nurses' reactions to traumatic events was developed.  The findings of this study have implications for both pre-licensure education and continuing professional education.  Many participants reported feeling ill-prepared and not having adequate knowledge to have difficult conversations with patients and their parents.  Educational needs and strategies are identified to better prepare nurses for their role in caring for traumatized children and to assist nurses in creating meaning from their experiencs.  Finally, the findings provide evidence for approaches to improve nurses' work environments, self-care, job satisfaction, and nurse retention and recruitment.  Professional boundaries, opportunities to informally vent, and support from nursing colleagues, leadership, and management are a few of the strategies identified by pediatric nurses as being important for preventing negative consequences associated with the exposure to the traumatic events of children.