Title

Clinician Emotions Surrounding Pediatric Oncology Patient Deterioration

Authors

Dylan E. Graetz, Department of Global Pediatric Medicine, St. Jude Children's Research Hospital, Memphis, TN, United States.
Emily Giannars, Department of Public Health, Emory University School of Public Health, Atlanta, GA, United States.
Erica C. Kaye, Division of Quality of Life and Palliative Care, St. Jude Children's Research Hospital, Memphis, TN, United States.
Marcela Garza, Department of Global Pediatric Medicine, St. Jude Children's Research Hospital, Memphis, TN, United States.
Gia Ferrara, Department of Global Pediatric Medicine, St. Jude Children's Research Hospital, Memphis, TN, United States.
Mario Rodriguez, Department of Oncology, Unidad Nacional de Oncología Pediátrica, Guatemala City, Guatemala.
Dora Judith Soberanis Vasquez, Department of Nursing, Unidad Nacional de Oncología Pediátrica, Guatemala City, Guatemala.
Alejandra Mendez Aceituno, Department of Critical Care, Unidad Nacional de Oncología Pediátrica, Guatemala City, Guatemala.
Federico Antillon-Klussmann, Unidad Nacional de Oncología Pediátrica, Guatemala City, Guatemala.
Jami S. Gattuso, Department of Nursing Research, St. Jude Children's Research Hospital, Memphis, TN, United States.
Karen L. Andes, Department of Public Health, Emory University School of Public Health, Atlanta, GA, United States.
Belinda N. Mandrell, Department of Nursing Research, St. Jude Children's Research Hospital, Memphis, TN, United States.
Justin N. Baker, Division of Quality of Life and Palliative Care, St. Jude Children's Research Hospital, Memphis, TN, United States.
Carlos Rodriguez-Galindo, Department of Global Pediatric Medicine, St. Jude Children's Research Hospital, Memphis, TN, United States.
Asya Agulnik, Department of Global Pediatric Medicine, St. Jude Children's Research Hospital, Memphis, TN, United States.

Abstract

BACKGROUND: Pediatric oncology patients have a high rate of clinical deterioration frequently requiring critical care. Patient deterioration events are distressing for clinicians, but little is known about how Pediatric Early Warning Systems (PEWS) impact clinicians' emotional responses to deterioration events. METHODS: Semi-structured interviews were conducted with 83 nurses, pediatricians, oncologists, and intensive care clinicians who had recently participated in a patient deterioration event at two pediatric oncology hospitals of different resource-levels: St. Jude Children's Research Hospital (N = 42 participants) in Memphis, Tennessee or Unidad Nacional de Oncología Pediátrica (N = 41 participants) in Guatemala City, Guatemala. Interviews were conducted in the participants' native language (English or Spanish), transcribed, and translated into English. Each transcript was coded by two researchers and analyzed for thematic content. RESULTS: Emotions around patient deterioration including concern, fear, and frustration were reported across all disciplines at both hospitals. Concern was often triggered by an elevated PEWS score and usually resulted in increased attention, which reassured bedside clinicians that patients were receiving necessary interventions. However, persistently elevated PEWS scores, particularly at St. Jude Children's Research Hospital, occasionally resulted in a false sense of relief, diminishing clinician attention and negatively impacting patient care. Nurses at both institutions described how PEWS amplified their voices, engendering confidence and empowerment, two of the only positive emotions described in the study. CONCLUSION: Clinicians experienced a range of emotions while caring for high-risk patients in the setting of clinical deterioration. These emotions have the potential to contribute to compassion fatigue and burnout, or to resilience. Acknowledgment and further investigation of the complex interplay between PEWS and clinician emotions are necessary to maximize the impact of PEWS on patient safety while simultaneously supporting staff wellbeing.

Publication Title

Frontiers in oncology

Share

COinS