Feudtner, C., Santucci, G., Feinstein, J. A., Snyder, C. R., Rourke, M. T., & Kang, T. I. (2007). Pediatrics, 119, 186-192.

These investigators examined factors that cause variation in healthcare providers' level of comfort about providing pediatric palliative care. In particular, they tested the hypothesis that nurses who are more inclined toward hopeful ways of thinking and feeling are also more comfortable providing palliative care. A cross-sectional survey of all the nurses at Children's Hospital of Philadelphia was conducted during the spring of 2005. The response rate to the survey was 44% (410 out of 932 eligible nurses), which the investigators noted was higher than that reported in comparable surveys of nurses. The Web-based survey incorporated questions regarding nurses' knowledge, attitudes, practices, and experiences regarding various aspects of palliative care. The Adult Dispositional Hope Scale was included as part of the survey to measure hopeful thinking. Most respondents were women who were younger than 40 years of age, had a decade or less of nursing experience, and had four or fewer hours of previous palliative care-specific education. Nurses reported feeling most competent regarding pain management and least competent regarding talking with children and families about dying. The results indicated that greater numbers of years in nursing practice, more hours of palliative care education, and higher scores on the Hope Scale were each associated with significantly higher levels of comfort working with dying children and their families, higher levels of palliative care competency, and lower levels of difficulty talking about death and dying. Among the predictors, the hours of palliative care education was the most substantial explanatory variable. Although further research is needed to substantiate these associations, the results suggested that provision of palliative care education is an important factor in enhancing nursing competence and level of comfort. Furthermore, the development and testing of hope-enhancing interventions for nurses who provide pediatric palliative care may be warranted.

Maureen Heaman