Journal List > J Korean Acad Nurs > v.47(3) > 1003246

Kang and Bang: Development and Evaluation of a Self-Reflection Program for Intensive Care Unit Nurses Who Have Experienced the Death of Pediatric Patients

Abstract

Purpose

This study aims to develop a self-reflection program for nurses who have experienced the death of pediatric patients in the intensive care unit and to evaluate its effectiveness.

Methods

The self-reflection program was developed by means of the following four steps: establishment of the goal through investigation of an initial request, drawing up the program, preliminary research, and implementation and improvement of the program. The study employed a methodological triangulation to evaluate the effectiveness of the program. Participants were 38 nurses who had experienced the death of pediatric patients (experimental group=15, control group=23); they were recruited using convenience sampling. The self-reflection program was provided over 6 weeks (6 sessions). Data were collected from April to August, 2014 and analyzed using t-tests and content analysis.

Results

The quantitative results showed that changes in personal growth (t=-6.33, p<.001) and burnout scores (z=-2.76, p=.005) were better in the experimental group compared to the control group. The qualitative results exhibited two themes, namely “personal growth” and “professional growth”, and ten sub-themes.

Conclusion

The self-reflection program developed by this study was effective in helping nurses who had experienced the death of pediatric patients to achieve personal growth through self-reflection, and it was confirmed that the program can be applied in a realistic clinical nursing setting. Furthermore, it can be recommended as an intervention program for clinical nurses.

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Table 1.
Research Design for Quantitative Study
Group Pretest Treatment Posttest Pretest Treatment Posttest
Control C1 No (6weeks) C2
Experimental E1 Self-reflection program (6weeks) E2

C1, E1=General characteristics, personal growth, compassion satisfaction, compassion fatigue, burnout; C2, E2:=Personal growth, compassion satisfaction, compassion fatigue, burnout.

Table 2.
Self-Reflection Program for Intensive Care Unit Nurses Who Have Experienced the Death of Pediatric Patients
Step Session (Time) Theme Objectives Contents
Introduction 1st (90min) What is my emotional Understand the objective and steps General overview of the program,
expression style? of the program. contents of each session and
: Confirmation of emotional Facilitate understanding between the participation
control style profiles moderator and participants, and Introduction of oneself by a nick-
among participants, and create name
intimacy. Confirmation of the final result for
Understand one’s own emotional emotional expression style
expression style.
Development 2nd (120min) The one child who remains Talk about the experience of the Debriefing about one’s experience
in my memory death of pediatric patients in a safe of the death of pediatric patient
: Sharing experiences of and comfortable environment to Verbalization of one’s emotion
caring for dying pediatric achieve emotional resolution. through debriefing
patients Empathy and support among the
participants
3rd (90min) Into the basket of loss Reflect on personal loss to look Verbalization of loss that holds
: Sharing my experience of back on one’s life and understand personal meaning
loss oneself. Use of the empathy card to encou-
Use the empathy card to encourage rage the participants to empathize
the participants to empathize. Writing a short note on one’s
personal experience of loss and
placing it in the basket of loss
4th (90min) Parting well Restructure the meaning of the Restructuring the meaning of the
: Finding my special parting death of pediatric patients to clearly death of pediatric patients through
ceremony understand the remaining emotions letter writing
and hope. Creating one’s own parting cere-
Acquire specific strategies to handle mony through group discussion
personal emotions regarding the
death of pediatric patients through
group activities among participants.
5th (90min) Understanding the parents Understand the bereaved parents and Reading books about bereaved
: Finding an effective identify effective communication parents and sharing emotions
strategy for strategies as a bereaved nurse. Share the experience of meeting
communication with the bereaved parents
parents Writing a condolence card to bere-
aved parents
Conclusion 6th (90min) I am a pediatric nurse Plan and act on self-care strategies. Writing and sharing a specific mini
: Establishing a self-care Confirm the value of caring as a holiday plan
strategy pediatric nurse at the intensive care Reflecting on one’s life as a nurse
unit. and creating a new resolution
Conclude the program. Providing feedback to each other
Table 3.
Homogeneity Tests between Experimental and Control Groups at Baseline (N=38)
Characteristics Exp. (n=15) Cont. (n=23) c2 or t or z p
n (%) or M±SD
Age (yr) 27.87±1.88 26.61±2.27 -1.78 .083
Marital status Unmarried 12 (80.0) 20 (87.0) 0.33 .663
Married 3 (20.0) 3 (13.0)
Offspring Yes 2 (13.3) 0 (0.0) 3.24 .149
No 13 (86.7) 23 (100.0)
Education level 3 year college 3 (20.0) 4 (17.4) 0.11 >.999
Bachelor 9 (60.0) 15 (65.2)
Master 3 (20.0) 4 (17.4)
Religion Yes 9 (60.0) 11 (47.8) 0.54 .522
No 6 (40.0) 12 (52.2)
Coresidence with family Yes 11 (73.3) 12 (52.2) 1.70 .310
No 4 (26.7) 11 (47.8)
Personality A-type 9 (60.0) 18 (78.3) 1.47 .285
B-type 6 (40.0) 5 (21.7)
Current working unit NICU 10 (66.7) 12 (52.2) 0.78 .506
PICU 5 (33.3) 11 (47.8)
Clinical career, hospital (yr) 4.70±2.02 3.77±1.91 -1.43 .162
Clinical career, NICU or PICU (yr) 3.50±1.90 3.60±1.67 0.17 .863
Number of pediatric patient’s deaths encountered during their career 9.73±11.74 13.00±13.31 0.77 .444
Number of pediatric patient’s deaths encountered during last year 4.07±2.96 5.09±3.52 0.93 .359
Most memorable pediatric patient’s death <6 month 9 (60.0) 12 (52.2) 0.23 .744
≥6 month 6 (40.0) 11 (47.8)
Death of significant others Have 5 (33.3) 7 (30.4) 0.04 >.999
None 10 (66.7) 16 (69.6)
Education related to terminal or hospice care† Yes 2 (13.3) 5 (21.7) 0.43 .681
No 13 (86.7) 18 (78.3)
Personal growth 38.80±11.23 41.00±12.98 0.54 .594
Compassion satisfaction 32.80±3.59 33.96±4.41 0.85 .402
Compassion fatigue 32.73±4.20 31.30±4.48 -0.99 .331
Burnout* 30.87±4.67 29.04±3.27 -0.65 .535

NICU=Neonatal Intensive Care Unit; PICU=Pediatric Intensive Care Unit; Exp.=Experimental group; Cont.=Control group.

Fisher’s exact test; *Mann-Whitney U test.

Table 4.
Comparison of Personal Growth, Compassion Satisfaction, Compassion Fatigue, and Burnout between Experimental and Control Groups (N=38)
Variable Time Exp. (n=15) Cont. (n=23) t or z p
M±SD
Personal Pre 38.80±11.23 41.00±12.98
   growth Post 53.27±10.46 40.48±10.42
Post-Pre 14.47±6.87 -0.52±7.30 -6.33 <.001
Compassion Pre 32.80±3.59 33.96±4.41
   satisfaction Post 34.73±3.58 34.52±3.85
Post-Pre 1.93±4.17 0.57±2.50 -1.27 .213
Compassion Pre 32.73±4.20 31.30±4.48
   fatigue Post 31.87±5.41 30.17±3.66
Post-Pre -0.87±3.27 -1.13±3.97 -0.21 .832
Burnout Pre 30.87±4.67 29.04±3.27
Post 27.87±3.20 29.09±3.66
Post-Pre* -3.00±3.27 0.04±2.23 -2.76 .005

Exp.=Experimental group; Cont.=Control group.

*Mann-Whitneey U test.

Table 5.
Qualitative Themes and Sub-themes Emerging from Focus Group Interview
Themes Sub-themes
1. Personal growth 1) Self-understanding through facing one’s
inner self
2) Emotional expression and resolution
through self-exposure
3) Restored comfort and confidence through
peer support
4) Having the opportunity for willingness to
practice self-care
5) Increase in spiritual interest
2. Professional 1) Increased capacity to cope with pediatric
growth patients’ death
2) Increased awareness of the importance of
the child
3) Improved empathy for the family of pediatric
patients
4) Looking for the value of professional nursing
roles and the motivational power of my job
5) Expecting continued support programs for
nurses
TOOLS
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