What Does the Staff Think?: Factors Associated With Clinical Staff Perceptions of What Constitutes High-Quality Dying and Death at a Tertiary Pediatric Hospital

In an effort to improve the care of a dying child in the hospital, research was conducted to identify factors associated with the staff's perception of high-quality dying and death. The research used a unique electronic survey that was administered to clinical staff caring for children within the final 3 days of their life in the hospital. Positive death experiences were associated with absence of patient pain, dyspnea, anxiety, or agitation and the presence of spiritual, psychological, and culturally appropriate care for the patient and family. A positive correlation with quality was noted if there was clarity about goals of care and appropriate directives were in place to alleviate suffering. When clinicians felt their needs were met and they had more end-of-life education, they also perceived the quality of the experience as higher and had less distress from the event. Variability in perceived quality of the death experience was noted between different units of the hospital. Providing a supportive environment for pediatric deaths is enhanced by ensuring certain processes are in place and clinicians have the education and support to deliver high-quality care at the end of life.