# Making sense of pediatric death: An exploratory qualitative study of emotion management strategies applied by the pediatric intensive care unit interprofessional team

## TL;DR

This study explores how healthcare workers in pediatric intensive care units manage their emotions when dealing with child deaths, highlighting the impact of systemic and cultural factors.

## Contribution

The study provides a holistic, interprofessional perspective on emotion management strategies in PICUs, emphasizing uneven access to emotional support across professions.

## Key findings

- Clinicians use strategies like reframing death and managing emotions as part of quality care, but these are influenced by systemic constraints.
- Access to emotional support resources varies by profession and unit culture, affecting how clinicians cope with pediatric death.
- Emotional labor is a shared experience across roles, but individual and systemic factors can either facilitate or hinder emotion management.

## Abstract

Caring for children at the end of life is a reality of practice in the pediatric intensive care unit (PICU). Learning how to make sense of death at work, and the emotions it entails, is necessary for all PICU professionals.

To explore how PICU clinicians manage their emotions when encountering pediatric death at work.

Exploratory qualitative study grounded in interpretive phenomenology and the theoretical lens of emotional labor. We conducted one-time semi-structured interviews. Once transcribed, we inductively coded interview transcripts and subsequently generated themes through reflexive thematic analysis.

Fifteen clinicians (n = 3 respiratory therapists; n = 3 physicians; n = 3 child life specialists; n = 2 nurses; n = 2 physiotherapists; n = 2 social workers) practicing in Canadian PICUs. The majority identified as women (n = 13). Four participants self-identified as Black, Indigenous, and/or a person of color.

We generated four themes that influenced how clinicians managed emotions related to death in PICU: (1) Figuring it out on the job; (2) Reframing and rationalizing death; (3) Managing emotions as quality end-of-life care; (4) Navigating organizational constraints. Although clinicians shared many strategies and resources for managing emotions, the ability to apply these strategies was impacted by systemic constraints (e.g., pace of work, understaffing) and unequal access across professions to unit-level resources.

Navigating pediatric death in the workplace requires skilled emotional labor, and clinician access to appropriate support to manage its impacts, which varies by unit culture and profession. PICU leaders should facilitate unit- and individual-level supports that are inclusive of all team members.

Making sense of PICU death

(i) What is already known about the topic?

• End of life care in the pediatric intensive care unit (PICU) involves emotional labour, which comes with associated mental health risks.

• Despite the interprofessional nature of all PICU care, existing research on this phenomenon focuses primarily on the experience of nurses.

(ii) What this paper adds

• We interviewed interprofessional PICU staff to bring a holistic perspective on how the team manages emotions around death at work, underscoring uneven access to supports across professions.

• Emotion management strategies were shared across roles and career stages; these could be facilitated or impeded by individual and systemic factors.

(iii) Implications for practice, theory or policy

• Managing emotional labour associated with child death is exacerbated by constraints to accessing resources, particularly processing time immediately after the death and timely debriefs.

• PICU leaders and those in similar environments should consider the entire clinical team when designing mental health supports and advocate for systemic changes that support clinician wellbeing (e.g., efforts to improve retention).