Ethical and Moral Conflicts in the Nursing Care of Pediatric Patients With Cancer and Their Families

Abstract

BackgroundPediatric oncology nurses encounter ethical and moral dilemmas when providing comprehensive care to pediatric patients with cancer and their families.ObjectiveThe aim of this study was to explore ethical and moral conflicts arising in the field of pediatric oncology from the perspective of nursing professionals.MethodThis qualitative secondary analysis was conducted with 10 nursing professionals from a pediatric cancer hospital through semistructured interviews and analyzed using thematic data analysis.ResultsTwo themes emerged: (1) living with conflicts intrinsic to the relationships, which describes multiple sources of conflict in the relationships of nursing professionals with the team, with the family, and with seriously ill children, summarizing trigger-sensitive topics to be addressed for its mediation; (2) developing moral resilience, which represents how nurses reframe the conflicts and make use of strategies to avoid being personally harmful.ConclusionsThe results highlight the challenging work environment of pediatric oncology, recognizing the multiple natures of sensitive topics to nursing professionals during clinical decision making and the incipient strategies in dealing with ethical and moral conflicts.Implications for PracticeThis study reveals self-reflection and intuitive strategies as protective factors, which could be applied as a step to support nurses encountering ethical and moral conflicts in pediatric oncology daily practice. Furthermore, because of the limited support services for nursing professionals, it is necessary to foresee institutional policies to embrace the development of moral resilience.

Realities and ideals: Experiences and needs of pediatric oncology nurses in communication processes with children and their families at the end‐of‐life period: A photovoice qualitative study

“…The ethical dilemma of uncertainty about death emerged as a process that pediatric oncology nurses struggled with in the end‐of‐life period. Pediatric oncology nurses often find themselves walking the fine line between giving hope and explaining the reality of the situation (Dos Santos et al, 2023). This ethical dilemma continues to be an area that requires more support and training for pediatric oncology nurses (Jewitt et al, 2023; Richoux et al, 2022).…”

“…In addition, individual and environmental factors significantly influence end‐of‐life experiences and interactions in pediatric oncology (Joren et al, 2023; Hirata et al, 2023; Vassileva et al, 2023). In the study by Dos Santos et al, it was emphasized that in light of the conflicts that pediatric oncology nurses experience while dealing with end‐of‐life children and bereaved families, their strategies are individual practices such as getting away from the situation or seeking introspection, or social practices such as communicating with the other team (Dos Santos et al, 2023). In this context, it draws attention to the importance of accepting and respecting these individual and environmental factors when developing support strategies, coping mechanisms, or interventions.…”

“…Engaging in open and supportive communication with children and their families during the end‐of‐life period in pediatric oncology represents a challenging experience for nurses (Hirata & Kobayashi, 2023; Newman et al, 2019; Richoux et al, 2022). Also, achieving ideal communication can often be a struggle, shaped by numerous factors such as limited resources, emotional burdens, and individual capacities (Dos Santos et al, 2023; Richoux et al, 2022; Sisk, Harvey, et al, 2022; Sisk, Keenan, et al, 2022). Upon review of the literature, there are a limited number of qualitative studies that deeply elucidate the experiences of communication processes between nurses, children, and their families during the end‐of‐life period, a time when the relationship is expected to terminate (Montgomery et al, 2017; Sawin et al, 2019).…”

“…Engaging in open and supportive communication with children and their families during the end-of-life period in pediatric oncology represents a challenging experience for nurses (Hirata & Kobayashi, 2023;Newman et al, 2019;Richoux et al, 2022). Also, achieving ideal communication can often be a struggle, shaped by numerous factors such as limited resources, emotional burdens, and individual capacities (Dos Santos et al, 2023;Richoux et al, 2022;Sisk, Harvey, et al, 2022;Sisk, Keenan, et al, 2022).…”