Moving and Handling Children After Death: An Inductive Thematic Analysis of the Factors That Influence Decision Making by Children's Hospice Staff

Abstract

Hospices for children and adolescents in the United Kingdom provide care to the bodies of deceased children in specially designed chilled bedrooms called “cool rooms.” In an effort to develop resources to support hospice practitioners to provide this specialist area of care, this study aimed to identify the factors that influence decision making when moving and handling children's bodies after death in a hospice cool bedroom. An internet-based survey was sent to all practitioners employed by 1 children's hospice. A total of 94.9% of eligible staff responded (n = 56). An inductive approach to thematic analysis was undertaken, using a 6-phase methodological framework. Three core themes were identified that inform practitioners' perception of the appropriateness of moving and handling decisions: care of the body, stages of care, and method of handling. The complexity of decision making and variation in practice was identified. Practitioners relied on both analytical and initiative decision making, with more experienced practitioners using an intuitive approach. Evidence-based policy and training influence the perception of appropriateness and the decisions and behavior of practitioners. The development of a policy and education framework would support practitioners in caring for children's bodies after death, standardizing expectations and measures of competence in relation to moving and handling tasks.

Care after death in children’s hospices: recommendations for moving and handling, and for managing physiological deterioration

“…There were great variations in the way the 33 children's hospices delivered care after death, notably in the length of stay, interventions provided and equipment used (Tatterton et al 2021b). Most approaches were congruent with legal requirements (Health and Safety at Work etc.…”

“…In general, care was safe and professional guidelines were adhered to, but there were some examples of care that contradicted best practice, such as the use of bedsheets to move a body up or down a bed (Tatterton et al 2021b). Hospices expressed concern that, although they believed their practice was safe, they were also aware that it varied, was often left to individual practitioners and could potentially be inequitable.…”

“…An electronic survey was developed by the research team to explore care after death practices by staff in children's hospices in the UK. The survey was adapted from the questionnaire that had been used to explore staff's practices at Martin House (Tatterton et al 2021b). The research team included a funeral director (DB), moving and handling trainers (AH, NL, JG), staff nurses (LK, JL) and a nurse consultant (MT), all of whom are proficient in the moving and handling of the bodies of deceased children.…”

“…The survey comprised ten questions. More information can be found in Tatterton et al (2021aTatterton et al ( , 2021b.…”

“…This was followed by a survey of UK children's hospices to explore hospice practitioners' perspectives on caring for a child's body after death and on supporting bereaved families. Extensive findings have been described and discussed elsewhere (Tatterton et al 2021a(Tatterton et al , 2021b. Most hospices that responded to the survey called for specific guidance on care after death.…”