Paediatric pain control

Our understanding of pain management in children has grown significantly in the past few decades; however, we still find reluctance to acknowledge and treat pain in children. Many myths prevail which, coupled with poor understanding, can undermine the effective treatment of pain in children. Understandably, many healthcare professionals are apprehensive and fearful about working with very sick and dying children; perhaps there is a sense of failure for being unable to ‘cure’. However, as pain is one of the most common symptoms in this group of children, relieving pain and distress can be an extremely rewarding experience. This chapter outlines the background and principles of understanding, evaluating, and treating pain in children with palliative care needs. It offers a basic overview of current understanding and practice and hopes to support healthcare professionals working in this challenging discipline.

Liberating Hope in the Context of Pediatric Care at the End of Life

The spiritual care of dying children and their families requires both sensitivity and competence. Parents – and adults, in general – not only recognize an intrinsic value in children, but also see them as important symbols of hope and as promise for the future. Hence, hope may be challenged when a child is facing death. From the field of spiritual and practical theology, this research attempts to correlate the experience of children and families, and Christian sources on hope. Particular attention is given to the importance of bodies and space, desires and fears, as well as to the role of narratives in order to deepen the meaning of hope in situations that seem bereft of it.

4526 Coping with End of Life Care: Compassion Fatigue and Burnout Effects on Cortisol Patterns of Health Care Providers Caring for Children

OBJECTIVES/GOALS: The objectives are to assess the impact of cumulative grief on the development of Compassion Fatigue (CF) and Burnout Syndrome (BS) in HCPs who care for dying children. We will also evaluate the relationship between CF and cortisol patterns in HCPs. METHODS/STUDY POPULATION: Cross-sectional study to be conducted in a Pediatric Hospital in Puerto Rico. A sample of 50 pediatric nurses will be selected to collect the data to evaluate the occurrence of CF and BS among HCP caring for children during end of life (EoL). Study subjects will include nurses who care for dying children in the Intensive Care Units and Oncology ward. Nurses working in the pediatric ward will be included as the control group. Three validated instruments (Spanish Version) will be administered (Professional Quality of Life vIV, Maslach Burnout Inventory- HSS, briefCOPE scale). Cortisol samples in saliva and hair will also be taken to determine levels in these HCPs. RESULTS/ANTICIPATED RESULTS: Our expected outcome is that CF and BS will be more frequent in HCPs caring for children during EoL compared with controls and that EoL nurses will have higher scores on CF scale and more frequent dysregulated cortisol patterns. DISCUSSION/SIGNIFICANCE OF IMPACT: Understanding how HCPs cope with grief caused by child death and the occurrence of CF and BO in our hispanic population allowing us to develop support strategies based on the specific HCPs needs. This knowledge will help improve HCPs’ well-being and may diminish the physiologic impact on cortisol.

Describing the pediatric resident experience in caring for dying patients.

51 Background: Cancer remains the leading cause of childhood death beyond infancy. Though growing subspecialty palliative care provides expertise in caring for dying children, all pediatricians encounter dying patients and should feel adequately prepared to participate in their care. Clinicians who feel insufficiently trained in communication or end-of-life care are more likely to distance themselves from seriously ill patients and report higher levels of distress and burnout. Pediatric residents are often responsible for the frontline care of dying children in the hospital and yet, most pediatric residencies lack a formal end-of-life curriculum. Here, we aim to understand the experience of pediatric residents caring for dying patients. Methods: A thirty-four item survey instrument was administered to residents in a large pediatric residency program at a tertiary care center at Rising Junior Orientation and Rising Senior Orientation in spring 2018. All residents present completed the survey. Results: Seventy-six residents completed surveys including 46 rising juniors and 30 rising seniors. Only 19 residents (25%) reported receiving any training in caring for dying children; most of which was by noon/morning conferences or informal teaching. Nearly all (70/74; 95%) residents felt that their training in caring for dying children was not sufficient. A majority of residents reported minimal to no comfort with discussion of goals of care (73%) or resuscitation status (69%), managing pain (76%), anxiety (79%), and dyspnea (80%) at the end-of-life, performing a death exam (81%), and reaching out to families after the death of a child (85%). A majority of residents anticipate continuing to care for dying children after residency (50/76; 66%). Conclusions: Pediatric residents are uncomfortable with caring for dying patients and receive minimal training, suggesting that end-of-life care is a large gap in the pediatric residency training experience.