Caring for Children Dying of Cancer
This descriptive study explored and compared the grief responses and experiences of Greek physicians and nurses who provide care to children dying of cancer. Interviews were conducted with 14 oncologists and 16 pediatric oncology nurses. Data were subjected to a combination of qualitative and quantitative methods of analysis. For both groups, the dying process and death of children were highly stressful experiences and triggered a grieving process. Differences, however, were observed in terms of the way these two groups (a) perceived the loss of the child and (b) expressed or avoided their grief. It became apparent that health professionals' grieving process was affected by how they perceived their role, interventions, and contribution in the care of the dying child, which in turn was influenced by the social and cultural context in which care is provided to children with cancer. Findings suggest that despite the distress caused by children's death, both nurses and physicians identified specific rewards they reaped from caring for children who are terminally ill.

It is widely accepted that caring for patients who are terminally ill is a demanding and difficult task. Much attention has been given to the stress that health care professionals experience when caring for adult patients, and a number of personal and work-related factors have been identified as contributing to professional distress and burnout (Chiriboga, Jenkins, & Bailey, 1983; Jenkins & Ostchega, 1986; Papadatou, Anagnostopoulos, & Monos, 1994; Vachon, 1986, 1997; Yasko, 1983). Unfortunately, considerably fewer studies explore the distress of professionals who provide care to dying children, even though it is recognized that such care evokes intense fear, increased feelings of helplessness, and a spiritual quest for meaning in a death that is often perceived as reversing the order of nature (Oehler & Davidson, 1992). According to Kushnir, Rabin, and Azulai (1997), the major source of occupational stress among pediatric nurses is their preoccupation with the death and dying process of young patients.

Recently, there has been a shift from the study of stress and burnout to the understanding of professionals' responses to the death of children as grief manifestations (Davies et al., 1996; Hinds et al., 1994; Papadatou, Martinson, & Chung, 2001; Rashotte, Fothergrill-Bourbonnais, & Chamberlain, 1997). Davies and colleagues (1996) studied the responses of pediatric oncology nurses and identified a number of strategies they use to handle their distress over the death of their young patients. Strategies that facilitated adjustment involved the open expression of grief and the attribution of meaning to the child's death. Furthermore, peer support and a sense of being valued were identified as conditions that enhanced nurses' coping. By contrast, the personal or work-related expectations that did not allow the expression of grief constrained nurses' coping with patient loss. The use of various coping strategies in dealing with distress had personal and professional implications that affected both their involvement with dying children as well as their self-perception.

Papadatou, Martinson, and Chung (in press) recently studied the experiences of nurses who provide care to dying children in pediatric oncology and critical care units in Greece and Hong Kong. Findings revealed that regardless of work or cultural setting, nurses experience a grieving process characterized by a fluctuation between two psychic processes: one involves the experiencing and expression of grief; the other, the avoidance or repression of grief by moving away from the loss experience. This fluctuation process is normal, healthy, and adaptive, as it allows health care professionals to grieve without being overwhelmed by the loss experience (Papadatou, 2000).

The purpose of this descriptive study was to further explore the grieving process and compare the subjective experiences of physicians and nurses who provide care to children dying of cancer in Greece. More particularly, the authors were interested in answering the following questions: (a) What motivates professionals to work with seriously ill children? (b) What challenges do they encounter while caring for dying children? (c) How are they affected by children's death? and (d) What are some of the factors that affect their desire to stay or leave this particular field of work in which exposure to childhood death occurs more frequently than in many other fields of nursing?

This study was both a part, as well as an extension of, a transcultural study conducted with nurses who worked in pediatric oncology and intensive care units (Papadatou, Martinson, & Chung, in press). Results from the initial study invited the authors to further explore the similarities and differences between Greek nurses and physicians in terms of how they perceive and experience the dying process and death of children.

Quite recently, the concepts of "grief" and "mourning" have been the objects of redefinition and debate in the literature. Rando (2000) and Corr, Nabe, and Corr (1997) suggest that grief is the reactive response to loss, while mourning encompasses a series of actions undertaken to accommodate the loss within a person's life. By contrast, Stroebe and Schut (1998) define mourning as "the social expressions or acts, expressive of grief, which are shared by the practices of a given society or cultural group" (p. 7). In this study, the authors chose to define grieving as the process that comprises a person's grief responses and coping strategies in his or her attempt to adjust to an experience that is perceived as a loss and accommodated it into one's life.