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

Background: 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. Objective: To explore how PICU clinicians manage their emotions when encountering pediatric death at work. Design: 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. Methods: 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. Results: 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. Conclusion: 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.