Date of Award


Degree Type


Degree Name

Doctor of Philosophy



First Advisor

Kathleen Sawin

Committee Members

Kathleen Sawin, Verna Hendricks-Ferguson, Julia Snethen, Josh Mersky, Sandra Underwood


Communication, End of Life, Nurse, Oncology, Palliative Care, Pediatric


Advances in cancer and supportive therapy have led to improved outcomes for children with cancer. Despite progress, children still die from complications of cancer therapy or their disease. Communication during palliative care and end of life is essential to successful navigation through the end of life continuum. Nurse communication during palliative care and end of life is a phenomenon with limited research, and it is unclear how the level of nursing experience influences the perspectives of nurses communicating during end of life. The purpose of this dissertation study was to describe the commonalities of nurses' experiences of communicating palliative care and end of life perspectives when caring for dying pediatric oncology patients, and perceptions of barriers and facilitators to effective communication. This study was part of a larger multi-site qualitative study. The framework that guided this study is based on empirical phenomenology as a research philosophy and approach, and on group-as-a-whole theory. This study represented focus group data gathered from 27 pediatric oncology nurses who had greater than five years of experience or who were advanced practice nurses not involved in the direct evaluation of other nurses. The overall finding was characterized as the "Essence of Experience", which reflected how the concept of experience transcended the core themes and provided nurses the know-how to optimize nurse PC/EOL communication. Five core themes with corresponding themes and subthemes surfaced from rich focus group discussions and supported the overall finding. The core themes included (a) evolution of PC/EOL, (b) skill of knowing, (c) expanded essence of caring, (d) experienced nurse as committed advocate, and (e) valuing individual response to grief. Enhancing nurse communication skills during palliative care and end of life requires opportunities to gain experience coupled with clinical strategies, such as standardized curricula, simulation, competency-based orientation programs, mentorship and peer support. Future research is needed to better understand outcomes associated with strategies aimed at improving nurse communication skills during palliative care and end of life in pediatric oncology.

Included in

Nursing Commons