The Social Organization of Terminal Care in Two Pediatric Hospitals

Abstract

This was a study of how staff organized behavior around dying children in two pediatric hospitals in a midwestern city. Both hospitals were observed for a period of a month, and eleven cases were compared in terms of staff organization of care and efforts of staff to adjust at death. Staff were seen to negotiate various demands upon care on the basis of whether or not they defined the death of a particular patient to be certain or uncertain. These definitions then served as guides to negotiations. Patients whose death was seen as uncertain had a higher claim of staff time than those whose death was considered certain. The result was that staff had less interaction with, and required less efforts to adjust after, the death of a child whose death was considered certain, and more involvement and more effort to adjust with the death of a child which was not considered certain. These strategies were not seen as preconceived plans of actions that were applied to situations but rather strategies that emerged as staff members attempted to negotiate varying demands upon time.