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Belser T, Exl MT, Nydahl P, Zumstein-Shaha M, Jeitziner MM. Experiences of parents visiting an adult family member in the intensive care unit accompanied by their underaged children: A qualitative study. Aust Crit Care 2024; 37:783-789. [PMID: 38631938 DOI: 10.1016/j.aucc.2024.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Revised: 02/12/2024] [Accepted: 02/16/2024] [Indexed: 04/19/2024] Open
Abstract
OBJECTIVES The objective of this study was to explore experiences and needs of parents visiting critically ill family members in intensive care units (ICUs) accompanied by their underaged children (<18 years). METHODS Six semistructured interviews with parents were conducted in a qualitative design. Data analysis and synthesis were performed using Braun and Clarke's thematic analysis. This study was conducted in five adult ICUs in Switzerland. FINDINGS Parents opted for early and truthful involvement of their children, and the majority initiated the visits themselves. Five themes were identified: feeling of shock by the entire family; crying in front of the children; feeling welcome with the children; knowing that the children can cope with it; and holding the family together. Parents felt only partially welcomed in the ICU when accompanied by their children. In one case, the parents withdrew the child from the visit. CONCLUSIONS Parents experienced the visit to a critically ill family member in the ICU with their underaged children as challenging. They were emotionally vulnerable and yet took the initiative to keep the family together. Parents had to mediate between their children, the critically ill family member, and the treatment team. Awareness of the needs of the parents visiting with underaged children is important in clinical practice. There is a need for family-centred structures and processes, including adequate visiting times and rooms suitable for children with books, pictures, and toys.
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Affiliation(s)
- Tanja Belser
- Department of Neurosurgery, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 18, 3010 Bern, Switzerland.
| | - Matthias Thomas Exl
- Department of Intensive Care Medicine, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 18, 3010 Bern, Switzerland.
| | - Peter Nydahl
- Nursing Research, University Hospital of Schleswig-Holstein, Arnold-Heller-Str. 3, 24105 Kiel, Germany; Institute of Nursing Science and Development, Paracelsus Medical University, Salzburg, Austria.
| | - Maya Zumstein-Shaha
- Bern University of Applied Sciences Health, Murtenstrasse 10, 3008 Bern, Switzerland; University of Witten/Herdecke, Department of Nursing, Alfred-Herrhausen-Strasse 50, 58448 Witten, Germany.
| | - Marie-Madlen Jeitziner
- Department of Intensive Care Medicine, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 18, 3010 Bern, Switzerland; Institute of Nursing Science (INS), Department of Public Health (DPH), Faculty of Medicine, University of Basel, Bernoullistrasse 28, 4056 Basel, Switzerland.
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Dryden-Palmer K, Shinewald A, O'Leary K. Supporting siblings during the critical illness hospitalization of a child: learning from experience. Front Pediatr 2024; 12:1337491. [PMID: 39252752 PMCID: PMC11381246 DOI: 10.3389/fped.2024.1337491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Accepted: 07/30/2024] [Indexed: 09/11/2024] Open
Abstract
Introduction Childhood critical illness impacts the entire family of the critically ill patient. Disruptions to usual family rhythms and routines, established relationships, physical relocations or shifts in caregivers, and the uncertainty about the patient's well-being can have significant impacts on siblings and other connected children in the family. Promoting and facilitating family interactions and engaging younger family members in the hospital experience have been shown to reduce patient and family anxiety, enhance family adaptation, and improve child and family outcomes. The critical care team can implement evidence-informed approaches to address and mitigate challenges for families and provide developmentally aligned support to impacted siblings. Aim This conceptual paper describes the potential impacts of a critical illness hospitalization on siblings, approaches to supporting siblings, and practical interventions drawn from a synthesis of the current literature and the author's practice experience caring for critically ill children and their families. Data sources A traditional review and narrative analysis moderated by the authors and supported by lived experience. Conclusions There is a range of impacts of a critical illness hospitalization on siblings and young family members of the patient. Providing consistent, transparent, and supportive child, sibling, and whole family-centered care can improve the experience and outcomes for the child and family.
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Affiliation(s)
- Karen Dryden-Palmer
- Paediatric Intensive Care Unit, The Hospital for Sick Children, Toronto, ON, Canada
- Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, ON, Canada
| | - Alexis Shinewald
- Paediatric Intensive Care Unit, The Hospital for Sick Children, Toronto, ON, Canada
- Child Life Program, The Hospital for Sick Children, Toronto, ON, Canada
| | - Kimberly O'Leary
- Child Life Program, The Hospital for Sick Children, Toronto, ON, Canada
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Butler AE, Clark TJ, Glazner J, Giallo R, Copnell B. "We want to include him in that journey": A qualitative descriptive study of parental experiences and considerations for sibling inclusion in the paediatric ICU. Intensive Crit Care Nurs 2024; 83:103696. [PMID: 38608616 DOI: 10.1016/j.iccn.2024.103696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Revised: 03/25/2024] [Accepted: 03/28/2024] [Indexed: 04/14/2024]
Abstract
OBJECTIVES Siblings are an important yet often forgotten part of the paediatric intensive care unit (PICU) family experience. Commonly, siblings are supported through the experience by their parents; however, very little is known about parental experiences of providing this support. This study aims to explore parental experiences of supporting sibling inclusion in PICU. RESEARCH METHODOLOGY/DESIGN This study utilised a qualitative descriptive approach to conduct semi-structured interviews with 6 parents of 5 children with congenital heart disease who had spent time in PICU. Data were analysed using reflexive thematic analysis. SETTING Australian PICUs. FINDINGS Parental considerations and experiences for sibling inclusion were identified across three key phases: Pre-inclusion, The PICU visit, and Post-inclusion. Prior to including siblings in PICU, parents considered various ways of sharing information with siblings, and weighed up the risks and benefits of bringing siblings into PICU. Parents also recounted a number of challenges and facilitators to a positive sibling experience in PICU, including supportive staff and fun activities. Finally, parents, identified that siblings require ongoing support after their inclusion in PICU and made suggestions for ongoing availability of information and supportive resources. CONCLUSIONS This study has illuminated key parental experiences when supporting sibling inclusion in PICU before, during and after their visit. By understanding these parental experiences, PICU staff can work with and support parents where needed, helping to achieve a positive sibling inclusion experience. IMPLICATIONS FOR CLINICAL PRACTICE Parents need ongoing support to explain the PICU to siblings of critically ill children and may benefit from specific visual resources to aid communication. In addition, PICUs should aim to ensure the physical layout is supportive of sibling needs, with dedicated spaces for siblings to play and take time out during their experience.
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Affiliation(s)
- Ashleigh E Butler
- School of Nursing and Midwifery, La Trobe University, Bundoora Campus, Melbourne, Australia. https://twitter.com/@AshleighEButler
| | - Tara-Jane Clark
- Paediatric Intensive Care Unit, The Royal Children's Hospital, Melbourne, Australia.
| | - Judith Glazner
- Department of Respiratory and Sleep Medicine, The Royal Children's Hospital, Melbourne, Australia.
| | - Rebecca Giallo
- The Centre for Social and Early Emotional Development, School of Psychology, Deakin University, Geelong, Australia; Intergenerational Health Group, Murdoch Children's Research Institute, Melbourne, Australia.
| | - Beverley Copnell
- School of Nursing and Midwifery, La Trobe University, Bundoora Campus, Melbourne, Australia. https://twitter.com/@Bev_Copnell
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Fontana I, Lissoni B, Fumagalli R. Beauty, the beautician and empathy in the intensive care unit. Intensive Care Med 2024; 50:612-613. [PMID: 38285050 DOI: 10.1007/s00134-024-07328-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Accepted: 01/17/2024] [Indexed: 01/30/2024]
Affiliation(s)
- Isabella Fontana
- Intensive Care Unit "Bozza", ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Barbara Lissoni
- Intensive Care Unit "Bozza", ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Roberto Fumagalli
- Intensive Care Unit "Bozza", ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy.
- Department of Medicine and Surgery, University of Milan-Bicocca, Monza, Italy.
- Department of Anesthesia and Intensive Care Medicine, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy.
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Strik JJMH, Tijssen KAM, Salamah HKZ, de la Haye N, Schieveld JNM. On children's visits, mobile phones and family empowerment in paediatric intensive care medicine. Intensive Care Med 2023; 49:710-711. [PMID: 37138121 PMCID: PMC10155646 DOI: 10.1007/s00134-023-07070-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/06/2023] [Indexed: 05/05/2023]
Affiliation(s)
- Jacqueline J M H Strik
- Division of Child and Adolescent Psychiatry and Psychology, Department of Psychiatry and Psychology, Maastricht University Medical Centre, PO Box 5800, 6202 AZ, Maastricht, The Netherlands.
- School for Mental Health and Neuroscience (MHeNs), Maastricht University, Maastricht, The Netherlands.
- Mutsaersstichting (Mutsaers Foundation and Educational Institute), Venlo, The Netherlands.
| | - Kim A M Tijssen
- Division of Child and Adolescent Psychiatry and Psychology, Department of Psychiatry and Psychology, Maastricht University Medical Centre, PO Box 5800, 6202 AZ, Maastricht, The Netherlands
- School for Mental Health and Neuroscience (MHeNs), Maastricht University, Maastricht, The Netherlands
| | - Husam K Z Salamah
- Division of Child and Adolescent Psychiatry and Psychology, Department of Psychiatry and Psychology, Maastricht University Medical Centre, PO Box 5800, 6202 AZ, Maastricht, The Netherlands
- School for Mental Health and Neuroscience (MHeNs), Maastricht University, Maastricht, The Netherlands
| | - Nicole de la Haye
- Department of Paediatrics, Maastricht University Medical Centre, Maastricht, The Netherlands
- Paediatric Intensive Care Unit (PICU), Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Jan N M Schieveld
- Division of Child and Adolescent Psychiatry and Psychology, Department of Psychiatry and Psychology, Maastricht University Medical Centre, PO Box 5800, 6202 AZ, Maastricht, The Netherlands
- School for Mental Health and Neuroscience (MHeNs), Maastricht University, Maastricht, The Netherlands
- Mutsaersstichting (Mutsaers Foundation and Educational Institute), Venlo, The Netherlands
- European Graduate School of Neuroscience (EURON), Maastricht, The Netherlands
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Brauchle M, Deffner T, Nydahl P. On children's visits, mobile phones and family empowerment in paediatric intensive care medicine. Author's reply. Intensive Care Med 2023; 49:712-713. [PMID: 37133739 PMCID: PMC10155643 DOI: 10.1007/s00134-023-07081-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/16/2023] [Indexed: 05/04/2023]
Affiliation(s)
- Maria Brauchle
- Department of Anaesthesiology and Intensive Care Medicine, Hospital Landeskrankenhaus Feldkirch, Carinagasse 35, 6800 Feldkirch, Austria
| | - Teresa Deffner
- Department of Anaesthesiology and Intensive Care Medicine, University Hospital Jena, Jena, Germany
| | - Peter Nydahl
- University Hospital of Schleswig-Holstein, Kiel, Germany
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Hauw-Berlemont C, Davagnar C, Champigneulle B, Bellenfant F, Aissaoui N. Patients' and relatives' concern about the children in their family when a family member is hospitalized in the adult ICU. Intensive Care Med 2023; 49:595-596. [PMID: 37017698 DOI: 10.1007/s00134-023-07035-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/11/2023] [Indexed: 04/06/2023]
Affiliation(s)
- Caroline Hauw-Berlemont
- Medical Intensive Care Unit, European Hospital Georges Pompidou, Assistance Publique-Hôpitaux de Paris, Université Paris Cité, Paris, France.
| | - Cindy Davagnar
- Medical Intensive Care Unit, European Hospital Georges Pompidou, Assistance Publique-Hôpitaux de Paris, Université Paris Cité, Paris, France
| | - Benoît Champigneulle
- Department of Anaesthesiology and Critical Care, European Hospital Georges Pompidou, Assistance Publique-Hôpitaux de Paris, Université Paris Cité, Paris, France
| | - Florence Bellenfant
- Department of Anaesthesiology and Critical Care, European Hospital Georges Pompidou, Assistance Publique-Hôpitaux de Paris, Université Paris Cité, Paris, France
| | - Nadia Aissaoui
- Medical Intensive Care Unit, European Hospital Georges Pompidou, Assistance Publique-Hôpitaux de Paris, Université Paris Cité, Paris, France
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Brauchle M, Deffner T, Brinkmann A, Dehner S, Dubb R, Finkeldei S, Gatzweiler B, Hermes C, Heyd C, Hoffmann M, Jeitziner MM, Kaltwasser A, Kern T, Knochel K, Krüger L, Melching H, Michels G, Müller-Wolff T, Pelz S, Rudolph J, Schindele D, Seidlein AH, Simon A, Ufelmann M, Nydahl P. [Children visiting intensive care units and emergency departments : Kids are welcome!]. Med Klin Intensivmed Notfmed 2023:10.1007/s00063-023-01004-z. [PMID: 37076742 PMCID: PMC10115374 DOI: 10.1007/s00063-023-01004-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Revised: 02/21/2023] [Accepted: 03/06/2023] [Indexed: 04/21/2023]
Abstract
In this white paper, key recommendations for visitation by children in intensive care units (ICU; both pediatric and adult), intermediate care units and emergency departments (ED) are presented. In ICUs and EDs in German-speaking countries, the visiting policies for children and adolescents are regulated very heterogeneously: sometimes they are allowed to visit patients without restrictions in age and time duration, sometimes this is only possible from the age of teenager on, and only for a short duration. A request from children to visit often triggers different, sometimes restrictive reactions among the staff. Management is encouraged to reflect on this attitude together with their employees and to develop a culture of family-centered care. Despite limited evidence, there are more advantages for than against a visit, also in hygienic, psychosocial, ethical, religious, and cultural aspects. No general recommendation can be made for or against visits. The decisions for a visit are complex and require careful consideration.
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Affiliation(s)
- Maria Brauchle
- Klinik für Anästhesie und Intensivmedizin, Landeskrankenhaus Feldkirch, Feldkirch, Österreich
| | - Teresa Deffner
- Klinik für Anästhesie und Intensivmedizin, Universitätsklinikum Jena, Jena, Deutschland
| | - Alexander Brinkmann
- Klinik für Anästhesie, operative Intensivmedizin und spezielle Schmerztherapie, Kliniken Landkreis Heidenheim gGmbH, Heidenheim, Deutschland
| | - Svenja Dehner
- Klinik fürAnästhesiologie, Intensiv- und Schmerztherapie mit Abteilung Palliativmedizin, Klinikum St. Georg gGmbH, Leipzig, Deutschland
| | - Rolf Dubb
- Akademie der Kreiskliniken Reutlingen GmbH, Reutlingen, Deutschland
| | - Simon Finkeldei
- KinderKrisenIntervention, der AETAS Kinderstiftung, München, Deutschland
| | - Birga Gatzweiler
- Ludwig-Maximilians-Universität Klinikum Kinderpalliativzentrum München, München, Deutschland
| | | | - Christian Heyd
- Weiterbildung in den Gesundheitsfachberufen, Universitätsmedizin Mainz, Mainz, Deutschland
| | - Magdalena Hoffmann
- Klinische Abteilung für Endokrinologie und Diabetologie, Universitätsklinik für Innere Medizin/Research Unit for Safety in Health, Klinische Abteilung für Plastische, Ästhetische und Rekonstruktive Chirurgie, Universitätsklinik für Chirurgie, Medizinische Universität Graz, Graz, Österreich
- Stabsstelle Qualitätsmanagement-Risikomanagement, Landeskrankenhaus(LKH)-Universitätsklinikum Graz, Graz, Österreich
| | - Marie-Madlen Jeitziner
- Universitätsklinik für Intensivmedizin, Universitätsspital Bern (Inselspital), Universität Bern, Bern, Schweiz
| | | | - Tita Kern
- KinderKrisenIntervention der AETAS Kinderstiftung, München, Deutschland
| | - Kathrin Knochel
- Klinikum rechts der Isar, Technische Universität München, München, Deutschland
| | - Lars Krüger
- Herz- und Diabeteszentrum NRW, Universitätsklinikum der Ruhr-Universität Bochum, Bad Oeynhausen, Deutschland
| | - Heiner Melching
- Deutsche Gesellschaft für Palliativmedizin, Berlin, Deutschland
| | - Guido Michels
- Klinik für Akut- und Notfallmedizin, St.-Antonius-Hospital gGmbH, Eschweiler, Deutschland
| | | | - Sabrina Pelz
- Universitäts- und Rehabilitationskliniken Ulm, Ulm, Deutschland
| | - Julian Rudolph
- Abteilung für Anästhesie und Intensivmedizin, Landeskrankenhaus Feldkirch, Feldkirch, Österreich
| | - Denise Schindele
- Regionale Kliniken Holding, Klinikum Ludwigsburg, Ludwigsburg, Deutschland
| | - Anna-Henrikje Seidlein
- Institut für Ethik und Geschichte der Medizin, Zentrum für Intensiv- und Überwachungspflege, Universitätsmedizin Greifswald, Greifswald, Deutschland
| | - Arne Simon
- Klinik für Pädiatrische Onkologie und Hämatologie, Universitätsklinikum des Saarlandes, Homburg/Saar, Deutschland
| | - Marina Ufelmann
- Pflegedirektion/Bildungszentrum Klinikum rechts der Isar, Technische Universität München, München, Deutschland
| | - Peter Nydahl
- Pflegeforschung und -entwicklung, Universitätsklinikum Schleswig-Holstein Kiel, Kiel, Deutschland.
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