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Zhang SM, Chan YY, Lai LL, Liang PR, Lin M. Parental Postoperative Pain Management Perceptions, Attitudes, and Practices in Pediatric Limb Fractures. Pain Manag Nurs 2023; 24:506-512. [PMID: 37574333 DOI: 10.1016/j.pmn.2023.07.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Revised: 06/11/2023] [Accepted: 07/20/2023] [Indexed: 08/15/2023]
Abstract
BACKGROUND Post-surgical pain in children is common, severe, and inadequately controlled. An effective model should involve the participation of parents. AIMS To investigate parental perceptions, attitudes, and practices in postoperative pain management in children with limb fractures and analyze the factors affecting parental practices. DESIGN This was a descriptive cross-sectional study. SETTINGS Research was conducted at a tertiary Children's Hospital Affiliated with Soochow University. PARTICIPANTS Parents whose children (age, 6-18 years) underwent orthopedic fracture surgery between January 1, 2020, and August 31, 2020, were recruited using purposive sampling. METHODS The parents were asked to complete self-report questionnaires: "Pain Management Knowledge and Attitudes Questionnaire" and "Parents' Use of Pain Relief Strategies Questionnaire." The Wong-Baker Faces Scale was used to measure pain intensity in children. The Mann-Whitney U test, Kruskal-Wallis H test, and correlation and regression analyses were used for statistical analyses. RESULTS Data of 180 parents were collected. Of the participants, 80.6%, 78.3%, and 71.7% had low-to-moderate scores for knowledge, general attitudes, and use of pain relief strategies, respectively. Moreover, 93.9% of parents had moderate-to-high scores for negative attitudes toward medication, despite 89.5% of them reporting moderate-to-high pain intensities in their children (median proxy-report of pain intensity, 7.0 [3.00]). Multivariate linear stepwise regression showed that parents' use of pain-relief strategies was related to their general attitudes, knowledge, and sex. CONCLUSIONS Most parents had low-to-moderate scores for perceptions and general attitudes toward children's postoperative pain management, and use of pain relief strategies. Moreover, they lacked knowledge of and had negative attitudes toward pain assessment and analgesics, which significantly impacted their practices. CLINICAL IMPLICATIONS Clinical pediatric nurses should provide appropriate support for the entire family of the child. Moreover, to enhance parental practices, they should develop targeted parental education programs for pain management, particularly regarding pain assessment tools and pain medications.
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Affiliation(s)
- Su-Mei Zhang
- Nursing Department, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, China; Department of Orthopedic Surgery, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, China.
| | - Yu-Ying Chan
- Discipline Supervision Office, Children's Hospital of Soochow University, Suzhou, Jiangsu Province, China
| | - Li-Li Lai
- Nursing Department, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, China; Department of Orthopedic Surgery, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, China
| | - Pei-Rong Liang
- Department of Orthopedic Surgery, Children's Hospital of Soochow University, Suzhou, Jiangsu Province, China
| | - Mao Lin
- Department of Orthopedic Surgery, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, China
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2
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Broden EG, Mazzola E, DeCourcey DD, Blume ED, Wolfe J, Snaman JM. The roles of preparation, location, and palliative care involvement in parent-perceived child suffering at the end of life. J Pediatr Nurs 2023; 72:e166-e173. [PMID: 37355461 DOI: 10.1016/j.pedn.2023.06.024] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Revised: 06/14/2023] [Accepted: 06/14/2023] [Indexed: 06/26/2023]
Abstract
PURPOSE Parents' perceptions of their child's suffering affect their bereavement experience. Identifying factors that shape parental perceptions of suffering could help build effective supportive interventions for children and parents navigating EOL and grief. We aimed to compare parent-perceived child suffering between diagnostic groups and identify related factors. DESIGN AND METHODS We combined databases from 3 surveys of parents whose children who died following cancer, a complex chronic condition (CCC), or advanced heart disease. We built multivariable logistic regression models to identify relationships between parent-perceived child suffering and parent/child, illness experience, and care-related factors. RESULTS Among 277 parents, 41% rated their child's suffering as moderate or high. Fifty-seven percent of parents whose child died from cancer reported that their child suffered "a lot" or "a great deal" at EOL, compared to 33% whose child died from a CCC, and 17% whose child died from heart disease (P < 0.001). Preparation for EOL symptoms was associated with decreased parent-perceived child suffering in multivariable modeling, with parents who were prepared for EOL 68% less likely to rate their child's suffering as high compared to those who felt unprepared (AOR: 0.32, CI [0.13-0.77], P = 0.013). CONCLUSIONS Preparing families for their child's EOL may help mitigate lingering perceptions of suffering. Operationalizing preparation is crucial to optimizing family support during EOL care. IMPLICATIONS TO PRACTICE Preparation for symptoms, and access to resources, including medical/psychosocial interventions and staff, may help ease parental perception of EOL suffering. Clinicians should prioritize preparing families for what to expect during a child's dying process.
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Affiliation(s)
- Elizabeth G Broden
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, MA, USA.
| | - Emanuele Mazzola
- Department of Data Science, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Danielle D DeCourcey
- Department of Pediatrics, Harvard Medical School, Boston, MA, USA; Division of Medical Critical Care, Boston Children's Hospital, Boston, MA, USA
| | - Elizabeth D Blume
- Department of Pediatrics, Harvard Medical School, Boston, MA, USA; Department of Cardiology, Boston Children's Hospital, Boston, MA, USA
| | - Joanne Wolfe
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, MA, USA; Department of Pediatrics, Harvard Medical School, Boston, MA, USA
| | - Jennifer M Snaman
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, MA, USA; Department of Pediatrics, Harvard Medical School, Boston, MA, USA
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3
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Zayegh AM. Addressing Suffering in Infants and Young Children Using the Concept of Suffering Pluralism. JOURNAL OF BIOETHICAL INQUIRY 2022; 19:203-212. [PMID: 35089498 DOI: 10.1007/s11673-021-10161-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Accepted: 10/27/2021] [Indexed: 06/14/2023]
Abstract
Despite the central place of suffering in medical care, suffering in infants and nonverbal children remains poorly defined. There are epistemic problems in the detection and treatment of suffering in infants and normative problems in determining what is in their best interests. A lack of agreement on definitions of infant suffering leads to misunderstanding, mistrust, and even conflict amongst clinicians and parents. It also allows biases around intensive care and disability to (mostly unconsciously) affect medical decision-making on behalf of infants. In this paper, I propose the concept of suffering pluralism, which is a novel multidimensional view of infant suffering based on subjective and objective components. The concept of suffering pluralism is more inclusive of the multiple ways in which infant suffering can occur. It acknowledges and defines a subjective component to infant suffering, while also focusing moral attention on objective well-being by describing it using the language of suffering. This concept allows us to better weigh up subjective and objective components of well-being. It also encourages clarity and consistency in claiming suffering, which is likely to improve communication and reduce conflict in medical decision-making for unwell infants and children. I will end by exploring possible critiques and limitations of this concept.
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Affiliation(s)
- Amir M Zayegh
- The Royal Women's Hospital Melbourne, Locked Bag 300, Corner Grattan St & Flemington Rd, Parkville, Melbourne, 3052, Australia.
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4
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Broden EG, Hinds PS, Werner-Lin A, Quinn R, Asaro LA, Curley MAQ. Nursing Care at End of Life in Pediatric Intensive Care Unit Patients Requiring Mechanical Ventilation. Am J Crit Care 2022; 31:230-239. [PMID: 35466341 PMCID: PMC11289849 DOI: 10.4037/ajcc2022294] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
BACKGROUND Parents' perceptions of critical care during the final days of their child's life shape their grief for decades. Little is known about nursing care needs of children actively dying in the pediatric intensive care unit (PICU). OBJECTIVES To examine associations between patient characteristics, circumstances of death, and nursing care requirements for children who died in the PICU. METHODS A secondary analysis of the data set from the Randomized Evaluation of Sedation Titration for Respiratory Failure trial was conducted. RESULTS This analysis included 104 children; 67 died after withdrawal of life-sustaining treatments; 21, after failed resuscitation; and 16, after brain death. Patients had a median age of 7.5 years, were cognitively appropriate, and were intubated for acute respiratory failure. Daily pain and sedation scores indicated patients' comfort was well managed (mean pain scores: modal, 0; peak, 2; mean sedation scores: modal, -2; peak, -1). Patients with longer PICU stays more often experienced pain and agitation on the day of death. Illness trajectory (acute, complex chronic condition, or cancer) was associated with pain scores (P = .04). Specifically, children with cancer had higher pain scores than children with acute illness trajectories (P = .01). Many patients (62%) had no change in critical care devices in their last days of life (median, 5 devices). Patterns of pain, sedation, comfort medications, and nursing care requirements did not differ by circumstances of death. CONCLUSION Children with cancer and longer PICU stays may need comprehensive comfort management. Invasive devices left in place during withdrawal of life support may have inhibited parents' ability to connect with their child. Future research should incorporate parents' perspectives.
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Affiliation(s)
- Elizabeth G Broden
- Elizabeth G. Broden is a postdoctoral research fellow in psychosocial oncology and palliative care at Dana-Farber Cancer Institute, Boston, Massachusetts, and a pediatric ICU/CICU nurse at Yale New Haven Children's Hospital, New Haven, Connecticut
| | - Pamela S Hinds
- Pamela S. Hinds is the William and Joanne Conway Chair in Nursing Research and executive director of Nursing Science, Professional Practice, and Quality Outcomes, Children's National Hospital, Washington, DC, and a pediatrics professor, George Washington University, Washington, DC
| | - Allison Werner-Lin
- Allison Werner-Lin is an associate professor, University of Pennsylvania School of Social Policy and Practice, Philadelphia, Pennsylvania, and a senior advisor, National Cancer Institute, Bethesda, Maryland
| | - Ryan Quinn
- Ryan Quinn is a biostatistician, Biostatistics Evaluation Collaboration Consultation and Analysis Lab, University of Pennsylvania School of Nursing, Philadelphia, Pennsylvania
| | - Lisa A Asaro
- Lisa A. Asaro is a biostatistician, Department of Cardiology, Boston Children's Hospital, Boston, Massachusetts
| | - Martha A Q Curley
- Martha A. Q. Curley is the Ruth M. Colket Endowed Chair in Pediatric Nursing, Research Institute, Children's Hospital of Philadelphia, Pennsylvania; a professor, University of Pennsylvania School of Nursing, Philadelphia, Pennsylvania; and a professor, Anesthesia and Critical Care Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
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Stilwell P, Hudon A, Meldrum K, Pagé MG, Wideman TH. What is Pain-Related Suffering? Conceptual Critiques, Key Attributes, and Outstanding Questions. THE JOURNAL OF PAIN 2022; 23:729-738. [PMID: 34852304 DOI: 10.1016/j.jpain.2021.11.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Revised: 11/11/2021] [Accepted: 11/12/2021] [Indexed: 11/19/2022]
Abstract
Suffering holds a central place within pain research, theory, and practice. However, the construct of pain-related suffering has yet to be operationalized by the International Association for the Study of Pain and is largely underdeveloped. Eric Cassell's seminal work on suffering serves as a conceptual anchor for the limited pain research that specifically addresses this construct. Yet, important critiques of Cassell's work have not been integrated within the pain literature. This Focus Article aims to take a preliminary step towards an updated operationalization of pain-related suffering by 1) presenting key attributes of pain-related suffering derived from a synthesis of the literature and 2) highlighting key challenges associated with Cassell's conceptualization of suffering. We present 4 key attributes: 1) pain and suffering are inter-related, but distinct experiences, 2) suffering is a subjective experience, 3) the experience of suffering is characterized by a negative affective valence, and 4) disruption to one's sense of self is an integral part of suffering. A key outstanding challenge is that suffering is commonly viewed as a self-reflective and future-oriented process, which fails to validate many forms of suffering and marginalizes certain populations. Future research addressing different modes of suffering - with and without self-reflection - are discussed. PERSPECTIVE: This article offers a preliminary step toward operationalizing the construct of pain-related suffering and proposes priorities for future research. A robust operationalization of this construct is essential to developing clinical strategies that aim to better recognize and alleviate suffering among people living with pain.
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Affiliation(s)
- Peter Stilwell
- School of Physical and Occupational Therapy, McGill University, Montreal, Quebec, Canada; Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR), IURDPM, CIUSSS-Centre-Sud-de-l'Ile-de-Montréal, Montreal, Quebec, Canada
| | - Anne Hudon
- Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR), IURDPM, CIUSSS-Centre-Sud-de-l'Ile-de-Montréal, Montreal, Quebec, Canada; School of Rehabilitation, Université de Montréal, Montreal, Quebec, Canada; Ethics Research Center (CRÉ), Montreal, Quebec, Canada
| | | | - M Gabrielle Pagé
- Department of Anesthesiology and Pain Medicine, Université de Montréal, Montreal, Quebec, Canada; Department of Psychology, Université de Montréal, Montreal, Quebec, Canada; Centre de recherche du Centre hospitalier de l'Universite de Montréal (CRCHUM), Montreal, Quebec, Canada
| | - Timothy H Wideman
- School of Physical and Occupational Therapy, McGill University, Montreal, Quebec, Canada; Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR), IURDPM, CIUSSS-Centre-Sud-de-l'Ile-de-Montréal, Montreal, Quebec, Canada.
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Affiliation(s)
- David Isaacs
- Clinical Ethics, Sydney Children's Hospital Network, Sydney, New South Wales, Australia
| | - Anne Preisz
- Clinical Ethics, Sydney Children's Hospital Network, Sydney, New South Wales, Australia.,School of Medicine, University of Notre Dame, Sydney, New South Wales, Australia
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Fortney CA, Baughcum AE, Moscato EL, Winning AM, Keim MC, Gerhardt CA. Bereaved Parents' Perceptions of Infant Suffering in the NICU. J Pain Symptom Manage 2020; 59:1001-1008. [PMID: 31837457 DOI: 10.1016/j.jpainsymman.2019.12.007] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Revised: 11/27/2019] [Accepted: 12/02/2019] [Indexed: 11/20/2022]
Abstract
CONTEXT It is challenging to provide supportive intensive care to infants in the neonatal intensive care unit (NICU), giving them every chance for survival, while also trying to minimize suffering for both the infant and parents. Parents who believe their infant is suffering may alter treatment goals based on their perceptions; however, it is unknown how parents come to believe that their infant may be suffering. OBJECTIVES To examine bereaved parents' perceptions of infant suffering in the NICU. METHODS Parents completed a qualitative interview exploring their perceptions of the level of suffering that their infant experienced at the end of life. Parents whose infant died in a large Midwestern Level IV regional referral NICU from July 2009 to July 2014 were invited to participate. Thirty mothers and 16 fathers from 31 families (31 of 249) participated in telephone interviews between three months and five years after their infant's death. RESULTS Four themes emerged from the qualitative analysis: 1) the presence/absence of suffering, 2) indicators of suffering, 3) temporal components of suffering (trajectory), and 4) influence of perceived suffering on parents, infants, and clinical decision making. CONCLUSION Parents used signs exhibited by infants, as well as information they received from the health care team to form their perceptions of suffering. Perceived suffering followed different trajectories and influenced the decisions that parents made for their infant. Soliciting parent perspectives may lead to improvements in the understanding of infant well-being, particularly suffering, as well as how parents rely on these perceptions to make treatment decisions for their infant.
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Affiliation(s)
- Christine A Fortney
- Center for Biobehavioral Health, The Research Institute at Nationwide Children's Hospital, Columbus, Ohio, USA; Martha S. Pitzer Center for Women, Children, and Youth, College of Nursing, The Ohio State University, Columbus, Ohio, USA.
| | - Amy E Baughcum
- Department of Psychology and Neuropsychology, Nationwide Children's Hospital, Columbus, Ohio, USA; Department of Pediatrics, College of Medicine, The Ohio State University, Columbus, Ohio, USA
| | - Emily L Moscato
- Center for Biobehavioral Health, The Research Institute at Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Adrien M Winning
- Center for Biobehavioral Health, The Research Institute at Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Madelaine C Keim
- Center for Biobehavioral Health, The Research Institute at Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Cynthia A Gerhardt
- Center for Biobehavioral Health, The Research Institute at Nationwide Children's Hospital, Columbus, Ohio, USA; Department of Psychology and Neuropsychology, Nationwide Children's Hospital, Columbus, Ohio, USA; Department of Pediatrics, College of Medicine, The Ohio State University, Columbus, Ohio, USA; Department of Psychology, The Ohio State University, Columbus, Ohio, USA
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8
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Marland E, Davies B. In the child's best interests: should life be sustained when further treatment is futile? Nurs Child Young People 2019; 31:23-27. [PMID: 31637896 DOI: 10.7748/ncyp.2019.e1107] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/21/2019] [Indexed: 06/10/2023]
Abstract
The aim of this article is to explore the concept of medical futility and the withdrawal of care for children in intensive care units. There have been several recent cases where medical staff have considered that there was no possibility of recovery for a child, yet their clinical judgments were challenged by the parents. The private anguish of these families became public, social media heightened emotions and this was followed by political and religious intrusion. Innovations in medical treatment and technological advances raise issues for all those involved in the care of children and young people especially when decisions need to be made about end of life care. Healthcare professionals have a moral and legal obligation to determine when treatment should cease in cases where it is determined to be futile. The aim should be to work collaboratively with parents but all decisions must be made in the best interests of the child. However, medical staff and parents may have differing opinions about care decisions. In part, this may be as a result of their unique relationships with the child and different understanding of the extent to which the child is in discomfort or can endure pain.
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Affiliation(s)
- Emma Marland
- Neonatal department, Royal Victoria Infirmary, Newcastle upon Tyne, England
| | - Barbara Davies
- Children's nursing, University of Northumbria, Newcastle upon Tyne, England
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Salter EK. The new futility? The rhetoric and role of "suffering" in pediatric decision-making. Nurs Ethics 2019; 27:16-27. [PMID: 31032704 DOI: 10.1177/0969733019840745] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
This article argues that while the presence and influence of "futility" as a concept in medical decision-making has declined over the past decade, medicine is seeing the rise of a new concept with similar features: suffering. Like futility, suffering may appear to have a consistent meaning, but in actuality, the concept is colloquially invoked to refer to very different experiences. Like "futility," claims of patient "suffering" have been used (perhaps sometimes consciously, but most often unconsciously) to smuggle value judgments about quality of life into decision-making. And like "futility," it would behoove us to recognize the need for new, clearer terminology. This article will focus specifically on secondhand claims of patient suffering in pediatrics, but the conclusions could be similarly applied to medical decisions for adults being made by surrogate decision-makers. While I will argue that suffering, like futility, is not sufficient wholesale justification for making unilateral treatment decisions, I will also argue that claims of patient suffering cannot be ignored, and that they almost always deserve some kind of response. In the final section, I offer practical suggestions for how to respond to claims of patient suffering.
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Mu PF, Tseng YM, Wang CC, Chen YJ, Huang SH, Hsu TF, Florczak KL. Nurses’ Experiences in End-of-Life Care in the PICU: A Qualitative Systematic Review. Nurs Sci Q 2018; 32:12-22. [DOI: 10.1177/0894318418807936] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The experiences of end-of-life care by nurses in the pediatric intensive care unit are the subject of this systematic review. Six qualitative articles from three different countries were chosen for the review using methods from Joanna Briggs Institute. The themes discovered included the following: insufficient communication, emotional burden, moral distress from medical futility, strengthening resilience, and taking steps toward hospice. These themes are discussed in detail followed by recommendations for practice to assist nurses in their quest for a good death for their pediatric patients.
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11
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Hill C, Knafl KA, Santacroce SJ. Family-Centered Care From the Perspective of Parents of Children Cared for in a Pediatric Intensive Care Unit: An Integrative Review. J Pediatr Nurs 2018; 41:22-33. [PMID: 29153934 PMCID: PMC5955783 DOI: 10.1016/j.pedn.2017.11.007] [Citation(s) in RCA: 72] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2017] [Revised: 11/08/2017] [Accepted: 11/08/2017] [Indexed: 10/18/2022]
Abstract
PROBLEM The Institute for Patient- and Family-Centered Care's (IPFCC) definition of family-centered care (FCC) includes the following four core concepts: respect and dignity, information sharing, participation, and collaboration. To date, research has focused on the provider experience of FCC in the PICU; little is known about how parents of children hospitalized in the pediatric intensive care unit (PICU) experience FCC. ELIGIBILITY CRITERIA Articles were included if they were published between 2006 and 2016, included qualitative, quantitative, or mixed methods results, related to care received in a PICU, and included results that were from a parent perspective. SAMPLE 49 articles from 44 studies were included in this review; 32 used qualitative/mixed methods and 17 used quantitative designs. RESULTS The concepts of respect and dignity, information sharing, and participation were well represented in the literature, as parents reported having both met and unmet needs in relation to FCC. While not explicitly defined in the IPFCC core concepts, parents frequently reported on the environment of care and its impact on their FCC experience. CONCLUSIONS As evidenced by this synthesis, parents of critically ill children report both positive and negative FCC experiences relating to the core concepts outlined by the IPFCC. IMPLICATIONS There is a need for better understanding of how parents perceive their involvement in the care of their critically ill child, additionally; the IPFCC core concepts should be refined to explicitly include the importance of the environment of care.
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Affiliation(s)
- Carrie Hill
- University of North Carolina at Chapel Hill, School of Nursing, Chapel Hill, NC, United States.
| | - Kathleen A Knafl
- University of North Carolina at Chapel Hill, School of Nursing, Chapel Hill, NC, United States
| | - Sheila Judge Santacroce
- University of North Carolina at Chapel Hill, School of Nursing, Chapel Hill, NC, United States
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Hebert LM, Watson AC, Madrigal V, October TW. Discussing Benefits and Risks of Tracheostomy: What Physicians Actually Say. Pediatr Crit Care Med 2017; 18:e592-e597. [PMID: 28938289 PMCID: PMC5716895 DOI: 10.1097/pcc.0000000000001341] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES When contemplating tracheostomy placement in a pediatric patient, a family-physician conference is often the setting for the disclosure of risks and benefits of the procedure. Our objective was to compare benefits and risks of tracheostomy presented during family-physician conferences to an expert panel's recommendations for what should be presented. DESIGN We conducted a retrospective review of 19 transcripts of audio-recorded family-physician conferences regarding tracheostomy placement in children. A multicenter, multidisciplinary expert panel of clinicians was surveyed to generate a list of recommended benefits and risks for comparison. Primary analysis of statements by clinicians was qualitative. SETTING Single-center PICU of a tertiary medical center. SUBJECTS Family members who participated in family-physician conferences regarding tracheostomy placement for a critically ill child from April 2012 to August 2014. MEASUREMENTS AND MAIN RESULTS We identified 300 physician statements describing benefits and risks of tracheostomy. Physicians were more likely to discuss benefits than risks (72% vs 28%). Three broad categories of benefits were identified: 1) tracheostomy would limit the impact of being in the PICU (46%); 2) perceived obstacles of tracheostomy can be overcome (34%); and 3) tracheostomy optimizes respiratory health (20%). Risks fell into two categories: tracheostomy involves a big commitment (71%), and it has complications (29%). The expert panel's recommendations were similar to risks and benefits discussed during family conferences; however, they suggested physicians present an equal balance of discussion of risks and benefits. CONCLUSIONS When discussing tracheostomy placement, physicians emphasized benefits that are shared by physicians and families while minimizing the risks. The expert panel recommended a balanced approach by equally weighing risks and benefits. To facilitate educated decision making, physicians should present a more extensive range of risks and benefits to families making this critical decision.
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Affiliation(s)
- Lauren M. Hebert
- Children’s Hospital at Memorial University Medical Center, Savannah, Georgia
- Mercer University School of Medicine Department of Pediatrics, Savannah, Georgia
| | - Anne C. Watson
- Children’s National Health Systems, Washington, District of Columbia
| | - Vanessa Madrigal
- Children’s National Health Systems, Washington, District of Columbia
- The George Washington University School of Medicine and Health Sciences Department of Pediatrics, Washington, District of Columbia
| | - Tessie W. October
- Children’s National Health Systems, Washington, District of Columbia
- The George Washington University School of Medicine and Health Sciences Department of Pediatrics, Washington, District of Columbia
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Bolt EE, Flens EQ, Pasman HRW, Willems D, Onwuteaka-Philipsen BD. Physician-assisted dying for children is conceivable for most Dutch paediatricians, irrespective of the patient's age or competence to decide. Acta Paediatr 2017; 106:668-675. [PMID: 27727473 DOI: 10.1111/apa.13620] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2016] [Revised: 09/13/2016] [Accepted: 10/06/2016] [Indexed: 11/27/2022]
Abstract
AIM Paediatricians caring for severely ill children may receive requests for physician-assisted dying (PAD). Dutch euthanasia law only applies to patients over 12 who make well-considered requests. These limitations have been widely debated, but little is known about paediatricians' positions on PAD. We explored the situations in which paediatricians found PAD conceivable and described the roles of the patient and parents, the patient's age and their life expectancy. METHODS We sent a questionnaire to a national sample of 276 Dutch paediatricians and carried out semi-structured interviews with eight paediatricians. RESULTS The response rate was 62%. Most paediatricians said performing PAD on request was conceivable (81%), conceivability was independent of the patient's age and whether the patient or parent(s) requested it. The paediatricians interviewed felt a duty to relieve suffering, irrespective of the patient's age or competency to decide. When this was not possible through palliative care, PAD was seen as an option for all patients who were suffering unbearably, although some paediatricians saw parental agreement and reduced life expectancy as prerequisites. CONCLUSION Most Dutch paediatricians felt PAD was conceivable, even under the age of 12 if requested by the parents. They seemed driven by a sense of duty to relieve suffering.
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Affiliation(s)
- Eva Elizabeth Bolt
- Department of Public and Occupational Health; EMGO Institute for Health and Care Research; VUmc Expertise Centre for Palliative Care; VU University Medical Center; Amsterdam The Netherlands
| | - Eva Quirien Flens
- Department of Public and Occupational Health; EMGO Institute for Health and Care Research; VUmc Expertise Centre for Palliative Care; VU University Medical Center; Amsterdam The Netherlands
| | - H. Roeline Willemijn Pasman
- Department of Public and Occupational Health; EMGO Institute for Health and Care Research; VUmc Expertise Centre for Palliative Care; VU University Medical Center; Amsterdam The Netherlands
| | - Dick Willems
- Section of Medical Ethics; Department of General Practice; Academic Medical Center; University of Amsterdam; Amsterdam The Netherlands
| | - Bregje Dorien Onwuteaka-Philipsen
- Department of Public and Occupational Health; EMGO Institute for Health and Care Research; VUmc Expertise Centre for Palliative Care; VU University Medical Center; Amsterdam The Netherlands
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Clément de Cléty S, Friedel M, Verhagen AAE, Lantos JD, Carter BS. Please Do Whatever It Takes to End Our Daughter's Suffering! Pediatrics 2016; 137:peds.2015-3812. [PMID: 26644491 DOI: 10.1542/peds.2015-3812] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/15/2015] [Indexed: 11/24/2022] Open
Abstract
What is the best way to care for a child with severe neurologic impairment who seems to be dying and is in intractable pain? Can we give sedation as we remove life support? Is it ethically permissible to hasten death? In the United States, 5 states have legalized assisted suicide (although only for competent adults). In Belgium and the Netherlands, euthanasia is legal for children under some circumstances. We present a case in which parents and doctors face difficult decisions about palliative care. Experts from Belgium, the Netherlands, and the United States then discuss how they would respond to such a case.
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Affiliation(s)
| | - Marie Friedel
- Haute Ecole Vinci and Université catholique de Louvain, Brussels, Belgium
| | - A A Eduard Verhagen
- Beatrix Children's Hospital, University Medical Center Groningen, University of Groningen, Groningen, Netherlands; and
| | - John D Lantos
- Children's Mercy Hospital and University of Missouri, Kansas City, Missouri
| | - Brian S Carter
- Children's Mercy Hospital and University of Missouri, Kansas City, Missouri
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