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Krewulak KD, Jaworska N, Lee L, Louis JS, Dmitrieva O, Leia MP, Doig C, Niven DJ, Parhar KKS, Rochwerg B, West A, Stelfox HT, Leigh JP, Fiest KM. Impact of restricted family presence during the COVID-19 pandemic on critically ill patients, families, and critical care clinicians: a qualitative systematic review. BMC Health Serv Res 2024; 24:936. [PMID: 39148067 PMCID: PMC11328402 DOI: 10.1186/s12913-024-11398-x] [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: 03/20/2024] [Accepted: 08/02/2024] [Indexed: 08/17/2024] Open
Abstract
BACKGROUND We aimed to synthesize the qualitative evidence on the impacts of COVID-19-related restricted family presence policies from the perspective of patients, families, and healthcare professionals from neonatal (NICU), pediatric (PICU), or adult ICUs. METHODS We searched MEDLINE, EMBASE, Cochrane Databases of Reviews and Clinical Trials, CINAHL, Scopus, PsycINFO, and Web of Science. Two researchers independently reviewed titles/abstracts and full-text articles for inclusion. Thematic analysis was completed following appraising article quality and assessing confidence in the individual review findings using standardized tools. RESULTS We synthesized 54 findings from 184 studies, revealing the impacts of these policies in children and adults on: (1) Family integrated care and patient and family-centered care (e.g., disruption to breastfeeding/kangaroo care, dehumanizing of patients); (2) Patients, families, and healthcare professionals (e.g., negative mental health consequences, moral distress); (3) Support systems (e.g., loss of support from friends/families); and (4) Relationships (e.g., loss of essential bonding with infant, struggle to develop trust). Strategies to mitigate these impacts are reported. CONCLUSION This review highlights the multifaceted impacts of restricted visitation policies across distinct care settings and strategies to mitigate the harmful effects of these policies and guide the creation of compassionate family presence policies in future health crises. REGISTRATION https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=290263 .
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Affiliation(s)
- Karla D Krewulak
- Department of Critical Care Medicine, Alberta Health Services & University of Calgary, Calgary, AB, Canada
| | - Natalia Jaworska
- Department of Critical Care Medicine, Alberta Health Services & University of Calgary, Calgary, AB, Canada
| | - Laurie Lee
- Department of Pediatrics, Cumming School of Medicine, Pediatric Intensive Care Unit, Children's Hospital Research Institute, Faculty of Nursing, University of Calgary, Calgary, Alberta, AB, Canada
| | - Julia St Louis
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON, Canada
| | - Olesya Dmitrieva
- Department of Critical Care Medicine, Alberta Health Services & University of Calgary, Calgary, AB, Canada
| | - Madison P Leia
- Department of Critical Care Medicine, Alberta Health Services & University of Calgary, Calgary, AB, Canada
| | - Christopher Doig
- Department of Critical Care Medicine, Alberta Health Services & University of Calgary, Calgary, AB, Canada
| | - Daniel J Niven
- Department of Critical Care Medicine, Alberta Health Services & University of Calgary, Calgary, AB, Canada
| | - Ken Kuljit S Parhar
- Department of Critical Care Medicine, Alberta Health Services & University of Calgary, Calgary, AB, Canada
| | - Bram Rochwerg
- Department of Medicine, Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
| | - Andrew West
- Canadian Society of Respiratory Therapists, Ottawa, ON, Canada
| | - Henry T Stelfox
- Department of Critical Care Medicine, Alberta Health Services & University of Calgary, Calgary, AB, Canada
- Department of Critical Care Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Jeanna Parsons Leigh
- Faculty of Health, School of Health Administration, Dalhousie University, Halifax, NS, Canada
| | - Kirsten M Fiest
- Department of Critical Care Medicine, Alberta Health Services & University of Calgary, Calgary, AB, Canada.
- Department of Community Health Sciences & O'Brien Institute for Public Health, University of Calgary, Calgary, AB, Canada.
- Department of Psychiatry & Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada.
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Stalder S, Händler-Schuster D, Benedetti FD. Parents' experiences of family and daily life after their child's stay in the pediatric intensive care unit: a qualitative descriptive study. BMC Pediatr 2024; 24:421. [PMID: 38956539 PMCID: PMC11218211 DOI: 10.1186/s12887-024-04883-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Accepted: 06/12/2024] [Indexed: 07/04/2024] Open
Abstract
INTRODUCTION The stay of a critically ill child in a pediatric intensive care unit (PICU) is a significant experience for the family. Thus far, little is known regarding the impact of this stay on parents and their healthy children for whom no continuous aftercare services are offered. This study aimed to capture the post-stay experience and needs of parents after this traumatic event so that they could return to family and everyday life. METHODS This qualitative descriptive study was conducted in collaboration with four pediatric intensive care units in Switzerland. It included parents whose children had fully recovered after a stay and who did not require continuous medical follow-up. All children were hospitalized in the PICU for at least 48 h. Data were collected through narrative pairs (n = 6) and individual interviews (n = 8). Interviews were audio recorded, transcribed, coded inductively according to Saldaña, and analyzed. RESULTS The results showed three related phases that influence each other to restore normality in daily life: Trust and inclusion in the treatment process during the stay (1), processing after the stay (2), and returning to everyday life (3). CONCLUSION Follow-up meetings should be available to all parents whose children have been hospitalized in the PICU. In particular, it should also be available to parents whose children have fully recovered and no longer have any medical disabilities.
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Affiliation(s)
- Sandra Stalder
- School of Health Sciences, Institute of Nursing, ZHAW - Zurich University of Applied Sciences, Katharina-Sulzer-Platz 9, Winterthur, 8401, Switzerland
| | - Daniela Händler-Schuster
- School of Health Sciences, Institute of Nursing, ZHAW - Zurich University of Applied Sciences, Katharina-Sulzer-Platz 9, Winterthur, 8401, Switzerland
- Medical Informatics, and Technology UMIT, Department of Nursing Science and Gerontology, Institute of Nursing, Private University of Health Sciences, Hall in Tyrol, Austria
- Faculty of Health, School of Nursing, Midwifery and Health Practice, Te Herenga Waka - Victoria University of Wellington - Te Herenga Waka, Wellington, New Zealand
| | - Franzisca Domeisen Benedetti
- School of Health Sciences, Institute of Nursing, ZHAW - Zurich University of Applied Sciences, Katharina-Sulzer-Platz 9, Winterthur, 8401, Switzerland.
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Quadir A, Festa M, Gilchrist M, Thompson K, Pride N, Basu S. Long-term follow-up in pediatric intensive care-a narrative review. Front Pediatr 2024; 12:1430581. [PMID: 39011062 PMCID: PMC11246917 DOI: 10.3389/fped.2024.1430581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2024] [Accepted: 06/06/2024] [Indexed: 07/17/2024] Open
Abstract
Pediatric intensive care is a rapidly developing medical specialty and with evolving understanding of pediatric pathophysiology and advances in technology, most children in the developed world are now surviving to intensive care and hospital discharge. As mortality rates for children with critical illness continue to improve, increasing PICU survivorship is resulting in significant long-term consequences of intensive care in these vulnerable patients. Although impairments in physical, psychosocial and cognitive function are well documented in the literature and the importance of establishing follow-up programs is acknowledged, no standardized or evidence-based approach to long-term follow-up in the PICU exists. This narrative review explores pediatric post-intensive care syndrome and summarizes the multifactorial deficits and morbidity that can occur in these patients following recovery from critical illness and subsequent discharge from hospital. Current practices around long-term follow-up are explored with discussion focusing on gaps in research and understanding with suggested ways forward and future directions.
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Affiliation(s)
- Ashfaque Quadir
- Paediatric Intensive Care Unit, The Children's Hospital at Westmead, Sydney, NSW, Australia
- The University of Sydney, Sydney, NSW, Australia
| | - Marino Festa
- Paediatric Intensive Care Unit, The Children's Hospital at Westmead, Sydney, NSW, Australia
| | - Michelle Gilchrist
- Paediatric Intensive Care Unit, The Children's Hospital at Westmead, Sydney, NSW, Australia
| | - Kate Thompson
- Paediatric Intensive Care Unit, The Children's Hospital at Westmead, Sydney, NSW, Australia
| | - Natalie Pride
- The University of Sydney, Sydney, NSW, Australia
- Kids Neuroscience Centre, The Children's Hospital at Westmead, Sydney, NSW, Australia
| | - Shreerupa Basu
- Paediatric Intensive Care Unit, The Children's Hospital at Westmead, Sydney, NSW, Australia
- Department of Cardiology, Boston Children's Hospital, Boston, MA, United States
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4
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Poh PF, Carey MC, Manning JC, Lee JH, Latour JM. Parental emotional, social and transitional health in the first 6 months after childhood critical illness: A longitudinal qualitative study. J Adv Nurs 2024. [PMID: 38922972 DOI: 10.1111/jan.16288] [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: 07/08/2023] [Revised: 12/07/2023] [Accepted: 06/06/2024] [Indexed: 06/28/2024]
Abstract
AIM To explore the experiences and support needs of parents in the first 6 months after paediatric critical care. DESIGN Longitudinal qualitative design. METHODS Sequential semi-structured qualitative interviews were conducted with a sample of 28 parents in succession at 1 month and at 6 months (n = 22) after their child's discharge from paediatric critical care using purposive sampling. Data were analysed using the adapted five-stage framework analysis. RESULTS Data were developed into eight synthesized themes, three domains and an overarching theme: Regaining Normalcy. Families of children requiring medical treatment at 6 months showed signs of adaption to daily care routines. The two domains were Parental Emotional Health and Parental Social Health. Parental Transitional Health, a third domain, was added to the Post Intensive Care Syndrome-paediatric framework. Parents were forward-looking and discussed emotional health, relating to current caregiving issues. Emotional attention was related to present challenges and concerns about current health and possible readmission to the hospital. In terms of Parental Social Health, families isolated themselves for infection control while remaining connected with families using chat applications. Parents were selective to whom they allowed access to their lives. The impact of parental transitional health was evident and emphasized the daily challenges associated with integration back to home life. Flexible work arrangements allowed working parents to support caregiving needs in the first 6 months after discharge. CONCLUSION In the first 6 months after paediatric critical illness, most families reported having moved past the experiences while having provoking memories of the admission period. Parents viewed the point of normalcy as child returned to school or when all medications were discontinued. Extension of transitional support can facilitate discharge experiences between paediatric critical care and normalcy. The findings highlight the importance of understanding the medium- and longer-term impact of paediatric critical care. IMPACT What problem did the study address? ○ Limited understanding of long-term parental experiences and support needs after PICU discharge. What were the main findings? ○ Most families regained normalcy when child returns to school or when medications were discontinued. Some families continued to show signs of adaptations at 6 months after PICU discharge. Where and on whom did the research have an impact? ○ The research has an impact on improving the understanding of long-term parental experiences and support needs after PICU discharge, informing clinical practice, guiding policy development and shaping parental support programs. REPORTING METHOD We reported this study using the COREQ guidelines. PATIENT OR PUBLIC CONTRIBUTION Prior to confirming the interview guide, three parents of critically ill children actively participated by reviewing and providing feedback on its content. They provided suggestions to refine the wording and ensure clarity to enhance the participants' understanding. By including the perspectives of these parents, we aimed to improve the overall quality and relevance of the interview guide.
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Affiliation(s)
- Pei-Fen Poh
- Division of Nursing, KK Women's and Children's Hospital, Singapore, Singapore
- School of Nursing and Midwifery, Faculty of Health, University of Plymouth, Plymouth, UK
- Paediatrics Academic Clinical Programme, Duke-NUS Medical School, Singapore, Singapore
| | - Matthew C Carey
- School of Nursing and Midwifery, Faculty of Health, University of Plymouth, Plymouth, UK
| | - Joseph C Manning
- Nottingham Children's Hospital, Nottingham University Hospitals NHS Trust, Nottingham, UK
- School of Healthcare, College of Life Sciences, University of Leicester, Leicester, UK
| | - Jan Hau Lee
- Paediatrics Academic Clinical Programme, Duke-NUS Medical School, Singapore, Singapore
- Children's Intensive Care Unit, KK Women's and Children's Hospital, Singapore, Singapore
| | - Jos M Latour
- School of Nursing and Midwifery, Faculty of Health, University of Plymouth, Plymouth, UK
- Department of Nursing, Zhongshan Hospital, Fudan University, Shanghai, China
- School of Nursing, Fudan University, Shanghai, China
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Chlebowski MM, Stark C, Khoury PR, Zang H, Baenziger J, Kasparian NA. Evaluation of the use of visual storytelling as an educational intervention in the cardiac ICU: reaching parents before they are in crisis. Cardiol Young 2023:1-9. [PMID: 38131140 DOI: 10.1017/s1047951123004201] [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] [Indexed: 12/23/2023]
Abstract
OBJECTIVE To evaluate the acceptability and safety of educational videos utilising visual storytelling to provide information about the cardiac ICU and post-operative care to parents. Videos were designed to educate, further encourage parents to engage in their child's cardiac care, and address common sources of distress. STUDY DESIGN Two educational videos and survey were sent to 29 families of children previously admitted to the cardiac ICU (April 2020-March 2021). Views regarding information quality, quantity, format, and relevance were assessed, as were parents' emotional responses. Quantitative thresholds for safety and acceptability were set a priori. An inductive approach to content analysis was applied to identify themes in qualitative data. RESULTS Sixteen parents participated (response rate: 55%). All acceptability and safety thresholds were met; 92% of parents rated the videos as helpful and 85% were "very" or "extremely likely" to recommend them to other families of children with CHD. No participants reported significant distress after viewing the videos. Expressions of parental engagement with their child's care team were common (92%). In qualitative responses, parents perceived the videos as potentially helpful in reducing distress if viewed prior to cardiac ICU admission. CONCLUSION Visual storytelling to orient parents to the cardiac ICU and address common stressors was found to be safe and acceptable when tested with parents of children previously admitted to the cardiac ICU. Further prospective studies are needed to test intervention effects when videos are viewed before or during cardiac ICU admission, especially for mitigating anxiety and traumatic stress associated with admission.
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Affiliation(s)
- Meghan M Chlebowski
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
- Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Christiana Stark
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
- Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Philip R Khoury
- Department of Epidemiology, Tulane University, New Orleans, LA, USA
| | - Huaiyu Zang
- Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Julia Baenziger
- Heart Institute and the Division of Behavioral Medicine and Clinical Psychology, Heart and Mind Wellbeing Center, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Nadine A Kasparian
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
- Heart Institute and the Division of Behavioral Medicine and Clinical Psychology, Heart and Mind Wellbeing Center, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
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Gouda SR, Pinto NP. Parental Perception and Measured Functional Status Following Pediatric Critical Illness: A Secondary Analysis of the Survivor Outcomes Study. Pediatr Crit Care Med 2023; 24:e621-e626. [PMID: 37548521 DOI: 10.1097/pcc.0000000000003342] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/08/2023]
Abstract
OBJECTIVES We evaluated the concordance between parent/guardian perception of child long-term function and objectively scored long-term functional status using the Functional Status Scale (FSS) among PICU survivors. DESIGN Secondary analysis of prospective cohort study. SETTING Urban, tertiary, academic PICU. PATIENTS PICU patients less than 18 years old were admitted between June and August 2012. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS We conducted telephone interviews of parents/guardians of PICU survivors ( n = 77) 6 months post-PICU discharge. We asked parents/guardians to characterize their child's functional status, and we determined FSS scores using scripted interview questions. Concordance between parent/guardian perceptions and FSS scores was assessed, revealing that parent/guardian perceptions of their child's functional status aligned poorly with FSS scores at 6 months (kappa coefficient 0.16). CONCLUSIONS These findings shed light on a critical disconnect between parent/guardian perspective and our current tools to measure a child's functional status following critical illness. In an era of decreased PICU mortality and increased long-term morbidity, the discordance between parent/guardian perception and available scoring tools in the assessment of long-term functional status highlights a key opportunity to improve communication and anchor expectations for long-term outcomes among PICU survivors.
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Affiliation(s)
- Suzanne R Gouda
- Divsion of Medical Critical Care, Department of Pediatrics, Boston Children's Hospital, Harvard Medical School, Boston, MA
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, MA
| | - Neethi P Pinto
- Department of Anesthesiology and Critical Care, Children's Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
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7
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Myers C, Tegtmeyer K, Dewan M. Championing the Spirit of O'hana in the PICU. Pediatr Crit Care Med 2023; 24:1092-1093. [PMID: 38055004 DOI: 10.1097/pcc.0000000000003367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/07/2023]
Affiliation(s)
- Carlie Myers
- Department of Pediatrics, College of Medicine, University of Cincinnati, Cincinnati, OH
- Division of Critical Care Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Ken Tegtmeyer
- Department of Pediatrics, College of Medicine, University of Cincinnati, Cincinnati, OH
- Division of Critical Care Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Maya Dewan
- Department of Pediatrics, College of Medicine, University of Cincinnati, Cincinnati, OH
- Division of Critical Care Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
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Chung NR, Chae SM. Mothering children at a paediatric intensive care unit with strict visiting hours: A qualitative study. Nurs Crit Care 2023. [PMID: 37818784 DOI: 10.1111/nicc.12985] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Revised: 08/29/2023] [Accepted: 09/13/2023] [Indexed: 10/13/2023]
Abstract
BACKGROUND Although a child- and family-centred care (CFCC) philosophy has been emphasized and adopted for decades in paediatric critical care settings in several countries, numerous issues from parents' perspectives regarding the philosophy remain unresolved. To facilitate the full translation of CFCC into clinical practice, health care professionals need an in-depth understanding of family experiences. Real-life mothering experiences, including maternal roles and identities, remain largely unknown at paediatric intensive care units (PICUs) in the Republic of Korea, where family visitation, presence, and participation are restricted. AIM To explore mothering experiences at a PICU where family visitation is strictly constrained, and to identify maternal needs and values. STUDY DESIGN We conducted a qualitative descriptive study of eight individual in-depth interviews with seven mothers of hospitalized children. Qualitative data were analysed using inductive thematic analysis. FINDINGS Five major themes, along with four subthemes, emerged: (1) shifts in maternal roles and responsibilities, (2) shifts in interpersonal relationships, (3) desire for CFCC in the PICU, (4) practising self-defined mothering roles, and (5) reconstructing maternal identities. The themes revealed the experiences of becoming mothers of a child in a constrained PICU. Ultimately, mothers demanded that the unit improve its physical and cultural environments through, for example, liberalized family visitation and participation in the care of their children. CONCLUSIONS Nursing professionals should lead the charge for humanizing a restrictive PICU in the Republic of Korea by ensuring a safe and open environment and mothering continuity based on child- and family-centred holistic care. RELEVANCE TO CLINICAL PRACTICE Effective interventions must be developed and tested to globally establish and fully implement strong evidence-based CFCC in PICUs; constant co-commitment among children, families, health care professionals, and institutions is also necessary.
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Affiliation(s)
- Na-Ry Chung
- Seoul National University Hospital, Seoul, Republic of Korea
| | - Sun-Mi Chae
- Seoul National University College of Nursing, The Research Institute of Nursing Science, Seoul, Republic of Korea
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9
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Cho YI, Kim HJ, Kim DH. Relationship between parental stress and post-traumatic stress disorder: The moderating effect of visitation restrictions in paediatric intensive care units during COVID-19. Nurs Crit Care 2023; 28:808-817. [PMID: 37170731 DOI: 10.1111/nicc.12929] [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: 09/20/2022] [Revised: 04/06/2023] [Accepted: 04/21/2023] [Indexed: 05/13/2023]
Abstract
BACKGROUND Visitation restrictions due to COVID-19 kept parents from being with their children who were hospitalized in the PICU and from meeting with professional staff. AIM This study examined the moderating effect of COVID-19-induced visitation restrictions on the relationship between stress and post-traumatic stress disorder in parents of children admitted to the paediatric intensive care unit. STUDY DESIGN We conducted a descriptive, exploratory study involving 93 parents of children hospitalized in the paediatric intensive care unit using the Korean version of the Parental Stressor Scale: Paediatric Intensive Care Unit and the Revised Impact of Events Scale. Descriptive, Pearson's correlation, and logistic regression analyses were used to investigate the data. Self-reported survey questionnaires were provided for parents to complete in a separate area of the outpatient clinic when they visited for follow-up care after their children were discharged from the paediatric intensive care unit. RESULTS Mothers showed significantly higher post-traumatic stress disorder scores than fathers. The relationship between all the sub-domains of perceived stress and post-traumatic stress disorder was statistically significant. Visitation restrictions because of the COVID-19 pandemic had significant moderating effects on the relationship between perceived parental stress and post-traumatic stress disorder. Moreover, the moderating effects of COVID-19 were exhibited when the two sub-domains-hyperarousal and intrusion-were investigated. CONCLUSIONS Paediatric intensive care unit visitation may be an important intervention for parental post-traumatic stress disorder. Parental visitation should be enabled, and alternative interventions should be developed in situations where visitation is prohibited. RELEVANCE TO CLINICAL PRACTICE It is necessary to develop and apply various and effective alternatives visitation that can prepare hospitals for visiting restrictions during pandemic situations which could emerge in the future.
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Affiliation(s)
- Young Il Cho
- College of Police and Criminal Justice, Dongguk University, Seoul, Republic of Korea
| | - Hyo Jin Kim
- College of Nursing, Seoul National University, Seoul, Republic of Korea
| | - Dong Hee Kim
- College of Nursing Science, Sungshin Women's University, Seoul, Republic of Korea
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10
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Abstract
Children who survive the pediatric intensive care unit (PICU) are at risk of developing post-intensive care syndrome in pediatrics (PICS-p). PICS-p, defined as new physical, cognitive, emotional, and/or social health dysfunction following critical illness, can affect the child and family. Historically, synthesizing PICU outcomes research has been challenging due to inconsistency in study design and in outcomes measurement. PICS-p risk may be mitigated by implementing intensive care unit best practices that limit iatrogenic injury and by supporting the resiliency of critically ill children and their families.
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11
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Poh PF, Carey MC, Lee JH, Manning JC, Latour JM. Impact of ethnicity on parental health outcomes and experiences after paediatric intensive care unit discharge: a mixed-methods systematic review. Eur J Pediatr 2022; 181:3817-3829. [PMID: 36098851 DOI: 10.1007/s00431-022-04595-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Revised: 05/18/2022] [Accepted: 08/15/2022] [Indexed: 11/03/2022]
Abstract
The impact of ethnicity on parental health outcome after paediatric intensive care unit (PICU) discharge remains unclear. Thirteen medical and healthcare databases, unpublished studies and grey literature were searched up to November 5, 2021. We performed a mixed-method systematic review to understand the impact of ethnicity on parental outcomes after PICU discharge, including eight quantitative and eight qualitative studies. Among 1529 parents included, 1064 (72%) were White. Higher prevalence of post-traumatic stress disorder was seen in Black parents (17% White vs 36% Black, p = .03). Latino ethnicity was found to have protective effect against anxiety as compared to White parents (coefficient - 4.27, p < .001). A total of 91 findings were aggregated into 14 categories, and the five synthesized themes from the eight qualitative studies were long-term psychological impact after PICU, use of coping strategies, challenges of re-integration, changes in relationships and the utilization of formal support services and resources. Mixed-method synthesis found that parents of ethnic minority group were underrepresented (18%) and had higher attrition rates in a longitudinal study as compared to White parents following childhood critical illness. Conclusion: There are significant gaps in evidence related to the impact of ethnicity on long-term parental health outcomes after PICU discharge. Ethnic diversity and inclusiveness in long-term PICU research may aid understanding of the parental experiences and outcomes to close the gap in health disparity.
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Affiliation(s)
- Pei-Fen Poh
- School of Nursing and Midwifery, Faculty of Health, University of Plymouth, Plymouth, UK. .,Children's Intensive Care Unit, KK Women's and Children's Hospital, 100 Bukit Timah Road, Singapore, 229899, Singapore.
| | - Matthew C Carey
- School of Nursing and Midwifery, Faculty of Health, University of Plymouth, Plymouth, UK.,Faculty of Health, The University of Plymouth Centre for Innovations in Health and Social Care: a Joanna Briggs Institute Centre of Excellence, University of Plymouth, Plymouth, UK
| | - Jan Hau Lee
- Children's Intensive Care Unit, KK Women's and Children's Hospital, 100 Bukit Timah Road, Singapore, 229899, Singapore.,Duke-NUS Medical School, Singapore, Singapore
| | - Joseph C Manning
- Nottingham Children's Hospital, Nottingham University Hospitals NHS Trust, Nottingham, UK.,Centre for Children and Young People Health Research, School of Health Sciences, University of Nottingham, Nottingham, UK
| | - Jos M Latour
- School of Nursing and Midwifery, Faculty of Health, University of Plymouth, Plymouth, UK.,Faculty of Health, The University of Plymouth Centre for Innovations in Health and Social Care: a Joanna Briggs Institute Centre of Excellence, University of Plymouth, Plymouth, UK.,School of Nursing, Midwifery and Paramedicine, Faculty of Health Sciences, Curtin University, Perth, Australia.,Department of Nursing, Hunan Children's Hospital, Changsha, China
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12
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Debelić I, Mikolčić A, Tihomirović J, Barić I, Lendić Đ, Nikšić Ž, Šencaj B, Lovrić R. Stressful Experiences of Parents in the Paediatric Intensive Care Unit: Searching for the Most Intensive PICU Stressors. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:11450. [PMID: 36141723 PMCID: PMC9517134 DOI: 10.3390/ijerph191811450] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Revised: 09/08/2022] [Accepted: 09/09/2022] [Indexed: 06/16/2023]
Abstract
Hospitalization of a child in the paediatric intensive care unit (PICU) is extremely stressful, both for the child and for his or her family. The purpose of this study was to gain deeper insight into the stressful experiences of parents of children hospitalized in the PICU. This study included 96 parents. The data were collected using a translated and standardized scale "The Parental Stressor Scale: Paediatric Intensive Care Unit (PSS: PICU)". This study confirms high exposure of parents to numerous PICU stressors. The most intense PICU stressor for parents was child's breathing depending on the ventilator (4.22 ± 1.17), and the least intense was child's demanding behaviour (1.17 ± 0.33). A significant positive correlation between the level of parents' perceived stress and the number of their children was recorded (r = 0.240, p = 0.02), while there was no significant correlation between the level of stress and other sociodemographic variables. A significantly higher level of stress was experienced by parents with primary school education (p = 0.032) and parents who are not healthcare professionals (p < 0.01). It is necessary to establish a system that will enable continuous assessment of parents' stress levels and timely prevention of stressful experiences for parents in the PICU.
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Affiliation(s)
- Ivana Debelić
- School of Nursing, Medicinska Škola Osijek, 31000 Osijek, Croatia
- Nursing Institute “Professor Radivoje Radić”, Faculty of Dental Medicine and Health Osijek, Josip Juraj Strossmayer University of Osijek, 31000 Osijek, Croatia
| | - Anamaria Mikolčić
- Nursing Institute “Professor Radivoje Radić”, Faculty of Dental Medicine and Health Osijek, Josip Juraj Strossmayer University of Osijek, 31000 Osijek, Croatia
| | - Jovana Tihomirović
- Nursing Institute “Professor Radivoje Radić”, Faculty of Dental Medicine and Health Osijek, Josip Juraj Strossmayer University of Osijek, 31000 Osijek, Croatia
| | - Iva Barić
- Nursing Institute “Professor Radivoje Radić”, Faculty of Dental Medicine and Health Osijek, Josip Juraj Strossmayer University of Osijek, 31000 Osijek, Croatia
- Specialist Practice of Occupational and Sports Medicine, Ilija Celebic, 31000 Osijek, Croatia
| | - Đurđica Lendić
- Nursing Institute “Professor Radivoje Radić”, Faculty of Dental Medicine and Health Osijek, Josip Juraj Strossmayer University of Osijek, 31000 Osijek, Croatia
- Paediatric Clinic, University Hospital Centre Osijek, 31000 Osijek, Croatia
| | - Željka Nikšić
- Nursing Institute “Professor Radivoje Radić”, Faculty of Dental Medicine and Health Osijek, Josip Juraj Strossmayer University of Osijek, 31000 Osijek, Croatia
- Paediatric Clinic, University Hospital Centre Osijek, 31000 Osijek, Croatia
| | - Barbara Šencaj
- Nursing Institute “Professor Radivoje Radić”, Faculty of Dental Medicine and Health Osijek, Josip Juraj Strossmayer University of Osijek, 31000 Osijek, Croatia
- Department of School Medicine, Teaching Institute of Public Health for the Osijek-Baranya County, 31000 Osijek, Croatia
| | - Robert Lovrić
- Nursing Institute “Professor Radivoje Radić”, Faculty of Dental Medicine and Health Osijek, Josip Juraj Strossmayer University of Osijek, 31000 Osijek, Croatia
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13
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Fakhory N, Lee LA, Seabrook JA, Ryan M, Miller L, Foster JR. Outcomes associated with family presence at the bedside of critically ill children in the pediatric intensive care unit: a scoping review protocol. JBI Evid Synth 2022; 20:2040-2047. [DOI: 10.11124/jbies-21-00283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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14
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Pedroso GER, Garcia APRF, Melo LDL. Visita à criança hospitalizada em terapia intensiva: vivências de irmãos reveladas por meio do brinquedo terapêutico dramático. ESCOLA ANNA NERY 2022. [DOI: 10.1590/2177-9465-ean-2021-0088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Resumo Objetivo: compreender, por meio do brinquedo terapêutico dramático, o significado, para o irmão, de visitar a criança hospitalizada em terapia intensiva. Método: pesquisa qualitativa, modalidade fenomenológica, que utilizou o brinquedo terapêutico dramático para acessar às experiências dos irmãos. Foi realizada em Unidade de Terapia Intensiva Pediátrica do interior do estado de São Paulo, Brasil. Participaram das sessões de brinquedo terapêutico 11 irmãos menores de 10 anos, as quais foram analisadas à luz da Teoria do Amadurecimento. Resultados: os irmãos, tendo um lugar para brincar, dramatizaram situações, anteriormente, vividas, de seu cotidiano e da visita à criança hospitalizada. Ao viver, criativamente, revelaram que brincar é fazer a integração das experiências do “eu”, favorecendo o continuar a ser diante da situação vivida. Conclusões e implicações para a prática: o Brinquedo Terapêutico Dramático compreendido à luz de um referencial teórico possibilitou que o irmão significasse a visita como uma experiência de integração do “eu”, revelando emoções, desejos e preferências do cotidiano. Nesse sentido, o cuidado ao irmão da criança hospitalizada define-se pela oferta do brincar livre, para que ele demonstre o sentimento de continuar a ser em suas interações com o mundo, no qual o contexto hospitalar tornou parte da realidade.
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Miller L, Richard M, Krmpotic K, Kennedy A, Seabrook J, Slumkoski C, Walls M, Foster J. Parental presence at the bedside of critically ill children in the pediatric intensive care unit: A scoping review. Eur J Pediatr 2022; 181:823-831. [PMID: 34626225 PMCID: PMC8501356 DOI: 10.1007/s00431-021-04279-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 09/14/2021] [Accepted: 09/30/2021] [Indexed: 11/26/2022]
Abstract
Parental presence at the bedside (PPB) of critically ill children in the pediatric intensive care unit (PICU) is necessary for operationalizing family-centred care. Previous evidence syntheses emphasize parent-healthcare provider interactions at rounds and resuscitation; our focus is the parent-child dyad. Prior to embarking on further study, we performed a scoping review to determine the breadth and scope of the literature addressing PPB of critically ill children in the PICU. We searched five online databases (MEDLINE, EMBASE, CINAHL, Cochrane Library, and PSYCHINFO) and the grey literature to identify English and French reports from January 1960 to June 2020 addressing physical parental presence with children (birth to 18 years) in intensive care units, without limitation by methodology. Screening, reference selection, and data extraction were performed by two independent reviewers. Data were extracted into a researcher-designed tool. We identified 204 publications (81 quantitative, 68 qualitative, 22 mixed methods, and 9 descriptive case or practice change studies, and a further 24 non-study reports). PPB was directly assessed in 78 (38%) reports, and was the primary objective in 64 (31%). Amount or quality of presence was addressed by 114 reports, barriers and enablers by 152 sources, and impacts and outcomes by 134 sources. While only 6 reports were published in the first two decades of our search (1960-1980), 17 reports were published in 2019 alone. Conclusions: A relatively large body of literature exists addressing PPB of critically ill children. Separate systematic evidence syntheses to assess each element of PPB are warranted. Scoping review protocol registration: Open science framework, protocol nx6v3, registered 9-September-2019. What is Known: • Parental presence at the bedside of critically ill children must be enabled to facilitate family centeredness in care. • Systematic evidence syntheses have focused on parental presence at rounds or resuscitation, rather than with the child throughout the intensive care journey. What is New: • Many reports (n=204) address parental presence at the bedside in the pediatric intensive care unit, though most do as incidental findings • Identifies studies addressing key elements of parental presence in the PICU including barriers and enablers to, amount and quality of, and impact and outcomes of parental presence, and demonstrates trends over time and geography.
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Affiliation(s)
- Lauren Miller
- Faculty of Medicine, Dalhousie University, Halifax, NS Canada
| | - Monique Richard
- Department of Pediatric Critical Care, IWK Health, Halifax, NS Canada
| | - Kristina Krmpotic
- Department of Pediatric Critical Care, IWK Health, Halifax, NS Canada
- Department of Critical Care, Faculty of Medicine, Dalhousie University, Halifax, NS Canada
| | - Anne Kennedy
- School of Education, Acadia University, Wolfville, NS Canada
| | - Jamie Seabrook
- School of Food and Nutritional Sciences, Brescia University College at Western University, London, ON Canada
- Department of Pediatrics and Department of Epidemiology & Biostatistics, Western University, London, ON Canada
- Children’s Health Research Institute and Lawson Health Research Institute, London, ON Canada
| | - Corey Slumkoski
- Department of Pediatric Critical Care Parent Partner, IWK Health, Halifax, NS Canada
| | - Martha Walls
- Department of Pediatric Critical Care Parent Partner, IWK Health, Halifax, NS Canada
| | - Jennifer Foster
- Department of Pediatric Critical Care, IWK Health, Halifax, NS Canada
- Department of Critical Care, Faculty of Medicine, Dalhousie University, Halifax, NS Canada
- Children’s Health Research Institute and Lawson Health Research Institute, London, ON Canada
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16
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Woo D, Yu H, Kim HJ, Choi M, Kim DH. [Untact Visit Service Development Based on an Application Reflecting the Circumstances during COVID-19: Focusing on Utilization in the Pediatric Intensive Care Units]. J Korean Acad Nurs 2021; 51:573-584. [PMID: 34737250 DOI: 10.4040/jkan.21143] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Revised: 09/27/2021] [Accepted: 09/29/2021] [Indexed: 11/09/2022]
Abstract
PURPOSE This study aimed to develop an untact visit service based on an application that can be utilized in the pediatric intensive care unit (PICU) during COVID-19. METHODS This study adopted the double diamond process of service design comprising the discovery, defining, and development stages. RESULTS We developed an untact visit service based on an application that considered the child's status, schedule, photo, and video messages, and so on. Moreover, we derived a service flow regarding the required roles and the type of flow shown between each stakeholder. CONCLUSION Considering the ongoing pandemic, the untact visit service is designed to increase rapport and participation of parents, share the child's information in real-time, and provide one-stop service without increasing healthcare providers' work. It will be a useful visit service that can be applied and evaluated in various hospital settings and the PICU.
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Affiliation(s)
- Dahae Woo
- Department of Industrial Design, Sungshin Women's University, Seoul, Korea
| | - Hanui Yu
- Department of Industrial Design, Sungshin Women's University, Seoul, Korea
| | - Hyo Jin Kim
- College of Nursing, Seoul National University, Seoul, Korea
| | - Minyoung Choi
- Department of Services and Design Engineering, Sungshin Women's University, Seoul, Korea
| | - Dong Hee Kim
- College of Nursing, Sungshin Women's University, Seoul, Korea.
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17
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The Healthcare Staffs' Perception of Parents' Participation in Critical Incidents at the PICU, a Qualitative Study. NURSING REPORTS 2021; 11:680-689. [PMID: 34968342 PMCID: PMC8608064 DOI: 10.3390/nursrep11030064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Revised: 07/19/2021] [Accepted: 07/20/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Internationally, there are very few guidelines regarding how near relations can be taken care of on a children's intensive care unit. Despite knowledge about the positive effects of parental presence, staff frequently reject parents out of insecurity. This study aimed to investigate health professionals' understanding of letting parents be present throughout critical situations. A qualitative method with semi-structured interviews was used to answer the aim of his study. Nine persons participated in the study, both physicians and nurses. The result showed that health professionals' main view is that parents' presence is positive. However, their presence often has lower priority than the medical focus of the child and the health professionals' concern of failure. CONCLUSION Health professionals have the power to decide if parents can be present in critical situations. Only when a parent demands to be present does that demand beat the decisions made by health professionals. Lack of resources within the team and fear of parents becoming a disturbance or a distraction are cited as the primary reasons not to let parents be present.
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18
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Parents' experiences during and after their child's stay in the paediatric intensive care unit - A qualitative interview study. Intensive Crit Care Nurs 2021; 67:103089. [PMID: 34238647 DOI: 10.1016/j.iccn.2021.103089] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 05/04/2021] [Accepted: 05/10/2021] [Indexed: 11/21/2022]
Abstract
BACKGROUND Having a child admitted to the paediatric intensive care unit (PICU) is often an emotional and stressful experience for parents. AIM The aim of the study was to explore parents' experiences during and after their child's hospitalization in the PICU and to investigate whether parents have a need for post-PICU follow-up. MATERIAL AND METHODS The research design was a qualitative study inspired by Ricoeur's phenomenological-hermeneutic approach. The context of the study was a six-bed PICU in a university hospital in Denmark. In 2017, semi-structured interviews were conducted with four couples and three mothers six to 14 weeks after their child had been discharged from the PICU. The data were analysed and interpreted through Ricoeur's three analytical levels and presented in themes and subthemes. FINDINGS Three themes were identified in the analytical process: "The challenging PICU stay", "The value of a network" and "The uncertain post-PICU trajectory". CONCLUSION Information, dialogue and interaction with familiar health professionals, the diary written by PICU nurses, the parents' personal network and social media supported the parents during and after the PICU stay. The parents expressed that post-PICU follow-up was not the most essential but that follow-up initiatives may be arranged individually.
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19
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Poh PF, Lee JH, Manning JC, Carey MC, Sultana R, Latour JM. Singapore's health outcomes after critical illness in kids: A study protocol exploring health outcomes of families 6 months after critical illness. J Adv Nurs 2021; 77:3531-3541. [PMID: 34081353 DOI: 10.1111/jan.14911] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Accepted: 05/08/2021] [Indexed: 01/18/2023]
Abstract
AIM To explore and understand the impact of paediatric intensive care unit (PICU) admission on longitudinal health outcomes, experiences and support needs of children and their parents in the first 6 months after PICU discharge and to examine the role of ethnicity. DESIGN This study uses a prospective, longitudinal design. METHODS The sample will include children (N = 110) and at least one parent (N = 110) admitted to the PICU (KKH-AM start-up fund, October 2020). Quantitative study: Participants will be recruited at PICU admission. Data will be collected at five time points: during PICU admission (T0), at PICU discharge (T1), 1 month (T2), 3 months (T3) and 6 months (T4) after PICU discharge. Questionnaires will assess physical and cognitive outcomes of the child survivor. Emotional and social health outcomes will be assessed for both the child and the parents. Qualitative study: At least 12 parents will take part in a semi-structured interview conducted at both 1 and 6 months after PICU to explore their experiences and support needs after PICU discharge. All interviews will be audio-recorded with verbatim transcription. We will use framework analysis for qualitative data analysis. DISCUSSION Understanding of Singapore health outcomes after critical illness in kids (SHACK) and their families is limited. There is an urgent need to comprehensively understand the health trajectory and consequences of the PICU child survivors and their families. This research will be the first to explore the health outcomes, needs and experiences after paediatric critical illness in Asia. IMPACT This study will provide an understanding of the health outcomes and trajectory of children and parents in the first 6 months after PICU discharge and examine the association between race and outcomes after PICU discharge. Identification of modifiable pre-disposing risk factors during the PICU admission will inform future interventions to improve long-term outcomes of children and parents following paediatric critical illness. TRIAL REGISTRATION Clinicaltrial.gov: ClinicalTrials.gov Identifier: NCT04637113.
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Affiliation(s)
- Pei-Fen Poh
- University of Plymouth, Plymouth, UK.,Children's Intensive Care Unit, KK Women's and Children's Hospital, Singapore
| | - Jan Hau Lee
- Children's Intensive Care Unit, KK Women's and Children's Hospital, Singapore.,Duke-NUS Medical School, Singapore
| | - Joseph C Manning
- School of Health Sciences, University of Nottingham, Nottingham, UK.,Paediatric Critical Care Outreach, Nottingham Children's Hospital, Nottingham University Hospital NHS Trust, Nottingham, UK
| | - Matthew C Carey
- Faculty of Health, School of Nursing and Midwifery, University of Plymouth, Plymouth, UK
| | | | - Jos M Latour
- University of Plymouth, Plymouth, UK.,Curtin University, Perth, Western Australia, Australia
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20
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Procter C, Morrow B, Pienaar G, Shelton M, Argent A. Outcomes following admission to paediatric intensive care: A systematic review. J Paediatr Child Health 2021; 57:328-358. [PMID: 33577142 DOI: 10.1111/jpc.15381] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2020] [Revised: 01/12/2021] [Accepted: 01/24/2021] [Indexed: 12/12/2022]
Abstract
AIM To describe the long-term health outcomes of children admitted to a paediatric intensive care unit. METHODS A systematic review of the literature was performed. Studies of children under 18 years of age admitted to a paediatric intensive care unit were included. Studies focussed on neonatal admissions and investigating specific paediatric intensive care unit interventions or admission diagnoses were excluded. A table was created summarising the study characteristics and main findings. Risk of bias was assessed using the Newcastle Ottawa Quality Assessment Scale for observational studies. Primary outcome was short-, medium- and long-term mortality. Secondary outcomes included measures of neurodevelopment, cognition, physical, behavioural and psychosocial function as well as quality of life. RESULTS One hundred and eleven studies were included, most were conducted in high-income countries and focussed on short-term outcomes. Mortality during admission ranged from 1.3 to 50%. Mortality in high-income countries reduced over time but this trend was not evident for lower income countries. Higher income countries had lower standardised mortality rates than lower income countries. Children had an ongoing increased risk of death for up to 10 years following intensive care admission as well as increased physical and psychosocial morbidity compared to healthy controls, with associated poorer quality of life. CONCLUSIONS There is limited high-level evidence for the long-term health outcomes of children after intensive care admission, with the burden of related morbidity remaining greater in poorly resourced regions. Further research is recommended to identify risk factors and modifiable factors for poor outcomes, which could be targeted in practice improvement initiatives.
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Affiliation(s)
- Claire Procter
- Pediatric Intensive Care, Division of Pediatric Critical Care and Children's Heart Disease, Red Cross War Memorial Children's Hospital and University of Cape Town, Cape Town, South Africa
| | - Brenda Morrow
- Department of Paediatrics, University of Cape Town, Cape Town, South Africa
| | - Genee Pienaar
- Public Health, Mental Health and Behavioral Sciences, Western Cape Department of Health, Cape Town, South Africa
| | - Mary Shelton
- Reference Librarian, University of Cape Town, Cape Town, South Africa
| | - Andrew Argent
- Pediatric Intensive Care, Division of Pediatric Critical Care and Children's Heart Disease, Red Cross War Memorial Children's Hospital and University of Cape Town, Cape Town, South Africa
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21
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Carlton EF, Weiss SL, Prescott HC, Prosser LA. What's the Cost? Measuring the Economic Impact of Pediatric Sepsis. Front Pediatr 2021; 9:761994. [PMID: 34869119 PMCID: PMC8634593 DOI: 10.3389/fped.2021.761994] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Accepted: 10/20/2021] [Indexed: 11/13/2022] Open
Abstract
Sepsis, life-threatening organ dysfunction secondary to infection, hospitalizes nearly 75,000 children each year in the United States. Most children survive sepsis. However, there is increasing recognition of the longer-term consequences of pediatric sepsis hospitalization on both the child and their family, including medical, psychosocial, and financial impacts. Here, we describe family spillover effects (the impact of illness on caregivers) of pediatric sepsis, why measurement of family spillover effects is important, and the ways in which family spillover effects can be measured.
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Affiliation(s)
- Erin F Carlton
- Division of Critical Care Medicine, Department of Pediatrics, University of Michigan, Ann Arbor, MI, United States.,Susan B. Meister Child Health Evaluation and Research Center, Department of Pediatrics, University of Michigan, Ann Arbor, MI, United States
| | - Scott L Weiss
- Department of Anesthesiology and Critical Care, Children's Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, United States.,Pediatric Sepsis Program, Children's Hospital of Philadelphia, Philadelphia, PA, United States
| | - Hallie C Prescott
- Veterans Affairs Center for Clinical Management Research, Health Services Research & Development Center of Innovation, Ann Arbor, MI, United States.,Department of Internal Medicine, Division of Pulmonary and Critical Care, University of Michigan, Ann Arbor, MI, United States
| | - Lisa A Prosser
- Susan B. Meister Child Health Evaluation and Research Center, Department of Pediatrics, University of Michigan, Ann Arbor, MI, United States.,Department of Health Management and Policy, School of Public Health, University of Michigan, Ann Arbor, MI, United States
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22
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Rennick JE, Knox AM, Treherne SC, Dryden-Palmer K, Stremler R, Chambers CT, McRae L, Ho M, Stack DM, Dougherty G, Fudge H, Campbell-Yeo M. Family Members' Perceptions of Their Psychological Responses One Year Following Pediatric Intensive Care Unit (PICU) Hospitalization: Qualitative Findings From the Caring Intensively Study. Front Pediatr 2021; 9:724155. [PMID: 34557460 PMCID: PMC8452961 DOI: 10.3389/fped.2021.724155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2021] [Accepted: 08/06/2021] [Indexed: 11/13/2022] Open
Abstract
Introduction: PICU hospitalization can have a profound impact on child survivors and their families. There is limited research on children's long-term recovery within the context of the family following critical illness. This study aimed to explore children's and parents' perceptions of long-term psychological and behavioral responses within the context of the family one year following PICU hospitalization. Materials and Methods: Caring Intensively is a mixed methods multi-site prospective cohort study that aims to examine children's psychological and behavioral responses over a 3-year period following PICU hospitalization. In this study, part of the qualitative arm of Caring Intensively, an interpretive descriptive design was used to explore children's recovery one year post-discharge. Purposive sampling was used to select 17 families, including 16 mothers, 6 fathers, and 9 children. Semi-structured, audio-recorded interviews were conducted. Data were analyzed iteratively using the constant comparison method. Results: Families described efforts to readapt to routine life and find a new normal following PICU hospitalization. Finding a New Normal consisted of four major themes: (1) Processing PICU Reminders and Memories, (2) Changing Perceptions of Health and Illness, (3) We Are Not the Same, and (4) Altered Relationships. Participants described significant emotional and behavioral changes during the year following discharge. The psychological impact of individual family members' experiences led to changes in their sense of self, which affected family dynamics. PICU memories and reminders impacted participants' perceptions of childhood health and illness and resulted in increased vigilance. Parents and siblings demonstrated increased concern for the child survivor's health, and the experience of long absences and new or altered caregiving roles resulted in changes in relationships and family dynamics. Conclusion: PICU hospitalization impacted the psychological well-being of all family members as they sought to re-establish a sense of normalcy one year following discharge. Parent and child experiences and responses were closely interconnected. Findings highlight the importance of increased follow-up care aimed at supporting the family's psychological recovery.
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Affiliation(s)
- Janet E Rennick
- Department of Nursing, The Montreal Children's Hospital, McGill University Health Centre (MUHC), Montreal, QC, Canada.,Ingram School of Nursing, Faculty of Medicine and Health Sciences, McGill University, Montreal, QC, Canada.,Department of Pediatrics, Faculty of Medicine and Health Sciences, McGill University, Montreal, QC, Canada.,Child Health and Human Development, Research Institute of the MUHC, Montreal, QC, Canada
| | - Alyssa M Knox
- Child Health and Human Development, Research Institute of the MUHC, Montreal, QC, Canada
| | - Stephanie C Treherne
- Child Health and Human Development, Research Institute of the MUHC, Montreal, QC, Canada
| | - Karen Dryden-Palmer
- Department of Critical Care, Hospital for Sick Children, Toronto, ON, Canada.,Child Health Evaluative Sciences, Research Institute, Hospital for Sick Children, Toronto, ON, Canada
| | - Robyn Stremler
- Child Health Evaluative Sciences, Research Institute, Hospital for Sick Children, Toronto, ON, Canada.,Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON, Canada
| | - Christine T Chambers
- Department of Psychology and Neuroscience and Department of Pediatrics, Dalhousie University, Halifax, NS, Canada
| | - Lyndsey McRae
- Department of Neurosciences and Trauma, Hospital for Sick Children, Toronto, ON, Canada
| | - Michelle Ho
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON, Canada.,Division of Paediatric Medicine, Complex Care Program, Hospital for Sick Children, Toronto, ON, Canada
| | - Dale M Stack
- Department of Psychology and Centre for Research in Human Development, Concordia University, Montreal, QC, Canada
| | - Geoffrey Dougherty
- Department of Pediatrics, Faculty of Medicine and Health Sciences, McGill University, Montreal, QC, Canada.,Child Health and Human Development, Research Institute of the MUHC, Montreal, QC, Canada.,Department of Epidemiology and Biostatistics, Faculty of Medicine and Health Sciences, McGill University, Montreal, QC, Canada
| | - Hailey Fudge
- School of Nursing, Faculty of Health, Dalhousie University, Halifax, NS, Canada
| | - Marsha Campbell-Yeo
- School of Nursing, Faculty of Health, Dalhousie University, Halifax, NS, Canada.,Department of Nursing and Department of Pediatrics, IWK Health, Halifax, NS, Canada
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23
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Terp K, Weis J, Lundqvist P. Parents' Views of Family-Centered Care at a Pediatric Intensive Care Unit-A Qualitative Study. Front Pediatr 2021; 9:725040. [PMID: 34513770 PMCID: PMC8424181 DOI: 10.3389/fped.2021.725040] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Accepted: 08/04/2021] [Indexed: 12/02/2022] Open
Abstract
Purpose: To describe parents' views of family-centered care at a pediatric intensive care unit. Design and Methods: A qualitative descriptive study with a deductive and inductive approach was conducted based on the principles of family-centered care. Inclusion criteria were parents of children cared for at a pediatric intensive care unit for at least 48 h. Parents of children who died during the hospital stay were excluded. The sample consisted of spontaneous responses from 70 parents to five open questions in the EMpowerment of PArents in THe Intensive Care questionnaire, which was completed at discharge. The spontaneous responses were analyzed using thematic analysis. Results: The analysis of the parents' statement illuminated that partnership, the essence of family-centered care, appeared incomplete. Partnership was particularly evident regarding parents' experiences of being treated with empathy and respect. It also seemed prominent in situations where the professional team provided support to the child, parents, and family. Based on the parents' statements there was potential for development of the family-centered care approach in aspects such as decision-making concerning care and treatment, as well as improving person-centered communication on order to capture parents' experiences and needs in the highly technological pediatric intensive care unit environment. Conclusions: Although in general parents were satisfied with the care, areas for improvement were identified such as participation in decision-making about care and treatment as well as person-centered communication. The results can contribute to future quality improvement interventions focusing family centered care at pediatric intensive care units.
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Affiliation(s)
- Karina Terp
- Department of Health Sciences, Lund University, Lund, Sweden
| | - Janne Weis
- Department of Neonatology, Copenhagen University Hospital, Copenhagen, Denmark
| | - Pia Lundqvist
- Department of Health Sciences, Lund University, Lund, Sweden
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24
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Living with the Memories-Parents' Experiences of Their Newborn Child Undergoing Heart Surgery Abroad: A Qualitative Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17238840. [PMID: 33260688 PMCID: PMC7730968 DOI: 10.3390/ijerph17238840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Revised: 11/22/2020] [Accepted: 11/24/2020] [Indexed: 11/24/2022]
Abstract
Parents of children with a congenital heart defect needing complex heart surgery are at high risk of developing health problems. One can assume that parents whose child undergoes heart surgery abroad will undoubtably face added and unique stressors and health vulnerabilities. The aim of this qualitative study was to explore the transition experiences of parents of children who underwent a complex heart surgery abroad as newborns 1–5 years ago. The qualitative content analysis methodology by Graneheim and Lundman was used. A purposive sample of twelve parents, whose child had undergone a heart surgery abroad, participated in face-to-face, semi-structured interviews. Interviews were transcribed and analyzed using inductive qualitative content analysis. The overarching theme of “living with the memories” emerged from parents’ experiences, emphasizing the long-lasting impact this stressful event had on their lives. These experiences were characterized by four main categories: (1) being in an unknown situation; (2) feeling connected; (3) wishing to be accepted; and (4) finding closure. The findings show that the transition of having a newborn child undergo heart surgery abroad superimposed on the expected parenthood. That parents need to feel connected and included as legitimate clients was highlighted in their stories of experienced vulnerabilities. The results highlight the need for interdisciplinary teams to support these vulnerable families, particularly with follow-up care.
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25
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Logan GE, Sahrmann JM, Gu H, Hartman ME. Parental Mental Health Care After Their Child's Pediatric Intensive Care Hospitalization. Pediatr Crit Care Med 2020; 21:941-948. [PMID: 32947380 PMCID: PMC7609586 DOI: 10.1097/pcc.0000000000002559] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OBJECTIVES Post-traumatic stress disorder, depression, and anxiety have all been found in parents of PICU survivors. How these research findings translate to actual use of mental health services by parents remains unknown. DESIGN Retrospective observational cohort study. SETTING Insurance claims data from 2006 to 2013 obtained from the IBM MarketScan Commercial Database. PATIENTS Parents of PICU survivors. INTERVENTIONS We examined rates of: 1) mental health diagnoses, 2) outpatient mental health visits, and 3) prescriptions for antidepressants and anxiolytics among parents, 6 months before and 6 months after their child's PICU admission, using each parent as their own control. MEASUREMENTS AND MAIN RESULTS Of the 95,070 parents identified, 9.5% received a new mental health diagnosis in the 6 months after their child's PICU hospitalization, which represented a 110% increase from pre-PICU rates. A smaller proportion of parents were given new prescriptions for antidepressants (3.4%) and anxiolytics (3.9%) in the 6 months after their child's PICU hospitalization. Mothers were twice as likely to receive a new mental health diagnosis and be taking a new medication than fathers in the post-PICU period. The parental diagnosis of acute stress disorder or post-traumatic stress disorder increased by 87% from the pre-PICU to the post-PICU period. CONCLUSIONS After their child's PICU hospitalization, the proportion of parents with a new mental health diagnosis nearly doubled. Mothers were at nearly twice the risk of receiving a new mental health diagnosis and receiving a new mental health medication compared with fathers. The proportion of parents receiving mental healthcare is much lower than the proportion reporting mental health symptoms in long-term outcomes studies. Whether this indicates a gap in healthcare delivery for parents with mental health symptoms remains unknown.
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Affiliation(s)
- Grace E. Logan
- Department of Pediatrics, Washington University in St. Louis, St. Louis, MO
| | - John M. Sahrmann
- Department of Medicine, Division of Infectious Diseases, Washington University in St. Louis, St. Louis, MO
| | - Hongjie Gu
- Division of Biostatistics, Washington University in St. Louis, St. Louis, MO
| | - Mary E. Hartman
- Department of Pediatrics, Washington University in St. Louis, St. Louis, MO
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Abela KM, Wardell D, Rozmus C, LoBiondo-Wood G. Impact of Pediatric Critical Illness and Injury on Families: An Updated Systematic Review. J Pediatr Nurs 2020; 51:21-31. [PMID: 31874458 DOI: 10.1016/j.pedn.2019.10.013] [Citation(s) in RCA: 60] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2019] [Revised: 10/23/2019] [Accepted: 10/25/2019] [Indexed: 01/28/2023]
Abstract
PROBLEM Pediatric ICUs (PICU) that have adopted family-centered care models welcome families to the critically ill child's bedside to partner with clinicians in decision-making and the provision of care. The aim of this review was to synthesize the evidence on the impact of critical illness and injury on families of children admitted to the PICU to identify research needs in pediatric critical care. ELIGIBILITY CRITERIA This systematic review included quantitative and qualitative studies that examined the experiences of families of children admitted to a PICU published between 2005 and 2019. SAMPLE 33 articles were selected for inclusion in the final analysis after screening those identified by searches in CINAHL, PubMed, PsycINFO, and reference lists of included publications. RESULTS Main parental stressors included the sights and sounds within the PICU, child acuity, changes to family functioning and parenting role, and uncertainty of the child's outcome. The most common need of parents was to be well-informed. Psychological, physical, and social impact of hospitalization were experienced by parents from days after admission to years after discharge. Spirituality was identified as a coping mechanism in half of the studies. CONCLUSIONS Parents experience negative effects of the ill child's admission to the PICU and to PICU exposure. IMPLICATIONS Careful consideration of the impact of the PICU admission on family members of critically ill or injured children is needed when implementing family-centered care strategies. Future research on other family members including the healthy sibling needs to be conducted.
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Affiliation(s)
- Karla M Abela
- The University of Texas Health Science Center at Houston, Cizik School of Nursing, United States of America.
| | - Diane Wardell
- The University of Texas Health Science Center at Houston, Cizik School of Nursing, United States of America
| | - Cathy Rozmus
- The University of Texas Health Science Center at Houston, Cizik School of Nursing, United States of America
| | - Geri LoBiondo-Wood
- The University of Texas Health Science Center at Houston, Cizik School of Nursing, United States of America
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Ahlberg M, Hollman Frisman G, Berterö C, Ågren S. Family Health Conversations create awareness of family functioning. Nurs Crit Care 2019; 25:102-108. [PMID: 31197904 DOI: 10.1111/nicc.12454] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Revised: 05/20/2019] [Accepted: 05/20/2019] [Indexed: 12/29/2022]
Abstract
BACKGROUND The whole family is affected if one family member is critically ill. The Family Health Conversation Intervention may give the family tools that support healthier family functioning. AIMS AND OBJECTIVES The aim of this study was to identify which components of family function are affected when families participate in Family Health Conversations. DESIGN A secondary analysis was performed of existing qualitative interviews. The Family Health Conversation is an intervention where nurses ask the family reflective questions, and reflection is made possible in three conversation sessions. METHODS This study included transcribed data from 13 follow-up interviews from seven families attending Family Health Conversations after three and 12 months. Data were analysed with narrative analysis, focusing on family function. RESULTS Three themes were identified. The families' family functioning had been supported with: improved understanding of each other-there was an understanding of being in the same situation but still having totally different experiences; more concern for each other-they talked about their different experiences and felt they had become closer to each other; and a process of working through-they had experienced working through various experiences, standing by and supporting, and then being able to move on. CONCLUSIONS The Family Health Conversation Intervention is provided to families, accompanied by nurses. The families in this study gained an awareness of their family function that brought the family closer because of improved understanding of each other and the situation. The families experienced openness, and the family members spoke more freely with each other, which facilitated the progress of working through the experience of critical illness and helped to maintain healthy family functioning. RELEVANCE TO CLINICAL PRACTICE It is important to have an overall perspective and to recognize the patient and the family as equally important within the family for awareness of family function.
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Affiliation(s)
- Mona Ahlberg
- Department of Anaesthesiology and Intensive Care, Department of Medical and Health Sciences, Linköping University, Linköping, Sweden.,Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
| | - Gunilla Hollman Frisman
- Anaesthetics, Operations and Speciality Surgery Centre, Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
| | - Carina Berterö
- Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
| | - Susanna Ågren
- Department of Medical and Health Sciences, Linköping University, Linköping, Sweden.,Department of Cardiothoracic Surgery, Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
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Ho S, Soong W, Wang KK. Stress and uncertainty in parents of children with tracheobronchial malacia and stenosis. Nurs Crit Care 2019; 24:399-406. [DOI: 10.1111/nicc.12413] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2018] [Revised: 11/01/2018] [Accepted: 12/11/2018] [Indexed: 11/30/2022]
Affiliation(s)
- Shing‐Huey Ho
- Paediatric Intensive Care UnitTaipei Veteran General Hospital Taipei City Taiwan, R.O.C
| | - Wen‐Jue Soong
- Paediatrics DepartmentTaipei Veteran General Hospital Taipei City Taiwan, R.O.C
| | - Kai‐Wei K Wang
- Department of NursingMackay Medical College New Taipei City Taiwan, R.O.C
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Suleman Z, Evans C, Manning JC. Parents' and carers' experiences of transition and aftercare following a child's discharge from a paediatric intensive care unit to an in-patient ward setting: A qualitative systematic review. Intensive Crit Care Nurs 2018; 51:35-44. [PMID: 30448084 DOI: 10.1016/j.iccn.2018.10.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2018] [Revised: 10/06/2018] [Accepted: 10/28/2018] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To explore parents' experiences of transition and aftercare following their child's discharge from a paediatric intensive care unit to an in-patient ward. METHODS A qualitative systematic review was conducted. Electronic databases CINAHL, MEDLINE, EMBASE, Psych INFO, and ASSIA were searched for qualitative studies with no date limits imposed. Methodological quality was assessed using the JBI QARI standardised critical appraisal instrument. Data were extracted into a standardised data extraction tool. Findings were pooled using a meta-aggregative approach. RESULTS Four studies were included in the final review that included a total of 95 participants. Forty-nine findings were extracted and through an iterative process resulting in four synthesised findings being developed. These included: (1) Dynamic emotional response pre, peri and post-transfer; (2) Involvement in care absent but fundamental to functioning; (3) Changes in care delivery and environment provoking adverse emotions and (4) Transition as a physical, emotional and social balancing act. CONCLUSION Transitioning from the paediatric intensive care unit to an in-patient ward can be a challenging time for parents, exposing them to a turbulent emotional and social status, and depleting their personal resources. Parents are aware of differences in the organisation and delivery of care between clinical areas which can compound the adversity experienced. Health professionals need to provide targeted support in order to mitigate these negative emotional, physical and social effects experienced.
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Affiliation(s)
- Zainab Suleman
- Sherwood Forest Hospitals NHS Foundation Trust, Kingsmill, UK; School of Health Sciences, The University of Nottingham, Nottingham, UK
| | - Catrin Evans
- School of Health Sciences, The University of Nottingham, Nottingham, UK; The University of Nottingham Centre of Evidence Based Health Care: A Collaborating Centre of The Joanna Briggs Institute, The University of Nottingham, Nottingham, UK
| | - Joseph C Manning
- School of Health Sciences, The University of Nottingham, Nottingham, UK; The University of Nottingham Centre of Evidence Based Health Care: A Collaborating Centre of The Joanna Briggs Institute, The University of Nottingham, Nottingham, UK; Nottingham Children's Hospital and Neonatology, Nottingham University Hospitals NHS Trust, Nottingham, UK; Children and Families Research, Centre for Innovative Research Across a Life Course, Coventry University, UK.
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Smith W. Concept Analysis of Family-Centered Care of Hospitalized Pediatric Patients. J Pediatr Nurs 2018; 42:57-64. [PMID: 30219300 DOI: 10.1016/j.pedn.2018.06.014] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2018] [Revised: 06/28/2018] [Accepted: 06/28/2018] [Indexed: 10/28/2022]
Abstract
AIM The purpose of this concept analysis is to provide a background of family-centered care of the hospitalized pediatric patient, clarify its components, and validate its significance to nursing practice and research. BACKGROUND The concept of family-centered care in the hospital environment has been discussed in the literature for over 60 years, yet its principles remain unclear and poorly implemented. Further analysis of this concept is warranted and has the potential to promote its integration into current nursing practice by increasing awareness and clarifying the essential attributes. DATA SOURCES A systematic review of the literature yielded thousands of resources which were narrowed to a comprehensive list of 37 sources rich in valuable and applicable content. REVIEW METHODS This analysis utilized the 8-step methodology of concept analysis described by Walker and Avant. FINDINGS The majority of research investigating the concept of family-centered care and the hospitalized pediatric patient found was focused on defining family-centered care and surveying both families and nurses on their understanding of the concept. Little research was found exploring the relationship of family-centered care with patient and family outcomes, or patient and family satisfaction. CONCLUSION Family-centered care of the pediatric patient in the hospital environment remains an abstract concept. It is recommended as a cornerstone of modern nursing practice, yet nurses report they lack sufficient education regarding its operationalization into practice. Elucidation of characteristics coupled with education regarding principles of the concept has the potential to augment further integration of family-centered care in the hospital environment.
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Affiliation(s)
- Wendi Smith
- Villanova University, Fitzpatrick College of Nursing, Villanova, PA, USA.
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