Family-Centered Care in the Pediatric Post Anesthesia Care Unit: Changing Practice to Promote Parental Visitation

Development and validation of a supportive programme for family caregivers of children suffering from cystic fibrosis: protocol for a sequential exploratory mixed-methods study

INTRODUCTION

Families with children who have cystic fibrosis (CF) face a multitude of challenges. They require complex and time-consuming daily care, various forms of knowledge and intricate care responsibilities. One of the most critical challenges that Iranian families of children with CF face is the lack of adequate support from health teams in the early stages of diagnosis, frequent hospitalisation and the postdischarge process. Unfortunately, limited studies have been conducted in this field, and the Iranian society lacks a comprehensive support programme for these families after leaving treatment centres or home care teams. Therefore, it is necessary to identify and redefine the needs of these families for better care and support in Iran.

METHODS AND ANALYSIS

A mixed-method research design with an exploratory sequential approach will be used in this study. The study consists of three stages: stage (1) the qualitative phase (conventional content analysis and scoping review); stage (2) the programme design phase (development of a support programme) and stage (3) the quantitative phase (validation of the programme through the Delphi method). In the first stage, data will be collected through interviews. Key concepts, evidence and gaps in research will also be identified, collected and analysed through a scoping review. In the second stage, a support programme will be designed based on the results of the content analysis of interviews and the findings from the scoping review. In the final phase, the study will aim to validate the designed programme through a Delphi study.

ETHICS AND DISSEMINATION

This study formed part of a Ph.D. degree and was approved by the ethics committee of Tabriz University of Medical Sciences (IR.TBZMED.REC.1402.395). Informed consent will be obtained from all study participants. Findings will be published in a peer-reviewed journal.

The Impact of Parental Presence on Emergence Delirium in Pediatric Patients After General Anesthesia: A Systematic Review and Meta-analysis

PURPOSE

This study reviewed existing literature on parental presence in cases of pediatric patients after general anesthesia and explored its effect on emergence delirium (ED) in the postanesthesia care unit (PACU).

DESIGN

Systematic review and meta-analysis.

METHODS

After protocol registration, we searched the PubMed, EMBASE, CINHAL, Web of Science, SCOPUS, and CENTRAL databases. Two authors independently searched and selected the relevant studies, assessed their risk of bias, and abstracted the data. The primary outcome was ED, and the additional outcome was pain. We provided the narrative synthesis and meta-analysis results.

FINDINGS

Of the 296 articles retrieved, 6 were included in the narrative synthesis, and 5 were used for the meta-analysis. Four studies were randomized controlled trials, and two studies were nonrandomized controlled trials. There were 348 pediatric patients in the parental presence group and 314 pediatric patients in the usual care group. Parental presence effectively reduced the ED score (mean difference, -0.58; 95% confidence interval [CI], -0.84 to -0.31; P < .001). The ED incidence rate (log odds ratio, -0.58; 95% CI, -1.24 to 0.09; P = .090) and pain score (standardized mean difference, -0.24; 95% CI, -0.57 to 0.10; P = .163) were lower in the parental presence group than in the usual care group. However, the differences were not statistically significant.

CONCLUSIONS

The presence of parents in the PACU can reduce ED in pediatric patients. Therefore, parental presence may be a useful intervention in the PACU.

Participatory Methods to Improve and Develop Pediatric Nursing Practice: A Scoping Review

Children's nurses in African pediatric settings are often responsible for leading practice improvements. There is a shortage of contextually relevant guidance to inform the design of practice improvement projects in African care settings. Distinctive features of children's nursing practice in Africa include high levels of family caregiver involvement, and organizational and professional cultures which value participation. While established practice improvement methods offer many strengths, methods developed in other geographies should not be adopted uncritically. Our purpose in undertaking this review was to inform selection of methods for a multi-center practice improvement project in Africa. Our aim was to identify types of participatory methods used to improve and develop pediatric nursing practice. We used the PRISMA-ScR method to conduct a scoping review to identify published reports of participatory methods used to improve and develop pediatric nursing practice. We undertook structured searches of five bibliographic databases to identify articles. Only articles written in the English language were included and no limitation was applied to publication date. We identified 7,406 titles and abstracts. After screening, 76 articles met the inclusion criteria. A wide range of participatory methodologies were identified; just under half (n = 34) reported on methods that were not recognized or named methodologies but can be described as collaborative in nature. Plan-do-study-act cycles were reported in 22 articles. There was considerable heterogeneity in frameworks, practical tools and/or nursing models on which the participatory methods were based and there was no apparent relationship between these and the choice of participatory methods. The outcomes identified were also heterogenous in nature and were grouped according to whether they improved structure and/or processes and patient outcomes. Most of the included articles stem from high-income countries with little evidence from low-middle-income countries and none in African settings. Less than half of the included articles involved family caregivers in their practice improvement methodologies. This review highlights the need for greater application of formalized methods for practice improvement and improved rigor and consistency in reporting outcomes. There is also a need to formalize participatory practice improvement methodologies specifically suited to Africa's context of children's nursing.

Use of Simulation Software in Optimizing PACU Operations and Promoting Evidence-Based Practice Guidelines

PURPOSE

As health care service costs continue to rise, hospitals are looking for innovative solutions to reduce financial burden while maintaining, and even advancing, quality of care. The objective of this study was to reduce costly delays in perioperative operations.

DESIGN

Quality improvement project using lean methodology.

METHODS

Discrete event simulation was used to evaluate multiple scenarios for improving the flow of patients through the Ambulatory Surgery Center's recovery unit. Bottlenecks were identified to safely minimize service delays and enhance the patient's experience.

FINDINGS

Applying the Theory of Constraints, postanesthesia care unit recovery time was identified as the system constraint. An average 5- to 8-minute reduction in recovery time would reduce OR delays by more than 20%. Improvement efforts were focused on application of evidence-based practice.

CONCLUSIONS

Simulation established a safe and cost-effective environment for exploring tests of change and optimizing the physical design and operations of an expansion hospital site.

Reduction of Postanesthetic Pediatric Distress: A Coordinated Approach

PURPOSE

Preoperative anxiety in children is associated with postoperative distress in recovery. Both are predictors of long-term maladaptive behavior. Remedies have been suggested to modify individual risk factors, but overall strategy is lacking.

DESIGN

An approach to anxiety reduction coordinated throughout the hospital experience has been developed in our day-stay pediatric surgical unit.

METHODS

There is a preadmission familiarization visit. On admission, time is spent in a playroom with other children. Anxiety is recorded using the modified Yale Preoperative Anxiety Scale. Children are distracted with an activity book during propofol induction. They are allowed to wake naturally, and emergence state is scored.

FINDING

The incidence of emergence distress is low in our study. Of 68 children, only one exhibited emergence delirium and three had inconsolable crying.

CONCLUSIONS

Important elements in reducing emergence distress are preadmission visit, use of a playroom, effective analgesia, anesthetic maintenance without short-acting volatiles, and undisturbed recovery with a parent present for reassurance.

Effects of Enhanced Family Visitation in Postanesthesia Services

PURPOSE

The purpose of this project was to assess the impact of an enhanced postanesthesia unit (PACU) family visitation program on surgical services staff.

DESIGN

This project was a cross-sectional study using a mixed methods approach.

METHODS

A survey, including scaled and qualitative items, was administered to surgical services personnel.

FINDINGS

A significant positive change occurred in respondents' feelings of comfort when providing emotional support to family members, and 2013 respondents agreed more often than earlier respondents with the notion that family members should have the option to visit in the PACU. Qualitative data showed continuing concerns with space, privacy, and interference with patient care.

CONCLUSIONS

Implementation of enhanced visiting policies in the PACU is associated with positive changes in staff attitudes toward family visitation and no diminishment of staff commitment to family support generally, but barriers to family visitation are persistent and substantial.

A Narrative Synthesis of the Components of and Evidence for Patient- and Family-Centered Care

A narrative synthesis was conducted to determine typical patient- and family-centered care (PFCC) components and their link to outcomes in pediatric populations. 68 studies with PFCC interventions and experimental designs were included. Study features were synthesized based on 5 core PFCC components (i.e., education from the provider to the patient and/or family, information sharing from the family to the provider, social-emotional support, adapting care to match family background, and/or s decision-making) and 4 outcome categories (health status; the experience, knowledge, and attitudes of the patient/family; patient/family behavior; or provider behavior). The most common PFCC component was education; the least common was adapting care to family background. The presence of social-emotional support alone, as well as educational interventions augmented with shared decision-making, social-emotional support, or adaptations of care based on family background, predicted improvements in families' knowledge, attitudes, and experience. Interventions that targeted the family were associated with positive outcomes.

Implementation of a Phase I Caregiver Visitation Program for a Specialized Pediatric Population

Phase I caregiver visitation practice has been endorsed and encouraged by the American Society of PeriAnesthesia Nurses, yet implementation has not been widespread. Literature has described benefits of visitation for patients and their caregivers. This article reports on a Phase I caregiver visitation program at a specialty care hospital. The steps of implementation and guidelines for both the health care team and the patient's caregivers are outlined. Visitation is recognized as promoting patient safety during Phase I recovery. A discussion of additional benefits and obstacles is addressed.

Pain management for pediatric tonsillectomy: an integrative review through the perioperative and home experience

PURPOSE

This integrative review aims to increase our understanding of current pain management care practices for children undergoing tonsillectomy.

CONCLUSIONS

Synthesis of the literature resulted in four main opportunities for care providers to manage pain: preoperative education and preparation, intraoperative surgical interventions, and postoperative pharmacologic and nonpharmacologic interventions in the post anesthesia care unit and home settings.

PRACTICE IMPLICATIONS

Nurses have many opportunities to understand pain management practices and intervene to minimize pain experienced in pediatric outpatients undergoing tonsillectomy.

Application of theory to family-centered care: a role for social workers

Family-centered care is an emerging trend in health care settings today. An explanation, principles, and a definition of family-centered care are offered and discussed. A theoretical framework, Balance Theory of Coordination, which can be utilized by social workers to develop and enhance family-centered care practices, is explained and discussed. Various family-centered care practices are examined within the context of Balance Theory of Coordination as examples.

Preferences for Visitation in the PACU

The purpose of this study was to identify PACU visitor update/visitation preferences. In a cross-sectional, descriptive design using a convenience sample, visitors of patients having elective or emergency surgery completed a survey of five update/visitation options and visitor characteristics. Visitation responses were ranked and compared based on visitor characteristics. Of 249 visitors, 64% were female; 94% visited adult patients. Of visitation options, a one-time, 5- to 10-minute visit within two hours of patient transfer to the PACU was most frequently preferred (27.3%), but no option was significantly preferred over the others. After categorizing visitors into two groups based on blood line ties, close family preferred a one-time visit and distant relatives/friends preferred a verbal report 30 minutes after PACU arrival (P = .015).

A critical pathway for successful outpatient ureteral reimplantation: a nursing perspective

Vesicoureteral reflux is a common pediatric urologic condition. Traditionally, surgical treatment of this condition requires a hospital stay of 1 to 6 days. Our experience has shown that both unilateral and bilateral extravesical ureteral reimplantation can be performed safely in the ambulatory surgery setting. Our perianesthesia care revolves around the concept of family-centered care. We have found that the key to our critical pathway involves both the patient and the family in every part of perianesthesia care. This "team" approach can be adapted for any pediatric procedure.