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Butler AE, Clark TJ, Glazner J, Giallo R, Copnell B. "We want to include him in that journey": A qualitative descriptive study of parental experiences and considerations for sibling inclusion in the paediatric ICU. Intensive Crit Care Nurs 2024; 83:103696. [PMID: 38608616 DOI: 10.1016/j.iccn.2024.103696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Revised: 03/25/2024] [Accepted: 03/28/2024] [Indexed: 04/14/2024]
Abstract
OBJECTIVES Siblings are an important yet often forgotten part of the paediatric intensive care unit (PICU) family experience. Commonly, siblings are supported through the experience by their parents; however, very little is known about parental experiences of providing this support. This study aims to explore parental experiences of supporting sibling inclusion in PICU. RESEARCH METHODOLOGY/DESIGN This study utilised a qualitative descriptive approach to conduct semi-structured interviews with 6 parents of 5 children with congenital heart disease who had spent time in PICU. Data were analysed using reflexive thematic analysis. SETTING Australian PICUs. FINDINGS Parental considerations and experiences for sibling inclusion were identified across three key phases: Pre-inclusion, The PICU visit, and Post-inclusion. Prior to including siblings in PICU, parents considered various ways of sharing information with siblings, and weighed up the risks and benefits of bringing siblings into PICU. Parents also recounted a number of challenges and facilitators to a positive sibling experience in PICU, including supportive staff and fun activities. Finally, parents, identified that siblings require ongoing support after their inclusion in PICU and made suggestions for ongoing availability of information and supportive resources. CONCLUSIONS This study has illuminated key parental experiences when supporting sibling inclusion in PICU before, during and after their visit. By understanding these parental experiences, PICU staff can work with and support parents where needed, helping to achieve a positive sibling inclusion experience. IMPLICATIONS FOR CLINICAL PRACTICE Parents need ongoing support to explain the PICU to siblings of critically ill children and may benefit from specific visual resources to aid communication. In addition, PICUs should aim to ensure the physical layout is supportive of sibling needs, with dedicated spaces for siblings to play and take time out during their experience.
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Affiliation(s)
- Ashleigh E Butler
- School of Nursing and Midwifery, La Trobe University, Bundoora Campus, Melbourne, Australia. https://twitter.com/@AshleighEButler
| | - Tara-Jane Clark
- Paediatric Intensive Care Unit, The Royal Children's Hospital, Melbourne, Australia.
| | - Judith Glazner
- Department of Respiratory and Sleep Medicine, The Royal Children's Hospital, Melbourne, Australia.
| | - Rebecca Giallo
- The Centre for Social and Early Emotional Development, School of Psychology, Deakin University, Geelong, Australia; Intergenerational Health Group, Murdoch Children's Research Institute, Melbourne, Australia.
| | - Beverley Copnell
- School of Nursing and Midwifery, La Trobe University, Bundoora Campus, Melbourne, Australia. https://twitter.com/@Bev_Copnell
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Sjöberg C, Ringdal M, Lundqvist P, Jildenstål P. How to Achieve Highly Professional Care in the Postoperative Ward: The Care of Infants and Toddlers. J Perianesth Nurs 2024:S1089-9472(24)00115-1. [PMID: 38958626 DOI: 10.1016/j.jopan.2024.03.019] [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: 11/14/2023] [Revised: 03/26/2024] [Accepted: 03/28/2024] [Indexed: 07/04/2024]
Abstract
PURPOSE The purpose of this study was to describe the experiences of critical care nurses (CCNs) and registered nurse anesthetists (RNAs) when monitoring and observing infants and toddlers recovering from anesthesia. DESIGN A qualitative design with a critical incident approach. METHODS Semistructured individual interviews were conducted with a purposeful sample of CCNs and RNAs (n = 17) from postanesthesia care units at two hospitals. The critical incident technique approach was used to guide the interviews, and data were analyzed inductively using thematic analysis. FINDINGS The main finding was the CCNs' and RNAs' description of how they "watch over the children and stay close" to provide emotional and physical safety. CCNs' and RNAs' experiences of observing and managing the children's small, immature airways were reflected in the theme "using situation awareness of the small, immature airways." The theme "understanding emergence agitation" describes the challenge that arises when children are anxious, feel insecure, and have pain, and the theme "having parents nearby" shows the necessity and value of involving parents in their children's care. CONCLUSIONS Findings from this study suggest that caring for infants and toddlers recovering from anesthesia requires experience and both technical and nontechnical skills. These are prerequisites for achieving readiness for planning, setting priorities, and adapting one's behavior if an adverse event occurs. Alertness and the ability to solve acute problems and make quick decisions are essential because of the risks associated with children's small, immature airways, as is the ability to understand and respond to emergence agitation. Having parents nearby is equally important for creating the conditions for compassionate child- and family-centered care.
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Affiliation(s)
- Carina Sjöberg
- Department of Medicine and Health Sciences, Lund University, Lund, Sweden; Department of Anaesthesiology, Surgery and Intensive Care, Sahlgrenska University Hospital, Gothenburg, Sweden.
| | - Mona Ringdal
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Department of Anaesthesiology and Critical Care, Kungälvs Hospital, Kungälv, Sweden
| | - Pia Lundqvist
- Department of Medicine and Health Sciences, Lund University, Lund, Sweden
| | - Pether Jildenstål
- Department of Medicine and Health Sciences, Lund University, Lund, Sweden; Department of Anaesthesiology, Surgery and Intensive Care, Sahlgrenska University Hospital, Gothenburg, Sweden; Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Department of Anaesthesiology and Intensive Care, Örebro University Hospital and School of Medical Sciences, Örebro University, Örebro, Sweden
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Dandy S, Wittkowski A, Murray CD. Parents' experiences of receiving their child's diagnosis of congenital heart disease: A systematic review and meta-synthesis of the qualitative literature. Br J Health Psychol 2024; 29:351-378. [PMID: 37968248 DOI: 10.1111/bjhp.12703] [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: 03/03/2023] [Revised: 07/31/2023] [Accepted: 10/18/2023] [Indexed: 11/17/2023]
Abstract
PURPOSE This systematic review aimed to synthesize qualitative research on parents' psychological experiences following their child's diagnosis of congenital heart disease (CHD). METHODS A systematic search of six electronic databases (CINAHL, Embase, MEDLINE, PsycINFO, PubMed and Web of Science) was completed, inclusive of all years up to May 2022. Any included articles were synthesized using thematic synthesis and appraised using the Critical Appraisal Skills Programme Qualitative Checklist. RESULTS Twenty-six articles were included. Four main themes, and 11 subthemes, emerged from the synthesis. Theme 1 (unpreparedness for the diagnosis) concerned parents' shock, guilt and anger regarding the diagnosis. Theme 2 (the overwhelming reality of CHD) described parental fear about decision-making and the child's prognosis, and the influence of professionals on parents' well-being. Theme 3 (mourning multiple losses) detailed parents' sadness at losing their envisioned pregnancy, birth and parenthood experiences. Theme 4 (redefining hopes to reach an acceptance of CHD) described parents' adjustment to the diagnosis. CONCLUSIONS Receiving a child's CHD diagnosis was a uniquely challenging situation for parents. The findings provided insight into the emotions parents experienced and how they adjusted to the diagnosis psychologically. As parents' experiences were significantly influenced by their interactions with professionals, clinicians should offer compassion, validation and clear information throughout the diagnosis process.
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Kruszecka-Krówka A, Cepuch G, Micek A. Stress Coping Strategies in Parents of Newborns and Infants with Congenital Cyanotic Heart Disease with Regard to Stress Levels and Negative Emotions. CHILDREN (BASEL, SWITZERLAND) 2024; 11:508. [PMID: 38790503 PMCID: PMC11120106 DOI: 10.3390/children11050508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/17/2024] [Revised: 04/17/2024] [Accepted: 04/22/2024] [Indexed: 05/26/2024]
Abstract
BACKGROUND Parents of children suffering from congenital heart disease experience high levels of stress and negative emotions. Therefore, recognition of parents' emotional states and their ways of coping with it is becoming more and more important. METHODS The study group consisted of 154 parents of newborns and infants with cyanotic congenital heart disease, before and after cardiac surgery (partial or full). To assess parental negative emotions, the level of stress, and strategies of coping with it, standardized questionnaires, such as HADS-M, PSS-10, and COPE, were used. RESULTS Stress levels in parents were high and associated with negative emotions (anxiety, depression, irritability), as well as the choice of non-constructive coping strategies, which was observed especially in younger parents. CONCLUSIONS Assessing parents' stress levels and ways of coping with stress can improve family functioning and provide better development conditions for the child.
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Affiliation(s)
- Agnieszka Kruszecka-Krówka
- Nursing and Midwifery Institute, Faculty of Health Sciences, Jagiellonian University Medical College, 25 Kopernik Street, 31-501 Krakow, Poland;
| | - Grażyna Cepuch
- Nursing and Midwifery Institute, Faculty of Health Sciences, Jagiellonian University Medical College, 25 Kopernik Street, 31-501 Krakow, Poland;
| | - Agnieszka Micek
- Statistical Laboratory, Faculty of Health Sciences, Jagiellonian University Medical College, 25 Kopernik Street, 31-501 Krakow, Poland;
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Cole L, Ridings L, Phillips SM. Stress and Coping Factors Affecting Health-Related Quality of Life in Parents of Children with Congenital Heart Disease: An Integrative Review. Pediatr Cardiol 2024; 45:457-470. [PMID: 37466733 DOI: 10.1007/s00246-023-03227-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Accepted: 07/02/2023] [Indexed: 07/20/2023]
Abstract
Parents of children with congenital heart disease experience unique stressors that affect their psychological well-being and health-related quality of life. A parent's ability to cope effectively influences how they adjust to stressful situations. The purpose of this review is to synthesize the factors influencing HRQoL in parents of children with congenital heart disease under the lens of the Transactional Model of Stress and Coping framework to identify areas for intervention and future research. An integrative literature review was conducted by keyword search of online databases PubMed, PsycINFO, Cumulative Index to Nursing and Allied Health Literature, and Medline from 2011 to 2022. Inclusion and exclusion criteria were applied to search results and studies were assessed for quality using the Mixed Method Appraisal Tool. The initial search yielded 1026 unique papers, and 24 were included based on the predefined criteria. The Transactional Model of Stress and Coping was applied to organize results and generate themes. Results showed a child's hospitalization is a time of uncertainty and distress for parents of children with congenital heart disease. Effective problem-focused and emotion-focused coping strategies can lead to reduced stress and improved health-related quality of life for parents. Additionally, multiple variables moderate the relationship between a parent's perceived stress and adjustment. Health care teams should focus on targeted education, faith, coping, and social support interventions. Further research is needed that examines the effect of mental health factors, cultural differences, and socioeconomic variables on the health-related quality of life of parents of children with congenital heart disease.
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Affiliation(s)
- Lianne Cole
- College of Nursing, Medical University of South Carolina, Charleston, USA.
| | - Leigh Ridings
- College of Nursing, Medical University of South Carolina, Charleston, USA
| | - Shannon M Phillips
- College of Nursing, Medical University of South Carolina, Charleston, USA
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de Silva GNJ, Gamage GP. Queens of hearts: Exploring the lived experiences of mothers caring for infants with complex congenital heart disease in Sri Lanka. J Health Psychol 2024:13591053241233382. [PMID: 38384242 DOI: 10.1177/13591053241233382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/23/2024] Open
Abstract
This qualitative study explored the lived experiences of eight Sri Lankan mothers of infants with complex congenital heart disease (CCHD) using semi-structured interviews. Four themes were generated as: illness perception, communication with medical staff, challenges faced, and coping mechanisms. These provided insight into the multi-faceted nature of mothers' experiences, importance of medical-caregiver communications and their need for psychosocial services. The findings enhance the limited knowledge of South-Asian primary CCHD caregiver experiences and will help in improving psychosocial support services in Sri Lanka.
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Kim S, Pistawka C, Langlois S, Osiovich H, Virani A, Kitchin V, Elliott AM. Genetic counselling considerations with genetic/genomic testing in Neonatal and Pediatric Intensive Care Units: A scoping review. Clin Genet 2024; 105:13-33. [PMID: 37927209 DOI: 10.1111/cge.14446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Revised: 09/23/2023] [Accepted: 10/15/2023] [Indexed: 11/07/2023]
Abstract
Genetic and genomic technologies can effectively diagnose numerous genetic disorders. Patients benefit when genetic counselling accompanies genetic testing and international guidelines recommend pre- and post-test genetic counselling with genome-wide sequencing. However, there is a gap in knowledge regarding the unique genetic counselling considerations with different types of genetic testing in the Neonatal Intensive Care Unit (NICU) and the Pediatric Intensive Care Unit (PICU). This scoping review was conducted to identify the gaps in care with respect to genetic counselling for infants/pediatric patients undergoing genetic and genomic testing in NICUs and PICUs and understand areas in need of improvement in order to optimize clinical care for patients, caregivers, and healthcare providers. Five databases (MEDLINE [Ovid], Embase [Ovid], PsycINFO [Ebsco], CENTRAL [Ovid], and CINHAL [Ebsco]) and grey literature were searched. A total of 170 studies were included and used for data extraction and analysis. This scoping review includes descriptive analysis, followed by a narrative account of the extracted data. Results were divided into three groups: pre-test, post-test, and comprehensive (both pre- and post-test) genetic counselling considerations based on indication for testing. More studies were conducted in the NICU than the PICU. Comprehensive genetic counselling was discussed in only 31% of all the included studies demonstrating the need for both pre-test and post-test genetic counselling for different clinical indications in addition to the need to account for different cultural aspects based on ethnicity and geographic factors.
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Affiliation(s)
- Sunu Kim
- Department of Medical Genetics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Carly Pistawka
- Department of Microbiology and Immunology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Sylvie Langlois
- Department of Medical Genetics, University of British Columbia, Vancouver, British Columbia, Canada
- BC Children's Hospital Research Institute, Vancouver, British Columbia, Canada
- Women's Health Research Institute, Vancouver, British Columbia, Canada
| | - Horacio Osiovich
- BC Children's Hospital Research Institute, Vancouver, British Columbia, Canada
- Women's Health Research Institute, Vancouver, British Columbia, Canada
- Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Alice Virani
- Department of Medical Genetics, University of British Columbia, Vancouver, British Columbia, Canada
- Ethics Service, Provincial Health Services Authority, Vancouver, British Columbia, Canada
| | - Vanessa Kitchin
- Woodward Library, University of British Columbia, Vancouver, British Columbia, Canada
| | - Alison M Elliott
- Department of Medical Genetics, University of British Columbia, Vancouver, British Columbia, Canada
- BC Children's Hospital Research Institute, Vancouver, British Columbia, Canada
- Women's Health Research Institute, Vancouver, British Columbia, Canada
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Cepuch G, Kruszecka-Krówka A, Lalik A, Micek A. Toxic Stress as a Potential Factor Inducing Negative Emotions in Parents of Newborns and Infants with Cyanotic Congenital Heart Disease. CHILDREN (BASEL, SWITZERLAND) 2023; 10:1893. [PMID: 38136095 PMCID: PMC10742307 DOI: 10.3390/children10121893] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Revised: 11/30/2023] [Accepted: 12/05/2023] [Indexed: 12/24/2023]
Abstract
BACKGROUND Parents who have a newborn with a congenital heart defect experience negative emotions, which may determine the emotional state of their children. METHODS The study group included 154 parents of newborns and infants with cyanotic congenital heart disease, before cardiac surgery and after the procedure. HADS m and PSS-10 questionnaires were used to assess parental anxiety, depression, aggression, and the level of stress. RESULTS High levels of depression, anxiety, total HADS and stress were diagnosed in a large group of parents, regardless of the stage of cardiac surgery treatment. A high level of stress was associated with a higher prevalence of emotional disturbance both in the total HADS (overall) and in all its individual domains. Anxiety and depression were more common in mothers. A high level of stress was a significant predictor of anxiety and depression in parents. CONCLUSIONS A high level of stress was a significant predictor of anxiety and depression in parents of infants with congenital heart disease. The parents' psychological condition is one of many potential determinants over the course of their child's treatment and recovery.
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Affiliation(s)
- Grażyna Cepuch
- Nursing and Midwifery Institute, Faculty of Health Sciences, Jagiellonian University Medical College, 31-501 Krakow, Poland; (G.C.); (A.L.)
| | - Agnieszka Kruszecka-Krówka
- Nursing and Midwifery Institute, Faculty of Health Sciences, Jagiellonian University Medical College, 31-501 Krakow, Poland; (G.C.); (A.L.)
| | - Anna Lalik
- Nursing and Midwifery Institute, Faculty of Health Sciences, Jagiellonian University Medical College, 31-501 Krakow, Poland; (G.C.); (A.L.)
| | - Agnieszka Micek
- Statistical Laboratory, Faculty of Health Sciences, Jagiellonian University Medical College, 31-501 Krakow, Poland;
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Elhoff JJ, Acosta S, Flores S, LaSalle J, Loomba R, McGetrick M, McKinney C, Ostrom M, Pande CK, Schlosser R, Schwab S, Savorgnan F. Parental holding of infants improves haemodynamics in the cardiac ICU. Cardiol Young 2023:1-6. [PMID: 38014584 DOI: 10.1017/s1047951123003931] [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: 11/29/2023]
Abstract
We performed a single-centre, retrospective study to assess physiologic changes of infants in the cardiac ICU while being held by their parent. Continuous data streaming of vital signs were collected for infants included in the study from January 2021 to March 2022. Demographic and clinical characteristics were collected from the electronic medical record. The physiologic streaming data were analysed using mixed-effects models to account for repeated measures and quantify the effect of parental holding. Comparison analysis was also performed controlling for intubation, pre-operative versus post-operative status, and whether the holding was skin-to-skin or not. Ninety-five patients with complete physiologic data were included in the study. There were no immediate adverse events associated with holding. Heart rate decreased during the response time compared to its baseline value (p = 0.01), and this decrease was more pronounced for the non-intubated and pre-operative patients. The near-infrared spectroscopy-based venous saturation increased overall (p = 0.02) in patients while being held. We conclude that parental holding of infants in the cardiac ICU can be safely accomplished, and the haemodynamic and oximetric profile during the holding is favourable compared to the infants' baseline prior to holding.
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Affiliation(s)
- Justin J Elhoff
- Department of Pediatrics, Pediatrix Medical Group, Sunrise Children's Hospital, Kirk Kerkorian School of Medicine at UNLV, Las Vegas, NV, USA
| | - Sebastian Acosta
- Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA
| | - Saul Flores
- Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA
| | | | - Rohit Loomba
- Department of Pediatrics, Advocate Children's Hospital, Chicago Medical School, Rosalind Franklin University of Medicine and Science, Chicago, IL, USA
| | - Molly McGetrick
- Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA
| | | | | | - Chetna K Pande
- Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA
| | | | | | - Fabio Savorgnan
- Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA
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10
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Arntzen T, Mikkelsen A, Emblem R, Lai X, Haugen G. Prenatal Diagnosis of Esophageal Atresia - Performance and Consequences. J Pediatr Surg 2023; 58:2075-2080. [PMID: 37407414 DOI: 10.1016/j.jpedsurg.2023.05.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 04/25/2023] [Accepted: 05/14/2023] [Indexed: 07/07/2023]
Abstract
BACKGROUND Prenatal diagnosis of congenital malformations is considered favorable. Esophageal atresia (EA) is prenatally detected in 10-40% of patients. The aims of our study were to assess factors influencing the prenatal detection rate and to study the outcome in EA patients with and without prenatal diagnosis. METHOD We included 136 patients in two time periods, group 1 (1996-2002, n = 68) and group 2 (2014-2020, n = 68). We registered clinical variables; prenatal signs, perinatal and postnatal outcome from the electronic patient record. RESULTS Twenty-five patients (18%) had a prenatal diagnosis of EA, significantly more during 2014-2020 (28%), than during 1996-2002 (9%). Patients with EA type A or B and with associated anomalies had increased likelihood of prenatal diagnosis, odds ratio (OR) 9.00 (1.99-40.69) and 3.53 (1.24-10.06), respectively. Among the 25 patients with prenatal diagnosis all had polyhydramnios and 16 had small/absent stomach. Prenatally diagnosed patients arrived significantly earlier at the surgical unit (median 2 h (2 h-1 days) vs 21 h (2 h-1275 days)), had more delayed primary anastomosis (OR 8.80 (2.68-28.92)) and anastomotic stricture (OR 3.11 (1.20-8.04)), longer length of stay (median 62 days (11-212 days) vs 20 days (2-270 days)) and longer time on ventilator (median 5 days (1-25 days) vs 1.5 days (0.5-33 days)) compared to patients without prenatal diagnosis. In multivariate analysis prenatal diagnosis predicts length of stay. CONCLUSION Prenatally diagnosed EA patients have more; type A and B malformations, associated anomalies and neonatal morbidity. Consequences of the assumed benefits of prenatal diagnosis; opportunity of early arrival to surgical care and prenatal counselling, must be further studied.
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Affiliation(s)
- T Arntzen
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway; Section for Pediatric Surgery, Oslo University Hospital, Oslo, Norway.
| | - A Mikkelsen
- Section for Pediatric Surgery, Oslo University Hospital, Oslo, Norway
| | - R Emblem
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway; Section for Pediatric Surgery, Oslo University Hospital, Oslo, Norway
| | - X Lai
- Oslo Centre for Biostatistics and Epidemiology, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - G Haugen
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway; Department of Fetal Medicine, Division of Obstetrics and Gynaecology, Oslo University Hospital, Oslo, Norway
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Ay A, Koç G. The effect of nursing care and follow-up for mothers of infants undergoing congenital heart surgery: a quasi-experimental study. Cardiol Young 2023; 33:1649-1656. [PMID: 36124651 DOI: 10.1017/s1047951122002979] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Improvements in congenital heart surgery have resulted in an increasing number of infants surviving, but there remain concerns about home care and difficulties experienced by mothers. This study was designed to evaluate the effect of nursing care and follow-up for the mothers of infants undergoing congenital heart surgery on anxiety, care burden, and self-efficacy. The study was designed as a quasi-experimental study with a pre-test and post-test control group design. The study included 40 mothers whose infants had undergone congenital heart surgery. Nursing care was provided to the mothers of the infants included in the study group through a total of six home follow-ups until the third month after surgery, guided by the North American Nursing Diagnosis Association and Nursing Diagnosis System and Nursing Interventions Classification. Data were collected through Care Needs Identification Form, Spielberger's State-Trait Anxiety Inventory, Zarit Burden Interview, and Parental Self-efficacy Scale. The mean State-Trait Anxiety Inventory and Zarit Burden Interview scores for the mothers in the intervention group decreased, while the mean Parental Self-efficacy Scale scores increased as the follow-up progressed and it was determined that by the third month, the difference between the mothers in the intervention group and those in the control group in terms of post-test State-Trait Anxiety Inventory, Zarit Burden Interview, and Parental Self-efficacy Scale had become statistically significant. Providing appropriate nursing care practices to the mothers of the infants had undergone congenital heart surgery in home setting has the potential to decrease the problems experienced by the mothers.
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Affiliation(s)
- Ayşe Ay
- Nursing Department, Faculty of Health Sciences, Başkent University, Ankara, Turkey
| | - Gülten Koç
- Obstetrics and Gynecologic Nursing Department, Faculty of Nursing, Hacettepe University, Ankara, Turkey
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Ay A, Çınar Özbay S, Boztepe H, Gürlen E. "All in One: Fear, Happiness, Faith" A Qualitative Study on Experiences and Needs of Turkish Mothers of Infants with Congenital Heart Disease. Compr Child Adolesc Nurs 2023; 46:126-141. [PMID: 36952516 DOI: 10.1080/24694193.2023.2190398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/25/2023]
Abstract
Having an infant with congenital heart disease (CHD) may cause difficulties and changes in mothers' life. This study was aim to explore the experiences and needs of Turkish mothers of infants with CHD. The study was carried out with the descriptive phenomenological method from qualitative research. The study sample included 18 mothers having infants in the age range of 0 to 2 years with CHD. The data were collected using a sociodemographic data form and a semi-structured interview form. The data obtained from the interviews were evaluated using the content and thematic analysis methods. Four main themes and sub-themes emerged from the qualitative data. "Effect of getting a diagnosis" with two sub-themes (emotional changes and a protective mother-infant relationship), "All emotions in one" with two sub-themes (fearing of death and torn between fear and hope), "Influences on a mother's life" with three sub-themes (forgetting herself, getting away from siblings' lives and relations with spouse), and stressors with three sub-themes (loss of control, physical care and unfulfilled needs). The results of the study provide insight into how Turkish mothers subjectively experience life after CHD. Mothers expected healthcare professionals to support and understand their experiences and needs. Healthcare professionals need to create an environment for mothers to cope with emotional difficulties, gain knowledge and care skills, and adapt to their lives.
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Affiliation(s)
- Ayşe Ay
- Nursing Department, Faculty of Health Sciences Başkent University, Ankara, Turkey
| | | | - Handan Boztepe
- Department of Nursing, Faculty of Health Sciences, Atılım University, Ankara, Turkey
| | - Eda Gürlen
- Faculty of Education, Department of Educational Sciences, Curriculum and Instruction, Hacettepe University Ankara, Ankara, Turkey
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Wu MH, Lee TY, Lin MH. The parental experience of participating in surgical decision-making regarding one's child with a congenital heart disease in Taiwan. J Pediatr Nurs 2023; 68:e103-e108. [PMID: 36437130 DOI: 10.1016/j.pedn.2022.11.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Revised: 11/17/2022] [Accepted: 11/17/2022] [Indexed: 11/26/2022]
Abstract
PURPOSE This study explores how parents experienced the surgical decision-making process for their child with a congenital heart disease (CHD). DESIGN AND METHODS Purposive sampling was used in this qualitative descriptive study at a medical center in Northern Taiwan. Twelve parents whose children had cardiac corrective surgery participated in one-to-one in-depth interviews. The interview content subsequently was transcribed verbatim and analyzed by content analysis. RESULTS Five themes, with 2 to 3 subthemes, were identified: 1) accumulating medical knowledge in a short time, 2) trusting the medical teams but parents needing clear communication, 3) feeling pervasive uncertainty, 4) using self-talk to calm down, and 5) looking for positive energy from various sources. CONCLUSIONS For the parents of these children with CHD, participating in surgical decision-making can be a difficult and stressful experience. When explaining the disease and treatment procedures, it is important for medical professionals to make sure of the individual parent's information needs, to use plain language and encourage parents to ask questions. PRACTICE IMPLICATIONS Although the surgery is imperative and inevitable, understanding the parents' worries and providing adequate support can help them reduce feelings of uncertainty during the decision-making and surgical processes.
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Affiliation(s)
- Mei-Hua Wu
- Department of Nursing, National Taiwan University Hospital, No. 7, Chung-Shan S. Rd, Taipei 10002, Taiwan, ROC.
| | - Tzu-Ying Lee
- School of Nursing, National Taipei University of Nursing and Health Sciences, 365, Ming Te Rd. Beitou 11219, Taipei, Taiwan, ROC.
| | - Mei-Hsiang Lin
- School of Nursing, National Taipei University of Nursing and Health Sciences, 365, Ming Te Rd. Beitou 11219, Taipei, Taiwan, ROC.
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14
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Abstract
BACKGROUND Parents who receive a diagnosis of a severe, life-threatening CHD for their foetus or neonate face a complex and stressful decision between termination, palliative care, or surgery. Understanding how parents make this initial treatment decision is critical for developing interventions to improve counselling for these families. METHODS We conducted focus groups in four academic medical centres across the United States of America with a purposive sample of parents who chose termination, palliative care, or surgery for their foetus or neonate diagnosed with severe CHD. RESULTS Ten focus groups were conducted with 56 parents (Mage = 34 years; 80% female; 89% White). Results were constructed around three domains: decision-making approaches; values and beliefs; and decision-making challenges. Parents discussed varying approaches to making the decision, ranging from relying on their "gut feeling" to desiring statistics and probabilities. Religious and spiritual beliefs often guided the decision to not terminate the pregnancy. Quality of life was an important consideration, including how each option would impact the child (e.g., pain or discomfort, cognitive and physical abilities) and their family (e.g., care for other children, marriage, and career). Parents reported inconsistent communication of options by clinicians and challenges related to time constraints for making a decision and difficulty in processing information when distressed. CONCLUSION This study offers important insights that can be used to design interventions to improve decision support and family-centred care in clinical practice.
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15
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Lepage C, Gaudet I, Doussau A, Vinay MC, Gagner C, von Siebenthal Z, Poirier N, Simard MN, Paquette N, Gallagher A. The role of parenting stress in anxiety and sleep outcomes in toddlers with congenital heart disease. Front Pediatr 2022; 10:1055526. [PMID: 36683797 PMCID: PMC9853386 DOI: 10.3389/fped.2022.1055526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Accepted: 11/25/2022] [Indexed: 01/09/2023] Open
Abstract
OBJECTIVES This retrospective cohort study investigates how parenting stress, measured at 4 months of age by use of a classic three-dimensional parent-reported scale (Parenting Stress Index, 4th Ed. or PSI-4), can predict anxiety symptoms and quality of sleep at 24 months in toddlers with congenital heart disease (CHD). STUDY DESIGN Sixty-six toddlers with CHD followed at our cardiac neurodevelopmental follow-up clinic were included in this study. As part of their systematic developmental assessment program, parents completed questionnaires on their stress level (PSI-4) when their child was 4 months old, and on their child's anxiety symptoms and quality of sleep at 24 months. Eight multiple linear regression models were built on the two measures collected at 24 months using the PSI-4 scores collected at 4 months. For each measure, four models were built from the PSI-4 total score and its three subscales (Parental Distress, Parent-Child Dysfunctional Interaction, Difficult Child), controlling for sex and socioeconomic status. RESULTS The PSI-4 Difficult Child subscale, which focuses on parenting anxiety related to the child's behavioral problems and poor psychosocial adjustment, accounted for 17% of the child's anxiety symptoms at 24 months. The two other PSI-4 subscales (Parental Distress and Parent-Child Dysfunctional Interaction) and the PSI-4 total score did not contribute significantly to the models. None of the four regression models on perceived quality of sleep were significant. It is important to note that 33% of parents responded defensively to the PSI-4. CONCLUSIONS Parenting stress related to the child's behavioral problems and poor psychosocial adjustment, measured when the child is 4 months old, is associated with the child's ulterior anxiety symptoms. As very few standardized tools are available to assess the behavioral and psychoaffective development of infants, this study highlights the importance of early psychosocial screening in parents of infants with CHD. The high rate of significant Defensive Responding Indices reminds us to not take parent reports at face value, as their actual stress levels might be higher.
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Affiliation(s)
- Charles Lepage
- Research Center, Sainte-Justine University Hospital Research Center, Montréal, QC, Canada.,Department of Psychology, Université de Montréal, Montréal, QC, Canada
| | - Isabelle Gaudet
- Research Center, Sainte-Justine University Hospital Research Center, Montréal, QC, Canada.,Department of Psychology, Université de Montréal, Montréal, QC, Canada
| | - Amélie Doussau
- Clinique d'investigation neurocardiaque (CINC), Sainte-Justine University Hospital, Montréal, QC, Canada
| | - Marie-Claude Vinay
- Clinique d'investigation neurocardiaque (CINC), Sainte-Justine University Hospital, Montréal, QC, Canada
| | - Charlotte Gagner
- Clinique d'investigation neurocardiaque (CINC), Sainte-Justine University Hospital, Montréal, QC, Canada
| | - Zorina von Siebenthal
- Clinique d'investigation neurocardiaque (CINC), Sainte-Justine University Hospital, Montréal, QC, Canada
| | - Nancy Poirier
- Research Center, Sainte-Justine University Hospital Research Center, Montréal, QC, Canada.,Clinique d'investigation neurocardiaque (CINC), Sainte-Justine University Hospital, Montréal, QC, Canada.,Department of Surgery, Division of Cardiac Surgery, Faculty of Medicine, Université de Montréal, Montréal, QC, Canada
| | - Marie-Noëlle Simard
- Research Center, Sainte-Justine University Hospital Research Center, Montréal, QC, Canada.,School of Rehabilitation, Faculty of Medicine, Université de Montréal, Montréal, QC, Canada
| | - Natacha Paquette
- Research Center, Sainte-Justine University Hospital Research Center, Montréal, QC, Canada.,Department of Psychology, Université de Montréal, Montréal, QC, Canada
| | - Anne Gallagher
- Research Center, Sainte-Justine University Hospital Research Center, Montréal, QC, Canada.,Department of Psychology, Université de Montréal, Montréal, QC, Canada
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16
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MacKay L, Benzies K, Raffin Bouchal S, Barnard C. Parental and Health Care Professionals' Experiences Caring for Medically Fragile Infants on Pediatric Inpatient Units. CHILDRENS HEALTH CARE 2021. [DOI: 10.1080/02739615.2021.1973900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Lyndsay MacKay
- Nursing, University of Calgary, Calgary, Alberta, Canada
| | - Karen Benzies
- Nursing, University of Calgary, Calgary, Alberta, Canada
| | | | - Chantelle Barnard
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
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17
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Man MA, Segers EW, Schappin R, Leeden K, Wösten‐van Asperen RM, Breur H, Weerth C, Hoogen A. Parental experiences of their infant's hospital admission undergoing cardiac surgery: A systematic review. Acta Paediatr 2021; 110:1730-1740. [PMID: 33251633 PMCID: PMC8248104 DOI: 10.1111/apa.15694] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Revised: 11/25/2020] [Accepted: 11/25/2020] [Indexed: 12/31/2022]
Abstract
AIM To explore parents' experiences of parenting a child hospitalised with congenital heart disease (CHD) and undergoing surgery. METHODS Five electronic databases were systematically searched for articles describing the experiences of parents with a child with a CHD. A thematic analysis approach was used to identify the most common themes. RESULTS A total of 188 articles were identified. Eight studies were included in the review. Four themes emerged, including balancing the parental role, experiencing anticipatory grief, decreasing parental stress using coping strategies and professional support. CONCLUSION Having a child with CHD undergoing heart surgery is a stressful experience due to, among other things, the different situation-related parenting role during the hospital stay and feelings of anticipatory grief. Healthcare professionals in the PICU have an essential role in supporting parents and understanding the needs that are crucial for the parents in order to provide better support and reduce stress and anxiety. More qualitative research regarding the pathway from the prenatal diagnosis through the early childhood period is warranted.
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Affiliation(s)
- Marjorie A.C.P. Man
- Wilhelmina Children’s Hospital University Medical Centre Utrecht Utrecht The Netherlands
| | - Elisabeth W. Segers
- Wilhelmina Children’s Hospital University Medical Centre Utrecht Utrecht The Netherlands
| | - Renske Schappin
- Department of Development and Education of Youth in Diverse Societies Utrecht University Utrecht The Netherlands
| | - Kees Leeden
- Wilhelmina Children’s Hospital University Medical Centre Utrecht Utrecht The Netherlands
| | | | - Hans Breur
- Wilhelmina Children’s Hospital University Medical Centre Utrecht Utrecht The Netherlands
| | - Carolina Weerth
- Donders Institute for Brain Cognition and Behaviour Radboud University Medical Center Nijmegen The Netherlands
| | - Agnes Hoogen
- Wilhelmina Children’s Hospital University Medical Centre Utrecht Utrecht The Netherlands
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18
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Elliott M, Erickson L, Russell CL, Chrisman M, Gross Toalson J, Emerson A. Defining a new normal: A qualitative exploration of the parent experience during the single ventricle congenital heart disease interstage period. J Adv Nurs 2021; 77:2437-2446. [PMID: 33591609 DOI: 10.1111/jan.14785] [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: 07/16/2020] [Revised: 01/03/2021] [Accepted: 01/16/2021] [Indexed: 11/28/2022]
Abstract
AIM To explore parents' experience of transition in the period between the palliative cardiac surgeries (i.e., the interstage period) of an infant with single ventricle congenital heart disease. DESIGN We conducted an exploratory naturalistic inquiry using a qualitative descriptive approach. METHODS A purposive sample of 11 parents of children with single ventricle disease was selected among families that participated in an interstage-period parental home monitoring program during the past 2 years. Interviews and field observations were conducted September-October 2019, and data were analyzed for themes. Analysis of data was inductive, although study questions and the interpretation of results were informed by Meleis' transition theory. RESULTS Parents described the experience of transition in interstage as a striving for normality, a theme that was clustered in subthemes of home, self, and infant. CONCLUSION Parents' experiences of striving for normality indicated a need for more targeted efforts to address parents' psychosocial needs during the highly stressful interstage transition. IMPACT This research underscored the complexity of parents' psychosocial support needs on returning home after their child's first palliative surgery. The findings also suggest need for examination of the transition following the second palliative heart surgery, when the home monitoring program is withdrawn. Understanding parent needs will help guide healthcare teams in developing ways to support parents as they adjust to home, self, and child.
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Affiliation(s)
- Melissa Elliott
- University of Missouri-Kansas City, Kansas City, Missouri, USA.,Children's Mercy Hospital, Kansas City, Missouri, USA
| | - Lori Erickson
- University of Missouri-Kansas City, Kansas City, Missouri, USA.,Children's Mercy Hospital, Kansas City, Missouri, USA
| | | | | | - Jami Gross Toalson
- University of Missouri-Kansas City, Kansas City, Missouri, USA.,Children's Mercy Hospital, Kansas City, Missouri, USA
| | - Amanda Emerson
- University of Missouri-Kansas City, Kansas City, Missouri, USA
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19
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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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20
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Knight Lozano R, May S, Clarkson C, Sarjeant R. Caregiver experiences of paediatric inpatient cardiac services: A qualitative systematic review. Eur J Cardiovasc Nurs 2020; 20:147-159. [PMID: 33849062 DOI: 10.1177/1474515120951974] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Revised: 07/04/2020] [Accepted: 08/02/2020] [Indexed: 11/15/2022]
Abstract
BACKGROUND Advances in paediatric care have contributed to an increasing survival of children with complex heart disease. Yet, life-saving management demands prolonged inpatient admissions, which contribute to emotional and psychological distress for parents and other caregivers in a role of main custody. AIM The purpose of this study was to identify, appraise and synthesise qualitative studies exploring caregivers' experiences of paediatric inpatient cardiac services, generating an understanding of their needs in hospital and informing priorities for change in healthcare delivery. METHODS Searches were conducted in Medline, Allied and Complimentary Medicine Database, Cumulative Index of Nursing and Allied Health Literature, EMCARE, Scopus, PsychINFO, Proquest, OpenGrey and ETHOs from 2008-2019, reflecting recent advances in cardiac healthcare. Articles were selected using predetermined eligibility criteria dictating qualitative inquiry into caregiver perspectives whilst their child received hospital-based interventions for heart disease. All eligible studies underwent quality appraisal. Framework synthesis was used to analyse and summarise findings. RESULTS Twenty-seven studies involving 689 caregivers from 11 countries were included. Three overarching themes were identified: 'emotional capacity to care', 'practicalities of caring', and 'the bigger picture of caring'. CONCLUSIONS Through analysis and summary of qualitative primary research, this review captures the emotional challenges that caregivers face and practicalities of undertaking a caregiver role, whilst looking after their child with heart disease in hospital. The results widen the context of the caregiver role, encompassing the whole family unit beyond the hospital environment. This review exposes the impact of these challenges on caregiver competence, wellbeing and attachment to their unwell child, informing priorities for development of family-centred paediatric inpatient cardiac services.
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Affiliation(s)
| | - Stephen May
- Faculty of Health and Wellbeing, Sheffield Hallam University, UK
| | - Carl Clarkson
- Department of Sport, Exercise and Rehabilitation, Northumbria University, UK
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21
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Christian BJ. Translational Research - Parental Stress Associated with Hospitalization of Children with Critical Life-Threatening Conditions and the Long-term Impact. J Pediatr Nurs 2020; 51:110-113. [PMID: 32001063 DOI: 10.1016/j.pedn.2020.01.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- Becky J Christian
- School of Nursing, The University of Louisville, KY, United States of America.
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22
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Hasinuddin M, Noviana U, Fitriah F. Family Support System as an Effort to Optimize Coping Mechanism of Preschool Children During Hospitalization. JURNAL NERS 2020. [DOI: 10.20473/jn.v14i2.17212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Introduction: The condition of the child during hospitalisation can experience stress due to environmental changes. Child coping mechanism is very supportive of the adaptation process. The purpose of this study was to analyze the effect of family support system on coping mechanisms during hospitalisation. Methods: It was quasi-experimental with pre-test post-test with control group design. The study population was preschool children who were treated in the Hospital of Bangkalan, East Java Province, Indonesia. Total sample was 60 respondents in treatment and control group and obtained consecutive sampling. The variables were family support system and coping mechanism. Data collection used Children’s Coping Behavior questionnaire and tested by paired t-test. Results: The treatment group showed the coping mechanism was mostly maladaptive (mean=34.07) and after the intervention most of them had adaptive coping (mean=46.87). Whereas in the control group before the intervention, the coping mechanism was mostly maladaptive (mean=36.22) and after the intervention most of the coping groups had maladaptive coping (mean=36.74). Conclusion: Family support systems play an important role in improving the adaptive coping of preschool children during hospitalisation. Nurses should maximise family support as a strategy in interacting with children to enhance coping mechanisms to reduce the stress of hospitalisation.
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