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Lisanti AJ, Min J, Golfenshtein N, Marino BS, Curley MAQ, Medoff-Cooper B. Perceived family-centered care and post-traumatic stress in parents of infants cared for in the paediatric cardiac intensive care unit. Nurs Crit Care 2024. [PMID: 38816199 DOI: 10.1111/nicc.13094] [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: 01/02/2024] [Revised: 05/09/2024] [Accepted: 05/14/2024] [Indexed: 06/01/2024]
Abstract
BACKGROUND Family-centred care (FCC), while a core value of paediatric hospitals, has not been well-studied in the paediatric cardiac intensive care unit (PCICU). AIMS To describe parents' perceptions of FCC provided by nurses in the PCICU during their infant's recovery from neonatal cardiac surgery and explore associations of perceptions of FCC on parent post-traumatic stress (PTS) 4 months post-discharge. STUDY DESIGN Data obtained from a previously conducted randomized clinical trial (RCT) on telehealth home monitoring after neonatal cardiac surgery at three free-standing paediatric hospitals were analysed from a subset of 164 parents who completed the FCC Scale at hospital discharge, which measures a parent's experience of nursing care that embodies core principles of FCC. The RCT intervention was provided after hospital discharge, having no influence on parent's perception of FCC. The intervention also had no effect on PTS. RESULTS Perceived FCC was lowest for items 'nurses helped me feel welcomed' and 'nurses helped me feel important in my child's care'. Having 12%-19% points lower perception of FCC at hospital discharge was associated with parent experience of six or more PTS symptoms, at least moderate PTS symptom severity, or PTS disorder diagnosis at 4-month follow-up. Every 10% increase in parental perceptions of FCC was associated with less PTS symptoms (β = -0.29, SE = 0.12; p = .02) and lower PTS symptom cluster scores of arousal (β = -0.18, SE = 0.08; p = .02). CONCLUSIONS Parents who perceived lower FCC during their infants' hospitalization were at increased risk for the development of PTS symptoms, more PTS symptom severity and PTS disorder diagnosis 4-months post-discharge. RELEVANCE TO CLINICAL PRACTICE Nurses have a prominent role to support the implementation of FCC for infants with cardiac defects and their parents. FCC may positively influence overall parent mental health and well-being, reducing the trauma and distress of the PCICU experience.
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Affiliation(s)
- Amy J Lisanti
- Department of Family and Community Health, School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Research Institute, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Jungwon Min
- Department of Biomedical and Health Informatics, Research Institute, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | | | - Bradley S Marino
- Department of Pediatric Cardiology, Cleveland Clinic Children's, Cleveland, Ohio, USA
| | - Martha A Q Curley
- Department of Family and Community Health, School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Research Institute, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Barbara Medoff-Cooper
- Department of Family and Community Health, School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Research Institute, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
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Lee LA, Foster JR, Nikitovic D, Garros D, Ryan MJ, Moghadam N, Slumkoski C, Walls M, Curran JA, Seabrook JA, Burgess S, Betts L, Barclay A, Choong K, Fontela P, Murthy S, Nicoll J, O'Hearn K, Sehgal A, Tijssen J. "We Aren't Meant to Go Through the Hardest Parts of Our Lives Alone": Family Experience With Restricted PICU Presence During the COVID-19 Pandemic. Crit Care Explor 2023; 5:e0989. [PMID: 38304703 PMCID: PMC10833634 DOI: 10.1097/cce.0000000000000989] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2024] Open
Abstract
CONTEXT PICUs across Canada restricted family presence (RFP) in response to the COVID-19 pandemic from allowing two or more family members to often only one family member at the bedside. The objective of this study was to describe the experiences and impact of RFP on families of critically ill children to inform future policy and practice. HYPOTHESIS RFP policies negatively impacted families of PICU patients and caused moral distress. METHODS AND MODELS National, cross-sectional, online, self-administered survey. Family members of children admitted to a Canadian PICU between March 2020 and February 2021 were invited to complete the survey. RFP-attributable distress was measured with a modified distress thermometer (0-10). Closed-ended questions were reported with descriptive statistics and multivariable linear regression assessed factors associated with RFP-attributable distress. Open-ended questions were analyzed using inductive content analysis. RESULTS Of 250 respondents who experienced RFP, 124 (49.6%) were restricted to one family member at the bedside. The median amount of distress that families attributed to RFP policies was 6 (range: 0-10). Families described isolation, removal of supports, and perception of trauma related to RFP. Most families (183, 73.2%) felt that policies were enforced in a way that made them feel valued by PICU clinicians, which was associated with less RFP-attributable distress. Differential impact was seen where families with lower household income indicated higher RFP-attributable distress score (2.35; 95% CI, 0.53-4.17; p = 0.03). Most respondents suggested that future policies should allow at least two family members at the bedside. INTERPRETATIONS AND CONCLUSIONS Families of children admitted to PICUs during the COVID-19 pandemic described increased distress, trauma, and removal of supports due to RFP policies. Vulnerable families showed an increased odds of higher distress. Healthcare professionals played an important role in mitigating distress. Allowance of at least two family members at the bedside should be considered for future policy.
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Affiliation(s)
- Laurie A Lee
- Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Faculty of Nursing, University of Calgary, Calgary, AB, Canada
| | - Jennifer R Foster
- Department of Pediatric Critical Care, IWK Health, Halifax, NS, Canada
- Department of Critical Care, Dalhousie University, Halifax, NS, Canada
| | - Dejana Nikitovic
- Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Daniel Garros
- Stollery Children's Hospital, Edmonton, AB, Canada
- Department of Pediatrics, Division of Critical Care Medicine, University of Alberta, Edmonton, AB, Canada
| | - Molly J Ryan
- Department of Pediatric Critical Care, IWK Health, Halifax, NS, Canada
| | - Neda Moghadam
- Patient Partner, Department of Pediatric Critical Care, IWK Health, Halifax, NS, Canada
| | - Corey Slumkoski
- Patient Partner, Department of Pediatric Critical Care, IWK Health, Halifax, NS, Canada
| | - Martha Walls
- Patient Partner, Department of Pediatric Critical Care, IWK Health, Halifax, NS, Canada
| | - Janet A Curran
- IWK Health, Halifax, NS, Canada
- Dalhousie School of Nursing, Dalhousie University, Halifax, NS, Canada
| | - Jamie A Seabrook
- Department of Pediatrics, Western University, London, ON, Canada
- Children's Health Research Institute, London, ON, Canada
- Lawson Health Research Institute, London, ON, Canada
- School of Food and Nutritional Sciences, Brescia University College, London, BC, Canada
- Department of Epidemiology & Biostatistics, Western University, London, ON, Canada
| | | | - Laura Betts
- Department of Pediatric Critical Care, IWK Health, Halifax, NS, Canada
| | - Amanda Barclay
- Department of Pediatrics, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
- Pediatrics, University of Victoria, Victoria, BC, Canada
- Island Health, Vancouver, BC, Canada
- Victoria General Hospital, Victoria, BC, Canada
| | - Karen Choong
- Departments of Pediatrics and Critical Care, McMaster University, Hamilton, ON, Canada
- McMaster Children's Hospital, Hamilton, ON, Canada
| | - Patricia Fontela
- Division of Pediatric Critical Care, Department of Pediatrics, McGill University, Montreal, QC, Canada
| | - Srinivas Murthy
- Division of Critical Care, Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada
| | - Jessica Nicoll
- Janeway Children's Health and Rehabilitation Centre, St. John's, NL, Canada
| | - Katie O'Hearn
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON, Canada
| | - Anupam Sehgal
- Department of Pediatrics, Queen's University, Kingston Health Sciences Centre, Kingston, ON, Canada
| | - Janice Tijssen
- Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
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