[Family's presence in the pediatric emergency room: opinion of health's professionals]

Effect of family presence on pain and anxiety levels among patients during invasive nursing procedures in an emergency department at a public hospital in Western Iran

Introduction

It is widely accepted that pain is the most common complaint during invasive nursing procedures, which causes anxiety in patients. The purpose of this study was to determine the effect of family presence on the level of pain and anxiety of patients during invasive nursing procedures in an emergency centre in 2019.

Methods

The present non-randomized controlled clinical trial was conducted on 70 patients referred to emergency centre at selected hospital affiliated to Kermanshah University of Medical Sciences, Iran, in 2018, who were selected by convenience sampling method and then randomly assigned into two groups of intervention (even days) and control (odd days). The invasive nursing procedure was performed for the intervention group in the family presence for physical and psychological support and for the control group without the family presence. Data collection tools were the Spielberger State-Trait Anxiety Inventory (STAI) and the Visual Analogue Scale (VAS). SPSS version 23 software was used to compare the mean scores of pain and anxiety using independent t-test.

Results

The mean pain score after the invasive procedure had no significant difference between the intervention group (3.9 ± 1.5) and the control group (4.7 ± 1.9) (P = 0.073). In the intervention group, the mean score of anxiety after invasive procedure was significantly lower than before the invasive procedure (P = 0.028), whereas the control group showed no change (P = 0.556).

Conclusion

The family presence during the invasive nursing procedures reduced the anxiety of patients but had no effect on their pain. Emergency nurses can take advantage of family presence during invasive procedures as a non-pharmacological intervention to reduce patients' anxiety.

A Scoping Review of the Impact of Family Presence on Pediatric Resuscitation Team Members

OBJECTIVES

The purpose of this scoping review was to identify the extent, range, and nature of information currently available on family presence during pediatric resuscitation on resuscitation team members and their performance.

DATA SOURCES

A comprehensive search strategy was created and executed by identifying primary keywords in central articles, pretesting key words and combinations of them in databases to confirm articles returned fell within the search parameters, and checking that key articles were returned which confirmed the search strategy was not too narrow.

STUDY SELECTION

Two members of the research team independently conducted relevance screening using predetermined inclusion and exclusion parameters. Titles and abstracts of retrieved articles were reviewed using the set criteria involving. From the refined list of selected articles, full texts of each article were considered for final determination of inclusion.

DATA EXTRACTION

Key items of information were gathered from each article selected using a predefined extraction list. The extracted information was then sorted into themes and relevant issues.

DATA SYNTHESIS

Of the 3,012 studies initially identified, 48 met the inclusion criteria. Themes identified included as follows: 1) attitudes and opinions on family presence during pediatric resuscitation; 2) reasons in support of or against family presence during pediatric resuscitation; 3) education, training, and support; and 4) resuscitation performance and outcomes. Our review of the available information highlighted that the majority of work done to this point has focused heavily on healthcare provider opinions and relied mainly on survey method.

CONCLUSIONS

We propose that future research employ more rigorous research techniques, such as randomized control trials, place greater emphasis on healthcare provider behaviors and clinical outcomes during family presence during pediatric resuscitation, and increase exploration into the education and training needs of healthcare providers who already currently manage family presence during pediatric resuscitation.

Effect of Midazolam Alone Versus Midazolam with Maternal Presence on Pain and Anxiety of Lumbar Puncture in 6 to 24-Month-Old Children

OBJECTIVES

Midazolam at a dosage of 0.5 mg/kg induces anxiolytic effects in 90% of children. This study was performed to elucidate whether intravenous midazolam with maternal presence is more efficient than intravenous midazolam alone in the reduction of pain and anxiety of lumbar puncture (LP) in 6 to 24-month-old children.

MATERIALS & METHODS

In this not-blinded clinical trial, we included 60 children aged 6 to 24 months old undergoing LP in the Pediatric Ward of Shahid Sadoughi Hospital, Yazd, Iran, from September 2014 to March 2015. The participants were randomly assigned to two groups, and all of them received painless injection of 0.5 mg/kg midazolam five minutes before LP. In group I, LP was performed with maternal presence and in group II, the mothers were absent. The primary outcomes included anxiety and pain scores before LP and during needle insertion to the skin for LP. The secondary outcomes comprised of success rates in the reduction of anxiety (anxiety score of four and more) and pain (pain score of less than three) when the needle was inserted to the skin for LP.

RESULTS

Twenty-eight girls and 32 boys were evaluated in the two groups. Maternal presence was found to be effective in the reduction of anxiety (2.7±0.65 vs. 3.83±0.87; P=0.001) and pain scores (3.8±1.75 vs. 6.1±1.63, P=0.001). In the maternal presence group, success rate in anxiety (76.7% vs. 16.6%; P=0.0001) and pain reduction (63.3 % vs. 6.7%; P=0.0001) was higher than in the midazolam alone group.

CONCLUSION

Maternal presence during lumbar puncture can reduce pain and anxiety among 6 to 24-month-old children.

Elaboración y validación del contenido y apariencia de la cartilla “punción venosa periférica para la familia”

Introducción: Durante la hospitalización del niño, en algunas situaciones clínicas, se necesita utilizar la Terapia Intravenosa por vía periférica, a través de la instalación de dispositivos intravenosos. Este procedimiento puede causar sentimientos negativos en la crianza, los cuales se pueden amenizar a través del uso de tecnologías didácticas e Instruccionales. De esta forma, el objetivo del estudio consiste en elaborar y validar el contenido y la apariencia de la cartilla titulada “Punción venosa periférica para la familia” con jurados especialistas en el área pediátrica. Materiales y Métodos: Se trata de una investigación metodológica del tipo elaboración y validación de cartilla educativa, realizada con siete jurados a través de la técnica Delphi. Para recolectar los datos se utilizó un instrumento estructurado que contenía variables categorizadas de la siguiente forma: contenido, lenguaje, ilustración, layout, motivación, cultura y aplicabilidad. Se adoptó como valor deseable el Índice de Validación de Contenido igual o superior a 0,80 para cada criterio evaluado. Resultados: En el estudio participaron siete jurados especialistas, todos del sexo femenino, enfermeras, de las cuales cinco son magister, una doctora y una especialista, que se desempeñaban en el campo de la educación, asistencia, investigación y extensión en el área pediátrica. La cartilla fue validada en la primera ronda de evaluación, obteniendo un Índice Global de Validación de Contenido de 0,98. Discusión y Conclusiones: Los jueces consideraron válida la cartilla propuesta en términos de contenido y apariencia, sugiriendo que este recurso educativo tiene potencial para ayudar en la educación en salud sobre la Cateterización Intravenosa Periférica impartida en niños. Cómo citar este artículo: Silva C, Lisboa S, Santos L, Carvalho S, Passos S, Santos S. Elaboração e validação de conteúdo e aparência da cartilha “Punção venosa periférica para a família”. Rev Cuid. 2019; 10(3): e830. http://dx.doi.org/10.15649/cuidarte.v10i3.830

Validation of instruments about family presence on invasive procedures and cardiopulmonary resuscitation in pediatrics

OBJECTIVE

to develop and validate instruments to identify health professionals' beliefs related to the presence of the child's family in invasive procedures and in cardiopulmonary resuscitation.

METHOD

study based on Psychometrics to conduct the theoretical, empirical and analytical stages, developed in a neonatal unit of a university hospital. The two instruments were constructed based on the literature and applied to 96 health professionals.

RESULTS

the Cronbach's Alpha of the instrument related to the professionals' beliefson invasive procedures was 0.863 and the instrument on cardiopulmonary resuscitation was 0.882. In both instruments, the tests performed indicated a correlation between the items. From the factorial analysis, four factors were generated: (1) benefits of the presence of the family; (2) impairment for professional practice; (3) strategies for the inclusion of the family; and (4) limitation of learning and decision making by the professional.

CONCLUSION

the instruments analyzed obtained a good internal consistency and are indicators of the professionals' beliefs with the potential to evaluate the quality of family care in this context.

Self-assessment of family inclusion in institutional policies and practices: nursing team perspective

Abstract Objective: To compare the evaluation carried out by the nursing teams of pediatric and maternal-infant with adult patient wards on the inclusion of families in institutional policies and practices. Method: A cross-sectional and descriptive study carried out in a university hospital with 148 professionals from the nursing team of the maternal and pediatric units and 43 from adult units. The data were analyzed by the program Statistical Package for the Social Sciences 22, using the chi-square test and Fisher's exact test. Results: The groups presented distinct perceptions about the differentiation between families and visitors in policies and practices; similar perceptions related to the policies and practices are not favorable to the presence of siblings and children, and to the non-inclusion of the families in aspects related to daily care. Conclusion and Implications for Practice: The perception of nursing teams indicates that families are not included in institutional policies and practices. The results of an organizational self-assessment about families' inclusion subsidize a way to improve organizational policies and practices, making it possible to draw up an action plan to implementing Patient and Family Centered Care at the institutional level.

Patterns of behaviour in families of critically ill patients in the emergency room: a focused ethnography

AIM

The aim of this study was to understand the patterns of behaviour from relatives of critically ill patients admitted to the emergency room.

BACKGROUND

Admission of a critically ill family member to an accident and emergency department is often a sudden and unexpected experience for the family. This stressful event often creates feelings of instability and intense suffering in relatives. Understanding the experiences of these families is essential for the provision of comprehensive health care in the emergency room.

DESIGN

A focused ethnography design was applied to the study.

METHODS

Peripheral participant observation and informal conversations were conducted in an emergency room in southern Brazil during January 2015. Analysis of data was based on Leininger.

FINDINGS

Suffering was recurrent among family members of critically ill patients admitted to the emergency room. The environment, which was conditioned by the patient's life-threatening situation and professionals' attitudes, resulted in relatives experiencing a range of feelings from suffering to calm. A distant approach and poor communication of professionals made relatives confused and silent. Factors that seemed to foster feelings of calm in families were the establishment of a continuous and close communication with professionals and the possibility to remain with the patient outside the established visiting hours.

CONCLUSION

The findings of this study challenge emergency department providers and managers to promote comprehensive care in the emergency room by inviting family members to be with the patient and by engaging in family-centred care.

FAMILY PERCEPTION ABOUT THEIR PRESENCE OR NOT IN A PEDIATRIC EMERGENCY SITUATION

ABSTRACT The objective was to understand the perception of family members who experienced an emergency situation in relation to their presence or not during the child's treatment in the Pediatric Emergency Department. A qualitative study developed in a Pediatric Emergency Department. The study subjects consisted of ten relatives who had experienced an emergency situation. Data collection was through semi-structured interviews and data were submitted for thematic content analysis. The results showed that among the ten relatives interviewed only one said that they preferred not to remain with the child during the emergency situation. Regarding the clinical condition of the children, five of them had special health care needs. Previous negative situations had influenced the family member's choice of staying during the assistance. Considering the benefits of family presence, it is recommended that nursing teams develop strategies which can facilitate the inclusion of the family in child care in any situation, while respecting the uniqueness of each person.