Sleep, sleepiness, and fatigue outcomes for parents of critically ill children

Sleep quantity and quality of critically ill children perceived by caregivers and bedside nursing staff: a pilot study

STUDY OBJECTIVES

Sleep is crucial for healing but often impaired in the pediatric intensive care unit due to environmental disruptions. Caregivers and bedside nursing staff are often most aware of these factors and the impact on patient sleep, but studies have not yet compared their perceptions.

METHODS

Caregivers and bedside nursing staff of pediatric patients staying a second night in the pediatric intensive care unit were asked to complete a survey regarding environmental factors (ie, temperature, light, sound, nursing staff room entries), sleep quality, and sleep quantity (ie, sleep duration, number of naps) of the pediatric patient. Caregivers were asked similar questions about their child's sleep at home.

RESULTS

The caregivers and nursing staff of 31 pediatric patients participated in this pilot study. There was no significant difference between caregiver and nursing staff ratings of sleep quality, sleep duration, number of naps, room temperature, sound, or light (P > .05 for all). Nursing staff did report significantly more room entries than caregivers (P = .01). Compared to sleep at home, caregivers reported sleep in the hospital to be of lower quality (P = .009) with more frequent room entries (P = .01).

CONCLUSIONS

Caregivers rate their child's sleep in the pediatric intensive care unit as lower quality than sleep at home. Caregivers and bedside nursing staff largely agree about pediatric patient sleep quality and quantity as well as environmental factors. This agreement may facilitate further research and interventions at improving sleep in the pediatric intensive care unit.

CITATION

Witte MA, Lloyd RM, McGree M, Kawai Y. Sleep quantity and quality of critically ill children perceived by caregivers and bedside nursing staff: a pilot study. J Clin Sleep Med. 2023;19(12):2027-2033.

Parental sleep when their child is sick: A phased principle-based concept analysis

Sleep is a common challenge for parents with sick children and can impact parents' health, wellbeing, and caregiving responsibilities. Despite the vast research around parental sleep when their child is sick, the concept is not clearly defined. A phased principle-based concept analysis that includes triangulation of methods and quality criteria assessment was used to explore how the concept is described, used, and measured in the current literature. The aim was to analyse and clarify the conceptual, operational, and theoretical basis of parental sleep when their child is sick to produce an evidence-based definition and to identify knowledge gaps. A systematic literature search including databases CINAHL, Embase, MEDLINE, PsychARTICLES, PsychINFO, Pubmed, Scopus and Web of Science, identified 546 articles. The final dataset comprised 74 articles published between 2005 and 2021 and was assessed using a criteria tool for principle-based concept analysis. Data were managed using NVivo, and thematic analysis was undertaken. A precise definition is not present in the literature. Various tools have been used to measure parents' sleep, as well as exploration via interviews, open-ended questions, and sleep diaries. The terminology used varied. Parental sleep when their child is sick is interrelated with other concepts (e.g., stress). A recommended definition is offered. A conceptual understanding of parental sleep when their child is sick will help to guide translational research and to conduct studies critical to clinical practice and research. Future research includes developing a measurement tool for parental sleep when their child is sick to be used in study design and future interventions.

Association of parent demographic and psychophysical characteristics and pediatric hospital falls: A pilot and feasibility study

PURPOSE

This pilot project evaluated the feasibility of conducting a study describing parental characteristics associated with pediatric hospital falls.

DESIGN AND METHODS

This observational case-control study enrolled parent-child dyads of children who fell in the hospital and age-matched controls. Parents completed demographic, anxiety, depression, fatigue, sleep disturbance and stress questionnaires.

RESULTS

Four of 14 (28.6%) eligible faller dyads were recruited. Stress scores were correlated with anxiety and depression scores. Power calculations indicated a need for 392 fallers for a future study to identify associations of parent characteristics and pediatric hospital falls.

CONCLUSIONS

Parents should be informed the ultimate goal of the research is to understand additional ways to prevent pediatric hospital falls. To decrease parental distraction during recruitment, researchers should engage volunteers or child life specialists to entertain younger children. Future studies should consider inclusion of non-English speaking subjects and children discharged within the post-fall eligibility time frame. To decrease multicollinearity concerns, the parent stress tool should be omitted. Due to the large number of fallers needed for an adequately powered sample, a multi-site study will be needed.

PRACTICE IMPLICATIONS

A parent is often present when their child falls in the hospital. Fall risk assessment focuses on patient characteristics, neglecting parental psychophysical characteristics which may be associated with risk of falling in the hospital. Associations of parent psychophysical characteristics and pediatric hospital falls needs to be studied further. This pilot study supports the feasibility of and provides recommendations for conducting a study to describe parent characteristics associated with pediatric hospital falls.

Intensive Care Unit Built Environments: A Comprehensive Literature Review (2005-2020)

BACKGROUND

The intensive care environment in hospitals has been the subject of significant empirical and qualitative research in the 2005-2020 period. Particular attention has been devoted to the role of infection control, family engagement, staff performance, and the built environment ramifications of the recent COVID-19 global pandemic. A comprehensive review of this literature is reported summarizing recent advancements in this rapidly expanding body of knowledge.

PURPOSE AND AIM

This comprehensive review conceptually structures the recent medical intensive care literature to provide conceptual clarity and identify current priorities and future evidence-based research and design priorities.

METHOD AND RESULT

Each source reviewed was classified as one of the five types-opinion pieces/essays, cross-sectional empirical investigations, nonrandomized comparative investigations, randomized studies, and policy review essays-and into nine content categories: nature engagement and outdoor views; family accommodations; intensive care unit (ICU), neonatal ICU, and pediatric ICU spatial configuration and amenity; noise considerations; artificial and natural lighting; patient safety and infection control; portable critical care field hospitals and disaster mitigation facilities including COVID-19; ecological sustainability; and recent planning and design trends and prognostications.

CONCLUSIONS

Among the findings embodied in the 135 literature sources reviewed, single-bed ICU rooms have increasingly become the norm; family engagement in the ICU experience has increased; acknowledgment of the therapeutic role of staff amenities; exposure to nature, view, and natural daylight has increased; the importance of ecological sustainability; and pandemic concerns have increased significantly in the wake of the coronavirus pandemic. Discussion of the results of this comprehensive review includes topics noticeably overlooked or underinvestigated in the 2005-2020 period and priorities for future research.

The effect of nurse support and social support on fatigue experienced by mothers whose children are hospitalized

The authors' aim in this study was carried out to determine the effect of social support and nurse support on fatigue experienced by mothers whose children were hospitalized. This is a descriptive, analytical and cross-sectional research study. Our study population consisted of all the mothers (n = 198) who had children hospitalized in the pediatric services of the public and training and research hospitals. Data were collected using a questionnaire, Nurse Parent Support Tool, Multidimensional Scale of Perceived Social Support and Brief Fatigue Inventory. Our finding the mothers accompanying their hospitalized children who received adequate nurse support were found to have less maternal fatigue.

Objective Sleep Characteristics and Factors Associated With Sleep Duration and Waking During Pediatric Hospitalization

IMPORTANCE

Children's sleep may be affected by hospitalization, yet few objective determinations of sleep patterns are reported for children in intensive care or general medicine units. There is limited research on relationships between sleep in hospital and child (eg, age, pain), treatment (eg, medications, nurse presence), or environmental (eg, noise, light, type of unit) factors.

OBJECTIVE

To determine sleep quantity and patterns in hospitalized children and determine factors associated with sleep quantity and nighttime waking for children in hospital.

DESIGN, SETTING, AND PARTICIPANTS

This was a prospective cross-sectional study of children admitted to a general pediatric unit or a pediatric intensive care unit at a pediatric quaternary teaching hospital in Toronto, Ontario, Canada, from October 2007 to July 2008. Participants included children aged 1 to 18 years who were expected to stay in hospital for at least 2 nights. Demographic data, information about the hospital stay and illness, and usual sleep habits were collected. Children wore an actigraph for 1 to 3 consecutive days and nights and completed a sleep diary. Sound and light meters were placed at the bedside. Data analyses took place in April 2009.

MAIN OUTCOMES AND MEASURES

The primary outcome was the mean number of minutes of child nighttime sleep from 7:30 pm to 7:29 am. Sleep variables were averaged over days and nights recorded (mean [SD] days and nights of wear, 2.54 [0.71]) and examined for associations with sleep quantity and patterns, as well as hazard of waking in the night.

RESULTS

Of 124 eligible children approached for inclusion, 69 children consented (35 [51%] female; 20 [29%] aged 1-3 years, 10 [14%] aged 4-7 years, 17 [24%] aged 8-12 years, and 22 [32%] aged 13-18 years; 58 [84%] in the general pediatric unit). Children aged 1 to 3, 4 to 7, 8 to 12, and 13 to 18 years obtained a mean (SD) of 444 (132), 475 (86), 436 (114), and 384 (83) minutes of nighttime sleep, respectively; mean (SD) number of night awakenings was 14 (3), 18 (3), 14 (8), and 12 (6), respectively. Children on general pediatric units slept 258 minutes more per night than children sleeping in the pediatric intensive care unit (95% CI, 165.16-350.56 minutes; P < .001), children admitted for planned surgery slept 123 minutes more than children admitted for exacerbations of chronic illness (95% CI, 49.23-196.01 minutes; P < .01), and children sleeping in rooms with other patients slept 141 minutes fewer than children in private rooms (95% CI, -253.51 to -28.35 minutes; P = .01). Sound events greater than 80 dB were significantly associated with increased risk of instantaneous waking (hazard ratio [HR], 1.35; 95% CI, 1.02-1.80; P = .04), as were light events greater than 150 lux (HR, 1.17; 95% CI, 1.01-1.36; P = .03), receiving a medication that promoted sleep (HR, 1.04; 95% CI, 1.00-1.08; P = .03), and having a nurse in the room for most or all of the night (HR, 1.08; 95% CI, 1.03-1.13; P = .003). Sleeping on the general pediatrics unit was significantly associated with decreased risk of instantaneous waking (HR, 0.81; 95% CI, 0.77-0.85; P < .001), as was being admitted for planned surgery (HR, 0.95; 95% CI, 0.91-0.99; P = .04), receiving a medication that promoted wakefulness (HR, 0.96; 95% CI, 0.93-0.995; P = .02), and sharing a room with another patient (HR, 0.78; 95% CI, 0.72-0.84; P < .001).

CONCLUSIONS AND RELEVANCE

In this cross-sectional study of hospitalized children, children experienced considerable nighttime waking and sleep restriction to levels below national clinical recommendations at a time when they most needed the benefits of sleep. Given light and noise were the greatest contributors to nighttime waking in hospital, clinicians, administrators and hospital design experts should work together for solutions.

Sleep characteristics of the parents of children admitted to a pediatric intensive care unit: risk factors and repercussion on their daily life activities

OBJECTIVE

to analyze the sleep characteristics of the parents of children admitted to a pediatric intensive care unit (PICU), the possible risk factors and impact of sleep quality on their daily life activities.

METHODS

Parents of children admitted to PICU for at least 48 h filled in a survey. Demographic data, sleep characteristics before and during admission and its impact on daily life activities measured by the FOSQ-10 questionnaire, were collected.

RESULTS

100 surveys from parents of 53 children admitted to the PICU were collected. Most children (74%) were cardiac patients. 55% of them had had previous PICU admissions. 45% of parents lived in a different city. They spent a median of 14 h a day (IQR 12-16) at the hospital and 89.2% did not attend work. Parents had significantly worse subjective sleep quality (p = 0.001), less sleeping hours/day (p = 0.001), more difficulty falling asleep (p = 0.001) and more night arousals (p = 0.001) during PICU admission than before. 77% of parents also had a bad FOSQ-10 score. Perceived sleep quality and FOSQ-10 score had a good correlation (p = 0.00, Kappa 0.43). Significant risk factors were living in a different city (p = 0.03), programmed admissions (p = 0.001), previous PICU admissions (p = 0.001), prolonged PICU length of stay (p = 0.03) and longer distance from home (p = 0.03).

CONCLUSIONS

Three quarters of the parents of children admitted to PICU suffer from sleep disorders, which negatively affects their personal lives. Perceived sleep quality had a good correlation with FOSQ-10 score. Institutional support is needed to optimize parents' resting conditions during their child's hospitalization.

Impact of Pediatric Critical Illness and Injury on Families: An Updated Systematic Review

PROBLEM

Pediatric ICUs (PICU) that have adopted family-centered care models welcome families to the critically ill child's bedside to partner with clinicians in decision-making and the provision of care. The aim of this review was to synthesize the evidence on the impact of critical illness and injury on families of children admitted to the PICU to identify research needs in pediatric critical care.

ELIGIBILITY CRITERIA

This systematic review included quantitative and qualitative studies that examined the experiences of families of children admitted to a PICU published between 2005 and 2019.

SAMPLE

33 articles were selected for inclusion in the final analysis after screening those identified by searches in CINAHL, PubMed, PsycINFO, and reference lists of included publications.

RESULTS

Main parental stressors included the sights and sounds within the PICU, child acuity, changes to family functioning and parenting role, and uncertainty of the child's outcome. The most common need of parents was to be well-informed. Psychological, physical, and social impact of hospitalization were experienced by parents from days after admission to years after discharge. Spirituality was identified as a coping mechanism in half of the studies.

CONCLUSIONS

Parents experience negative effects of the ill child's admission to the PICU and to PICU exposure.

IMPLICATIONS

Careful consideration of the impact of the PICU admission on family members of critically ill or injured children is needed when implementing family-centered care strategies. Future research on other family members including the healthy sibling needs to be conducted.

A comparative study of mothers of infants hospitalized in an open ward neonatal intensive care unit and a combined pod and single-family room design

Background

The well-being of mothers of infants requiring Neonatal Intensive Care Unit (NICU) hospitalization may be affected by the architectural design of the unit. A few recent studies suggest there may be some drawbacks of single-family rooms (SFRs) for infants and their mothers, such as isolation of mothers and reduced exposure to auditory stimulation for infants.

Purpose

To compare NICU-stress, symptoms of depression, perceptions of nurse-parent support and family-centered care, sleep disturbances, breastfeeding self-efficacy and readiness for discharge in mothers of infants cared for in an open ward (OW) to those cared for in a unit that includes both pods and SFRs.

Methods

A pre-post quasi-experimental study was conducted in a Canadian level 3 unit before and after transitioning to a new unit of 6-bed pods and SFRs. OW data were collected in 2014 and pod/SFR data 1 year after the transition in 2017 to 2018. Mothers of infants hospitalized for at least 2 weeks completed questionnaires about stress, depressive symptoms, support, family-centered care, and sleep disturbances. In the week prior to discharge, they responded to breastfeeding self-efficacy and readiness for discharge questionnaires. They described their presence in the NICU at enrollment and again prior to discharge.

Results

Pod/SFR mothers reported significantly less NICU-stress compared to OW mothers. OW mothers had greater sights and sounds stress and felt more restricted in their parental role. Pod/SFR mothers reported greater respect from staff. Controlling for maternal education, pod/SFR mothers perceived their infant’s readiness for discharge to be greater than OW mothers. There were no significant differences between groups in depressive symptoms, nurse-parent support, sleep disturbances, and breastfeeding self-efficacy.

At enrollment and again in the weeks preceding discharge, pod/SFR mothers were present significantly more hours per week than OW mothers, controlling for maternal education.

Conclusions

Further study of small pods is indicated as these units may be less stressful for parents, and enhance family-centered care, as well as maternal presence, compared to OWs.

A systematic integrative review of parents' experience and perception of sleep when they stay overnight in the hospital together with their sick children

AIMS AND OBJECTIVES

To elucidate knowledge available on parents' experience and perception of sleep when they stay overnight in hospital together with their sick children.

BACKGROUND

In Nordic countries, children are entitled to have at least one parent with them during hospitalisation. Parents' sleep, when accommodated at the hospital during the child's admission, may be a challenge.

DESIGN

A systematic literature search was conducted in EMBASE, MEDLINE and PsycINFO; period is restricted from 1 January 2007 to 1 April 2019. Studies included were those in which parents were accommodated in hospital with their child, 0-18 years of age, for at least one night. Original peer-reviewed scientific research papers conducting qualitative, quantitative or mixed designs were included. Systematic reviews were not included. This systematic integrative review was registered in PROSPERO and performed according to the PRISMA guidelines. All authors participated in study selection, data extraction and quality assessment of the literature.

RESULTS

Fifteen studies were included, and they varied in terms of origin, aims, design, methods used and sample size. Three overall main themes appeared: sleep quality, factors affecting sleep and consequences of sleep loss. Combined psychological factors were found to affect parents' sleep, as well as isolated psychological factors, for example, stress, anxiety, worries and difficult thoughts. Environmental and social factors were also identified, for example, privacy and caring for family.

CONCLUSION

Study of this subject is still in its exploratory phase. There is a need for the development of theory of substance in the clarification of the meaning of sleep among parents during difficult times such as children's hospitalisation.

RELEVANCE TO CLINICAL PRACTICE

Understanding risk factors associated with sleep and sleep deprivation in parents staying overnight in the hospital with their sick child is important, since lack of sleep may lead to serious stress-related outcomes for the parents.

Concurrence of sleep problems and distress: prevalence and determinants in parents of children with cancer

Background: Parents of children with cancer are at risk for sleep problems. If these problems persist, an important perpetuating factor might be ongoing parental distress. Objective: The aim of this study is to assess the prevalence of sleep problems and the concurrence with distress in parents of children treated for cancer, and to identify predictors of this symptom clustering. Method: Parents completed the Medical Outcomes Study (MOS) Sleep Scale and Distress Thermometer for Parents (DT-P). Clinically relevant sleep problems were defined as a score >1SD above the norm and clinical distress as a thermometer score above the established cut-off of 4. Four parent categories were constructed: neither sleep problems nor distress; no distress but sleep problems; no sleep problems but distress; both sleep problems and distress. Predictive determinants (sociodemographic, medical, psychosocial) for each category were assessed with multilevel multinomial logistic regression. Results: Parents (202 mothers and 150 fathers) of 231 children with different cancers participated. Mean time since diagnosis was 3.3 ± 1.4 years (90% off-treatment). The prevalence of sleep problems was 37%. Fifty percent of parents reported neither sleep problems nor distress, 9% had only sleep problems, 13% only distress, and 28% reported both. Compared to parents without sleep problems or distress, parents who reported both were more likely to report parenting problems (OR 4.4, [2.2-9.1]), chronic illness (OR 2.8, [1.2-6.5]), insufficient social support (OR 3.7, [1.5-9.1]), pre-existent sleep problems (OR 6.2, [2.0-18.6]) and be female (OR 1.8, [1.1-4.2]). Conclusions: Sleep problems are common in parents of children treated for cancer, and occur mostly in the presence of clinical distress. Future research must show which interventions are most effective in this group: mainly targeted at sleep improvement or with prominent roles for stress management or trauma processing.

Sleep in parents of preterm infants: A systematic review

BACKGROUND

Sleep disruption during the first postpartum year is associated with several negative health outcomes including postpartum depression. Such disruption may be a greater issue for parents of preterm neonates, yet literature on this subject has not been critically reviewed.

OBJECTIVE

To synthesize literature on sleep quantity, sleep quality, and factors influencing sleep among parents of preterm infants during infant hospitalization and following discharge.

DESIGN

A systematic review.

DATA SOURCES

Medline, EMBASE, CINAHL, PsycINFO, Scopus, and Cochrane Database of Systematic Reviews were searched from their inception to February 2017.

METHODS

Potentially eligible citations were reviewed by two independent reviewers. Both quantitative and qualitative studies were eligible for inclusion. Data on eligible studies and review outcomes were extracted using a customized form.

FINDINGS

Eighteen reports from 16 studies met inclusion criteria. Four studies included a control group of parents of full-term infants. Three studies reported sleep quantity means, of which only one provided values for an exclusive sample of mothers of preterm infants and found on average, mothers obtained 6.3 h of sleep/day in the first 5-10 days. Twelve studies reported on sleep quality; most (n = 10) relied on self-reported measures and identified poor subjective sleep quality whereas two studies objectively measured sleep of poor quality. Parental stress was the most consistent factor associated with sleep quality.

CONCLUSION AND IMPLICATIONS

Quality and quantity of sleep among parents of preterm infants is inadequate and may negatively influence family health outcomes. Further research on correlates and changes in sleep is required to identify at-risk parents and inform targeted clinical recommendations and interventions aimed at maximizing sleep for parents of preterm infants.

Sleep quality and noise: comparisons between hospital and home settings

BACKGROUND

Children and their parents report poor sleep in hospital and complain about noise.

OBJECTIVE

To measure sleep quality and noise levels in hospital and compare these with the home environment.

DESIGN

Observational within case-controlled study.

SETTING

Paediatric medical wards at Southampton Children's Hospital and bedrooms at home.

PARTICIPANTS AND METHODS

Participants were children aged 3-16 years and their co-sleeping parents. Sleep quality was measured using actigraphy for a maximum of 5 nights in each setting. Median sound levels at the bedside were monitored overnight in a subgroup in both settings.

MAIN OUTCOME MEASURES

Total sleep time, sleep efficiency, median sound levels overnight.

RESULTS

40 children and 16 mothers completed actigraphy in both settings. Children had on average 62.9 min, and parents 72.8 min, per night less sleep in hospital than at home. Both children and parents had poorer sleep quality in hospital than at home: mean sleep efficiency 77.0% vs 83.2% for children and 77.1% vs 88.9% for parents, respectively. Median sound levels in hospital measured in 8 children averaged 48.6 dBA compared with 34.7 dBA at home and exceeded World Health Organization recommendations of 30 dB.

CONCLUSIONS

Children and their mothers have poor quality sleep in paediatric wards. This may affect the child's behaviour, recovery and pain tolerance. Sleep deprivation adds to parental burden and stress. Sound levels are significantly raised in hospital and may contribute to poor sleep. Reduction in the level of noise might lead to an improvement in sleep, affecting the quality of stay of both parent and child.

Sleep and its relationship to health in parents of preterm infants: a scoping review

BACKGROUND

Sleep is essential for human health and functioning. Parents of preterm infants are susceptible to sleep disturbances because of stress related to the preterm birth. Poor sleep has the potential to affect parental health and well-being. The aim of this study was to identify and map evidence on sleep and its relationship to health in parents of preterm infants. No review has summarized the evidence on this topic.

METHODS

A scoping review was conducted. Seven health and medical electronic research databases were searched for relevant quantitative and qualitative primary studies, including grey literature. The search was performed March 2-7, 2017.

RESULTS

Ten American studies and one Australian study were included in the review. Most research was quantitative and focused on maternal sleep and mental health within the first two weeks after the childbirth. Both objective and subjective sleep measures were used to study sleep at the hospital; actigraphs were not used after discharge. Maternal sleep was poor early postpartum, and this was associated with negative health outcomes. Two cohort studies compared sleep in mothers of preterm and term infants, but the results were conflicting. In one qualitative study, fathers described their inability to catch up on sleep after homecoming with a preterm baby.

CONCLUSIONS

Quantitative studies reporting on maternal sleep early postpartum was most frequently occurring in the results. Qualitative research on the topic was identified as a knowledge gap. More cultural and geographical breadth, including research on fathers' sleep, is recommended in future research.

Discussing Death as a Possible Outcome of PICU Care

OBJECTIVES

To describe practical considerations related to discussions about death or possible death of a critically ill child.

DATA SOURCES

Personal experience and reflection. Published English language literature.

STUDY SELECTION

Selected illustrative studies.

DATA EXTRACTION

Not available.

DATA SYNTHESIS

Narrative and experiential review were used to describe the following areas benefits and potential adverse consequences of conversations about risk of death and the timing of, preparation for, and conduct of conversations about risk of death.

CONCLUSIONS

Timely conversations about death as a possible outcome of PICU care are an important part of high-quality ICU care. Not all patients "require" these conversations; however, identifying patients for whom conversations are indicated should be an active process. Informed conversations require preparation to provide the best available objective information. Information should include distillation of local experience, incorporate the patients' clinical trajectory, the potential impact(s) of alternate treatments, describe possible modes of death, and acknowledge the extent of uncertainty. We suggest the more factual understanding of risk of death should be initially separated from the more inherent value-laden treatment recommendations and decisions. Gathering and sharing of collective knowledge, conduct of additional investigations, and time can increase the factual content of risk of death discussions. Timely and sensitive delivery of this best available knowledge then provides foundation for high-quality treatment recommendations and decision-making.

Parental Presence at the Bedside of Critically Ill Children in a Unit With Unrestricted Visitation

OBJECTIVES

To determine the percentage of time that critically ill children have a parent at the bedside and to identify extrinsic factors that are associated with percent of time with parental presence at the bedside.

DESIGN

Prospective cohort study.

SETTING

PICU in a single tertiary care children's hospital.

SUBJECTS

Primary two parents of all children admitted to the PICU on 12 preselected days during a 1-year period from 2014 to 2015.

INTERVENTIONS

None.

MEASUREMENT AND MAIN RESULTS

A total of 111 observations of 108 unique PICU admissions and families were performed. Children had at least one parent present a mean of 58.2% (SD, 34.6%) of the time. Mothers spent more time at the bedside (56.3% [SD, 31.0%]) than fathers (37.3% [SD, 29.5%]) (p = 0.0001). Percent of time with parental presence at the bedside was positively correlated with age (rs = 0.23; p = 0.02) and negatively associated with Pediatric Risk of Mortality III score (rs = -0.26; p = 0.01). Percent of time with parental presence at the bedside was lower for children who were mechanically ventilated (42.8% [SD, 35.5%]) than not (64.5% [SD, 32.2%]) (p = 0.01) and whose parent(s) were single (45.5% [SD, 27.5%]) or cohabitating/common-law (35.7% [SD, 26.4%]) compared with parents who were married (64.2% [SD, 34.2%]) or separated/divorced (68.3% [SD, 28.8%]) (p = 0.02). Percent of time with parental presence at the bedside was higher for children with chronic illnesses (63.4% [SD, 32.9%] vs 50.1% [SD, 35.8%] without; p = 0.04), when there was a bed in the patient room (61.4% [SD, 34.0%] vs 32.5% [SD, 28.3%] without; p = 0.01), and when parents slept in the patient room (90.3% [SD, 11.2%]) compared with their own home (37.6% [SD, 34.4%]) (p < 0.0001). Percent of time with parental presence at the bedside was not correlated with day of PICU stay, number of siblings, previous PICU admission, isolation status, or nursing ratio.

CONCLUSIONS

Children had a parent present at the bedside approximately 60% of the time. The parents of younger, sicker children may benefit from supportive interventions during PICU admission. Further research is needed to examine both extrinsic and intrinsic factors affecting parental presence at the bedside.

Sleep disturbance in family caregivers of children who depend on medical technology

OBJECTIVES

Family caregivers of children who depend on medical technology (CMT) provide highly skilled care up to 24 hours per day. Sleep disruption places family caregivers at risk for poor health and related outcomes that threaten their long-term caregiving capacity. Few studies exist that have measured sleep in family caregivers, and most have relied entirely on subjective measures.

METHODS

In a prospective cohort study, family caregivers of CMT (n=42) and caregivers of healthy children (n=43) were recruited. Actigraphy data and a concurrent sleep diary were collected for 6 days/7 nights. Measures of sleep quality, depression, sleepiness, fatigue and quality of life were also administered.

RESULTS

Family caregivers of CMT averaged fewer hours of sleep per night (mean (SD)) (6.56 ± 1.4 vs 7.21 ± 0.6, p=0.02) of poorer quality (7.75 ± 2.9 vs 5.45 ± 2.8, p<0.01) than the control group. Three times as many family caregivers of CMT scored in the range for significant depressive symptomatology (12(33%) vs 4(10%), p=0.01) and experienced excessive daytime sleepiness (16(38%) vs 5(12%), p<0.01). Fatigue was also more problematic among family caregivers of CMT (22.12 ± 9.1 vs 17.44 ± 9.0, p=0.02).

CONCLUSIONS

Family caregivers of CMT are at risk of acute and chronic sleep deprivation, psychological distress and impaired daytime function that may threaten their capacity for sustained caregiving. Family caregivers of CMT may be important targets for screening for sleep disorders and the development of novel sleep-promoting interventions.

Psychological Outcomes in Parents of Critically Ill Hospitalized Children

Parents of children in pediatric intensive care units (PICUs) are subjected to significant psychological stress. The purpose of this study was to determine the prevalence of, and factors associated with anxiety, depressive symptoms and decisional conflict in parents of children hospitalized in the PICU. The study employed a descriptive, cross-sectional design to investigate the psychological status of 118 parents of 91 children (74 mothers and 44 fathers) admitted to the PICU, using measures of anxiety (STAI), depression (CES-D), and decisional conflict (DCS). Using hospital data and self-administered questionnaires, information on child and parent characteristics and psychological outcomes were collected. Objective measures of parental sleep also were examined using actigraphy and sleep diaries. The research findings indicated that 24% of parents achieved scores characteristic of severe anxiety. Proportions of parents with symptoms indicative of major depression and significant decisional conflict were 51% and 26% respectively. For all psychological outcomes, higher levels of social support were protective. Inconsistency in sleep schedule and sleep location affected psychological outcomes and are possible targets for future interventions. Given evidence that parents of children admitted to the PICU are at risk for developing post-traumatic stress symptoms, future studies should examine the effects of hospitalization on long-term parental psychological outcomes. Screening for those at risk and implementing interventions to promote coping strategies and reduce decisional conflict may be beneficial. Pediatric nurses have a critical role in assessing parents' psychological distress and promoting family health during a child's hospitalization.

Factors influencing fatigue among mothers with hospitalized children: A structural equation model

PURPOSE

The aim of this study was to identify the physiological, psychological, and situational factors affecting fatigue among mothers of hospitalized children.

DESIGN AND METHODS

This study used a cross-sectional descriptive design with a self-report questionnaire. Participants were 211 mothers with children younger than 6 years old who were admitted to general hospitals. Based on the theory of unpleasant symptoms, the physiological, psychological, and situational factors were tested using structural equation modeling.

RESULTS

Mothers' fatigue was influenced by physiological (β = .24), situational, and psychological factors (β = .17), and situational (β = .37) factors such as the mother's sleeping hours, the child's adaptation to hospitalization, anxiety and having support with their housework. These three factors explained 31.34% of the variance in fatigue. In particular, it was found that the psychological factors exacerbate the negative influence of the situational factors on fatigue. Moreover, the situational factors were most strongly related to mothers' fatigue, and they had an indirect effect via the psychological factors as a mediator.

PRACTICE IMPLICATIONS

It is necessary to implement a nursing intervention that targets the controllable factors such as anxiety and children's adaptation to hospitalization that were identified in this study. Pediatric nursing care should not be limited to treating children's illnesses, but should be extended to providing family-centered care.

Nurses' views of factors affecting sleep for hospitalized children and their families: A focus group study

Light, noise, and interruptions from hospital staff lead to frequent awakenings and detrimental changes to sleep quantity and quality for children who are hospitalized and their parents who stay with them overnight. An understanding of nurses' views on how care affects sleep for the hospitalized child and parent is crucial to the development of strategies to decrease sleep disturbance in hospital. The purpose of this descriptive qualitative study was to gain an understanding of nurses' views on their role in and influence on sleep for families; perceived barriers and facilitators of patient and parent sleep at night; strategies nurses use to preserve sleep; the distribution, between parent and nurse, of care for the child at night; views of the parent as a recipient of nursing care at night; and the nature of interactions between nurses and families at night. Thirty registered nurses from general pediatric and critical care units participated in one of four semi-structured focus groups. Four main influences on sleep were identified: child factors; environmental factors; nurse-parent interaction factors; and nursing care factors. Some of these restricted nurses' ability to optimize sleep, but many factors were amenable to intervention. Balancing strategies to preserve sleep with the provision of nursing assessment and intervention was challenging and complicated by the difficult nature of work outside of usual waking hours. Nurses highlighted the need for formal policy and mentoring related to provision of nursing care at night in pediatric settings.