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Demirbağ S, Ergin D. 'A voice of children: I would like a hospital just for children' - Children's perspectives on hospitalization: A phenomenological study. J Pediatr Nurs 2024; 77:e125-e131. [PMID: 38582668 DOI: 10.1016/j.pedn.2024.03.040] [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: 01/11/2024] [Revised: 03/15/2024] [Accepted: 03/27/2024] [Indexed: 04/08/2024]
Abstract
PURPOSE This study aimed to explore children's perception of hospital experience and interpretations of hospitalization. DESIGN AND METHODS Phenomenological qualitative study design was used. The sample consisted of 18 participants (seven-18 years old) from a general paediatric ward in a university hospital recruited using criterion sampling, a purposive sampling method. Individual semi-structured interviews were conducted face-to-face and were audio recorded. Inductive thematic analysis was used to analyze the data. RESULTS The participants talked about the symptoms, limitations and treatments of their diseases, as well as the team communication, lack of activity and physical conditions regarding the hospital. It was seen that the children reported each expression with positive or negative emotions. Finally, they did not neglect to mention their desires regarding the hospital and their daily life. Four main themes emerged "hospital, disease, mood, and desires". CONCLUSIONS Health professionals should care about the needs of children during hospitalization and children should be allowed to express themselves. PRACTICE IMPLICATIONS Knowing and understanding the needs of hospitalized children can guide the planning and implementation of quality nursing care processes.
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Affiliation(s)
- Selin Demirbağ
- Manisa Celal Bayar University, Faculty of Health Sciences, Department of Child Health and Diseases Nursing, Manisa, Turkey.
| | - Dilek Ergin
- Manisa Celal Bayar University, Faculty of Health Sciences, Department of Child Health and Diseases Nursing, Manisa, Turkey
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Alonso Lloret F, Gil Domínguez S, Fontecha Merino VM, Rodríguez Ferreiro C, Mendoza Soto A. Perioperative stress and anxiety in parents of children operated on for congenital heart disease. ENFERMERIA INTENSIVA 2023; 34:205-217. [PMID: 37775435 DOI: 10.1016/j.enfie.2023.07.001] [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: 05/26/2022] [Accepted: 03/24/2023] [Indexed: 10/01/2023]
Abstract
INTRODUCTION Levels of stress and anxiety suffered by parents of children with congenital heart disease (PCUCS) during their children's admission for cardiac surgery may be higher than those suffered by other parents who go through the same experience. OBJECTIVE General objective of this study was to measure the stress and anxiety suffered by PCUCS and parents of children undergoing renal surgery (PCURS) in relation to the intervention of their children. The specific objective of the quantitative study was to compare global stress and anxiety according to sex, time of the perioperative period, and cohort. The general objective of the qualitative section is to explore the experience that PCUCS and PCURS have during their hospital stay and to identify the specific factors that influence the genesis of stress and anxiety. METHOD A cohort study was carried out in which PCURS and PCUCS were included. The quantitative part was performed by comparing the scores of three questionnaires that measure stress levels (PSS-14), state anxiety (STAIE) and trait anxiety (STAIR) throughout three perioperative moments. At the same time, a qualitative study was carried out with semi-structured interviews and collection of diaries on which a descriptive phenomenological analysis was carried out, according to Munhall. The analysis of the text was carried out according to Colaizzi. RESULTS Stress and anxiety levels were significantly higher in PCUCS compared to PCURS. Mothers in the cardiac cohort were those with the highest scores on all scales. In the qualitative study, four themes emerged: "stress and anxiety from the moment of diagnosis", "surgical intervention as a critical moment", "harshness of the postoperative period in the Intensive Care Unit" and "joy and gratitude versus dependence and fear for the future". CONCLUSIONS PCUCS suffer higher levels of stress and anxiety than PCURS, being the mothers of the cardiac cohort those who suffer these disorders with greater intensity. This study can constitute a starting point to develop strategies that cover these parental needs.
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Affiliation(s)
- F Alonso Lloret
- Unidad de Cuidados Intensivos Pediátricos - Reanimación pediátrica, Hospital Universitario 12 de Octubre, Madrid, Spain.
| | - S Gil Domínguez
- Unidad de Cuidados Intensivos Pediátricos - Reanimación pediátrica, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - V M Fontecha Merino
- Unidad de Cuidados Intensivos Pediátricos - Reanimación pediátrica, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - C Rodríguez Ferreiro
- Unidad de Soporte Científico, Instituto de Investigación Sanitaria 12 de Octubre (imas12), Hospital Universitario 12 de Octubre, Madrid, Spain
| | - A Mendoza Soto
- Instituto Pediátrico del Corazón, Hospital Universitario 12 de Octubre, Madrid, Spain; Instituto de Investigación Sanitaria 12 de Octubre (imas12), Hospital Universitario 12 de Octubre, Madrid, Spain
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Sarrouilhe É, Ponteins L. [Multidisciplinary reflections on parental support in congenital cardiac resuscitation]. SOINS. PEDIATRIE, PUERICULTURE 2023; 44:33-37. [PMID: 37574231 DOI: 10.1016/j.spp.2023.06.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/15/2023]
Abstract
Half of all children with congenital heart disease develop specific neurodevelopmental disorders. As these are influenced as much by factors intrinsic to the pathology as by the environmental and family support that the young patient receives from birth, the team at the congenital heart disease unit at Bordeaux's university hospital has devised an individualized global pathway for these families to support the neurodevelopment of these toddlers from the antenatal period onwards.
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Affiliation(s)
- Élise Sarrouilhe
- Service de réanimation cardiaque congénitale, centre hospitalier universitaire de Bordeaux, site de Haut-Lévêque, avenue de Magellan, 33600 Pessac, France.
| | - Laurie Ponteins
- Service de réanimation cardiaque congénitale, centre hospitalier universitaire de Bordeaux, site de Haut-Lévêque, avenue de Magellan, 33600 Pessac, France
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Zhang QL, Lin SH, Lin WH, Chen Q, Cao H. The effect of applying telehealth education to home care of infants after congenital heart disease surgery. Int J Qual Health Care 2023; 35:6947076. [PMID: 36537207 DOI: 10.1093/intqhc/mzac102] [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: 03/31/2022] [Revised: 11/15/2022] [Accepted: 12/20/2022] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND The purpose of this study was to investigate the effect of applying telehealth education to home care of infants after congenital heart disease (CHD) surgery. METHODS A prospective randomized controlled study was conducted from July 2020 to February 2021 in Fujian Children's Hospital to compare the home care condition of infants after CHD surgery between the intervention group and the control group. RESULTS At 3 months after discharge, parents' caring ability and CHD knowledge in the intervention group were significantly better than those in the control group and were significantly improved compared with those at discharge time (P < 0.05). The parental care burden in the intervention group was significantly lower than that in the control group and was significantly lower than that at discharge time (P < 0.05). During the follow-up period, the rate of loss of follow-up and complications in the intervention group were significantly lower than those in the control group (P < 0.05). CONCLUSION Telehealth education via WeChat can effectively improve the knowledge of disease and home care ability of parents of infants after CHD surgery and reduce their home care burden, which can effectively reduce the incidence of complications and lost to follow-up rate after discharge.
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Affiliation(s)
- Qi-Liang Zhang
- Department of Cardiac Surgery, Fujian Children's Hospital (Fujian Branch of Shanghai Children's Medical Center), College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, No. 966 of Hengyu Road, Fuzhou, Fujian 350001, China
| | - Shi-Hao Lin
- Department of Cardiac Surgery, Fujian Children's Hospital (Fujian Branch of Shanghai Children's Medical Center), College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, No. 966 of Hengyu Road, Fuzhou, Fujian 350001, China
| | - Wen-Hao Lin
- Department of Cardiac Surgery, Fujian Children's Hospital (Fujian Branch of Shanghai Children's Medical Center), College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, No. 966 of Hengyu Road, Fuzhou, Fujian 350001, China
| | - Qiang Chen
- Department of Cardiac Surgery, Fujian Children's Hospital (Fujian Branch of Shanghai Children's Medical Center), College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, No. 966 of Hengyu Road, Fuzhou, Fujian 350001, China
| | - Hua Cao
- Department of Cardiac Surgery, Fujian Children's Hospital (Fujian Branch of Shanghai Children's Medical Center), College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, No. 966 of Hengyu Road, Fuzhou, Fujian 350001, China
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Puriani D, Allenidekania A, Afiyanti Y. The Experience of Uncertainty in Mothers Caring for Children at Home after Palliative Heart Surgery. Indian J Palliat Care 2023; 29:46-50. [PMID: 36846277 PMCID: PMC9944655 DOI: 10.25259/ijpc_453_20] [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: 07/09/2021] [Accepted: 10/05/2022] [Indexed: 01/22/2023] Open
Abstract
Objectives Palliative heart surgery is a compelling option for some children with congenital heart disease for which corrective heart surgery is not yet possible due to its complexity. As primary caregivers, mothers have the challenge of providing optimal care to their children at home post-surgery. This study aims to explore the experiences of mothers who are caring for children recovering from palliative heart surgery at home. The research applied descriptive, qualitative and phenomenology design. Material and Methods This study was conducted in Jakarta. The participants were 15 mothers of palliative heart surgery patients from seven provinces in Indonesia; Jakarta, Aceh, Bali, North Sumatra, West Java, Central Java and Banten. Data were collected using semi-structured interviews through the WhatsApp video call application and analysed using the Colaizzi method. Results Mothers often felt uncertain about how to provide the best care and felt that their needs for hospital services to assist them went unmet. Conclusions: This study has implications for the development of nursing services related to discharge planning for palliative heart surgery patients.
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Affiliation(s)
- Dewi Puriani
- Department of Paediatric Nursing, Faculty of Nursing, Universitas Indonesia, Depok, Indonesia
| | | | - Yati Afiyanti
- Department of Paediatric Nursing, Faculty of Nursing, Universitas Indonesia, Depok, Indonesia
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Mengesha EW, Amare D, Asfaw LS, Tesfa M, B Debela M, Ambaw Getahun F. Parental experiences in neonatal intensive care unit in Ethiopia: a phenomenological study. Ann Med 2022; 54:121-131. [PMID: 35001740 PMCID: PMC8745364 DOI: 10.1080/07853890.2021.2004320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
INTRODUCTION Neonatal intensive care unit is important to save the lives of a sick neonate; however, parents are challenged by several stressful conditions during their stay. Therefore, this study aimed to explore the lived experiences of parents in neonatal intensive care units in Ethiopia. METHODS We used a phenomenological study design. The data were collected using an in-depth interview method from purposively selected parents. In addition, we followed a thematic analysis approach and used Open Code Software Version 4.02 to process the data. RESULTS In this study, 18 parents were interviewed. The researchers have identified six themes. Parents complained of psychological problems like anxiety, stress, worries, hopelessness, and a state of confusion. In addition, anger, crying, sadness, frustration, dissatisfaction, regret, disappointment, feeling bad, self-blaming, nervousness, disturbance, and lack of self-control were major emotional problems raised by the parents. Parents expressed that health care providers showed indiscipline, lack of commitment, and uncooperative behaviour. Likewise, shortage of medicines, money, and limited time to visit their neonates were the other concerns of many parents. At the same time, parents were provided minimal information and limited cooperation from health care providers. CONCLUSION Parents whose infants admitted to the NICU were suffered from various psychological and emotional problems. Researchers recommend that health care providers should be supported parents with psycho-emotional problems, strengthen parents-healthcare workers' interaction, and scale up neonatal intensive care unit services to the primary health care centres.KEY MESSAGESParents whose infants admitted to the NICU were suffered from psychological and emotional problems.Poor NICU environment, shortage of equipment, long hospital stay, the presence of pandemic COVID-19, and lack of parental involvement in the care were identified barriers that affected parents' stay.
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Affiliation(s)
- Endalkachew Worku Mengesha
- School of Public Health, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
| | - Desalegne Amare
- School of Health Science, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
| | | | - Mulugeta Tesfa
- Department of Epidemiology, College of Health Sciences, Debre Markos University, Debre Markos, Ethiopia
| | - Mitiku B Debela
- School of Public Health, College of Medicine and Health Sciences, Maddawalabu University, Balie, Ethiopia
| | - Fentie Ambaw Getahun
- School of Public Health, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
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Incidence, Trends, and Seasonality of Paediatric Injury-Related Emergency Department Presentations at a Large Level 1 Paediatric Trauma Centre in Australia. TRAUMA CARE 2022. [DOI: 10.3390/traumacare2030033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
This retrospective cohort study aimed to examine the characteristics, incidence, temporal trends, and seasonality of paediatric injury-related Emergency Department (ED) presentations at a large metropolitan paediatric hospital. It included children aged ≤15 years who presented to the ED at The Children’s Hospital at Westmead, Sydney Australia, with a principal diagnosis of injury during the ten-year period from 1 January 2010 to 31 December 2019. Descriptive statistics were used to describe the characteristics of the cohort and the distribution of ED presentations by mode of arrival, triage category, discharge status, injury diagnosis. Negative binomial regression was used to examine percentage change in annual incidence. Seasonality was examined with Seasonal and Trend decomposition using Loess (STL). There were 134,484 (59.7% male children) paediatric injury-related ED presentations during the ten-year period, of which 23,224 (17.3%) were admitted to hospital. Head injury accounted for more than one-quarter (26.8%) of ED presentations. The average annual increase in incidence was more pronounced during the first five years (5.6% [95%CI 4.1% to 7.1%]) than in the last five years (0.8% [95%CI 0.2% to 1.5%]). The monthly incidence of ED presentations had a bimodal distribution with peaks during autumn (March–May) and spring (October–November) seasons. The mean number of ED presentations per day was higher on weekends (40.8 ± 0.3) than weekdays (35.3 ± 0.8). During 2010 to 2019, there was a significant increase in the annual incidence of injury-related ED presentations for children aged ≤15 years, with head injury accounting for more than one-quarter of the ED presentations. The incidence of paediatric injury-related ED presentations was higher during autumn and spring seasons and at weekends. These data will inform health resource planning and priority-setting and advocacy for child injury prevention strategies in Australia.
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Menahem S. Invited Commentary: Congenital Heart-A Success Story: What About the Mothers? World J Pediatr Congenit Heart Surg 2022; 13:332-333. [PMID: 35446215 DOI: 10.1177/21501351221090131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Samuel Menahem
- Department of Paediatrics, Monash University, Murdoch Children's Research Institute, Australian Centre for Heart Health, Melbourne, Australia
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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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Interactive video games to reduce paediatric procedural pain and anxiety: a systematic review and meta-analysis. Br J Anaesth 2021; 127:608-619. [PMID: 34340838 DOI: 10.1016/j.bja.2021.06.039] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 05/19/2021] [Accepted: 06/09/2021] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Procedural pain and anxiety in children can be poorly controlled, leading to significant short- and long-term sequelae, such as longer procedure times or future healthcare avoidance. Caregiver anxiety can exacerbate these effects. We aimed to evaluate the effect of interactive video game interventions on children's procedural pain and anxiety, including the effect of different types of video games on those outcomes. METHODS We conducted a systematic review and meta-analysis of the effectiveness of interactive video games compared with standard care in children (0-18 yr) undergoing painful procedures. We searched the databases MEDLINE, Embase, and PsycINFO. We conducted random-effects meta-analysis using 'R' of children's procedural pain and anxiety and caregivers' anxiety. RESULTS Of 2185 studies screened, 36 were eligible (n=3406 patients). Studies commonly involved venous access (33%) or day surgery (31%). Thirty-four studies were eligible for meta-analyses. Interactive video games appear to reduce children's procedural pain (standardised mean difference [SMD]=-0.43; 95% confidence interval [CI]: -0.67 to -0.20), anxiety (SMD=0.61; 95% CI: -0.88 to -0.34), and caregivers' procedural anxiety (SMD=-0.31; 95% CI: -0.58 to -0.04). We observed no difference between preparatory and distracting games, or between virtual reality and non-virtual reality games. We also observed no difference between interactive video games compared with standard care for most medical outcomes (e.g. procedure length), except a reduced need for restraint. Studies reported minimal adverse effects and typically had high intervention acceptability and satisfaction. CONCLUSIONS Our findings support introducing easily available video games, such as distraction-based conventional video games, into routine practice to minimise paediatric procedural pain and child/caregiver anxiety.
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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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Carlsson T, Klarare A, Mattsson E. Peer support among parents of children with congenital heart defects: A qualitative analysis of written responses submitted via an online survey. J Adv Nurs 2020; 76:3528-3536. [PMID: 33009854 PMCID: PMC7702174 DOI: 10.1111/jan.14541] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Revised: 07/02/2020] [Accepted: 08/10/2020] [Indexed: 11/30/2022]
Abstract
AIM To explore experiences of peer support among parents of children with congenital heart defects. DESIGN A study analysing written responses to open-ended questions about peer support, collected via an online survey distributed in Sweden. METHODS Respondents were recruited during 3 months in 2018 by means of convenience sampling, through ads via the Swedish foundation for families with children who have heart defects and two closed Facebook groups for peer support. An online survey containing open-ended questions was distributed and responses were analysed with systematic text condensation. RESULTS Peer support was grounded in a mutual understanding among parents and involved highly appreciated emotional support. Listening to the stories of peers meant an opportunity to gain useful insights about what life is like for parents of children with heart defects. Receiving and providing peer support was described as rewarding on a personal level. Negative aspects of peer support were also described, which sometimes led to psychological distress and withdrawal from peer support activities. CONCLUSION Peer support is emotionally relieving and appreciated among parents of children with congenital heart defects, who consider providing the support a rewarding responsibility. While peer support activities may have considerable benefits for individuals, it may also lead to psychological distress for some. IMPACT This study addressed peer support among parents of children with congenital heart defects. The main findings illustrate the potential impact peer support can have on individuals and calls attention to the experienced benefits related to peer support activities, while also providing some insights regarding potential negative aspects. The findings have relevance for nurses, midwives, and other health professionals working in settings providing care for these families.
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Affiliation(s)
- Tommy Carlsson
- The Swedish Red Cross University College, Huddinge, Sweden.,Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Anna Klarare
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden.,Ersta Sköndal Bräcke University College, Stockholm, Sweden
| | - Elisabet Mattsson
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden.,Ersta Sköndal Bräcke University College, Stockholm, Sweden
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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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Mangelsdorf SN, Conroy R, Mehl MR, Norton PJ, Alisic E. Listening to Family Life After Serious Pediatric Injury: A Study of Four Cases. FAMILY PROCESS 2020; 59:1191-1208. [PMID: 31506948 DOI: 10.1111/famp.12490] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Following a serious child injury, the entire family can be affected. Gaining an understanding of family support, interactions, and stress levels can help clinicians tailor treatment. Presently, these factors are assessed mainly via self-reports and structured observations. We aimed to explore the value of naturalistic observation of postinjury parent-child interactions, in order to highlight how clinicians might use these data in their practice. Our qualitative study involved an in-depth analysis of four cases from the Ear for Recovery project, against the backdrop of the larger sample's characteristics. Children who had been hospitalized with a serious injury wore the Electronically Activated Recorder (EAR). Over a two-day period postdischarge, the EAR recorded 30-second audio "snippets" every 5 minutes. Families also completed self-report measures on family functioning, child stress and social support, parent stress, optimism, and self-efficacy. For each case, two coders independently used an ethnographic method, integrating self-report measures, family and injury characteristics, audio recordings, and transcripts to mimic integration of information within clinical practice. The coders then reached consensus on the main themes for each case through discussion. Families showed substantial variation in their communication in terms of content, tone, and frequency, including moments of conflict, humor, and injury-related conversations. We explored how these recorded interactions converged with and diverged from the self-report data. The EAR provided an opportunity for rich descriptions of individual families' communication and activities, yielding potential clinical information that may be otherwise difficult or impractical to obtain.
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Affiliation(s)
- Shaminka N Mangelsdorf
- School of Psychological Sciences, Monash University, Melbourne, Vic., Australia
- Monash University Accident Research Centre, Monash University, Melbourne, Vic., Australia
- Murdoch Children's Research Institute, Melbourne, Vic., Australia
| | - Rowena Conroy
- Murdoch Children's Research Institute, Melbourne, Vic., Australia
- Melbourne School of Psychological Sciences, The University of Melbourne, Melbourne, Vic., Australia
- The Royal Children's Hospital, Melbourne, Vic., Australia
| | | | - Peter J Norton
- School of Psychological Sciences, Monash University, Melbourne, Vic., Australia
| | - Eva Alisic
- Monash University Accident Research Centre, Monash University, Melbourne, Vic., Australia
- Murdoch Children's Research Institute, Melbourne, Vic., Australia
- Jack Brockhoff Child Health and Wellbeing Program, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Vic., Australia
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MacKay L, Benzies K, Barnard C, Raffin Bouchal S. Parental Experiences Caring for Their Hospitalized Medically Fragile Infants: A Description of Grief, Stress, and Coping. Can J Nurs Res 2020; 53:191-201. [PMID: 32847405 DOI: 10.1177/0844562120954125] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Advances in care have increased survival and improved outcomes of infants with complex and chronic diseases. These medically fragile infants require long-term hospitalization and depend on technology for survival. Parents of these infants experience stress and difficulties adapting to their parental role. PURPOSE To present an account of parental experiences as they provided care for their hospitalized medically fragile infant. METHODS This study was part of a larger constructivist grounded theory study to provide a holistic understanding of the processes of care for medically fragile infants. For this sub-study, 21 parents of hospitalized medically fragile infants were recruited from a pediatric hospital in Western Canada. Parents participated in face-to-face, semi-structured interviews, which were transcribed and analyzed using initial and focused coding. RESULTS Parents of hospitalized medically fragile infants grieved the loss of parenting a healthy infant, and they experienced multiple stressors. Parents utilized various coping strategies to manage their grief and stressors. Some parents were unable to cope, which exacted a heavy toll on their physical and mental health. Parents recommended psychological support, access to physical activity, primary nursing, and health system navigators. CONCLUSIONS Parental recommendations can inform the design of interventions for parents of hospitalized medically fragile infants.
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Affiliation(s)
- Lyndsay MacKay
- Faculty of Nursing, University of Calgary, Calgary, Alberta, Canada
| | - Karen Benzies
- Faculty of Nursing, University of Calgary, Calgary, Alberta, Canada.,Departments of Pediatrics and Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Chantelle Barnard
- Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
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Mackay LJ, Benzies KM, Barnard C, Hayden KA. A scoping review of parental experiences caring for their hospitalised medically fragile infants. Acta Paediatr 2020; 109:266-275. [PMID: 31343765 DOI: 10.1111/apa.14950] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Revised: 05/07/2019] [Accepted: 07/23/2019] [Indexed: 11/26/2022]
Abstract
AIM To synthesise and summarise evidence from published research articles regarding parental experiences caring for their hospitalised medically fragile infant. METHODS We searched four electronic databases in April 2018 using three main concepts individually and in combination: infant, medically fragile, parents. We examined articles about experiences of parents caring for the medically fragile infant in a hospital setting. We conducted thematic analysis on the 34 included articles. RESULTS Parents experienced high rates of depressive symptoms, depression, stress, anxiety, distress and post traumatic stress. Parent-infant interactions were disrupted. Parents experienced loss and worry in response to the diagnosis of their infant, which altered or delayed parental role attainment. Supports and coping were key for parents to manage their stress. CONCLUSION Parents of medically fragile infants experience multiple stressors, elevated levels of mental health difficulties, trouble attaining their parental role and often struggle to cope. Development of interventional research is needed to test targeted strategies aimed at reducing parental stress and mental health difficulties. Interventions should include: screening for parental mental health, psychological support, healthcare professional education, strategies to enhance parent-infant interactions and improved relationship competencies among healthcare professionals.
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Affiliation(s)
| | - Karen M. Benzies
- Faculty of Nursing University of Calgary Calgary AB Canada
- Departments of Paediatrics and Community Health Sciences, Cumming School of Medicine University of Calgary Calgary AB Canada
| | - Chantelle Barnard
- Department of Pediatrics, Cumming School of Medicine University of Calgary Calgary AB Canada
| | - K Alix Hayden
- Libraries and Cultural Resources University of Calgary Calgary AB Canada
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Svensson MK, Wahlberg A, Gislason GH. Chronic Paradoxes: A Systematic Review of Qualitative Family Perspectives on Living With Congenital Heart Defects. QUALITATIVE HEALTH RESEARCH 2020; 30:119-132. [PMID: 31526075 DOI: 10.1177/1049732319869909] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
There have been substantial advances in the diagnostics and treatment of congenital heart defects (CHDs) in recent decades, and this has improved survival significantly. Consequently, there is a growing interest in how CHDs affect the daily lives of children and youth. We examine life with CHDs as a particular kind of living from the perspectives of both children and youth with CHDs and their families through a systematic review of existing qualitative research. Based on a meta-ethnographic analysis of 20 articles (identified through PubMed, EMBASE, EBSCOhost, PSYCHinfo, Scopus, and Web of Science from January 7 to 12, 2016), we argue that living with CHDs is characterized by chronic paradoxes arising out of the transitions, normalities, and futures that families have to navigate.
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Affiliation(s)
- Marie Kofod Svensson
- The Danish Heart Foundation, Copenhagen, Denmark
- Department of Anthropology, University of Copenhagen, Copenhagen, Denmark
| | - Ayo Wahlberg
- Department of Anthropology, University of Copenhagen, Copenhagen, Denmark
| | - Gunnar H Gislason
- The Danish Heart Foundation, Copenhagen, Denmark
- Department of Cardiology, Copenhagen University Hospital Herlev and Gentofte, Denmark
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18
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Jepsen SL, Haahr A, Eg M, Jørgensen LB. Coping with the unfamiliar: How do children cope with hospitalization in relation to acute and/or critical illness? A qualitative metasynthesis. J Child Health Care 2019; 23:534-550. [PMID: 30453743 DOI: 10.1177/1367493518804097] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
The aim of this study was to identify and describe how young children cope with hospitalization in relation to acute and/or critical illness. The study is a qualitative metasynthesis inspired by the approach described by Sandelowski and Barroso. Based on an exhaustive literature search, six studies were included. Data were analyzed through a taxonomic analysis. The findings revealed that the hospitalized children face a variety of challenges during admission to the hospital due to acute and/or critical illness. The main challenge was that hospitalized children strive to cope with different aspects of 'the unfamiliar' that emerge in their illness treatment and hospital stay. The unfamiliar refers to unknown experiences on a physical, emotional, and relational level. Subsequently, children cope with the unfamiliar by striving to convert the hospital stay into something more similar to everyday life, using strategies to secure basic needs and constructing familiarity in the hospital stay. The consequences of the children's coping behavior are discussed and how children strive to keep their integrity intact during illness and hospitalization are revealed.
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Affiliation(s)
| | - Anita Haahr
- VIA Health Promotion & Rehabilitation, Centre for Research and Development, VIA University College, Denmark
| | - Marianne Eg
- Department of Paediatrics, Regional Hospital Viborg, Viborg, Denmark.,The Centre for Nursing Research, Viborg, Denmark
| | - Lene Bastrup Jørgensen
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.,Cairos A/S, Copenhagen, Denmark
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Mental health care for parents of babies with congenital heart disease during intensive care unit admission: Systematic review and statement of best practice. Early Hum Dev 2019; 139:104837. [PMID: 31455569 DOI: 10.1016/j.earlhumdev.2019.104837] [Citation(s) in RCA: 55] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
INTRODUCTION Congenital heart disease (CHD) is one of the most common causes of infant admission to pediatric intensive care and is associated with profound psychological stress for mothers, fathers and their infants. Intensive care unit admission represents an opportunity to offer evidence-based strategies to prevent or minimize severe psychological distress and promote secure bonding and attachment, alongside high-quality infant medical care. OBJECTIVES We aimed to identify, synthesize and critically appraise published evidence on the efficacy and cost-effectiveness of mental health interventions delivered in neonatal, pediatric or cardiac intensive care units for parents of infants with CHD. A secondary goal was to develop recommendations for advancing health policy, practice and research in the field. METHODS In accordance with a prospectively registered protocol (CRD42019114507), six electronic databases were systematically searched for studies reporting results of a controlled trial of a mental health intervention for parents of infants aged 0-12 months with a congenital anomaly requiring intensive care unit admission. To maximize generalizability of results, trials involving infants with any type of structural congenital anomaly requiring surgery were included. Outcomes included intervention type, process, efficacy, and cost-effectiveness. RESULTS Across all forms of congenital anomaly, only five trials met inclusion criteria (four in CHD, one in gastrointestinal malformation). All interventions engaged parents face-to-face, but each had a distinct therapeutic approach (parent-infant interaction and bonding, early pediatric palliative care, psycho-education, parenting skills training, and family-centered nursing). Four of the five trials demonstrated efficacy in reducing maternal anxiety, although the quality of evidence was low. Positive results were also found for maternal coping, mother-infant attachment, parenting confidence and satisfaction with clinical care, as well as infant mental (but not psychomotor) development at 6 months. Mixed results were found for maternal depression and infant feeding. No evidence of efficacy was found for improving parent, infant or family quality of life, physical health or length of infant hospital stay, and there were no data on cost-effectiveness. CONCLUSIONS Stronger evidence for the efficacy of mental health interventions to buffer the effects of intensive care unit admission for parents of infants with CHD is urgently needed. Robust, high-quality trials are lacking, despite the established need and demand, and health policies prioritizing parent mental health care in the context of early childhood adversity are needed.
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20
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Lotto R, Jones I, Seaton SE, Dhannapuneni R, Guerrero R, Lotto A. Congenital Cardiac Surgery and Parental Perception of Risk: A Quantitative Analysis. World J Pediatr Congenit Heart Surg 2019; 10:669-677. [PMID: 31701827 DOI: 10.1177/2150135119872489] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Interpretation of risk by parents of children undergoing congenital cardiac surgery is poorly documented. The available evidence highlights a dichotomy where clinicians suggest parents may not grasp the complexity and risk associated with procedures, while some parents suggest risk is unnecessarily overemphasized. AIM To quantify how risk is perceived by parents. METHODS One hundred six parents of children undergoing cardiac surgery were recruited and completed a Likert-type scale from 1 (perceived low risk) to 6 (perceived high risk), at 5 points: arrival at preadmission, post discussion with anethetist/surgeon, day of surgery, discharge from intensive care, and at outpatient follow-up. The surgical sample was stratified according to Risk Adjustment in Congenital Heart Surgery level. ANALYSIS Data were analyzed using Wilcoxon rank tests for differences in distributions of scores and Krippendorff α to examine the level of agreement. RESULTS Median parental risk scores varied over time, with no consistent risk scores observed. Maternal scores were consistently higher than paternal scores at every time point (P < .001). Postoperative complications resulted in a persistent rise in risk perception at follow-up (P < .001). Analysis of parental risk scores and objective measures of surgical risk highlighted poor agreement that was particularly marked at the extremes of risk. CONCLUSIONS Parents perceived higher risk scores than those reported by the clinical team. Mothers reported statistically significantly higher scores than their partners, highlighting potential tensions. In addition, the changing perception of risk over time emphasizes the need for flexible levels of support and information as parents navigate uncertainty.
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Affiliation(s)
- Robyn Lotto
- Faculty of Health, Liverpool John Moores University, Webster Street, Liverpool, United Kingdom
| | - Ian Jones
- Faculty of Health, Liverpool John Moores University, Webster Street, Liverpool, United Kingdom
| | - Sarah E Seaton
- Department of Health Sciences, University of Leicester, Leicester, United Kingdom
| | - Ram Dhannapuneni
- Department of Cardiac Surgery, Alder Hey Children's Hospital, Liverpool, United Kingdom
| | - Rafael Guerrero
- Department of Cardiac Surgery, Alder Hey Children's Hospital, Liverpool, United Kingdom
| | - Attilio Lotto
- Faculty of Health, Liverpool John Moores University, Webster Street, Liverpool, United Kingdom.,Department of Cardiac Surgery, Alder Hey Children's Hospital, Liverpool, United Kingdom
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Thomi M, Pfammatter JP, Spichiger E. Parental emotional and hands-on work-Experiences of parents with a newborn undergoing congenital heart surgery: A qualitative study. J SPEC PEDIATR NURS 2019; 24:e12269. [PMID: 31468697 DOI: 10.1111/jspn.12269] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2018] [Revised: 07/28/2019] [Accepted: 08/05/2019] [Indexed: 02/06/2023]
Abstract
PURPOSE To explore both mothers' and fathers' experiences from prenatal or postnatal diagnosis of their newborn's congenital heart disease (CHD) to the first discharge after heart surgery in a Swiss university children's hospital. DESIGN AND METHOD A qualitative research approach, based on a constructivist paradigm, was applied to explore participants' experiences and perceptions. Parents of nine children with moderate to severe CHD participated in semistructured joint couple interviews. Data were analyzed inductively via an iterative process, following the steps of thematic analysis. RESULTS Between the child's CHD diagnosis and hospital discharge after neonatal cardiac surgery, the overarching theme for parents was being confronted with demanding emotional and hands-on work. This parental work included four themes with subthemes: Parents had to tackle a route through an unknown hospital world from receiving the CHD diagnosis and experiencing delivery to attending to their child in the pediatric intensive care unit and during surgery, as well as during the transfer to and the stay on the pediatric cardiac unit. They experienced an at times challenging interplay with health care professionals, performed teamwork as the nuclear family and managed concerned relatives and friends. PRACTICE IMPLICATIONS Health care professionals should establish trustful relationships with parents, while accompanying families continuously, providing consistent, straightforward information, and expressing appreciation for the parents' exceptional emotional and hands-on work. Health care professionals' awareness of parent's experiences is vital to compassionate family-centered care.
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Affiliation(s)
- Mirjam Thomi
- University Children's Hospital, Inselspital, Bern University Hospital, Bern, Switzerland.,Center for Congenital Heart Disease, Department of Cardiology, Inselspital, Bern University Hospital, Bern, Switzerland
| | - Jean-Pierre Pfammatter
- Center for Congenital Heart Disease, Department of Cardiology, Inselspital, Bern University Hospital, Bern, Switzerland
| | - Elisabeth Spichiger
- Institute of Nursing Science, Department of Public Health, University of Basel, Basel, Switzerland.,Head Office of Nursing and Allied Health Professionals, Inselspital, Bern University Hospital, Bern, Switzerland
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22
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Uhm JY, Choi MY. Mothers' needs regarding partnerships with nurses during care of infants with congenital heart defects in a paediatric cardiac intensive care unit. Intensive Crit Care Nurs 2019; 54:79-87. [PMID: 31353190 DOI: 10.1016/j.iccn.2019.07.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2018] [Revised: 06/28/2019] [Accepted: 07/04/2019] [Indexed: 11/20/2022]
Abstract
OBJECTIVES We investigated mothers' needs in forming partnerships with nurses based on children's postoperative recovery in a paediatric cardiac intensive care unit. DESIGN This was a descriptive study using prospective data. SETTING Data were collected from 36 mothers enrolled in a mother-nurse partnership program. MAIN OUTCOME MEASURES We investigated mothers' need for information and participation activities using a self-made survey tool, as well as the duration of mothers' care participation and physical engagement and psychological connectedness. RESULTS The mothers desired information on their infants' postoperative stability in the early recovery phases and information on infants' transfer and care in the later phases. Mothers' mean duration of care participation increased as infants' recovery progressed (15.82 ± 8.76 minutes in the second phase of recovery to 29.46 ± 4.53 minutes in the fifth phase; F = 19.54, p < .001). Mothers' physical engagement and psychological connectedness also increased with infants' recovery (F = 200.95, p < .001; F = 93.27, p < .001, respectively). Mothers generally passively participated at first and gradually developed more positive and enthusiastic participation as infants recovered. CONCLUSION Infants' condition heavily influenced mothers' needs regarding partnerships. Thus, nurses must individually provide mothers with information and encourage them to participate in care.
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Affiliation(s)
- Ju-Yeon Uhm
- Department of Nursing, Daegu Haany University, 1 Haanydaero, Gyeongsan-si, Gyeongsangbuk-Do 712-715, Republic of Korea.
| | - Mi-Young Choi
- Department of Nursing Science, Chungbuk National University, Chungdae-ro 1, Seowon-Gu, Cheongju, Chungbuk 28644, Republic of Korea.
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Kassa AM, Engstrand Lilja H, Engvall G. From crisis to self-confidence and adaptation; Experiences of being a parent of a child with VACTERL association - A complex congenital malformation. PLoS One 2019; 14:e0215751. [PMID: 31002700 PMCID: PMC6474607 DOI: 10.1371/journal.pone.0215751] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2018] [Accepted: 04/08/2019] [Indexed: 11/24/2022] Open
Abstract
Aim Knowledge is scarce regarding mothers’ and fathers’ experiences of being a parent of a child with VACTERL association—a complex malformation. The aim of the study was to describe experiences of being a parent of a child with VACTERL association. Method Semi-structured interviews were performed with ten mothers and nine fathers face-to-face or by telephone and analyzed by using Qualitative content analysis. Results The parents described crisis reactions at the discovery of malformations in their child. Involvement in care was reported from the initial hospital admission until actively taking responsibility for treatments at home. Eventually the health condition became an integrated part of everyday life. The parents expressed the importance of meeting other families with a child with VACTERL. Descriptions were given of more or less professionalism with perceived discrepancies of knowledge and experience between the healthcare professionals in the tertiary hospital and those in the local hospital. Difficulties in receiving medical support during the initial period at home were described. Furthermore, emotional support and practical arrangements regarding parental accommodation and transportation varied. Conclusion Being a parent of a child with VACTERL association involves crisis, mixed emotional reactions and shared responsibility for the child´s treatment and care with the professional care providers. Psychological processing, good medical care and support from experts, and peer support from other parents is essential in the parents’ struggle to reach self-confidence and adaptation. A care plan with individualized tailored care for each child including a training and support plan for the parents is warranted. To reduce the described discrepancies in knowledge and experience between the local and tertiary hospital, video sessions with the parents and responsible professionals at the local and tertiary hospital could be an appropriate mode of transferring information at discharge and follow up of the child.
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Affiliation(s)
- Ann-Marie Kassa
- Department of Women’s and Children’s Health, Uppsala University, Uppsala, Sweden
- Department of Pediatric Surgery, University Children's Hospital, Uppsala, Sweden
- * E-mail:
| | - Helene Engstrand Lilja
- Department of Women’s and Children’s Health, Uppsala University, Uppsala, Sweden
- Department of Pediatric Surgery, University Children's Hospital, Uppsala, Sweden
| | - Gunn Engvall
- Department of Women’s and Children’s Health, Uppsala University, Uppsala, Sweden
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Ni ZH, Lv HT, Ding S, Yao WY. Home care experience and nursing needs of caregivers of children undergoing congenital heart disease operations: A qualitative descriptive study. PLoS One 2019; 14:e0213154. [PMID: 30870440 PMCID: PMC6417691 DOI: 10.1371/journal.pone.0213154] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2018] [Accepted: 02/16/2019] [Indexed: 12/02/2022] Open
Abstract
Aims and objectives To explore the home care experiences of caregivers taking care of CHD children before and after cardiac surgery. Background Despite the prevalence of congenital heart disease (CHD) in childhood, little is known about the experiences and impacts on the children and their caregivers after CHD diagnosis and surgery. Such knowledge is needed for meaningful support. Design A qualitative descriptive study. Methods Twenty-two caregivers of CHD children undergoing cardiac surgery participated in semi-structured interviews at a University Children’s Hospital in China. Data were collected by an experienced and trained interviewer. Qualitative content analysis was chosen to describe the experiences of the caregivers. Results Caregivers of CHD children experienced significant demands. After the children underwent their CHD operations, the caregivers experienced complex psychological feelings and excessive stress impacting upon theirlives. In addition, caregivers constantly adapted their roles with self-fulfillment in caring activities. Conclusions CHD surgery has a major impact on the emotions and daily lives of children and their caregivers. This study offers a framework for understanding the importance of actively listening to caregivers so coping strategies can be implemented. Relevance to clinical practice Theexperiencesdescribed in this study contribute to a better understanding of the needs of caregivers whose children underwent CHD operations. They also provide valuable information to professional medical care staff that developfuture nursing assessments.
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Affiliation(s)
- Zhi Hong Ni
- Children’s Hospital of Soochow University, Suzhou, China
| | - Hai Tao Lv
- Children’s Hospital of Soochow University, Suzhou, China
- * E-mail: (HTL); (SD)
| | - Sheng Ding
- Children’s Hospital of Soochow University, Suzhou, China
- * E-mail: (HTL); (SD)
| | - Wen Ying Yao
- Children’s Hospital of Soochow University, Suzhou, China
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Gaskin KL, Wray J, Barron DJ. Acceptability of a parental early warning tool for parents of infants with complex congenital heart disease: a qualitative feasibility study. Arch Dis Child 2018; 103:880-886. [PMID: 29567664 DOI: 10.1136/archdischild-2017-313227] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2017] [Revised: 02/27/2018] [Accepted: 03/03/2018] [Indexed: 11/04/2022]
Abstract
AIM To explore the acceptability and feasibility of a parental early warning tool, called the Congenital Heart Assessment Tool (CHAT), for parents going home with their infant between first and second stage of surgery for complex congenital heart disease. BACKGROUND Home monitoring programmes were developed to aid early recognition of deterioration in fragile infants between first and second surgical stage. However, this necessitates good discharge preparation to enable parents to develop appropriate knowledge and understanding of signs of deterioration to look for and who to contact. DESIGN This was a longitudinal qualitative feasibility study, within a constructivist paradigm. Parents were taught how to use the CHAT before taking their infant home and asked to participate in semistructured interviews at four time points: before discharge (T0), 2 weeks after discharge (T1), 8 weeks after discharge (T2) and after stage 2 surgery (T3). Interviews were transcribed verbatim and thematically analysed. SETTING One tertiary children's cardiac centre in the UK. SUBJECTS Twelve parents of eight infants who were discharged following first stage cardiac surgery for complex congenital heart disease, between August 2013 and February 2015. RESULTS Four main themes emerged: (1) parental preparation and vigilance, (2) usability, (3) mastery, and (4) reassurance and support. CONCLUSIONS The study highlighted the benefit of appropriately preparing parents before discharge, using the CHAT, to enable identification of normal infant behaviour and to detect signs of clinical deterioration. The study also demonstrated the importance of providing parents with information about when and who to call for management advice and support.
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Affiliation(s)
- Kerry Louise Gaskin
- Nursing and Midwifery Department, Institute of Health and Society, University of Worcester, Worcester, UK
| | - Jo Wray
- Centre for Nursing and Allied Health, Great Ormond Street Hospital NHS Foundation Trust, London, UK
| | - David J Barron
- Cardiac Surgery Department, Birmingham Children's Hospital NHS Foundation Trust, Birmingham, UK
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Abstract
Parental stress is a universal experience for parents who have children diagnosed with CHD and has been studied within the context of the child's illness, but not through a broader health disparity lens. This paper provides a thorough synthesis of the current literature on parental stress addressing disparities in parents of children with CHD. Several theories and models from within this literature are described and a new comprehensive framework, the Parental Stress and Resilience in CHD Model, is presented. Future research and clinical implications are discussed.
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Simeone S, Pucciarelli G, Perrone M, Angelo GD, Teresa R, Guillari A, Gargiulo G, Comentale G, Palma G. The lived experiences of the parents of children admitted to a paediatric cardiac intensive care unit. Heart Lung 2018; 47:631-637. [PMID: 30173952 DOI: 10.1016/j.hrtlng.2018.08.002] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2018] [Revised: 07/26/2018] [Accepted: 08/02/2018] [Indexed: 11/17/2022]
Abstract
BACKGROUND Congenital heart disease is a common birth defect rather than a paediatric disease. Parents often discover this disease after their children's birth and then often learn that cardiac surgery is the only solution. A child's admission to a paediatric cardiac intensive care unit (PCICU) may lead to high levels of stress, anxiety and depression in parents. OBJECTIVES To describe the lived experiences of mothers and fathers during their children's confinement in a PCICU. METHODS A phenomenological study was conducted. This method combines descriptive features (Husserlian) and interpretive phenomenology (Gadamerian). The subjects were interviewed with open questions to allow them full freedom of expression and were asked to describe their experiences when their children were admitted to the PCICU. Each interview was audio-recorded and lasted between 20 and 60 minutes. The researchers involved in the analysis each independently immersed themselves in the data by reading and re-reading the transcripts in order to gain a sense of the whole dataset. The extrapolation of the themes followed. The individual researchers compared the various extrapolated themes. RESULTS We enrolled 16 participants. Three main themes emerged: 1) the fear of the potential loss of their children, (2) the feeling of having lost their roles as parents and (3) the desire to receive more information and be an active part of the treatment process. CONCLUSION A child's admission to a PCICU requires healthcare staff to take care of the child's family members as well. Knowing about mothers' and fathers' experiences is crucial in implementing a holistic and multidisciplinary process of care.
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Affiliation(s)
- Silvio Simeone
- Department of Cardiology, Cardiac Surgery and Emergency, University of Naples Federico II, Naples, Italy
| | - Gianluca Pucciarelli
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy.
| | - Marco Perrone
- Department of Cardiology, Cardiac Surgery and Emergency, University of Naples Federico II, Naples, Italy
| | - Grazia Dell Angelo
- Department of Cardiology, Cardiac Surgery and Emergency, University of Naples Federico II, Naples, Italy
| | - Rea Teresa
- Department of Hygiene, University of Naples Federico II, Naples, Italy
| | - Assunta Guillari
- Department of Hygiene, University of Naples Federico II, Naples, Italy
| | - Gianpaolo Gargiulo
- Pediatric Cardiac Surgery, University of Naples Federico II, Naples, Italy
| | - Giuseppe Comentale
- Pediatric Cardiac Surgery, University of Naples Federico II, Naples, Italy
| | - Gaetano Palma
- Pediatric Cardiac Surgery, University of Naples Federico II, Naples, Italy
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Hinton L, Locock L, Long AM, Knight M. What can make things better for parents when babies need abdominal surgery in their first year of life? A qualitative interview study in the UK. BMJ Open 2018; 8:e020921. [PMID: 29961020 PMCID: PMC6042569 DOI: 10.1136/bmjopen-2017-020921] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2017] [Revised: 03/29/2018] [Accepted: 05/24/2018] [Indexed: 01/25/2023] Open
Abstract
OBJECTIVES To understand the experiences of parents of infants who required surgery early in life. To identify messages and training needs for the extended clinical teams caring for these families-including paediatric surgeons, neonatologists, nurses, obstetricians, midwives and sonographers. SETTING UK-wide interview study, including England, Wales and Scotland. PARTICIPANTS In-depth interviews were conducted with 44 parents who had a baby who underwent early abdominal surgery. Conditions included those diagnosed antenatally (eg, exomphalos, gastroschisis, congenital diaphragmatic hernia) or those which were detected postnatally (eg, Hirschsprung's disease, necrotising enterocolitis). Interviews were video and audio recorded and analysed using a modified grounded-theory approach. RESULTS While some parents reported experiencing excellent communication and felt they were listened to and involved by the care team, this was not always the case. Dealing with large, complex medical and surgical teams could result in conflicting messages, uncertainty and distress. Parents wanted information but also described being overwhelmed and wanting to distance themselves to maintain hope. Information and support from other parents in hospital and online groups were highly valued. Of particular concern was support when going home and caring for their baby after discharge; an open access policy for readmission offered a helpful safety net. CONCLUSIONS Listening to the experience of parents provides rich data to enhance clinical understandings on how to improve information and communication with parents, and ameliorate the deep and lasting distress and anxiety that some parents feel when their infants face early surgery. We suggest that the writings of Bourdieu could have resonance in interpreting the experiences of parents as they enter the world of highly technical neonatal medicine and surgery and the knowledge of the professionals who work in these environments.
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Affiliation(s)
- Lisa Hinton
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
- NIHR Oxford Biomedical Research Centre, Oxford, UK
| | - Louise Locock
- Health Service Research, University of Aberdeen, Aberdeen, UK
| | - Anna-May Long
- Nuffield Department of Population Health, National Perinatal Epidemiology Unit, University of Oxford, Oxford, UK
| | - Marian Knight
- Nuffield Department of Population Health, National Perinatal Epidemiology Unit, University of Oxford, Oxford, UK
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Simeone S, Platone N, Perrone M, Marras V, Pucciarelli G, Benedetti M, Dell'Angelo G, Rea T, Guillari A, Da Valle P, Gargiulo G, Botti S, Artioli G, Comentale G, Ferrigno S, Palma G, Baratta S. The lived experience of parents whose children discharged to home after cardiac surgery for congenital heart disease. ACTA BIO-MEDICA : ATENEI PARMENSIS 2018; 89:71-77. [PMID: 29644992 PMCID: PMC6357628 DOI: 10.23750/abm.v89i4-s.7223] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Indexed: 01/21/2023]
Abstract
BACKGROUND Congenital Heart Diseases (CHDs) afflicting children are estimated in 8 per 1000 live births. Recent advances in surgery and medical treatments allowed an improvement in survival rates leading to changes in diseases management as chronic conditions. Parents involvement during clinical pathways is considered an essential component of care, but frequently they experience stress and anxiety conditions during the care path. These feelings are typical of the pre and peri-operative period, however they don't disappear easily and sometimes they can increase after hospital discharge, affecting the family environment and its behaviors. AIM OF THE WORK The purpose of this qualitative study is to examine the lived experience of parents during the time just after their children return home from hospital after undergoing surgery for CHD. METHODS Parents were enrolled and interviewed as a prepositive sampling until concept saturation using Cohen's phenomenology approach. A quantitative approach was also applied using SF-12 questionnaire. The study was conducted in two Italian hospitals: the Pediatric Heart Surgery Center of the Fondazione Toscana G. Monasterio Institute in Massa and the Pediatric Cardiac Surgery Center of the Federico II University Hospital in Naples. RESULTS The main themes emerged after the analysis were "happiness and uncertainty"; "chronic psychophysical fatigue"; "the rediscovery of a strong link with health care professionals". CONCLUSIONS Fully understand the life experience of these families will allow the implementation of targeted health interventions through the implementation of shared strategies and tools to reduce families and children discomfort after hospital discharge.
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Affiliation(s)
- Silvio Simeone
- General and Pediatric Cardiac Surgery Unit, Department of Advanced Biomedical Sciences, Federico II University Hospital, Naples.
| | - Nicol Platone
- G. Pasquinucci Heart Hospital, Gabriele Monasterio Foundation, Massa.
| | - Marco Perrone
- General and Pediatric Cardiac Surgery Unit, Department of Advanced Biomedical Sciences, Federico II University Hospital, Naples.
| | - Valentina Marras
- G. Pasquinucci Heart Hospital, Gabriele Monasterio Foundation, Massa.
| | | | - Martina Benedetti
- G. Pasquinucci Heart Hospital, Gabriele Monasterio Foundation, Massa.
| | - Grazia Dell'Angelo
- General and Pediatric Cardiac Surgery Unit, Department of Advanced Biomedical Sciences, Federico II University Hospital, Naples.
| | - Teresa Rea
- Pubblic Health Department, Federico II University Hospital, Naples.
| | - Assunta Guillari
- Pubblic Health Department, Federico II University Hospital, Naples.
| | - Paola Da Valle
- G. Pasquinucci Heart Hospital, Gabriele Monasterio Foundation, Massa.
| | | | - Stefano Botti
- Haematology Unit, Azienda Unità Sanitaria Locale - IRCCS, Reggio Emilia.
| | | | - Giuseppe Comentale
- General and Pediatric Cardiac Surgery Unit, Department of Advanced Biomedical Sciences, Federico II University Hospital, Naples.
| | - Salvatore Ferrigno
- General and Pediatric Cardiac Surgery Unit, Department of Advanced Biomedical Sciences, Federico II University Hospital, Naples.
| | - Gaetano Palma
- General and Pediatric Cardiac Surgery Unit, Department of Advanced Biomedical Sciences, Federico II University Hospital, Naples.
| | - Stefania Baratta
- G. Pasquinucci Heart Hospital, Gabriele Monasterio Foundation, Massa.
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Gabriel MG, Wakefield CE, Vetsch J, Karpelowsky JS, Darlington ASE, Grant DM, Signorelli C. The Psychosocial Experiences and Needs of Children Undergoing Surgery and Their Parents: A Systematic Review. J Pediatr Health Care 2018; 32:133-149. [PMID: 29066150 DOI: 10.1016/j.pedhc.2017.08.003] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2017] [Accepted: 08/05/2017] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Surgery in children can be difficult for patients and parents. We aimed to summarize pediatric patients' and parents' psychosocial experiences and needs in surgery. METHOD We used the Ovid search engine and screened 877 abstracts across three databases to extract data on pediatric patients' and parents' surgical experiences. RESULTS Our search yielded 11 eligible studies representing 1,307 children undergoing surgery and their parents. Children's adverse experiences included psychological and behavioral changes before, during, and after surgery (e.g., anxiety, eating disturbances). Parents commonly experienced psychological distress. Children's needs related to medical and health care services, whereas parents had high information needs. DISCUSSION Children's adverse experiences can negatively affect medical outcomes. Children's experiences are inextricably linked to their parents' and can become negatively affected by their parents' adverse experiences. Patients and parents with previous hospitalizations and surgeries had worse surgical experiences, highlighting further research in the context of chronic illness.
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Beke DM. Norwood Procedure for Palliation of Hypoplastic Left Heart Syndrome: Right Ventricle to Pulmonary Artery Conduit vs Modified Blalock-Taussig Shunt. Crit Care Nurse 2018; 36:42-51. [PMID: 27908945 DOI: 10.4037/ccn2016861] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
Patients with hypoplastic left heart syndrome undergo a series of operations to separate the pulmonary and systemic circulations. The first of at least 3 operations occurs in the newborn period, with a stage I palliation. The goal of stage I palliation is to provide pulmonary blood flow and create an unobstructed systemic outflow tract. Advances in surgical techniques and intraoperative and postoperative care have helped decrease morbidity and mortality for patients with hypoplastic left heart syndrome who have the stage I Norwood operation, but the patients continue to be at increased risk for hemodynamic collapse and adverse outcomes. This article discusses risk factors, surgical approach, postoperative nursing and medical management strategies, differences between and outcomes for the Norwood operation with the right ventricle to pulmonary artery conduit and the Norwood operation with a modified Blalock-Taussig shunt.
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Affiliation(s)
- Dorothy M Beke
- Dorothy M. Beke is a clinical nurse specialist in the cardiac intensive care unit at Boston Children's Hospital, Boston, Massachusetts. She is the unit's mechanical circulatory support clinical resource, the cardiovascular program bereavement coordinator, and a nurse practitioner in the cardiology preoperative clinic.
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32
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Experience of fathers of neonates with congenital heart disease in South Korea. Heart Lung 2017; 46:439-443. [DOI: 10.1016/j.hrtlng.2017.08.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2017] [Revised: 08/22/2017] [Accepted: 08/24/2017] [Indexed: 11/18/2022]
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Reis SMGD, Leite ACAB, Alvarenga WDA, Araújo JS, Zago MMF, Nascimento LC. Meta-synthesis about man as a father and caregiver for a hospitalized child. Rev Lat Am Enfermagem 2017. [PMCID: PMC5614234 DOI: 10.1590/1518-8345.1850.2922] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
ABSTRACT Objective: to identify, analyze and synthesize the father’s experience in care for a hospitalized child from results of primary qualitative studies. Method: this is a qualitative meta-synthesis through which 12 articles were analyzed, selected in the Cumulative Index to Nursing and Allied Health Literature databases, Latin American and Caribbean Literature in Health Sciences, Public Medline, Scopus, PsycINFO and Web of Science, published between 1995 and 2015. The methodological steps proposed by Sandelowski and Barroso were used to systematize the review, as well as concepts from the anthropology of masculinities to analyze and discuss the synthesis. Results: the synthesis was presented by means of two themes: 1) paternal dilemmas - what man feels and faces during the hospitalization of the child, highlighting the emotional involvement and change in the family and work relationship, and 2) paternal identities - masculinities readjusted in view of the child’s illness, which reveals identity marks and repressed fatherhood in the hospital environment. Both themes illustrate the challenges and readjustment of parental identity. Final considerations: to get to know the experiences of the father during the hospitalization of the child and the way in which the challenges for the readjustment of roles related to masculinity could broaden the range of nursing and other health professionals, alerting to the importance of including the father as a protagonist or coadjuvant in the care for hospitalized children.
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Simeone S, Pucciarelli G, Perrone M, Rea T, Gargiulo G, Dell'Angelo G, Guillari A, Comentale G, Palma G, Vosa C. Comparative Analysis: Implementation of a Pre-operative Educational Intervention to Decrease Anxiety Among Parents of Children With Congenital Heart Disease. J Pediatr Nurs 2017; 35:144-148. [PMID: 28131545 DOI: 10.1016/j.pedn.2017.01.008] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2016] [Revised: 01/20/2017] [Accepted: 01/20/2017] [Indexed: 02/05/2023]
Abstract
PURPOSE The present study evaluated the efficacy of a nursing educational intervention in alleviating the level of parental anxiety in the parents of children who required heart surgery for the first time. DESIGN AND METHODS A comparative study was used to explore the parents of children who had to undergo cardiac surgery. Parents of children were randomized into 2 groups: 1) control group and 2) experimental group or parents that received the educational intervention about PICU stay. RESULT The results of STAY-1 showed that the average anxiety score of group 1 was lower than that of group 2 (63.0 [SD=3.5] vs. 70.4 [SD=2.8]). CONCLUSION In order to decrease levels of parental anxiety and stress prior to paediatric surgery, parents should be adequately informed about planned therapeutic procedures. PRACTICE IMPLICATIONS We speculate that pre-surgery parent education on what to expect before, during and after their child's cardiac surgery may improve parents' knowledge and satisfaction and decrease anxiety.
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Affiliation(s)
- Silvio Simeone
- Department Activities Integrated Cardiology, Cardiac Surgery and Emergency cardiovascular - ICU Cardiac Surgery University Hospital Policlinico Federico II, Naples, Italy.
| | | | - Marco Perrone
- Department Activities Integrated Cardiology, Cardiac Surgery and Emergency cardiovascular - ICU Cardiac Surgery University Hospital Policlinico Federico II, Naples, Italy
| | - Teresa Rea
- Department of Hygiene and Public Health, AOU Federico II, Naples, Italy
| | | | - Grazia Dell'Angelo
- Department Activities Integrated Cardiology, Cardiac Surgery and Emergency cardiovascular - ICU Cardiac Surgery University Hospital Policlinico Federico II, Naples, Italy
| | - Assunta Guillari
- Department of Hygiene and Public Health, AOU Federico II, Naples, Italy
| | | | - Gaetano Palma
- Pediatric Cardiac Surgery, AOU Federico II, Naples, Italy
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Parents' preparedness for their infants' discharge following first-stage cardiac surgery: development of a parental early warning tool. Cardiol Young 2016; 26:1414-24. [PMID: 27431411 DOI: 10.1017/s1047951116001062] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
UNLABELLED Aim The aim of this study was to explore parental preparedness for discharge and their experiences of going home with their infant after the first-stage surgery for a functionally univentricular heart. BACKGROUND Technological advances worldwide have improved outcomes for infants with a functionally univentricular heart over the last 3 decades; however, concern remains regarding mortality in the period between the first and second stages of surgery. The implementation of home monitoring programmes for this group of infants has improved this initial inter-stage survival; however, little is known about parents' experiences of going home, their preparedness for discharge, and parents' recognition of deterioration in their fragile infant. METHOD This study was conducted in 2011-2013; eight sets of parents were consulted in the research planning stage in September, 2011, and 22 parents with children aged 0-2 years responded to an online survey during November, 2012-March, 2013. Description of categorical data and deductive thematic analysis of the open-ended questions were undertaken. RESULTS Not all parents were taught signs of deterioration or given written information specific to their baby. The following three themes emerged from the qualitative data: mixed emotions about going home, knowledge and preparedness, and support systems. CONCLUSIONS Parents are not adequately prepared for discharge and are not well equipped to recognise deterioration in their child. There is a role for greater parental education through development of an early warning tool to address the gap in parents' understanding of signs of deterioration, enabling appropriate contact and earlier management by clinicians.
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