Partnership in care: parents' views of participation in their hospitalized child's care

Mothers' Involvement in Pediatric Postoperative Pain Care in a Tertiary Healthcare Setting in Saudi Arabia

Background Many children feel moderate to intense pain in the hospital following surgery. Untreated pain can have deleterious physical and psychological effects. Mothers' involvement in child pain care and management postoperatively has been shown to be important in improving the outcomes and experiences of children, mothers, and health professionals. Aims To explore mothers' involvement in postoperative pain care and management of their children during hospitalization and following discharge and identify approaches to improve management and participation activities. Methods We used a qualitative single case study design with thematic analysis. The analysis included 20 mother-child dyads and 21 nurses, involving observation of participants and semi-structured interviews of mothers and nurses. The analysis also incorporated a review of documents from the pediatric surgical department (hospital policies and forms).  Findings The following main themes and sub-themes were generated from the data: (i) provision of pain information (expected type, frequency, and duration of pain after surgery, pain intensity score, pain relief medication, and pain management methods), (ii) communication deficiency (language barrier and breakdown in communication between health professionals), (iii) emotional and physical support (family support, environmental comfort, and sleep and meal requirements), (iv) social and cultural influences (patriarchal society, cultural and religious beliefs, and work status), and (v) hospital facilities, provisions, and services (entertainment, follow-up programs, education courses on pain management for nurses, and materials and services). Conclusions The study examined mothers' participation in postoperative pain care and management in a cohort of children admitted to a tertiary care setting in Saudi Arabia, highlighting key factors that influence involvement and suggesting approaches for improving participation.

A structural equation model of developing a partnership between pediatric nurses and parents of children with cancer in South Korea

PURPOSE

A trust-based cooperative partnership between pediatric nurses and parents of children with cancer is a significant factor in improving parents' coping abilities and reducing their anxiety. We aimed to identify factors and construct a structural equation model of developing a partnership between pediatric nurses and parents of children with cancer in South Korea. The model was based on Lazarus and Folkman's stress-coping-adaptation model.

DESIGN AND METHODS

Data were collected utilizing a structured questionnaire, which included the following variables: parental stress, perceived nursing support, empowerment, coping, communication with nurses and nurse-parents partnership. The study participants included 205 parents of children diagnosed with cancer and receiving treatment as either inpatients or outpatients in South Korea. We used SPSS/WIN 26.0 to analyze the data and AMOS 26.0 to conduct the structural equation modeling.

RESULTS

Empowerment (β = 0.536, p = 0.001) and communication with nurses (β = 0.169, p = 0.021) explained 26.0% of the total variance of nurse-parents partnership.

CONCLUSIONS

The final model constructed here was confirmed to be suitable for explaining and predicting parent-nurse partnerships. Our results are meaningful in constructing partnership model between pediatric nurses and parents of children with cancer based on conceptual model.

PRACTICAL IMPLICATIONS

Strategies and efforts to enhance communication with nurses and parental empowerment will be helpful for enhancing parent-nurse partnerships as children and parents go through the treatment process.

The Parent-Child Patient Unit (PCPU): Evidence-Based Patient Room Design and Parental Distress in Pediatric Cancer Centers

Children with cancer are frequently hospitalized during diagnosis and treatment. Since the early 1980s, parents are co-admitted because their presence positively affects children’s adjustment to hospitalization and reduces post-traumatic stress. However, the size and overall architectural design of the rooms were never adapted to the doubling of the occupancy rate. Since studies show that many parents experience high levels of distress due to their child’s illness, the purpose of this study was to investigate the impact of the architecture of the aged patient rooms on parental distress. A video observation targeted parent–child interaction related to five architectural determinants: (a) function and place of interaction, (b) distance between parent and child, (c) used space, (d) withdrawal, and (e) duration of the interaction. A total of 22 families were included in two Dutch children’s hospitals. Results show a significant association between parental distress and three architectural determinants: The less anxious the parents were and the better they estimated their child’s well-being, the more distance they created between themselves and their child, and the more space, privacy, and withdrawal options were used. These findings are discussed within a new patient room typology, the parent–child patient unit (PCPU), which reacts to the evident association of parental distress and the design.

PICU Early Mobilization and Impact on Parent Stress

BACKGROUND AND OBJECTIVES

Early mobilization of critically ill children may improve outcomes, but parent refusal of mobilization therapies is an identified barrier. We aimed to evaluate parent stress related to mobilization therapy in the PICU.

METHODS

We conducted a cross-sectional survey to measure parent stress and a retrospective chart review of child characteristics. Parents or legal guardians of children admitted for ≥1 night to an academic, tertiary-care PICU who were proficient in English or Spanish were surveyed. Parents were excluded if their child's death was imminent, child abuse or neglect was suspected, or there was a contraindication to child mobilization.

RESULTS

We studied 120 parent-child dyads. Parent mobilization stress was correlated with parent PICU-related stress (r_s [119] = 0.489; P ≤ .001) and overall parent stress (r_s [110] = 0.272; P = .004). Increased parent mobilization stress was associated with higher levels of parent education, a lower baseline child functional status, more strenuous mobilization activities, and mobilization therapies being conducted by individuals other than the children's nurses (all P < .05). Parents reported mobilization stress from medical equipment (79%), subjective pain and fragility concerns (75%), and perceived dyspnea (24%). Parent-reported positive aspects of mobilization were clinical improvement of the child (70%), parent participation in care (46%), and increased alertness (38%).

CONCLUSIONS

Parent mobilization stress was correlated with other measures of parent stress and was associated with child-, parent-, and therapy-related factors. Parents identified positive and stressful aspects of mobilization therapy that can guide clinical care and educational interventions aimed at reducing parent stress and improving the implementation of mobilization therapies.

Acceptability of a family-centered newborn care model among providers and receivers of care in a Public Health Setting: a qualitative study from India

BACKGROUND

Family-centered care (FCC), based on collaborative participation of the family along with a team of health care providers, is found to increase the well-being of sick infants in neonatal critical care units. Over the last 4 years, the neonatal unit of Dr. Ram Manohar Lohia Hospital in Delhi has innovated and developed an implementation framework for FCC. This qualitative study assessed the acceptability of family-centered care among providers and family members of neonates to identify gaps and challenges in implementation.

METHODS

In-depth interviews were conducted among a purposive sample of twelve family members of admitted neonates and six providers to examine their perceptions and experiences regarding FCC.

RESULTS

Family members and providers expressed a positive perception and acceptance of FCC based on the competencies and knowledge acquired by parents and other caregivers of essential newborn care. Family members reported being satisfied with the overall health care experience due to the transparency of care and allowing them to be by their baby's bedside. Limitations in the infrastructure or lack of facilities at the public hospital did not seem to dilute these positive perceptions. Providers also perceived FCC as a good practice to be continued in spite of concerns around sharing of nursery space with parents, the need for constant vigilance of parents' practices in handling of their newborns, and the need for separate, designated nursing staff for FCC.

CONCLUSION

Both providers and receivers of neonatal care found FCC to be an acceptable form of care. Providers identified challenges and suggested possible solutions, such as need of periodic provider sensitization on FCC, improved staff organization, and provision of mother-friendly facilities to enable her to provide around-the-clock care by her baby's bedside. Overcoming these challenges would allow for better integration of FCC within general clinical care in neonatal care units.

Parents' experiences of Family Centred Care practices

PURPOSE

The aim of this study was to gain knowledge and understanding of how parents experience Family Centred Care (FCC) using a relatively new tool, and to identify aspects of FCC practice for further development.

DESIGN AND METHODS

A cross-sectional study involving a convenience sample of 48 parents of hospitalised children completed a seven-item instrument that measures importance and consistency associated with the core aspects of FCC practice, in addition to an open-ended question about what does FCC mean to parent.

RESULTS

Eighty-five percent of parents reported positive experiences of receiving FCC practice from nurses, with lower consistency reported in parents' feelings of being seen as important in their child's care, feeling valued as a team member, or well cared for by nurses. Parents definition of FCC were concise and involved informal expressions such as allowing parents to stay with their hospitalised child, and family inclusion in child's care and care for the whole family.

CONCLUSIONS

Although recent FCC debate represent the 'unit of care' in FCC as 'a child within the family context', parents' perspectival view of FCC places themselves as care recipient with a strong understanding of the ideals of partnership-in-care.

PRACTICE IMPLICATIONS

Nurses and service providers can use current findings to promote the consistent application of Family Centred Care in their everyday practice, and to recognise current barriers to the effective implementation of Family Centred Care in nursing practice.

"It goes against the grain": A qualitative study of the experiences of parents' administering distressing health-care procedures for their child at home

BACKGROUND

Parents caring for children with complex and long-term conditions at home take on responsibility for technical health-care procedures that may cause their child distress. Little evidence exists about parents' experience of this specific aspect of their caring role.

AIMS

To explore and understand parents' experiences of administering distressing health-care procedures as part of caring for their child at home.

DESIGN

An explorative qualitative study.

METHODS

A purposive sample of parents who were currently carrying out, or had previously carried out, health-care procedures they thought their child found distressing was recruited. Data were collected using in-depth interviews and analysed thematically.

FINDINGS

Administering these procedures was not just a clinical task. That the procedures caused distress for the child meant there were additional issues to consider and address. A major issue for parents was being able to prevent or minimize their child's distress, which in turn was closely linked to parents' own emotional discomfort in the situation. Parents also had to manage their child's physical and verbal resistance, their own emotional discomfort during the procedure, and the presence and reaction of siblings in the home. The types of support that were valued by parents included advice about managing their child's distress and resistance, occasional assistance with procedures, addressing the emotional aspects of the role, and adequate training and on-going supervision.

CONCLUSION

The "added" challenges of assuming this responsibility have implications for the support of parents caring for ill children at home.

Mutual Expectations of Mothers of Hospitalized Children and Pediatric Nurses Who Provided Care: Qualitative Study

PURPOSE

This study attempted to identify the mutual expectations of mothers whose children were hospitalized in the pediatric department of a university hospital and nurses who provided care.

DESIGN AND METHODS

A descriptive phenomenological design has been used in this study. Data were obtained through tape-recorded semi-structured interviews. This study was conducted at a pediatric clinic, at a university hospital in a small city in Turkey. Participants comprised five nurses working in the children's clinic and 24 mothers who accompanied their children to the hospital.

RESULTS

The six major themes that emerged were mothers' feelings and thoughts about the hospital experience, mothers' expectations for attention and support during hospitalization, mothers' expectations for invasive procedures, issues regarding physical comfort and hospital infrastructure, nurses' feelings and thoughts about working in the pediatric clinic, and nurses' expectations of the mothers.

CONCLUSIONS

Mothers expected nurses to provide physical support including medication administration, and installing/applying IV and nebulizer treatments; and emotional support in terms of having a friendly, rather than critical attitude, and being approachable and receptive of mothers' questions and anxieties. Nurses stated that they were aware of these expectations but needed mothers to be understanding and tolerant, considering their difficult working conditions.

PRACTICE IMPLICATIONS

Children's hospitalization is a stressful experience for parents. Open and therapeutic communication and relationships between parents and nurses contribute to improving the quality of care provided to children and their families.

Neglect of Postoperative Pain Management in Children: A Qualitative Study Based on the Experiences of Parents

Identifying parents' experiences of barriers to optimal postoperative pain management in children.

DESIGN AND METHODS

This qualitative-content analysis study was conducted with 16 parents whose school-age children had undergone emergency abdominal surgery in university hospitals of Ahvaz, southern Iran. A purposive sampling method was used to select the participants. The semi-structured interviews with all of the participants were recorded, transcribed, and analysed.

RESULTS

After data analysis, neglect emerged as the main theme. This neglect consisted of three categories including the healthcare system's disregard, insufficient sensitivity of the healthcare providers, and hesitance or delays of parents and children in asking for care.

CONCLUSION

The optimal management of children's postoperative pain requires the provision of relevant infrastructures by the healthcare system, responsible performance of the health professionals beyond the routine, and active and informed participation of both parents and children.

Chronic respiratory failure: Utilization of a pediatric specialty integrated care program

OBJECTIVE

Describe utilization and satisfaction in a specialty integrated care program for children with severe, chronic respiratory insufficiency (CRI).

SUBJECTS

Enrollees of the Critical Care, Anesthesia, Perioperative Extension (CAPE) and Home Ventilation Program.

METHODS

Children with CRI received home visits, care coordination, and "on-demand" 24/7 access to physicians. Program activity and outcomes were recorded for 3 years using an adapted Care Coordination Measurement Tool© version. Parents completed the Consumer Assessment of Healthcare Providers and Systems (CAHPS). Patient characteristics, program activity, clinical outcomes, utilization, and satisfaction were summarized using descriptive statistics.

RESULTS

CAPE provided care for 320 patients from 2012 to 2014 with a median of 7 encounters per year. Neuromuscular (n=132, 41%), chronic lung disease (n=37, 12%), and congenital heart disease (n=13, 4%) represented the majority of underlying conditions. Services included 905 home, 504 clinic, and 3633 telephone encounters, of which 43.6% included a care coordination activity. CAHPS (n=102) revealed that 92.1% (n=93) of children had at least one non-urgent (i.e., routine) visit and nearly two-thirds (64.7%, n=66) reported the need for urgent or emergency care. Overall, parents were highly satisfied with CAPE, with a mean satisfaction rating of 9.3 (±1.3) out of 10. Most parents reported that the CAPE team understood the child's (96.0%, n=95) and family's day-to-day life (86.9%, n=86).

CONCLUSIONS

When given open access to an intregated care program, children in our highly complex population required a median of 7 encounters per year. We believe that this experience is scalable and may inform other organizations contemplating similar services.

Using appreciative inquiry to bring neonatal nurses and parents together to enhance family-centred care: A collaborative workshop

Family-centred care (FCC) has been well recognised, accepted and reported in the literature as an optimised way of caring for hospitalised children. While neonatal units strive to adopt this philosophy, published research suggests there are difficulties implementing FCC principles in daily practice. Appreciative inquiry (AI) is a philosophy and methodology that offers a unique, strength-based approach to promoting organisational learning and positive organisational change. As a participatory approach, AI facilitates change from the ground up and lends itself to building effective partnerships or collaborations. This article reports the findings of a one-day workshop using an AI methodology to bring neonatal nurses and parents together to enhance the FCC within a neonatal intensive care unit in Sydney, Australia. Participants (n = 15) developed collaborative insights of optimal FCC that can be built upon to support neonates and their families in the future. Shared visions were formed, strategies identified and a development plan made for ongoing collaborations and partnerships. AI provides a flexible framework that enables the mandatory collaboration needed to develop action plans that can form the catalyst for organizational change in health-care research and practice.

How do intensive care nurses perceive families in intensive care? Insights from the United Kingdom and Australia

AIMS AND OBJECTIVES

To compare how intensive care nurses in the UK and Australia (AU) perceive families in intensive care units (ICUs).

BACKGROUND

International healthcare research and practice is often based on an underlying assumption of a person- or family-centred ideology. While nurses in ICUs acknowledge the importance of patients' families, a true integration of families as units of care is often not realised.

DESIGN

Data from ICU nurses from two international studies: (1) a constructivist grounded theory study in the UK and (2) a quasi-experimental non-equivalent clinical study in AU. Data were collected in tertiary adult ICUs in the UK and AU. Nurse-to-patient ratio for high-acuity patients was 1:1 in both units.

PARTICIPANTS

Twenty ICU nurses in five focus groups (UK study) and 197 surveys were sent out to ICU nurses in AU (response rate 26%).

RESULTS

Evidence from both studies makes visible the contribution of family care in adult ICUs. Nurses remaining in control and initiating family member care involvement are less likely to perceive families as a burden. The AU study indicated that when nurses partner with families to deliver care, there was a minimal effect on their workload. The nurses concluded that inviting family members to be a part of the patient's care should be usual practice in ICUs.

CONCLUSION

Nurses should promote, facilitate and invite the integration of families in care in today's healthcare system. This is mandatory as families are the caring resource for these patients during an often prolonged recovery trajectory.

RELEVANCE TO CLINICAL PRACTICE

Families are more likely to be successfully integrated into a more active involvement with ICU patients when they are not perceived as a burden. Inviting and supporting family members is not necessarily time-consuming and starts the journey of supporting ICU survivors' recovery journey.

The Arabic version of the Parental Stressor Scale: psychometric properties and Jordanian parents’ stress during child admission to PICU

This paper presents an exploration of the validity and reliability of the translated Arabic version of the original English version of the Parental Stressor Scale: Paediatric Intensive Care Unit (PSS: PICU) with a sample of Jordanian parents of children admitted to a paediatric intensive care unit. Three hundred and fifty parents were recruited to the study. The PSS: PICU was completed by parents within 15 minutes. Data were collected from parents ( N = 350) from different governmental, private and educational hospitals in Amman, Jordan. Subscales measuring stress from Child’s Appearance, Procedures, Sights and Sounds, Staff Communication, Staff Behavior, Parental Role, and Child’s Behavior and Emotions showed a range of responses and showed good internal consistency. Parents in this study perceived stress from various sources during their child’s hospitalisation. The dimensions ranked most stressful in the PICU were procedures (mean = 3.8, standard deviation, SD = 1.11), the child’s behaviors and emotions (mean = 3.72, SD = 1.04) and child’s appearance (mean = 3.71, SD = 0.75). The least listed stressful items were behaviors of professional staff in the unit (mean = 2.19, SD = 0.73), and staff communication in the unit (mean = 2.25, SD = 0.81). The reported elevated levels of parental stress underscores the importance of ongoing screening for factors impacting on psychological well-being and the inclusion of this information in education and counseling strategies in the inpatient settings. Consideration of areas of parent education regarding stressful ICU environment, and children’s behavioral and emotional reaction to hospitalisation could help reduce stress for Jordanian parents.

The psychosocial experience of parents receiving care closer to home for their ill child

Current health policy in England regarding the management of childhood illness advocates for care to be delivered as close to home as possible. The aim of this article is to report findings from a qualitative component of a larger study evaluating models of care closer to home (CCTH) for children and young people who are ill. The focus is on parents' psychosocial experience of receiving CCTH for their ill child. A qualitative case study design was used, with four Primary Care Trusts in England as the case study sites. In-depth, semi-structured interviews were conducted with 27 parents and one extended family caregiver of children using CCTH services within the case study sites. Interviews were conducted face-to-face and audio-recorded with permission. Data were collected in 2009. There was an overall preference for CCTH over hospital-based care where possible. The parents in this study experienced differing levels of responsibility as part of this care, and responded to this in different ways. Being supported emotionally and socially by practitioners was an important part of receiving CCTH for parents, especially when they had increased responsibility as part of this care. Developing relationships with practitioners appeared to be a medium through which parents received support. If the provision of CCTH continues to expand in line with current policy, provision of support for parents should be considered a fundamental aspect of service development.

Parental involvement in their school-aged children's post-operative pain management in the hospital setting: a comprehensive systematic review

BACKGROUND

Paediatric pain management remains a challenge in clinical settings. Parents can contribute to the effective and accurate pain assessment and management of their child. No systematic reviews regarding the parental involvement in their child's post-operative pain management have been published.

OBJECTIVE

To determine the best available evidence regarding parental involvement in managing their children's post-operative pain in the hospital setting.

INCLUSION CRITERIA

The review considered studies that included parents of all ethnic groups with children aged between 6 to 12 years old who were hospitalised and undergone surgery of any kind with post-operative surgical or incision site pain where care was provided in acute hospital settings. The phenomena of interest were the experiences of parents in managing their children's post-operative pain.

SEARCH STRATEGY

A three-step search strategy was utilised in each component of this review. Major databases searched included: MEDLINE, CINAHL, Scopus, ScienceDirect, the Cochrane library, PubMed as well as Google Scholar. The search included published studies and papers in English from 1990 to 2009.

METHODOLOGICAL QUALITY

Each included study was assessed by two independent reviewers using the appropriate appraisal checklists developed by the Joanna Briggs Institute (JBI).

DATA COLLECTION

Quantitative and qualitative data were extracted from the included papers using standardised data extraction tools from the JBI, Meta-analysis Statistics Assessment and Review Instrument data extraction tool for descriptive/case series and the JBI-Qualitative Assessment and Review Instrument data extraction tool for interpretive and critical research.

DATA SYNTHESIS

The five quantitative studies included in this review were not suitable for meta-analysis due to clinical and methodological heterogeneity and therefore the findings are presented in a narrative form. The two qualitative studies were from the same study, therefore meta-synthesis was not possible. Hence the results of the studies were presented in a narrative format.

RESULTS

Seven papers were included in this review. The evidence identified topics including: pharmacological and non-pharmacological interventions carried out by parents; the experience of concern, fear, helplessness, anxiety, depression, frustration and lack of support felt by parents during their child's hospitalisation; communication issues and knowledge deficits; need for information by parents to promote effective participation in managing their child's post-operative pain.

CONCLUSION

This review revealed pharmacological and non-pharmacological interventions carried out by parents to alleviate their children's post-operative pain. Obstacles and promoting factors influencing parents' experiences as well as their needs in the process of caring were identified.

IMPLICATIONS FOR PRACTICE

Parents' roles in their child's surgical pain management should be clarified and their efforts acknowledged, which will encourage parents' active participation in their child's caring process. Nurses should provide guidance, education and support to parents.

IMPLICATIONS FOR RESEARCH

More studies are needed to examine parents' experiences in caring for their child, investigate the effectiveness of education and guidance provided to parents by the nurses and explore the influence of parents' cultural values and nurses' perceptions of parental participation in their child's care.

Struggling to create new boundaries: a grounded theory study of collaboration between nurses and parents in the care process in Iran

AIM

To develop a substantive grounded theory of nurse-mother interaction in the care of chronically ill children in hospital setting.

BACKGROUND

Interaction between nurses and parents is critical in paediatric hospital settings. This area of practice in developing countries has been under-researched.

METHOD

The qualitative research design of grounded theory methodology was used to develop a theory of nurse-parent interaction within the child care. Registered Nurses (n=17) and mothers of chronically ill children (n=14) from two central paediatric hospital in Iran participated in this study. In-depth interviews with nurses and mothers were conducted using theoretical sampling between July 2007 and August 2008. The data were analysed using constant comparative analysis.

FINDINGS

'Struggling to create new boundaries' as a core variable was a dominant socio-psychological process that was manifesting itself within three stages: facing up to and perceiving the environmental pressures, balancing nurse's duties, and controlling the nurse-parent boundary in the care.

CONCLUSION

It is concluded that nurses and parents need a care model, which addresses their collaboration and improved interpersonal relationship and clearly defines the boundary of their roles based on the needs of both sides while allowing parents to choose their role in these defined boundaries and providing parent education with aim to empower them for care at home.

Parents' views on information in childhood cancer care

PURPOSE

The aim of the study is to highlight parents' views on information in childhood cancer care.

METHOD

A qualitative design, appropriate to gain a holistic view, has been chosen. Eight families with children diagnosed with cancer, of various ages and gender and from various backgrounds, participated in five interviews each during the first year of the child's illness.

RESULTS

If the parents' needs were fulfilled, they were better equipped to handle the illness of their child, which is totally dependant on how the matter of information is dealt with. Information is a complex and demanding issue for the persons involved and the families' views were divergent in this area. Sometimes they seemed to obtain the information successfully and sometimes there were great problems in this respect. Therefore their preferences must be considered.

CONCLUSION

There has to be an improvement from the aspects of what, when and how information is provided. The major findings of this study indicate that the families need better support and more distinct instructions to be able to cope with the situation.

The evolution of family-centered care

AIM

The aim of this study is to explore the history of family-centered care (FCC).

BACKGROUND

FCC was developed after Word War II, when nursing, then deeply paternalistic, had become asynchronous with changing social expectations for the care of hospitalized children.

METHODS

This is a historical review of literature reflecting development of pediatric models of care using publications of classic theorists and others.

RESULTS

Development of FCC resulted from work by U.S. and UK researchers, theorists, and advocates. Their research was right for its time, and its acceptance was the result of social readiness for change resulting from people's experience of Word War II.

CONCLUSION

Word War II brought about changes enabling emergence of lobby groups concerned with children in hospital, awakening of pediatric health professionals to family-oriented practice, and development of models of care that allowed widescale adoption of FCC.

Parental presence during resuscitation in the PICU: the parents' experience. Sharing and surviving the resuscitation: a phenomenological study

AIM AND OBJECTIVE

To provide in-depth understanding of the meaning for parents who were present or absent during a resuscitation attempt on their child in the PICU.

BACKGROUND

Family presence during resuscitation remains a topic of debate with both benefits and disadvantages identified, yet few studies have asked parents of children in PICU to describe their experiences of being present or absent during this resuscitation and what this means to their understanding and coping. Additionally, minimal research has investigated parental presence during a successful resuscitation.

DESIGN

A qualitative design was used based upon van Manen's interpretative phenomenological approach.

METHODS

Fourteen parents of critically ill children from one paediatric intensive care unit in Australia, who had either survived or died following a resuscitation attempt were interviewed.

RESULTS

Four main themes were identified: (1) being only for a child; (2) making sense of a living nightmare; (3) maintaining hope in the face of reality; (4) living in a relationship with staff.

CONCLUSIONS

The findings underpin the inherent need for parents to choose to be present during resuscitation to make sense of the situation. Memories of the resuscitation were not long-lasting and distress was for the potential death of a child, rather than the resuscitation scene. Parents who did not witness their child's resuscitation were more distressed than those who did. Having the opportunity to make the decision to stay or leave was important for parents. Support during the resuscitation was best provided by experienced clinical nurses.

RELEVANCE TO PRACTICE

Recognition of the parents' compelling need to stay will improve nurses' understanding of how witnessing this event may assist family coping and functioning. Ways in which parents may be better supported in making the decision to stay or leave during resuscitation are identified.

From distance toward proximity: fathers lived experience of caring for their preterm infants

Open interviews with 13 fathers were performed, using a hermeneutic phenomenological method, to illuminate their lived experience of caring for their preterm infant. Their lived experience was expressed as a process moving from initial feelings of distance toward feelings of proximity. The process was described as a pendulum that was easily disturbed. Feelings of distance included experiences of living beside reality, becoming an outsider, and living with worry. Feelings of proximity included experiences of returning to reality, becoming a family, and facing the future. Illumination of the father-infant interaction adds to the family-centered body of knowledge in neonatal nursing.

Providing care in chronic disease: the ever-changing balance of integrating palliative and restorative medicine

Caring for children who have a chronic life-limiting illness can be emotionally and physically challenging. Just as families may struggle with whether they are making the right decisions, care providers struggle with whether they are giving the right advice, predicting the medical course correctly, and making the correct medical decisions. Uncertainty is a constant for the family and the care provider. The willingness of the care provider to develop a relationship with the family that involves continuing communication and re-evaluation of the child's condition and the family's perspective can relieve some of the emotional and physical suffering associated with a chronic disease and support the family in times of hope and grief.

Challenging the philosophy of partnership with parents: A grounded theory study

BACKGROUND

Parent participation is viewed as a pivotal concept to the provision of high quality nursing care for children and their families. Since the 1990's, the term 'partnership with parents' has increasingly been reported in the literature and adopted as a philosophy of care in most paediatric units in the United Kingdom.

OBJECTIVES

To explore children's, parents', and nurses' views on participation in care in the healthcare setting.

DESIGN

Using grounded theory, data were collected through in-depth interviews, and participant observation. Sample consisted of eleven children, ten parents and twelve nurses from four paediatric wards in two hospitals in England.

RESULTS

Most nurses assumed that parents would participate in care and viewed their role as facilitators rather than 'doers'. Nurses reported that the ideology of partnership with parents did not accurately reflect or describe their relationships with parents. Parents could never be partners in care as control of the boundaries of care rested with the nurses. Parents felt compelled to be there and to be responsible for their children's welfare in hospital.

CONCLUSIONS

The pendulum of parent participation has swung from excluding parents in the past to making parents feel total responsibility for their child in hospital. It is argued that the current models or theories on parent participation/partnership are inappropriate or inadequate because they do not address important elements of children's, parents' and nurses' experiences in hospital.

Negotiation of parental roles within family-centred care: a review of the research

AIMS AND OBJECTIVES

To review research published in the past 15 years about how children's nurses' negotiate with parents in relation to family-centred care.

BACKGROUND

Family-centred care is a basic tenet of children's nursing and requires a process of negotiation between health professionals and the family, which results in shared decision-making about what the child's care will be and who will provide this. The literature highlights inconsistencies in the degree to which nurses are willing to negotiate with parents and allow them to participate in decisions regarding care of their child. There is need to explore further the extent to which nurses communicate and negotiate shared care with children and their parents.

CONCLUSIONS

Three themes emerged from this review of the literature relating to whether role negotiation occurred in practice, parental expectations of participation in their child's care and issues relating to power and control. Parents wanted to be involved in their child's care but found that nurses' lack of communication and limited negotiation meant that this did not always occur. Nurses appeared to have clear ideas about what nursing care parents could be involved with and did not routinely negotiate with parents in this context.

RELEVANCE TO CLINICAL PRACTICE

For family-centred care to be a reality nurses need to negotiate and communicate with children and their families effectively. Parents need to be able to negotiate with health staff what this participation will involve and to negotiate new roles for themselves in sharing care of their sick child. Parents should be involved in the decision-making process. However, research suggests that a lack of effective communication, professional expectations and issues of power and control often inhibit open and mutual negotiation between families and nurses.

Parents' experiences of negotiating care for their technology-dependent child

The aim of this exploratory study was to understand the negotiation of care as experienced by the parents of technology-dependent children in a hospital context. Qualitative semi-structured interviews were undertaken with a group of six parents. Parents felt that their roles as parents were not considered enough by nurses and they tended to be seen as carers, not parents. Negotiation of care was not always apparent. Instead, nurses often made assumptions about parental involvement in care. Parents wanted to carry out care when in hospital, but were not always given choices. Parents also reported a desire for more confident nurses. This study highlights the need to gain insight into parents' experiences, in order that nurses can provide care in a way negotiated to suit the individual family. Suggestions for further research in this area are offered.

Parents’ experiences of participation in the care of hospitalised children: A qualitative study

BACKGROUND

The introduction of unrestricted visiting hours has led to the encouragement of parents to stay with and participate in the care of their hospitalised child. In order to stay with the hospitalised child, parents have to be away from home or work, which in turn impacts on their personal and family life. However, no published study on parents' experiences of childcare participation during paediatric hospitalisation has been found for a Chinese population.

OBJECTIVES

This study explored Chinese parents' experiences of their participation in taking care of their hospitalised child.

DESIGN

A qualitative exploratory design was adopted to capture parents' experiences of participation.

SETTINGS

The study was conducted in four paediatric wards of a regional acute general hospital in the New Territories, a major geographical region of Hong Kong.

PARTICIPANTS

Nineteen parents (16 mothers and three fathers) who had a child hospitalised for more than 48 h and identified themselves as staying comparatively longer with the child than their counterpart were recruited.

METHODS

Data were collection by tape-recorded semi-structured interview.

RESULTS

Four major categories that illustrated parents' experiences of participation in childcare were identified: reasons for staying with the child, rescheduling of family's routine, expectations of nurses, and comments on facility provisions. The findings highlight parents' desire for participation in caring for their hospitalised child, their unexpressed needs for communication and concern about the non-monetary costs of participation.

CONCLUSIONS

Most parents viewed accompanying their hospitalised child as an unconditional aspect of being a parent and had a strong desire for participation. Parents' need for communication and emotional support during their participation of childcare in paediatric unit are universal. As Chinese parents are passive in seeking help, nurses should take the initiative in assessing their needs and offering them support accordingly.

Nurses as providers of support for mothers of premature infants

AIM

The study aims to explore the supportive behaviour of nurses as experienced by mothers of premature infants in Hong Kong.

BACKGROUND

The sudden, unexpected delivery of a premature infant is an extreme shock to parents. Studies have confirmed the importance of nursing support to the relief of stress of parents.

DESIGN

A descriptive study design.

METHODS

A convenience sampling of 37 mothers in a neonatal Intensive Care Unit were recruited from a regional hospital to complete the 'Nurses Parent Support Tool' (NPST) which consists of four aspects: communication information support, emotional support, parental esteem support and quality care-giving support. Six mothers were interviewed after the completion of the tool to give examples of supportive and non-supportive behaviour.

RESULTS

The results showed that all of the mothers rated all nursing support items as important. However, there was a significant mean difference between perceived and received nursing support. These findings demonstrated that parents desired more nursing support than they received, particularly in the area of supportive communication and the giving of information. Comparatively, emotional support was rated less important as well as having been less often received than the other three domains of support. Interviews with six mothers further gave examples and described the types, attributes and the phases of support in the Chinese setting.

CONCLUSION

The findings indicate that Chinese parents are desirous of more nursing support than they received.

RELEVANCE TO CLINICAL PRACTICE

Nurses should be aware of the importance of tailoring nursing support to meet the needs of parents of premature infants.

Significados atribuídos à vivência materna como acompanhante do recém-nascido pré-termo e de baixo peso

OBJETIVOS: identificar o significado de ser mãe acompanhante do recém-nascido pré-termo e de baixo peso, em participantes de um grupo de apoio multidisciplinar. MÉTODOS: pesquisa qualitativa, realizada por meio de estudo descritivo e exploratório. O contexto da investigação foi o Hospital das Clínicas da Universidade Federal de Pernambuco, sendo os dados coletados por meio da observação e entrevista gravada com 16 mães acompanhantes, no período de março a dezembro de 2003, seguindo critérios de inclusão até a saturação teórica, em resposta a duas questões norteadoras. Utilizou-se a análise de conteúdo, na modalidade análise temática transversal. RESULTADOS: a idade das mães variou entre 15 e 28 anos e 11 delas já tinham um filho. A partir da percepção materna acerca da experiência vivida, foram identificados quatro temas: o sofrimento pela separação da família e o apoio recebido; o alojamento materno como prisão; a não admissão da possibilidade de alta sem o filho e o alojamento materno enquanto espaço de novas amizades, aconselhamento e conflitos. CONCLUSÕES: o estudo aponta para a necessidade da ação humana de cuidar. O aprendizado coletivo se dá de forma concreta e positiva num contexto formal, podendo servir como subsídio para outras realidades.

Trustful bonds: A key to “becoming a mother” and to reciprocal breastfeeding. Stories of mothers of very preterm infants at a neonatal unit

A preterm birth and subsequent hospitalization of an infant at a neonatal unit (NU) implies an extraordinary life situation for mothers, in which the maternal role and breastfeeding begin and evolve in a medical and unfamiliar setting. Descriptions of how women experience "becoming a mother" and breastfeeding in such a situation are sparse and this question was addressed in the present study. In this qualitative study, inspired by the grounded theory approach, in-depth interviews were conducted with 25 mothers whose very preterm infants had been cared for in seven NUs in Sweden. Findings indicated the importance of quality in social bonds with the infant, father, staff and other mothers at the NU, for "becoming mothers" and experiencing mutually satisfying breastfeeding. Three themes comprised a structure for descriptions of experiences, social bonds and mediated emotions: (1) 'loss' of the infant and the emotional chaos--"putting life on hold"; (2) separation--a sign of being unimportant as a person and mother; and (3) critical aspects of becoming more than a physical mother. The qualities were described as trustful or distrustful, characterized by accompanying feelings of pride/trust or shame/distrust. Social bonds were affected not only by the interpersonal interplay but also by the public environment and care routines. In conclusion, the contextual setting and distrustful social bonds impaired the ability to "become mothers" and the sensation of reciprocity i.e. breastfeeding becoming dutiful and not mutually satisfying. As breastfeeding is an intimate interplay and a personal choice it was considered that the best breastfeeding support would seem to be provision of a favorable environment that enhances the mother's confidence in herself. The contextual setting should be modeled such as to create conditions for a trustful and reciprocal mother-infant bond.

Determinants of parental behaviour when children undergo day-care surgery

AIMS

This paper reports an investigation of the nature and strength of parental beliefs about their participation in their children's day-care surgery as well as demonstrated parental behaviours during the immediate post-recovery period.

BACKGROUND

Parents want to participate in their children's hospital care but their behaviour does not reflect their intention. Parents' beliefs about their role in the hospital may be a factor influencing the way they help their children at the course of a day-care surgery.

RESEARCH METHODS

A descriptive correlative design was used. French and English speaking parents of 3-12-year old children were asked to complete a self-administered questionnaire which comprised 42 items measuring the intensity of attitudes, norms and sense of control and their influence in predicting their intention to participate in hospital care. Parents' behaviours during the first hour following the child's return from the recovery room were video-recorded.

RESULTS

A total of 220 parents participated in the study. Parental beliefs about participation in care were quite strong in terms of subjective norms, sense of control and attitude, predicting 64% of their intention to participate. Parents demonstrated mostly attitude type behaviours, while the level of demonstrated helping behaviours was somewhat low.

CONCLUSIONS

Parents can be valuable partners in ambulatory care settings. Clinicians and health care managers should aim at establishing a true partnership with parents, in order to improve the quality of care given to children and their family in hospital and at home.

A survey of Chinese nurses’ guidance to parents in children's postoperative pain relief

AIMS AND OBJECTIVES

The aim of the study was to describe parental guidance provided by Chinese nurses regarding non-pharmacological methods in children's surgical pain relief as well as factors related to this.

BACKGROUND

Parental involvement in children's pain management has been acknowledged and encouraged in recent years. However, parents' lack of related information has been pointed out and little is known about how parents are guided to use non-pharmacological methods to relieve the pain.

METHODS

A previously validated European questionnaire survey was conducted in 2002. Structured questionnaires were distributed to all 187 nurses working at 12 surgical wards in five hospitals of Fujian Province, China. The average response rate was 98%.

RESULTS

The results show that nurses informed parents of the majority of cognitive information. The most commonly guided non-pharmacological methods were distraction, positive reinforcement, comforting/reassurance, positioning and relaxation. Nurses' background factors, including age, education, nursing position, professional work experience, number of their own children and experiences of earlier hospitalizations of their children, were significantly related to their perceptions regarding parental guidance.

CONCLUSIONS

Chinese nurses provided much guidance to parents on non-pharmacological methods. However, the results show that sensory information and physical methods were poorly conveyed to parents, which needs future attention to reinforce parents' active role in pain management.

RELEVANCE TO CLINICAL PRACTICE

This study provides new information on Chinese nurses' guiding parents to use non-pharmacological methods in pain alleviation, thereby contributing to the body of knowledge on this subject. Furthermore, the study makes the respondents aware of the importance of involving parents in their child's pain management.

Integrating palliative care into chronic care for children with severe neurodevelopmental disabilities

BACKGROUND

Children with severe neurodevelopmental disabilities and complex medical conditions are a growing and unique segment of the pediatric population. The increasing use of life sustaining technologies has provided the chance at an extended life and increasing inclusion within the broader community. Families work to overcome personal and professional biases, clinical uncertainties, and pragmatic obstacles to improve quality of life. Little attention, however, has been paid to the unique challenges of caring for a dying child affected with neurodevelopmental delay.

DISCUSSION

In this paper we outline several specific barriers to the provision of excellent end-of-life care for these children and their families. We also outline our approach for overcoming these barriers.

SUMMARY

The benefit of comprehensive palliative care in select pediatric populations has been demonstrated. Extending and tailoring those service to meet the unique needs of children with severe disabilities is the next logical step in that continuum. Ultimately, acknowledging that the lives of children with neurodevelopmental disabilities and their families have a unique quality will permit the human face of medical care to keep pace with technologic advances. Appreciation of the value of a perhaps incomparable quality of life will allow for a better quality of dying for children with severe neurodevelopmental disabilities.

A child’s admission to hospital: a qualitative study examining the experiences of parents

AIMS

To compare the experiences of parents and children during inpatient admission to either a paediatric intensive care unit (PICU) or a general paediatric ward (GPW) with a specific focus on identifying factors which may influence psychological outcome.

METHODS

Semi-structured qualitative interviews of 20 parents whose children had been admitted to hospital. Cases were sampled purposively to ensure representation of both groups (PICU and GPW admissions). Interviews were tape recorded, transcribed and subjected to a thematic analysis.

RESULTS

The experiences of parents were explored with regard to illness onset, admission to PICU or GPW and the discharge period. In the PICU group, the sources of stress differed according to the stage: at onset, they were mainly related to their child's illness; during admission, concerns were focused on their child's appearance; finally, on discharge, possible relapse of the illness, impact of the admission on the child and family and the lack of clear follow-up were the central themes. In the GPW group, parents reported similar themes but with lower levels of associated stress. Both groups identified good communication with the medical team and opportunities for participation as helpful in reducing stress.

CONCLUSIONS

Admission to hospital is stressful for parents particularly if the child is admitted to PICU. Hospital staff should enhance communication with parents and maximise opportunities for parental participation in the child's treatment. Such interventions may reduce parents' experience of stress during the admission and have the potential to improve psychological outcome.

Parents in accident and emergency: Roles and concerns

Attending Accident and Emergency (A&E) with a child who has sustained a minor injury is a common experience for parents. Little research has focused on parents' behaviour in these circumstances, but children in previous studies have identified parents as their primary source of support. This article reports findings from a qualitative study that reveals the responsibilities that parents adopt and the concerns they express. Data were collected through observation of the A&E experience of thirty-four children and the parents who accompanied them. Ten parents were interviewed at home a few days after the visit to A&E. Analysis revealed that parents adopted a number of roles: support, advocate, communicator, guide/enforcer and entertainer. Sources of concern included the child's injuries, but responsibilities such as work and the welfare of other siblings became more pressing once parents realised that the child's injuries were not serious. In addition parents' behaviour and comments indicated that they were anxious that practitioners should see them as responsible and caring parents. Anxieties could impair parents' ability to adopt the roles described suggesting that practitioners seeking to reduce the psychological impact of A&E encounters on the child must also recognise and manage parental concerns.