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Jin Y, Mazrekaj D. The association between parenthood and health: A comparison of people in same-sex and different-sex relationships. SSM Popul Health 2024; 26:101685. [PMID: 38881819 PMCID: PMC11179624 DOI: 10.1016/j.ssmph.2024.101685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Revised: 04/25/2024] [Accepted: 05/27/2024] [Indexed: 06/18/2024] Open
Abstract
Understanding social inequalities in parental health is crucial for family functioning and child development. Theoretically, the double burden of parenting and minority stress may lead to the negative association between parenthood and health outcomes being stronger for people in same-sex relationships. Moreover, drawn from the social control process and the compensation mechanism, the negative association between parenthood and health risk behaviors may become stronger for people in same-sex relationships. Yet, empirical evidence on parental health disparities between parents in same- and different-sex relationships is limited. Using linear and logistic regression models, coarsened exact matching, and entropy balancing on Dutch data between 2008 and 2021 (196 people in same-sex relationships and 6948 people in different-sex relationships), we investigate the relationship between parenthood and three health outcomes (self-rated health, physical health, and mental health) and two health risk behaviors (smoking and heavy episodic drinking). We find that parents on average are less likely to experience heavy episodic drinking than non-parents. The association between parenthood and health does not differ between people in same-sex and different-sex relationships.
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Affiliation(s)
- Yuxuan Jin
- Netherlands Interdisciplinary Demographic Institute (NIDI) - KNAW/University of Groningen, Lange Houtstraat 19, 2511 CV, Den Haag, the Netherlands
- Department of Sociology, Utrecht University, Padualaan 14, 3584 CH, Utrecht, the Netherlands
| | - Deni Mazrekaj
- Department of Sociology, Utrecht University, Padualaan 14, 3584 CH, Utrecht, the Netherlands
- Nuffield College, University of Oxford, New Road, OX1 1NF, Oxford, UK
- Leuven Economics of Education Research, KU Leuven, Naamsestraat 69, 3000, Leuven, Belgium
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Collins ME, Hall M, Shah SS, Molloy MJ, Aronson PL, Cotter JM, Steiner MJ, McCoy E, Tchou MJ, Stephens JR, Markham JL. Phlebotomy-free days in children hospitalized with common infections and their association with clinical outcomes. J Hosp Med 2024; 19:251-258. [PMID: 38348499 DOI: 10.1002/jhm.13282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 12/08/2023] [Accepted: 01/01/2024] [Indexed: 04/04/2024]
Abstract
BACKGROUND Phlebotomy for hospitalized children has consequences (e.g., pain, iatrogenic anemia), and unnecessary testing is a modifiable source of waste in healthcare. Days without blood draws or phlebotomy-free days (PFDs) has the potential to serve as a hospital quality measure. OBJECTIVE To describe: (1) the frequency of PFDs in children hospitalized with common infections and (2) the association of PFDs with clinical outcomes. DESIGN, SETTINGS AND PARTICIPANTS We performed a cross-sectional study of children hospitalized 2018-2019 with common infections at 38 hospitals using the Pediatric Health Information System database. We included infectious All Patients Refined Diagnosis Related Groups with a median length of stay (LOS) >2 days. We excluded patients with medical complexity, interhospital transfers, those receiving intensive care, and in-hospital mortality. MAIN OUTCOME AND MEASURES We defined PFDs as hospital days (midnight to midnight) without laboratory blood testing and measured the proportion of PFDs divided by total hospital LOS (PFD ratio) for each condition and hospital. Higher PFD ratios signify more days without phlebotomy. Hospitals were grouped into low, moderate, and high average PFD ratios. Adjusted outcomes (LOS, costs, and readmissions) were compared across groups. RESULTS We identified 126,135 encounters. Bronchiolitis (0.78) and pneumonia (0.54) had the highest PFD ratios (most PFDs), while osteoarticular infections (0.28) and gastroenteritis (0.30) had the lowest PFD ratios. There were no differences in adjusted clinical outcomes across PFD ratio groups. Among children hospitalized with common infections, PFD ratios varied across conditions and hospitals, with no association with outcomes. Our data suggest overuse of phlebotomy and opportunities to improve the care of hospitalized children.
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Affiliation(s)
- Megan E Collins
- Department of Pediatrics, Children's Mercy Kansas City, University of Missouri-Kansas City School of Medicine, Kansas City, Missouri, USA
| | - Matt Hall
- Department of Pediatrics, Children's Mercy Kansas City, University of Missouri-Kansas City School of Medicine, Kansas City, Missouri, USA
- Children's Hospital Association, Lenexa, Kansas, USA
| | - Samir S Shah
- Division of Hospital Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Matthew J Molloy
- Division of Hospital Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Paul L Aronson
- Departments of Pediatrics and Emergency Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - Jillian M Cotter
- University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, Colorado, USA
| | | | - Elisha McCoy
- Department of Pediatrics, Le Bonheur Children's Hospital, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Michael J Tchou
- University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, Colorado, USA
| | - John R Stephens
- University of North Carolina, Chapel Hill, North Carolina, USA
| | - Jessica L Markham
- Department of Pediatrics, Children's Mercy Kansas City, University of Missouri-Kansas City School of Medicine, Kansas City, Missouri, USA
- University of Kansas School of Medicine, Kansas City, Kansas, USA
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3
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Cosquer M, Jousselme C. The experience of parents in Ronald McDonald houses in France. Arch Pediatr 2023; 30:219-225. [PMID: 36990937 DOI: 10.1016/j.arcped.2023.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Revised: 11/21/2022] [Accepted: 02/12/2023] [Indexed: 03/29/2023]
Abstract
BACKGROUND Ronald McDonald houses are located close to children's hospitals. They enable the hospitalized child to benefit from their family's presence, while helping the family to cope better with their child's hospital stay. This study aimed to describe the experience of parents staying in Ronald McDonald houses in France, identify their needs, and study the psychological impact of their child being in hospital. METHOD This cross-sectional observational epidemiological study was conducted in 2016, using anonymous self-administered questionnaires offered to parents staying in one of the nine Ronald McDonald houses in France. The questionnaire had two sections: a general section about the hospitalized child, and a 62 questions section to be completed by each parent, including a Hospital Anxiety and Depression Scale (HADS). RESULTS The participation rate was 62.9%: 71% of mothers completed the questionnaire (n = 320), and 54.7% of fathers did so (n = 246). They were the parents of 333 children (53.9% boys, 46.1% girls), under 1 year old (44.1%), hospitalized in the following three departments: intensive care (24%), pediatric oncology (23.1%), and neonatal care (20.1%). The mothers on average spent 11 h a day at their child's bedside, while the fathers spent 8 h 47 min. The parents tended to be employees or manual workers, and mostly lived together, with an average 2-h journey to hospital. They reported financial problems in 42.1% of cases, significant sleep deprivation (>90 min) in 73.2% of cases, and anxiety and depressive disorders: anxiety (59%) and depression (26%). There were some significant differences between the experiences of mothers and fathers: mothers lost out on their sleep and lost more appetite, and spent more time at their child's bedside, while the fathers encountered twice as many work-related difficulties (p<0.01). Additionally, their perception of the Ronald McDonald House was similar, as over 90% of them stated that this family accommodation allowed them to feel closer to their child and supported them in their role as parents. CONCLUSION The parents of children in hospital were 6-8 times more anxious than the general population, while clinical symptoms of depression were twice as common as in the overall population. Despite this suffering linked to their child's illness, the parents rated highly the support provided by the Ronald McDonald House in helping them cope with their child's time in hospital.
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Smith S, Tallon M, Smith J, Angelhoff C, Mörelius E. Parental sleep when their child is sick: A phased principle-based concept analysis. J Sleep Res 2022; 31:e13575. [PMID: 35468663 PMCID: PMC9786861 DOI: 10.1111/jsr.13575] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Revised: 01/28/2022] [Accepted: 02/16/2022] [Indexed: 12/30/2022]
Abstract
Sleep is a common challenge for parents with sick children and can impact parents' health, wellbeing, and caregiving responsibilities. Despite the vast research around parental sleep when their child is sick, the concept is not clearly defined. A phased principle-based concept analysis that includes triangulation of methods and quality criteria assessment was used to explore how the concept is described, used, and measured in the current literature. The aim was to analyse and clarify the conceptual, operational, and theoretical basis of parental sleep when their child is sick to produce an evidence-based definition and to identify knowledge gaps. A systematic literature search including databases CINAHL, Embase, MEDLINE, PsychARTICLES, PsychINFO, Pubmed, Scopus and Web of Science, identified 546 articles. The final dataset comprised 74 articles published between 2005 and 2021 and was assessed using a criteria tool for principle-based concept analysis. Data were managed using NVivo, and thematic analysis was undertaken. A precise definition is not present in the literature. Various tools have been used to measure parents' sleep, as well as exploration via interviews, open-ended questions, and sleep diaries. The terminology used varied. Parental sleep when their child is sick is interrelated with other concepts (e.g., stress). A recommended definition is offered. A conceptual understanding of parental sleep when their child is sick will help to guide translational research and to conduct studies critical to clinical practice and research. Future research includes developing a measurement tool for parental sleep when their child is sick to be used in study design and future interventions.
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Affiliation(s)
- Stephanie Smith
- School of Nursing and MidwiferyEdith Cowan UniversityPerthWAAustralia,Perth Children's HospitalNedlands, PerthWAAustralia
| | - Mary Tallon
- School of NursingCurtin UniversityPerthWAAustralia
| | - James Smith
- Centre for Precision HealthCollaborative Genomics and Translation GroupSchool of Medical and Health SciencesEdith Cowan UniversityPerthWAAustralia,Centre for Healthcare Resilience and Implementation ScienceAustralian Institute for Health InnovationMacquarie UniversitySydneyNSWAustralia
| | - Charlotte Angelhoff
- Crown Princess Victoria's Child and Youth Hospital and Department of Biomedical and Clinical SciencesLinköping UniversityLinköpingSweden
| | - Evalotte Mörelius
- School of Nursing and MidwiferyEdith Cowan UniversityPerthWAAustralia,Perth Children's HospitalNedlands, PerthWAAustralia
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Sackinger D, Carlin K, Zierler B. Association of parent demographic and psychophysical characteristics and pediatric hospital falls: A pilot and feasibility study. J Pediatr Nurs 2022; 63:28-38. [PMID: 34954549 DOI: 10.1016/j.pedn.2021.12.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Revised: 12/15/2021] [Accepted: 12/15/2021] [Indexed: 12/27/2022]
Abstract
PURPOSE This pilot project evaluated the feasibility of conducting a study describing parental characteristics associated with pediatric hospital falls. DESIGN AND METHODS This observational case-control study enrolled parent-child dyads of children who fell in the hospital and age-matched controls. Parents completed demographic, anxiety, depression, fatigue, sleep disturbance and stress questionnaires. RESULTS Four of 14 (28.6%) eligible faller dyads were recruited. Stress scores were correlated with anxiety and depression scores. Power calculations indicated a need for 392 fallers for a future study to identify associations of parent characteristics and pediatric hospital falls. CONCLUSIONS Parents should be informed the ultimate goal of the research is to understand additional ways to prevent pediatric hospital falls. To decrease parental distraction during recruitment, researchers should engage volunteers or child life specialists to entertain younger children. Future studies should consider inclusion of non-English speaking subjects and children discharged within the post-fall eligibility time frame. To decrease multicollinearity concerns, the parent stress tool should be omitted. Due to the large number of fallers needed for an adequately powered sample, a multi-site study will be needed. PRACTICE IMPLICATIONS A parent is often present when their child falls in the hospital. Fall risk assessment focuses on patient characteristics, neglecting parental psychophysical characteristics which may be associated with risk of falling in the hospital. Associations of parent psychophysical characteristics and pediatric hospital falls needs to be studied further. This pilot study supports the feasibility of and provides recommendations for conducting a study to describe parent characteristics associated with pediatric hospital falls.
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Affiliation(s)
- Denise Sackinger
- Seattle Children's, M/S FA.2.114, PO Box 5371, Seattle, WA 98145-5005, USA; University of Washington, 1959 NE Pacific Street, Seattle, WA 98195, USA.
| | - Kristen Carlin
- Seattle Children's Research Institute, Biostatistics, Epidemiology, and Analytics in Research, 1920 Terry Ave, M/S CURE-4, Seattle, WA 98101, USA.
| | - Brenda Zierler
- University of Washington, 1959 NE Pacific Street, Seattle, WA 98195, USA.
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Stephens JR, Hall M, Cotter JM, Molloy MJ, Tchou MJ, Markham JL, Shah SS, Steiner MJ, Aronson PL. Trends and Variation in Length of Stay Among Hospitalized Febrile Infants ≤60 Days Old. Hosp Pediatr 2021; 11:915-926. [PMID: 34385333 DOI: 10.1542/hpeds.2021-005936] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
OBJECTIVES Researchers in recent studies suggest that hospitalized febrile infants aged ≤60 days may be safely discharged if bacterial cultures are negative after 24-36 hours of incubation. We aimed to describe trends and variation in length of stay (LOS) for hospitalized febrile infants across children's hospitals. METHODS We conducted a multicenter retrospective cohort study of febrile infants aged ≤60 days hospitalized from 2016 to 2019 at 39 hospitals in the Pediatric Health Information System database. We excluded infants with complex chronic conditions, bacterial infections, lower respiratory tract viral infections, and those who required ICU admission. The primary outcomes were trends in LOS overall and for individual hospitals, adjusted for patient demographics and clinical characteristics. We also evaluated the hospital-level association between LOS and 30-day readmissions. RESULTS We identified 11 868 eligible febrile infant encounters. The adjusted mean LOS for the study cohort decreased from 44.0 hours in 2016 to 41.9 hours in 2019 (P < .001). There was substantial variation in adjusted mean LOS across children's hospitals, range 33.5-77.9 hours in 2016 and 30.4-100.0 hours in 2019. The change from 2016 to 2019 in adjusted mean LOS across individual hospitals also varied widely (-23.9 to +26.7 hours; median change -1.8 hours, interquartile range: -5.4 to 0.3). There was no association between hospital-level LOS and readmission rates (P = .70). CONCLUSIONS The LOS for hospitalized febrile infants decreased marginally between 2016 and 2019, although overall LOS and change in LOS varied substantially across children's hospitals. Continued quality improvement efforts are needed to reduce LOS for hospitalized febrile infants.
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Affiliation(s)
- John R Stephens
- North Carolina Children's Hospital and School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Matt Hall
- Children's Hospital Association, Overland Park, Kansas
| | - Jillian M Cotter
- Children's Hospital Colorado and School of Medicine, University of Colorado, Aurora, Colorado
| | - Matthew J Molloy
- Cincinnati Children's Hospital Medical Center and University of Cincinnati, Cincinnati, Ohio
| | - Michael J Tchou
- Children's Hospital Colorado and School of Medicine, University of Colorado, Aurora, Colorado
| | - Jessica L Markham
- Children's Mercy Hospital and University of Missouri-Kansas City, Kansas City, Missouri
| | - Samir S Shah
- Cincinnati Children's Hospital Medical Center and University of Cincinnati, Cincinnati, Ohio
| | - Michael J Steiner
- North Carolina Children's Hospital and School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Paul L Aronson
- Departments of Pediatrics and Emergency Medicine, School of Medicine, Yale University, New Haven, Connecticut
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Stephens JR, Hall M, Markham JL, Tchou MJ, Cotter JM, Shah SS, Steiner MJ, Gay JC. Outcomes Associated With High- Versus Low-Frequency Laboratory Testing Among Hospitalized Children. Hosp Pediatr 2021; 11:563-570. [PMID: 33952575 DOI: 10.1542/hpeds.2020-005561] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
BACKGROUND AND OBJECTIVES Previous pediatric studies have revealed substantial variation in laboratory testing for specific conditions, but clinical outcomes associated with high- versus low-frequency testing are unclear. We hypothesized that hospitals with high- versus low-testing frequency would have worse clinical outcomes. METHODS We conducted a multicenter retrospective cohort study of patients 0 to 18 years old with low-acuity hospitalizations in the years 2018-2019 for 1 of 10 common All Patient Refined Diagnosis Related Groups. We identified hospitals with high-, moderate-, and low-frequency testing for 3 common groups of laboratory tests: complete blood cell count, basic chemistry studies, and inflammatory markers. Outcomes included length of stay, 7- and 30-day emergency department revisit and readmission rates, and hospital costs, comparing hospitals with high- versus low-frequency testing. RESULTS We identified 132 391 study encounters across 44 hospitals. Laboratory testing frequency varied by hospital and condition. We identified hospitals with high- (13), moderate- (20), and low-frequency (11) laboratory testing. When we compared hospitals with high- versus low-frequency testing, there were no differences in adjusted hospital costs (rate ratio 0.89; 95% confidence interval 0.71-1.12), length of stay (rate ratio 0.98; 95% confidence interval 0.91-1.06), 7-day (odds ratio 0.99; 95% confidence interval 0.81-1.21) or 30-day (odds ratio 1.01; 95% confidence interval 0.82-1.25) emergency department revisit rates, or 7-day (odds ratio 0.84; 95% confidence interval 0.65-1.25) or 30-day (odds ratio 0.91; 95% confidence interval 0.76-1.09) readmission rates. CONCLUSIONS In a multicenter study of children hospitalized for common low-acuity conditions, laboratory testing frequency varied widely across hospitals, without substantial differences in outcomes. Our results suggest opportunities to reduce laboratory overuse across conditions and children's hospitals.
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Affiliation(s)
- John R Stephens
- North Carolina Children's Hospital and School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina;
| | - Matt Hall
- Children's Hospital Association, Overland Park, Kansas
| | - Jessica L Markham
- Children's Mercy Hospital and University of Missouri-Kansas City, Kansas City, Missouri
| | - Michael J Tchou
- Children's Hospital Colorado and School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Jillian M Cotter
- Children's Hospital Colorado and School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Samir S Shah
- Cincinnati Children's Hospital Medical Center and University of Cincinnati, Cincinnati, Ohio; and
| | - Michael J Steiner
- North Carolina Children's Hospital and School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - James C Gay
- Monroe Carell Jr Children's Hospital at Vanderbilt, Nashville, Tennessee
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Burns MA, Aralova M, Ellis SJ, Aslanyan KS, Egorkina T, Wakefield CE. Pediatric psycho-oncology in Russia: Caregiver mental health and sleep outcomes on the oncology wards. Psychooncology 2020; 30:185-193. [PMID: 32935374 DOI: 10.1002/pon.5547] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Revised: 08/31/2020] [Accepted: 08/31/2020] [Indexed: 12/19/2022]
Abstract
OBJECTIVES Caregivers are at risk of poor sleep and elevated distress during their child's cancer treatment. Russia is currently underrepresented in the international psycho-oncology field, with no identified psychosocial standards of care, and limited or inconsistent psychological service provision, particularly for caregivers. This study aimed to determine the prevalence of Russian caregivers' psychological distress and identify factors associated with caregiver sleep duration when staying on the pediatric oncology ward. METHODS We recruited 74 caregivers of children with cancer and 74 comparison caregivers in Rostov-on-Don, Russia. Participants completed a survey assessing clinical outcomes, sleep (St Mary's Hospital Sleep Questionnaire), and psychological distress (Depression Anxiety Stress Scales-21 [DASS-21]). RESULTS Caregivers of children with cancer reported significantly higher scores for all DASS-21 subscales and higher depression (48.6% vs. 24.6%), anxiety (47.3% vs. 12.3%), and stress (45.9% vs. 0%) scores from "moderate" to "extremely severe." Caregivers of children with cancer reported significantly shorter sleep duration (5.82 vs. 7.49 h, t[143] = -6.22, p = 0.002), more night-time awakenings (3.20 vs. 1.25, t[135] = 6.94, p < 0.001) and worse sleep quality (46.5% vs. 9.6%; x2 [1] = 24.4, p < 0.001) than comparison caregivers. Caregivers with a higher total DASS-21 score (B = -1.32, p = 0.032) and those who were closer to diagnosis (B = -1.53, p = 0.012) reported shorter sleep duration. CONCLUSIONS Russian caregivers of children with cancer experience high rates of psychological distress and poor sleep on the oncology ward. These findings provide an important target for future research and culturally relevant clinical interventions to improve caregivers' mental health and capacity for care.
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Affiliation(s)
- Mary A Burns
- Behavioural Sciences Unit, Kids Cancer Centre, Sydney Children's Hospital, Randwick, New South Wales, Australia.,Discipline of Pediatrics, School of Women's and Children's Health, UNSW Medicine, UNSW Sydney, Sydney, New South Wales, Australia
| | - Marina Aralova
- Psychophysiology and Clinical Psychology Department, Southern Federal University, Rostov-on-Don, Rostov Oblast, Russia
| | - Sarah J Ellis
- Behavioural Sciences Unit, Kids Cancer Centre, Sydney Children's Hospital, Randwick, New South Wales, Australia.,Discipline of Pediatrics, School of Women's and Children's Health, UNSW Medicine, UNSW Sydney, Sydney, New South Wales, Australia
| | - Karapet S Aslanyan
- Centre for Pediatric Oncology and Hematology, Children's District Hospital, Rostov-on-Don, Rostov Oblast, Russia
| | - Taisia Egorkina
- Behavioural Sciences Unit, Kids Cancer Centre, Sydney Children's Hospital, Randwick, New South Wales, Australia.,Discipline of Pediatrics, School of Women's and Children's Health, UNSW Medicine, UNSW Sydney, Sydney, New South Wales, Australia
| | - Claire E Wakefield
- Behavioural Sciences Unit, Kids Cancer Centre, Sydney Children's Hospital, Randwick, New South Wales, Australia.,Discipline of Pediatrics, School of Women's and Children's Health, UNSW Medicine, UNSW Sydney, Sydney, New South Wales, Australia
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Løyland B, Angelhoff C, Kristjánsdóttir G, Sjølie H. A systematic integrative review of parents' experience and perception of sleep when they stay overnight in the hospital together with their sick children. J Clin Nurs 2019; 29:706-719. [PMID: 31821674 DOI: 10.1111/jocn.15134] [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] [Received: 05/28/2019] [Revised: 11/19/2019] [Accepted: 11/21/2019] [Indexed: 12/15/2022]
Abstract
AIMS AND OBJECTIVES To elucidate knowledge available on parents' experience and perception of sleep when they stay overnight in hospital together with their sick children. BACKGROUND In Nordic countries, children are entitled to have at least one parent with them during hospitalisation. Parents' sleep, when accommodated at the hospital during the child's admission, may be a challenge. DESIGN A systematic literature search was conducted in EMBASE, MEDLINE and PsycINFO; period is restricted from 1 January 2007 to 1 April 2019. Studies included were those in which parents were accommodated in hospital with their child, 0-18 years of age, for at least one night. Original peer-reviewed scientific research papers conducting qualitative, quantitative or mixed designs were included. Systematic reviews were not included. This systematic integrative review was registered in PROSPERO and performed according to the PRISMA guidelines. All authors participated in study selection, data extraction and quality assessment of the literature. RESULTS Fifteen studies were included, and they varied in terms of origin, aims, design, methods used and sample size. Three overall main themes appeared: sleep quality, factors affecting sleep and consequences of sleep loss. Combined psychological factors were found to affect parents' sleep, as well as isolated psychological factors, for example, stress, anxiety, worries and difficult thoughts. Environmental and social factors were also identified, for example, privacy and caring for family. CONCLUSION Study of this subject is still in its exploratory phase. There is a need for the development of theory of substance in the clarification of the meaning of sleep among parents during difficult times such as children's hospitalisation. RELEVANCE TO CLINICAL PRACTICE Understanding risk factors associated with sleep and sleep deprivation in parents staying overnight in the hospital with their sick child is important, since lack of sleep may lead to serious stress-related outcomes for the parents.
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Affiliation(s)
- Borghild Løyland
- Department of Nursing and Health Promotion, Faculty of Health Sciences, OsloMet - Oslo Metropolitan University, Oslo, Norway
| | - Charlotte Angelhoff
- Division of Nursing Science, Department of Social and Welfare Studies, Linköping University, Norrköping, Sweden.,Department of Pediatrics, Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
| | - Gudrún Kristjánsdóttir
- Faculty of Nursing, University of Iceland, Reykjavík, Iceland.,Hringurinn Children's Hospital, Landspitali University Hospital, Reykjavik, Iceland
| | - Hege Sjølie
- Department of Nursing and Health Promotion, Faculty of Health Sciences, OsloMet - Oslo Metropolitan University, Oslo, Norway
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10
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Angelhoff C, Sjølie H, Mörelius E, Løyland B. "Like Walking in a Fog"-Parents' perceptions of sleep and consequences of sleep loss when staying overnight with their child in hospital. J Sleep Res 2019; 29:e12945. [PMID: 31724227 DOI: 10.1111/jsr.12945] [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] [Received: 05/09/2019] [Revised: 09/18/2019] [Accepted: 10/15/2019] [Indexed: 01/05/2023]
Abstract
Disruption of parental sleep in hospital, with frequent awakenings and poor sleep quality, limits the parents' resources to meet the child's needs and maintain parental wellbeing. The aim of the study was to explore and describe how parents perceive their sleep when staying overnight with their sick child in hospital. A further aim was to explore and describe parents' perception of what circumstances influence their sleep in the hospital. Twenty-two parents who were accommodated with their sick child (0-17 years) in paediatric wards in Norway and Sweden participated. Interviews were conducted during the hospital stay to elicit their perspectives. Phenomenography was used to analyse data. Two descriptive categories were found: (a) "Perceptions of sleep", with two sub-categories: "Sleep in the paediatric ward" and "Consequences of sleep loss"; and (b) "Circumstances influencing sleep in the paediatric ward" with three sub-categories: "The importance of the family", "Information and routines at the paediatric ward", and "Accommodation facilities". Parents' sleep and needs must be acknowledged in paediatric wards. An individual plan of care for the upcoming night could be a valuable tool for both the parents and nurses. The child's medical needs must be met with respect to the parents' willingness to take part in the child's care during the night, and the need for rest and sleep for both parent and child.
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Affiliation(s)
- Charlotte Angelhoff
- Department of Pediatrics and Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
| | - Hege Sjølie
- Department of Nursing and Health Promotion, Oslo Metropolitan University, Oslo, Norway
| | - Evalotte Mörelius
- School of Nursing and Midwifery, Edith Cowan University, Joondalup, WA, Australia.,Perth Children's Hospital, Nedlands, WA, Australia
| | - Borghild Løyland
- Department of Nursing and Health Promotion, Oslo Metropolitan University, Oslo, Norway
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11
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Quality Improvement Initiative to Reduce Nighttime Noise in a Transplantation and Cellular Therapy Unit. Biol Blood Marrow Transplant 2019; 25:1844-1850. [DOI: 10.1016/j.bbmt.2019.05.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2019] [Revised: 05/01/2019] [Accepted: 05/01/2019] [Indexed: 01/08/2023]
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12
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Tchou MJ, Hall M, Shah SS, Johnson DP, Schroeder AR, Antoon JW, Genies MC, Quinonez R, Miller CW, Shah SP, Brady PW. Patterns of Electrolyte Testing at Children's Hospitals for Common Inpatient Diagnoses. Pediatrics 2019; 144:e20181644. [PMID: 31171587 PMCID: PMC6615522 DOI: 10.1542/peds.2018-1644] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/11/2019] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Overuse of laboratory testing contributes substantially to health care waste, downstream resource use, and patient harm. Understanding patterns of variation in hospital-level testing across common inpatient diagnoses could identify outliers and inform waste-reduction efforts. METHODS We conducted a multicenter retrospective cohort study of pediatric inpatients at 41 children's hospitals using administrative data from 2010 to 2016. Initial electrolyte testing was defined as testing occurring within the first 2 days of an encounter, and repeat testing was defined as subsequent testing within an encounter in which initial testing occurred. To examine if testing rates correlated across diagnoses at the hospital level, we compared risk-adjusted rates for gastroenteritis with a weighted average of risk-adjusted rates in other diagnosis cohorts. For each diagnosis, linear regression was performed to compare initial and subsequent testing. RESULTS In 497 719 patient encounters, wide variation was observed across hospitals in adjusted, initial, and repeat testing rates. Hospital-specific rates of testing in gastroenteritis were moderately to strongly correlated with the weighted average of testing in other conditions (initial: r = 0.63; repeat r = 0.83). Within diagnoses, higher hospital-level initial testing rates were associated with significantly increased rates of subsequent testing for all diagnoses except gastroenteritis. CONCLUSIONS Among children's hospitals, rates of initial and repeat electrolyte testing vary widely across 8 common inpatient diagnoses. For most diagnoses, hospital-level rates of initial testing were associated with rates of subsequent testing. Consistent rates of testing across multiple diagnoses suggest that hospital-level factors, such as institutional culture, may influence decisions for electrolyte testing.
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Affiliation(s)
- Michael J Tchou
- Department of Pediatrics, College of Medicine, University of Cincinnati, Cincinnati, Ohio;
- Division of Hospital Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Matt Hall
- Children's Hospital Association, Lenexa, Kansas
| | - Samir S Shah
- Department of Pediatrics, College of Medicine, University of Cincinnati, Cincinnati, Ohio
- Division of Hospital Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - David P Johnson
- Division of Hospital Medicine, Department of Pediatrics, School of Medicine, Vanderbilt University, Nashville, Tennessee
| | - Alan R Schroeder
- Department of Pediatrics, School of Medicine, Stanford University, Palo Alto, California
| | - James W Antoon
- Children's Hospital, University of Illinois, University of Illinois Hospital and Health Sciences System, Chicago, Illinois
| | - Marquita C Genies
- Department of Pediatrics, Johns Hopkins University, Baltimore, Maryland
| | - Ricardo Quinonez
- Section of Pediatric Hospital Medicine, Department of Pediatrics, Baylor College of Medicine and Texas Children's Hospital, Houston, Texas
| | - Christopher W Miller
- Division of Pediatric Inpatient Medicine, Department of Pediatrics, University of Utah, Salt Lake City, Utah; and
| | - Snehal P Shah
- Division of Hospitalist Medicine, Department of Pediatrics, Washington University in St Louis, St Louis, Missouri
| | - Patrick W Brady
- Department of Pediatrics, College of Medicine, University of Cincinnati, Cincinnati, Ohio
- Division of Hospital Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
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13
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Haddad S, Dennis CL, Shah PS, Stremler R. Sleep in parents of preterm infants: A systematic review. Midwifery 2019; 73:35-48. [PMID: 30877909 DOI: 10.1016/j.midw.2019.01.009] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2018] [Revised: 01/09/2019] [Accepted: 01/13/2019] [Indexed: 01/24/2023]
Abstract
BACKGROUND Sleep disruption during the first postpartum year is associated with several negative health outcomes including postpartum depression. Such disruption may be a greater issue for parents of preterm neonates, yet literature on this subject has not been critically reviewed. OBJECTIVE To synthesize literature on sleep quantity, sleep quality, and factors influencing sleep among parents of preterm infants during infant hospitalization and following discharge. DESIGN A systematic review. DATA SOURCES Medline, EMBASE, CINAHL, PsycINFO, Scopus, and Cochrane Database of Systematic Reviews were searched from their inception to February 2017. METHODS Potentially eligible citations were reviewed by two independent reviewers. Both quantitative and qualitative studies were eligible for inclusion. Data on eligible studies and review outcomes were extracted using a customized form. FINDINGS Eighteen reports from 16 studies met inclusion criteria. Four studies included a control group of parents of full-term infants. Three studies reported sleep quantity means, of which only one provided values for an exclusive sample of mothers of preterm infants and found on average, mothers obtained 6.3 h of sleep/day in the first 5-10 days. Twelve studies reported on sleep quality; most (n = 10) relied on self-reported measures and identified poor subjective sleep quality whereas two studies objectively measured sleep of poor quality. Parental stress was the most consistent factor associated with sleep quality. CONCLUSION AND IMPLICATIONS Quality and quantity of sleep among parents of preterm infants is inadequate and may negatively influence family health outcomes. Further research on correlates and changes in sleep is required to identify at-risk parents and inform targeted clinical recommendations and interventions aimed at maximizing sleep for parents of preterm infants.
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Affiliation(s)
- Summer Haddad
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada; The Hospital for Sick Children (SickKids), Toronto, Ontario, Canada.
| | - Cindy-Lee Dennis
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada; Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Canada
| | - Prakesh S Shah
- Department of Pediatrics, Mount Sinai Hospital, Toronto, Ontario, Canada; Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
| | - Robyn Stremler
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada; The Hospital for Sick Children (SickKids), Toronto, Ontario, Canada
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14
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Peirce LB, Orlov NM, Erondu AI, Anderson SL, Chamberlain M, Gozal D, Arora VM. Caregiver and Staff Perceptions of Disruptions to Pediatric Inpatient Sleep. J Clin Sleep Med 2018; 14:1895-1902. [PMID: 30373684 DOI: 10.5664/jcsm.7488] [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: 01/19/2018] [Accepted: 08/02/2018] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVES Sleep is critical to a child's health and well-being, but children are likely to sleep less and be awakened more often during the night in the hospital than at home. To date no studies have compared caregiver, nurse, and physician perspectives of nighttime sleep disruptions in the pediatric general medicine setting. Our aim was to assess caregiver, nurse, and physician perspectives on the most frequent in-hospital disruptors of sleep for pediatric patients. Additionally, we evaluated the degree of agreement of those opinions between the caregivers and medical team. METHODS Caregivers, nurses, and physicians were surveyed using the Potential Hospital Sleep Disruption and Noises Questionnaire (PHSDNQ) regarding their opinions on factors that disrupt sleep. Caregiver responses were collected via a convenience sample of patients hospitalized from February to August 2017 and hospital staff was surveyed once regarding overall perception. The perceived percentage of patients disrupted by each factor was calculated and compared among groups using chi-square tests. Using caregiver rank order based on mean response as the reference gold standard, the absolute differences of nurse and physician rank orders were summed and analyzed using a two-sample test of proportion. In addition, staff was asked knowledge and empowerment questions about how to maximize patient sleep in the hospital and responses were compared using chi-square tests. RESULTS A total of 162 caregivers, 77 nurses (84% response rate), and 81 physicians (90% response rate) completed surveys. Checking vital signs (50%), nurse/physician interruption (49%), and continuous pulse oximetry (38%) were the three most prevalent disruptors of pediatric inpatient sleep as reported by caregivers. Significant differences were observed between caregiver, nurse, and physician responses for pain, anxiety, alarms, noise, and tests (P ≤ .001 for all). Both nurse and physician rank orders were discordant when compared to caregivers; there was no significant difference between the two staff groups. When compared to physicians, nurses reported doing more to help children sleep in the hospital (33% versus 94%, P < .001). CONCLUSIONS Although caregivers report medical interventions such as checking vital signs, nurse/physician interruption, and continuous pulse oximetry as the most frequent disruptors of inpatient pediatric sleep, pediatric staff has poor insight into these disruptions.
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Affiliation(s)
- Leah B Peirce
- Pritzker School of Medicine, University of Chicago, Chicago, Illinois
| | - Nicola M Orlov
- Pritzker School of Medicine, University of Chicago, Chicago, Illinois.,Section of Academic Pediatrics, University of Chicago Medical Center, Chicago, Illinois
| | - Amarachi I Erondu
- Pritzker School of Medicine, University of Chicago, Chicago, Illinois
| | - Samantha L Anderson
- Section of General Internal Medicine, University of Chicago Medical Center, Chicago, Illinois
| | | | - David Gozal
- Section of Pediatric Sleep Medicine, University of Chicago Medical Center, Chicago, Illinois
| | - Vineet M Arora
- Pritzker School of Medicine, University of Chicago, Chicago, Illinois.,Section of General Internal Medicine, University of Chicago Medical Center, Chicago, Illinois
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15
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Nassery W, Landgren K. Parents' Experience of Their Sleep and Rest When Admitted to Hospital with Their Ill Child: A Qualitative Study. Compr Child Adolesc Nurs 2018; 42:265-279. [PMID: 30388907 DOI: 10.1080/24694193.2018.1528310] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
The aim of this study was to explore parents' experiences of sleep and rest while admitted to hospital together with their ill child. When a child is hospitalized, it can be a traumatic experience for the entire family. Adaptation to the new situation and new parental responsibilities is necessary. Hospitalized children demand more supervision and care, making sleep disturbance a common challenge among these parents. A qualitative exploratory interview study was conducted using semi-structured individual or couple interviews with 17 parents (12 mothers and five fathers) admitted together with their ill child for shorter or longer periods at pediatric wards at a university hospital in Sweden. Interviews were analyzed with content analysis. Sufficient amount of sleep and rest was described as vital for parental functioning. The main theme Factors influencing sleep and rest emerged with three subthemes. Environmental factors describe experiences such as disturbing sounds and uncomfortable beds. Interpersonal factors describe how supportive relations with spouses, relatives, nurses, and doctors were experienced as strengthening the parental confidence and helping parents to relax. Parents wanted to participate in the care but appreciated help from the nurses when they needed rest or support. The last subtheme, Organizational factors, describe how continuous information about the child's care and prognosis was experienced as the most important factor to feel secure and calm. Parents expressed that a possibility to buy lunch and dinner at the ward would greatly relieve parents' stress and help them rest. Parents in this study were grateful that they were allowed to stay by their child's side, but pointed out improvement opportunities. Single rooms with comfortable beds for the parents were in high demand to promote relaxation and sleep. Continuous, adjusted, information was seen as important. All hospitalized children have the right to partake in their own treatment and care, and they need a parent at their side. By optimizing parents' sleep and rest in the hospital, a more positive experience of the hospitalization can be achieved for the entire family.
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Affiliation(s)
| | - Kajsa Landgren
- Department of Health Sciences, Faculty of Medicine, Lund University , Lund , Sweden
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16
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Tchou MJ, Tang Girdwood S, Wormser B, Poole M, Davis-Rodriguez S, Caldwell JT, Shannon L, Hagedorn PA, Biondi E, Simmons J, Anderson J, Brady PW. Reducing Electrolyte Testing in Hospitalized Children by Using Quality Improvement Methods. Pediatrics 2018; 141:peds.2017-3187. [PMID: 29618583 PMCID: PMC7008632 DOI: 10.1542/peds.2017-3187] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/18/2017] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Despite studies indicating a high rate of overuse, electrolyte testing remains common in pediatric inpatient care. Frequently repeated electrolyte tests often return normal results and can lead to patient harm and increased cost. We aimed to reduce electrolyte testing within a hospital medicine service by >25% within 6 months. METHODS We conducted an improvement project in which we targeted 6 hospital medicine teams at a large academic children's hospital system by using the Model for Improvement. Interventions included standardizing communication about the electrolyte testing plan and education about the costs and risks associated with overuse of electrolyte testing. Our primary outcome measure was the number of electrolyte tests per patient day. Secondary measures included testing charges and usage rates of specific high-charge panels. We tracked medical emergency team calls and readmission rates as balancing measures. RESULTS The mean baseline rate of electrolyte testing was 2.0 laboratory draws per 10 patient days, and this rate decreased by 35% after 1 month of initial educational interventions to 1.3 electrolyte laboratory draws per 10 patient days. This change has been sustained for 9 months and could save an estimated $292 000 in patient-level charges over the course of a year. Use of our highest-charge electrolyte panel decreased from 67% to 22% of testing. No change in rates of medical emergency team calls or readmission were found. CONCLUSIONS Our improvement intervention was associated with significant and rapid reduction in electrolyte testing and has not been associated with unintended adverse events.
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Affiliation(s)
- Michael J. Tchou
- Division of Hospital Medicine, Department of Pediatrics, Cincinnati, Ohio;,James M. Anderson Center for Health Systems Excellence, Cincinnati, Ohio
| | | | | | - Meifawn Poole
- Pediatric Residency Training Program, Cincinnati, Ohio
| | | | | | - Lauren Shannon
- Division of Hospital Medicine, Department of Pediatrics, Cincinnati, Ohio
| | - Philip A. Hagedorn
- Division of Hospital Medicine, Department of Pediatrics, Cincinnati, Ohio
| | - Eric Biondi
- Department of Pediatrics, Johns Hopkins Children’s Center, Baltimore, Maryland
| | - Jeffrey Simmons
- Division of Hospital Medicine, Department of Pediatrics, Cincinnati, Ohio;,James M. Anderson Center for Health Systems Excellence, Cincinnati, Ohio
| | - Jeffrey Anderson
- James M. Anderson Center for Health Systems Excellence, Cincinnati, Ohio;,Heart Institute, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
| | - Patrick W. Brady
- Division of Hospital Medicine, Department of Pediatrics, Cincinnati, Ohio;,James M. Anderson Center for Health Systems Excellence, Cincinnati, Ohio
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17
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Coleman K, Flesch L, Petiniot L, Pate A, Lin L, Crosby L, Beebe DW, Nelson A, Alonso PB, Davies SM, Baker RB, Dandoy CE. Sleep disruption in caregivers of pediatric stem cell recipients. Pediatr Blood Cancer 2018; 65:e26965. [PMID: 29350494 PMCID: PMC5867266 DOI: 10.1002/pbc.26965] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2017] [Revised: 11/29/2017] [Accepted: 12/16/2017] [Indexed: 11/08/2022]
Abstract
Parents/caregivers of hospitalized patients are at risk of sleep disruption. We performed a cross-sectional quantitative and qualitative evaluation of sleep in parents/caregivers of children undergoing hematopoietic stem cell transplant (HSCT; n = 17). Additionally, we explored the frequency of room entries for hospitalized patients undergoing HSCT (n = 189 nights). Twelve caregivers (71%) demonstrated significant sleep disturbance, 12 (71%) described sleep quality as poor, 15 (88%) averaged < 6 hours of sleep per night, 14 (82%) awakened at least four times per night. Patient rooms were entered a median of 12 times per night (interquartile range 10-15). Intervention studies to improve caregiver sleep during hospitalization are needed.
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Affiliation(s)
- Kristen Coleman
- Division of Bone Marrow Transplant and Immune Deficiency, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
- Department of Patient Services, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Laura Flesch
- Division of Bone Marrow Transplant and Immune Deficiency, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
- Department of Patient Services, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Lisa Petiniot
- Division of Bone Marrow Transplant and Immune Deficiency, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Abigail Pate
- Division of Bone Marrow Transplant and Immune Deficiency, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Li Lin
- Department of Patient Services, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Lori Crosby
- Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Dean W. Beebe
- Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Adam Nelson
- Division of Bone Marrow Transplant and Immune Deficiency, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Priscila Badia Alonso
- Division of Bone Marrow Transplant and Immune Deficiency, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Stella M. Davies
- Division of Bone Marrow Transplant and Immune Deficiency, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Rachel B. Baker
- Department of Patient Services, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Christopher E. Dandoy
- Division of Bone Marrow Transplant and Immune Deficiency, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
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18
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Abstract
BACKGROUND Historically, the relationship between infant and mother in the neonatal intensive care unit (NICU) has been the main focus of parenting research, leaving a gap in the literature regarding the paternal experience. PURPOSE The purpose of this study was to gain an understanding of the lived experience of fathering an infant born at less than 28 weeks' gestation admitted to a level III NICU. METHODS Seven fathers of premature infants (25-27 weeks' gestation) participated in a semistructured interview about the experience of becoming a father to a premature infant at least 1 to 2 weeks after the NICU admission. Data were collected in 2015. FINDINGS The primary themes identified were looking in, persevering, holding, and finding my way. Fathers in this study described feeling like an outsider in the NICU while learning to trust strangers, protect the mother and the child, and continue to work and provide for the family. Holding for the first time is pivotal in this journey, as the moment of solidifying the connection with the child. IMPLICATIONS FOR PRACTICE The findings from this study bring awareness of the experiences of fathers during the NICU journey of having a premature infant. Nurses should encourage paternal participation and involvement, visitation, and facilitate kangaroo care opportunities early and often. IMPLICATIONS FOR RESEARCH The findings from this study allow nurses to better understand the paternal experience of having a premature infant born at less than 28 weeks. However, future research should continue to investigate the paternal experience with other gestational ages as well as the influence of stress of fathers during this experience.
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19
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Angelhoff C, Edéll-Gustafsson U, Mörelius E. Sleep quality and mood in mothers and fathers accommodated in the family-centred paediatric ward. J Clin Nurs 2017; 27:e544-e550. [PMID: 28960555 DOI: 10.1111/jocn.14092] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/19/2017] [Indexed: 11/30/2022]
Abstract
AIMS AND OBJECTIVES To describe sleep quality and mood in parents accommodated with their sick child in a family-centred paediatric ward. Secondary aims were to compare mothers' and fathers' sleep quality and mood in the paediatric ward and to compare the parents' sleep quality and mood between the paediatric ward and in a daily-life home setting after discharge. BACKGROUND Frequent interruptions, ward noise and anxiety affect parents' sleep quality and mood negatively when accommodated with their sick child in paediatric wards. Poor sleep quality and negative mood decrease the parents' ability to sustain attention and focus, and to care for their sick child. METHODS This was a prospective and descriptive study. Eighty-two parents (61 mothers and 21 fathers) with children (median age 6.25 years) admitted to six paediatric wards participated in the study. Uppsala Sleep Inventory, a sleep diary and the Mood Adjective Checklist were used to measure sleep quality and mood. RESULTS The parents had a good sleep quality in the paediatric ward even though they had more nocturnal awakenings compared to home. Moreover, they were less alert, less interested and had reduced concentration, and were more tired, dull and passive in the hospital than at home after discharge. Vital sign checks, noises made by the staff and medical treatment were given reasons influencing sleep. Poor sleep quality correlated with negative mood. CONCLUSION Parents' sleep quality in family-centred paediatric care is good. However, the habitual sleep efficacy before admittance to the hospital is lower than expected and needs to be further investigated. RELEVANCE TO CLINICAL PRACTICE The healthcare professionals should acknowledge parents' sleep and mood when they are accommodated with their sick child. Further should care at night be scheduled and sleep promoted for the parents to maintain health and well-being in the family.
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Affiliation(s)
- Charlotte Angelhoff
- Department of Social and Welfare Studies, Division of Nursing Science, Linköping University, Norrköping, Sweden.,Department of Paediatrics and Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
| | - Ulla Edéll-Gustafsson
- Department of Medicine and Health Sciences, Division of Nursing Science, Linköping University, Linköping, Sweden
| | - Evalotte Mörelius
- Department of Social and Welfare Studies, Division of Nursing Science, Linköping University, Norrköping, Sweden
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20
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Stremler R, Haddad S, Pullenayegum E, Parshuram C. Psychological Outcomes in Parents of Critically Ill Hospitalized Children. J Pediatr Nurs 2017; 34:36-43. [PMID: 28274664 DOI: 10.1016/j.pedn.2017.01.012] [Citation(s) in RCA: 73] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2016] [Revised: 01/12/2017] [Accepted: 01/19/2017] [Indexed: 10/20/2022]
Abstract
Parents of children in pediatric intensive care units (PICUs) are subjected to significant psychological stress. The purpose of this study was to determine the prevalence of, and factors associated with anxiety, depressive symptoms and decisional conflict in parents of children hospitalized in the PICU. The study employed a descriptive, cross-sectional design to investigate the psychological status of 118 parents of 91 children (74 mothers and 44 fathers) admitted to the PICU, using measures of anxiety (STAI), depression (CES-D), and decisional conflict (DCS). Using hospital data and self-administered questionnaires, information on child and parent characteristics and psychological outcomes were collected. Objective measures of parental sleep also were examined using actigraphy and sleep diaries. The research findings indicated that 24% of parents achieved scores characteristic of severe anxiety. Proportions of parents with symptoms indicative of major depression and significant decisional conflict were 51% and 26% respectively. For all psychological outcomes, higher levels of social support were protective. Inconsistency in sleep schedule and sleep location affected psychological outcomes and are possible targets for future interventions. Given evidence that parents of children admitted to the PICU are at risk for developing post-traumatic stress symptoms, future studies should examine the effects of hospitalization on long-term parental psychological outcomes. Screening for those at risk and implementing interventions to promote coping strategies and reduce decisional conflict may be beneficial. Pediatric nurses have a critical role in assessing parents' psychological distress and promoting family health during a child's hospitalization.
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Affiliation(s)
- Robyn Stremler
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Canada; The Hospital for Sick Children (SickKids), Toronto, Canada.
| | - Summer Haddad
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Canada; The Hospital for Sick Children (SickKids), Toronto, Canada
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21
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22
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Neglect of Postoperative Pain Management in Children: A Qualitative Study Based on the Experiences of Parents. J Pediatr Nurs 2016; 31:439-48. [PMID: 27033024 DOI: 10.1016/j.pedn.2016.02.012] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2015] [Revised: 02/23/2016] [Accepted: 02/29/2016] [Indexed: 12/17/2022]
Abstract
UNLABELLED 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.
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23
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Schondelmeyer AC, Brady PW, Landrigan CP. Alarm fatigue: Clearing the air. J Hosp Med 2016; 11:153-4. [PMID: 26662376 DOI: 10.1002/jhm.2521] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2015] [Accepted: 11/05/2015] [Indexed: 11/08/2022]
Affiliation(s)
- Amanda C Schondelmeyer
- Division of Hospital Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
- James M. Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Patrick W Brady
- Division of Hospital Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
- James M. Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Christopher P Landrigan
- Division of General Pediatrics, Department of Medicine, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
- Division of Sleep Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
- Division of Sleep Medicine, Harvard Medical School, Boston, Massachusetts
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24
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Stremler R, Adams S, Dryden-Palmer K. Nurses' views of factors affecting sleep for hospitalized children and their families: A focus group study. Res Nurs Health 2015; 38:311-22. [PMID: 25970699 DOI: 10.1002/nur.21664] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/14/2015] [Indexed: 11/09/2022]
Abstract
Light, noise, and interruptions from hospital staff lead to frequent awakenings and detrimental changes to sleep quantity and quality for children who are hospitalized and their parents who stay with them overnight. An understanding of nurses' views on how care affects sleep for the hospitalized child and parent is crucial to the development of strategies to decrease sleep disturbance in hospital. The purpose of this descriptive qualitative study was to gain an understanding of nurses' views on their role in and influence on sleep for families; perceived barriers and facilitators of patient and parent sleep at night; strategies nurses use to preserve sleep; the distribution, between parent and nurse, of care for the child at night; views of the parent as a recipient of nursing care at night; and the nature of interactions between nurses and families at night. Thirty registered nurses from general pediatric and critical care units participated in one of four semi-structured focus groups. Four main influences on sleep were identified: child factors; environmental factors; nurse-parent interaction factors; and nursing care factors. Some of these restricted nurses' ability to optimize sleep, but many factors were amenable to intervention. Balancing strategies to preserve sleep with the provision of nursing assessment and intervention was challenging and complicated by the difficult nature of work outside of usual waking hours. Nurses highlighted the need for formal policy and mentoring related to provision of nursing care at night in pediatric settings.
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Affiliation(s)
- Robyn Stremler
- Associate Professor, Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Room 288, 155 College Street, Toronto, Ontario, Canada, M5T 1P8.,Adjunct Scientist, The Hospital for Sick Children, Toronto, Canada
| | - Sherri Adams
- Nurse Practitioner, Paediatric Medicine Complex Care Program, The Hospital for Sick Children, Toronto, Canada
| | - Karen Dryden-Palmer
- Clinical Nurse Specialist, Bereavement Coordinator, Critical Care, The Hospital for Sick Children, Toronto, Canada
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25
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McCann D, Bull R, Winzenberg T. Sleep deprivation in parents caring for children with complex needs at home: a mixed methods systematic review. JOURNAL OF FAMILY NURSING 2015; 21:86-118. [PMID: 25527511 DOI: 10.1177/1074840714562026] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
A significant number of children with a range of complex conditions and health care needs are being cared for by parents in the home environment. This mixed methods systematic review aimed to determine the amount of sleep obtained by these parents and the extent to which the child-related overnight health or care needs affected parental sleep experience and daily functioning. Summary statistics were not able to be determined due to the heterogeneity of included studies, but the common themes that emerged are that parents of children with complex needs experience sleep deprivation that can be both relentless and draining and affects the parents themselves and their relationships. The degree of sleep deprivation varies by diagnosis, but a key contributing factor is the need for parents to be vigilant at night. Of particular importance to health care professionals is the inadequate overnight support provided to parents of children with complex needs, potentially placing these parents at risk of poorer health outcomes associated with sleep deprivation and disturbance. This needs to be addressed to enable parents to remain well and continue to provide the care that their child and family require.
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26
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Edéll-Gustafsson U, Angelhoff C, Johnsson E, Karlsson J, Mörelius E. Hindering and buffering factors for parental sleep in neonatal care. A phenomenographic study. J Clin Nurs 2014; 24:717-27. [PMID: 25041598 DOI: 10.1111/jocn.12654] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/01/2014] [Indexed: 11/30/2022]
Abstract
AIMS AND OBJECTIVES To explore and describe how parents of preterm and/or sick infants in neonatal care perceive their sleep. BACKGROUND Parents experience many stressful situations when their newborn infant is preterm and/or sick. This affects bonding. By developing more family-centred care units with single-family rooms, parents are given the opportunity to stay and care for their newborn infant(s) 24 hours a day. Lack of sleep may affect new parents' ability to cope with the many challenges they face on a daily basis. DESIGN A phenomenographic study with an inductive and exploratory design. METHODS Semi-structured interviews were conducted with twelve parents of infants in neonatal care between January-March 2012. To describe variations in perception of the phenomenon, data were analysed using phenomenography. FINDINGS Four descriptive categories were identified within the phenomenon sleep in parents of preterm and/or sick infants in neonatal care: impact of stress on sleep; how the environment affects sleep; keeping the family together improves sleep; and, how parents manage and prevent tiredness. CONCLUSION Anxiety, uncertainty and powerlessness have a negative influence on sleep. This can be decreased by continuous information, guidance and practical support. Skin-to-skin care was perceived as a stress-reducing factor that improved relaxation and sleep and should be encouraged by the nurse. The parents also mentioned the importance of being together. Having a private place where they could relax and take care of themselves and their newborn infant improved sleep. It was also desirable to involve older siblings in order to decrease feelings of loneliness, sadness and isolation. RELEVANCE FOR CLINICAL PRACTICE Improved parental sleep in neonatal care may help the families cope with the situation and facilitate problem-solving, emotional regulation and the transition to parenthood.
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Affiliation(s)
- Ulla Edéll-Gustafsson
- Department of Medicine and Health Sciences, Faculty of Health Sciences, Linköping University, Linköping, Sweden
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27
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Franck L, Wray J, Gay C, Dearmun AK, Alsberge I, Lee KA. Where do parents sleep best when children are hospitalized? A pilot comparison study. Behav Sleep Med 2014; 12:307-16. [PMID: 23745984 DOI: 10.1080/15402002.2013.801347] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
This pilot study compared the sleep quality and quantity of parents who slept at their hospitalized child's bedside with parents who slept at the hospital's onsite Ronald McDonald House® (RMH). Wrist actigraphy and questionnaires were used to estimate parent sleep quality and quantity. Parents who slept at their hospitalized child's bedside (n = 27) experienced more sleep disruption (wake after sleep onset) and reported poorer sleep quality and feeling less rested than parents who slept at RMH (n = 11). Bedside accommodation was associated with poorer parent sleep even when controlling for the covariates of child age and parent gender. Nearby family accommodations, such as RMH, may facilitate parent-child proximity during a child's hospitalization while also providing parents with opportunities for essential sleep.
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Affiliation(s)
- Linda Franck
- a Department of Family Health Care Nursing University of California , San Francisco
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28
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Abstract
OBJECTIVES To describe sleep quantity, sleep patterns, fatigue, and sleepiness for parents of critically ill hospitalized children. DESIGN Prospective observational study. SETTING Quaternary academic PICU. PARTICIPANTS One hundred eighteen parents of 91 children recruited during their child's PICU stay. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS For 5 days and nights, parents wore an actigraph to determine objective sleep-wake times and reported sleep location, level of fatigue (Fatigue Visual Analogue Scale), and sleepiness (Stanford Sleepiness Scale). Mean amounts of nocturnal sleep were less than recommended for optimal health (398 min, fathers vs 422 min, mothers; p = 0.04). Parents woke frequently (7.8 wakes, fathers; 7.2 wakes, mothers) and spent over an hour awake at night (65 min, fathers; 60 min, mothers). On 130 nights (26%), parents slept less than 6 hours and 209 nights (44%) were evaluated as "worse" sleep than usual. Fifty-four parents (53%) experienced more than 30% difference in minutes of sleep between consecutive nights. Mean morning fatigue levels (41 mm, fathers vs 46 mm, mothers; p = 0.03) indicated clinically significant fatigue. Sleeping in a hotel, parent room, or residence was associated with 3.2 more wakes per night (95% CI, 0.61-5.78; p = 0.015) than sleeping in a hospital lounge or waiting room. CONCLUSIONS We performed a prospective observational study of 118 parents of critically ill children using objective measures of sleep and validated scales to assess fatigue and sleepiness. We found that more than a quarter of nights met criteria for acute sleep deprivation, there was considerable variability in the amount of nocturnal sleep that individual participants slept on different nights, and sleep was fragmented with a large portion of the night spent awake. Future research should focus on interventions that improve parents' ability to return to sleep upon awakening and maintain regular sleep-wake schedules.
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29
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Abstract
Family systems are dynamic, with reciprocal interactions among family members. When children have sleep problems, they often awaken a parent, affecting parent sleep and subsequent parent daytime functioning. Child sleep patterns can also be disrupted by parent cognitions related to the child's sleep, as well as when parents are experiencing external stressors (eg, work or marital problems). This article focuses on sleep in a family context, reviewing the relationship between sleep among children and their parents from infancy to adolescence. Sleep in the family when a child has a chronic illness or development disorder is also reviewed.
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Affiliation(s)
- Lisa J. Meltzer
- Assistant Professor of Pediatrics, Division of Pediatric Behavioral Health, National Jewish Health, Denver, CO
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30
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Stremler R, Dhukai Z, Wong L, Parshuram C. Factors influencing sleep for parents of critically ill hospitalised children: a qualitative analysis. Intensive Crit Care Nurs 2010; 27:37-45. [PMID: 21163648 DOI: 10.1016/j.iccn.2010.11.001] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2010] [Revised: 11/08/2010] [Accepted: 11/09/2010] [Indexed: 11/26/2022]
Abstract
The aim of this study was to describe factors affecting the sleep of parents of critically ill children and to determine strategies used to improve their sleep. One hundred and eighteen parents of 91 children recruited during their child's paediatric intensive care unit stay responded in writing to open-ended questions assessing their experiences with sleep and eliciting ideas for strategies to promote sleep to be used by parents and provided by hospital staff. Patterns and concepts were coded and organised into themes using a qualitative descriptive approach. Seven themes emerged related to influences on and strategies to improve sleep: (1) the child's condition; (2) being at the bedside or not; (3) difficult thoughts and feelings; (4) changes to usual sleep; (5) caring for self and family; (6) the hospital environment and (7) access to sleep locations. Parents described multiple, often competing, demands that affected their ability to achieve sleep, regardless of location. Many more factors that influenced sleep were described than strategies to improve sleep, highlighting the need for nurses to explore with parents the unique barriers and facilitators to sleep they encounter and to develop and rigorously test interventions to improve sleep.
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Affiliation(s)
- Robyn Stremler
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Canada.
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