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Carew M, Redley B, Bloomer MJ. Competing Tensions: Nurse Perceptions of Family-Centered Care and Parents' Needs in Neonatal Care. Adv Neonatal Care 2024; 24:35-42. [PMID: 38193725 DOI: 10.1097/anc.0000000000001136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2024]
Abstract
BACKGROUND Family-centered care is founded upon collaboration between parents and healthcare professionals, caring for a child and parents as one entity. The unfamiliar neonatal environment and complexity of care can make family-centered care challenging. PURPOSE To explore neonatal nurses' perceptions of family-centered care and parents' cultural needs. METHODS This was a qualitative descriptive study using interviews to gather data from registered nurses, and analyzed using inductive content analysis. RESULTS Ten neonatal nurses participated in online interviews, lasting an average of 25 minutes. Parents' cultural needs were poorly understood and assumed synonymous with family-centered care. While all acknowledged the importance of family-centered care, most described tasks to parent-infant bonding, rather than a broader embodiment of family-centered care. In time of uncertainty, emergent clinical priorities took priority over a family-centered approach to care. Cultural care was poorly understood, and care tasks associated with supporting parent-infant bonding suggest further work is necessary to promote embodiment of family-centered care beyond individual tasks. While emergent clinical priorities and neonate well-being will always be the priority, finding a way to respond that concords with the ethos of family-centered care is also essential. IMPLICATIONS FOR PRACTICE AND RESEARCH Clear and consistent leadership is needed to demonstrate greater embodiment of family-centered care, which includes cultural care for parents. Strong leadership and targeted education are key to supporting this change. Further research is warranted to examine and observe practice, in particular how parents' cultural needs are assessed and integrated into family-centered care in neonatal settings.
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Affiliation(s)
- Maddison Carew
- Maternity Unit, Bass Coast Health, Wonthaggi, Victoria, Australia (Ms Carew); School of Nursing and Midwifery, Deakin University, Geelong, Victoria, Australia (Ms Carew and Prof Redley); Health Complaints Commissioner, Melbourne, Victoria, 3000, Australia (Prof Redley); and School of Nursing and Midwifery, Griffith University, Nathan, Queensland, and Menzies Health Institute Queensland, Griffith University, Nathan, Queensland, and Intensive Care Unit, Princess Alexandra Hospital, Metro South Health, Woolloongabba, Queensland, Australia (Prof Bloomer)
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Ledin ER, Eriksson A, Mattsson J. "What choice do you have knowing your child can't breathe?!": Adaptation to Parenthood for Children Who Have Received a Tracheostomy. SAGE Open Nurs 2024; 10:23779608241245502. [PMID: 38601012 PMCID: PMC11005490 DOI: 10.1177/23779608241245502] [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: 08/07/2023] [Revised: 01/22/2024] [Accepted: 03/19/2024] [Indexed: 04/12/2024] Open
Abstract
Introduction A growing number of parents are navigating parenthood influenced by medical complexity and technological dependency as the group of children with long-term tracheostomy grows. However, little is known regarding the parental experiences of parenthood for this heterogeneous group of children now surviving through infancy and intensive care. Objective This study aimed to analyze how parents of children who have received a tracheostomy adapted to parenthood. Methods Interviews were conducted and analyzed following a constructivist grounded theory approach. Ten parents of seven children living with a tracheostomy in Sweden were recruited via the long-term intensive care unit (ICU). Results The core variable of parenthood "Stuck in survival" was explained by two categories and six subcategories. The category "Unaddressed previous history" describes the experiences from being in the ICU environment and how the parents are not able, due to insufficient time and resources, to address these stressful experiences. The category "Falling through the cracks of a rigid system" describes how the parents found themselves and their children to be continuously ill-fitted in a medical system impossible to adapt to their needs and situation. Parents placed the starting point of parenthood with the birth of the child, whilst the tracheotomy only constituted a turning point and would lead to the loss of any previously held expectations regarding parenthood. Conclusion This study identified a previously undescribed period prior to tracheostomy placement, which may have long-lasting effects on these families. The care provided in ICUs following the birth of a child who will require tracheostomy may not be tailored or adapted to accommodate the needs of these families leading to long-lasting effects on parenthood.
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Affiliation(s)
- Ellinor Rydhamn Ledin
- Department of Ergonomics - CBH, KTH Royal Institute of Technology, Huddinge, Sweden
- Department of Health Sciences, Swedish Red Cross University, Huddinge, Sweden
| | - Andrea Eriksson
- Department of Ergonomics - CBH, KTH Royal Institute of Technology, Huddinge, Sweden
| | - Janet Mattsson
- Department of Nursing and Health Sciences, University of South-Eastern Norway, Campus Vestfold, Norway
- Department of Nursing and Integrated Health Sciences, Kristianstad University, Kristianstad, Sweden
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Treiman-Kiveste A, Kangasniemi M, Kalda R, Pölkki T. Parental Participation in Their Infants' Procedural Pain Alleviation with Nonpharmacologic Methods in Estonia. Pain Manag Nurs 2023; 24:641-649. [PMID: 37002054 DOI: 10.1016/j.pmn.2023.02.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Revised: 02/11/2023] [Accepted: 02/19/2023] [Indexed: 06/19/2023]
Abstract
BACKGROUND Aim: To describe parent's participation in their infants' procedural pain alleviation using nonpharmacologic methods in neonatal and neonatal intensive care units. METHOD A descriptive cross-sectional survey study was carried out in four Estonian hospitals between 2019 and 2020. Data were collected by using a validated questionnaire comprised of three sections: (1) background information of parents and infants; (2) nonpharmacologic methods used by parents; and (3) parental guidance by nurses on the methods. Altogether 280 questionnaires were distributed to parents and 232 of them were received back. Finally, 189 of them were included in the study (response rate 67.5%). The data were analyzed using descriptive and analytical statistics. Analysis of open-ended questions followed principles of inductive content analysis. RESULTS Most participants reported using nonpharmacologic methods, such as holding and placing the infant in a more comfortable position, nearly always/always (61%, 62%, respectively). However, rarely used methods included skin-to-skin contact (7%), breastfeeding the infant (7%), and listening to recorded music (3%). While studying a correlation between the parents' use of nonpharmacologic methods and their guidance, we found a correlation among all nonpharmacologic methods. However, almost half (48%) of the parents reported that the nurses advised them "sometimes" or "nearly always/ always" to go elsewhere during painful procedures rather than participating in alleviation of the infant´s pain. CONCLUSIONS The parents reported using mostly the nonpharmacologic methods that were easy to implement and did not require thorough instructions in preparation. In addition, it seemed that parents wanted to be more involved in their infant's pain alleviation, but they were advised not to take part in painful procedures and pain alleviation for various reasons. Therefore, more attention should be paid to the principles of family-centered care. As health care providers, we should welcome all families as team members to involve in their infants' pain alleviation in the neonatal and neonatal intensive care units.
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Affiliation(s)
- Airin Treiman-Kiveste
- From the Institute of Family Medicine and Public Health, Faculty of Medicine, University of Tartu, Tartu, Estonia; Nursing and Midwifery Department, Tartu Health Care College, Tartu, Estonia.
| | - Mari Kangasniemi
- From the Institute of Family Medicine and Public Health, Faculty of Medicine, University of Tartu, Tartu, Estonia; University Researcher, University of Turku, Turku, Finland
| | - Ruth Kalda
- From the Institute of Family Medicine and Public Health, Faculty of Medicine, University of Tartu, Tartu, Estonia
| | - Tarja Pölkki
- Research Unit of Nursing Science and Health Management, University of Oulu, Oulu University Hospital, Finland
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Calhoun J, Kline-Tilford A, Verger J. Evolution of Pediatric Critical Care Nursing. Crit Care Nurs Clin North Am 2023; 35:265-274. [PMID: 37532380 DOI: 10.1016/j.cnc.2023.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/04/2023]
Abstract
Pediatric critical care nursing is a key pillar in patient care and outcomes for children who are ill and injured. Tremendous advances have occurred in pediatric critical care and nursing. This article provides an overview of the key advances in pediatric critical care nursing through the decades.
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Affiliation(s)
- Jackie Calhoun
- UPMC Children's Hospital of Pittsburgh, The University of Pittsburgh, School of Nursing, 3500 Victoria Street, 440 Victoria Building, Pittsburgh, PA 15261, USA
| | | | - Judy Verger
- College of Nursing, University of Iowa, Iowa City, Iowa, USA
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Sunkwa-Mills G, Senah K, Tersbøl BP. Infection prevention and control in neonatal units: An ethnographic study of social and clinical interactions among healthcare providers and mothers in Ghana. PLoS One 2023; 18:e0283647. [PMID: 37418459 PMCID: PMC10328309 DOI: 10.1371/journal.pone.0283647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Accepted: 03/14/2023] [Indexed: 07/09/2023] Open
Abstract
INTRODUCTION Healthcare-associated infections (HAIs) are a global health challenge, particularly in low- and middle-income countries (LMICs). Infection prevention and control (IPC) remains an important strategy for preventing HAIs and improving the quality of care in hospital wards. The social environment and interactions in hospital wards are important in the quest to improve IPC. This study explored care practices and the interactions between healthcare providers and mothers in the neonatal intensive care units (NICU) in two Ghanaian hospitals and discusses the relevance for IPC. METHODOLOGY This study draws on data from an ethnographic study using in-depth interviews, focus group discussions involving 43 healthcare providers and 72 mothers, and participant observations in the wards between September 2017 and June 2019. The qualitative data were analysed thematically using NVivo 12 to facilitate coding. FINDINGS Mothers of hospitalized babies faced various challenges in coping with the hospital environment. Mothers received sparse information about their babies' medical conditions and felt intimidated in the contact with providers. Mothers strategically positioned themselves as learners, guardians, and peers to enable them to navigate the clinical and social environment of the wards. Mothers feared that persistent requests for information might result in their being labelled "difficult mothers" or might impact the care provided to their babies. Healthcare providers also shifted between various positionings as professionals, caregivers, and gatekeepers, with the tendency to exercise power and maintain control over activities on the ward. CONCLUSION The socio-cultural environment of the wards, with the patterns of interaction and power, reduces priority to IPC as a form of care. Effective promotion and maintenance of hygiene practices require cooperation, and that healthcare providers and mothers find common grounds from which to leverage mutual support and respect, and through this enhance care for mothers and babies, and develop stronger motivation for promoting IPC.
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Affiliation(s)
- Gifty Sunkwa-Mills
- Ghana Health Service, Central Region, Kasoa, Ghana
- Global Health Section, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Kodjo Senah
- Department of Sociology, University of Ghana, Accra, Ghana
| | - Britt Pinkowski Tersbøl
- Global Health Section, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
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Goldstein G, Karam O, Miller Ferguson N. The Effects of Expectation Setting and Bundle Consent on Acute Caregiver Stress in the PICU: A Randomized Controlled Trial. Pediatr Crit Care Med 2023:00130478-990000000-00195. [PMID: 37125809 DOI: 10.1097/pcc.0000000000003265] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
OBJECTIVES Having a child admitted to the PICU is a stressful experience for parents and can have long-term negative mental health consequences. The objective was to determine if formalized expectation setting and bundled consent for invasive procedures upon admission impacts the acute stress burden on parents. DESIGN Prospective cluster randomized controlled trial. SETTING Single-center, tertiary PICU. SUBJECTS Parents/guardians of patients, 0-18 years old, admitted to PICU. INTERVENTIONS During experimental weeks, all patients admitted to PICU were bundled-consented for common procedures and given a novel unit introductory letter and "Common Procedures Explained" document. During control weeks, all patients were consented for invasive procedures with separate consents for each procedure. Parents then completed a demographic survey and Stress Overload Scale-Short (SOS-S) 48-72 hours after their child's admission. For each participant, the SOS-S generates a Personal Vulnerability (PV) score and an Event Load (EL) score. Parents' perception of the life-threatening nature of their child's condition was also evaluated. MEASUREMENTS AND MAIN RESULTS Over 73 weeks, 1,882 patients were screened and 261 consented to the SOS-S. Median PV score was 10.4 in the control group and 9.1 in the experimental group (p = 0.15). Median EL score was 11.3 for the control group and 10.5 in the experimental group (p = 0.42). Adjusting for demographic variables and severity of illness, there was no independent association between either PV or EL and bundled consent. However, a parent's perception of threat-to-life was significantly related to the allocated group (p = 0.036), which resulted in a decreased percentage of parents who rated their child's illness as "Extremely" life-threatening (experimental group, 17% vs control group, 26%). CONCLUSIONS This study did not demonstrate a decrease in stress when bundled consent was obtained. However, this intervention decreased the parents' perceived severity of illness. Further multicenter studies are needed to evaluate the effects of bundled consent on parents.
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Affiliation(s)
- Gregory Goldstein
- Pediatric Critical Care Medicine, Golisano Children's Hospital, SUNY Upstate Medical University, Syracuse, NY
| | - Oliver Karam
- Pediatric Critical Care Medicine, Department of Pediatrics, Yale School of Medicine, New Haven, CT
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Hookway L, Brown A, Grant A. Breastfeeding sick children in hospital: Exploring the experiences of mothers in UK paediatric wards. MATERNAL & CHILD NUTRITION 2023; 19:e13489. [PMID: 36808886 PMCID: PMC10019061 DOI: 10.1111/mcn.13489] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Revised: 01/16/2023] [Accepted: 01/24/2023] [Indexed: 02/23/2023]
Abstract
There is a paucity of literature exploring the challenges of breastfeeding sick children in hospital. Previous research has focused on single conditions and hospitals which limits understanding of the challenges in this population. Although evidence suggests that current lactation training in paediatrics is often inadequate, it is unclear where the specific training gaps are. This qualitative interview study of UK mothers aimed to explore the challenges of breastfeeding sick infants and children on a paediatric ward or paediatric intensive care unit. From 504 eligible respondents, a sample of 30 mothers of children aged 2-36 months with various conditions and demographic backgrounds was purposively chosen, and a reflexive thematic analysis undertaken. The study identified previously unreported impacts such as complex fluid needs, iatrogenic withdrawal, neurological irritability and changes to breastfeeding behaviour. Mothers described breastfeeding as emotionally and immunologically meaningful. There were many complex psychological challenges such as guilt, disempowerment, and trauma. Wider struggles such as staff resistance to bedsharing, inaccurate breastfeeding information, lack of food and inadequate breast pump provision made breastfeeding more challenging. There are numerous challenges related to breastfeeding and responsively parenting sick children in paediatrics, and these also impacted maternal mental health. Staff skill and knowledge gaps were widespread, and the clinical environment was not always conducive to supporting breastfeeding. This study highlights strengths in clinical care and provides insight into what measures are perceived as supportive by mothers. It also highlights areas for improvement, which may inform more nuanced paediatric breastfeeding standards and training.
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Affiliation(s)
- Lyndsey Hookway
- Centre for Lactation, Infant Feeding and Translation (LIFT), School of Health and Social CareSwansea UniversitySwanseaUK
| | - Amy Brown
- Centre for Lactation, Infant Feeding and Translation (LIFT), School of Health and Social CareSwansea UniversitySwanseaUK
| | - Aimee Grant
- Centre for Lactation, Infant Feeding and Translation (LIFT), School of Health and Social CareSwansea UniversitySwanseaUK
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Setchell B, Marufu TC, Nelson D, Manning JC. Effectiveness of preventative care strategies for reducing pressure injuries (PIs) in children aged 0-18 admitted to intensive care: A systematic review and meta-analysis. J Tissue Viability 2023; 32:228-241. [PMID: 37055299 DOI: 10.1016/j.jtv.2023.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Revised: 03/02/2023] [Accepted: 04/03/2023] [Indexed: 04/08/2023]
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Simpson-Collins M, Fry M, Sheppard-Law S. The Influence of Busyness on the Therapeutic Relationship, Nursing Activities and Teamwork: An Ethnography. Compr Child Adolesc Nurs 2023; 46:65-77. [PMID: 36730835 DOI: 10.1080/24694193.2022.2160517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
To explore a notion of busyness within the context of pediatric acute care and how this influences the therapeutic relationship, nursing activities and teamwork between pediatric nurses and families. Ethnography was the research design. Semi-structured interviews and non-participant observation were used for data collection, which was undertaken in a level four pediatric inpatient unit in Sydney, New South Wales Australia. Brewer's (2000) ethnographic framework for analysis and interpretation was utilized and findings are presented as a realist tale. Interviews with 10 pediatric nurses and 10 parents, and 40 h of non-participant observations were conducted. Three themes are presented, which detail the cultural dimensions of busyness: i) the meaning of busyness; ii) relationships within the pediatric nursing team; and iii) shaping the therapeutic relationship. This ethnography identified how pediatric nurse and parental expectations and collaborative partnerships were re-shaped by busyness. Importantly, the ethnography has presented how busyness is perceived by pediatric nurses and parents, which require new negotiations and a rebalance of workload. Findings have implications for the healthcare workforce and organizational structure. Future research is required to explore how different ways of working better support the pediatric nurse and families during busyness.
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Affiliation(s)
- Melinda Simpson-Collins
- Faculty of Health, School of Nursing and Midwifery Ultimo, NSW, University of Technology Sydney, Sydney, New South Wales, Australia.,Nursing and Midwifery Directorate, Northern Sydney Local Health District, Royal North Shore Hospital, St Leonards, New South Wales, Australia
| | - Margaret Fry
- Faculty of Health, School of Nursing and Midwifery Ultimo, NSW, University of Technology Sydney, Sydney, New South Wales, Australia.,Nursing and Midwifery Directorate, Northern Sydney Local Health District, Royal North Shore Hospital, St Leonards, New South Wales, Australia
| | - Suzanne Sheppard-Law
- Faculty of Health, School of Nursing and Midwifery Ultimo, NSW, University of Technology Sydney, Sydney, New South Wales, Australia.,Sydney Children's Hospital Network, Bright Alliance Building, Randwick, New South Wales, Australia
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Parent and Provider Perspectives on Primary Continuity Intensivists and Nurses for Long-Stay Pediatric Intensive Care Unit Patients. Ann Am Thorac Soc 2023; 20:269-278. [PMID: 36322431 DOI: 10.1513/annalsats.202205-379oc] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
Rationale: Primary continuity intensivists and nurses for long-stay patients (LSPs) in pediatric intensive care units (PICUs) are understudied strategies used to mitigate the fragmented care of typical rotating care models. Objectives: To investigate the advantages and disadvantages of primary continuity intensivists and nurses for LSPs as perceived by their parents and PICU providers. Methods: We conducted a prospective cross-sectional mixed-methods study of the perspectives of parents whose children were admitted to a PICU for >10 days and had one or more complex chronic conditions regarding the care provided by their PICU intensivists and nurses. As part of a trial, patients had been randomized to care provided by a rotating on-service intensivist who changed weekly and by PICU nurses who changed every 12 hours (usual care group) or to care provided by the same on-service intensivist plus a primary continuity intensivist and primary nurses (primary group). In addition, PICU providers (intensivists, fellows, and nurses) were queried for their perspectives on primary intensivists and nurses. Novel questionnaires, assessed for content and face validity and for readability, were used. The parental questionnaire involved indicating their degree of agreement with 16 statements about their children's care. The provider questionnaire involved rating potential advantages of primary continuity intensivists and nurses and estimating the frequency of disadvantages. Descriptive statistics and divergent stack bar charts were used; parents' and providers' responses were compared, stratified by their children's group (usual care or primary) and provider role, respectively. Results: The parental response rate was 71% (120 completed questionnaires). For 10 of 16 statements, parents whose children had primary continuity intensivists and nurses indicated significantly more positive perceptions of care (e.g., communication, listening, decision making, problems due to changing providers). The provider response rate was 61% (117 completed questionnaires); more than 80% believed that primary intensivists and nurses were highly or very highly beneficial for LSPs. Providers perceived more benefits for patients/families (e.g., informational continuity, facilitating and expediting decision making) than for staff/institutions (e.g., staff satisfaction). Providers reported associated stress, expenditure of time and effort, and decreased staffing flexibility with primary practices. Conclusions: Perceived benefits of primary continuity intensivists and nurses by both parents and providers support more widespread adoption and study of these continuity strategies.
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Andrade RC, Leite ACAB, Alvarenga WDA, Neris RR, Araújo JS, Polita NB, Silva-Rodrigues FM, De Bortoli PS, Jacob E, Nascimento LC. Parental psychosocial needs in Brazilian paediatric intensive care units. Intensive Crit Care Nurs 2022; 72:103277. [PMID: 35672209 DOI: 10.1016/j.iccn.2022.103277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Revised: 04/30/2022] [Accepted: 05/30/2022] [Indexed: 11/05/2022]
Abstract
BACKGROUND Having children admitted in the intensive care unit is a demanding experience for parents. They encounter several difficulties during this process, and it is important to properly identify their psychosocial needs for the health team to address appropriately. OBJECTIVE The aim of the study is to identify the psychosocial needs encountered by parents of children in pediatric intensive care units in Brazil. METHODS A descriptive study with a qualitative approach was used to increase understanding of psychosocial experiences of parents. Individual semi-structured interviews were conducted with 11 parents of hospitalized children in pediatric intensive care units in Brazil. Thematic analysis was used to analyze the data. The university ethics review committee approved the research protocol. All parents were informed on study details and provided written consent prior to the interview. RESULTS Four themes were constructed: 1) Support from family and peers; 2) Support from the healthcare team; 3) Parental role; and 4) Emotional recovery. Parents expressed diverse psychosocial needs based on family and peer social support, child's clinical condition, as well as the structure, norms, and routines of health care teams during hospitalization. CONCLUSIONS The findings highlight the importance of nursing assessment of psychosocial experiences encountered by parents of children in pediatric intensive care units, which will guide planning of individualized interventions and to increase family-centered care in pediatric intensive care units.
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Affiliation(s)
- Rosyan Carvalho Andrade
- Centro Universitário de Lavras, Rua Padre José Poggel, 506, Centenario, Lavras, Minas Gerais 37200-000, Brazil
| | - Ana Carolina Andrade Biaggi Leite
- Escola de Enfermagem de Ribeirão Preto, Universidade de São Paulo, Av. dos Bandeirantes, 3900, Campus Universitário, Bairro Monte Alegre, Ribeirão Preto, São Paulo, Brazil
| | | | - Rhyquelle Rhibna Neris
- Escola de Enfermagem de Ribeirão Preto, Universidade de São Paulo, Av. dos Bandeirantes, 3900, Campus Universitário, Bairro Monte Alegre, Ribeirão Preto, São Paulo, Brazil
| | - Jeferson Santos Araújo
- Universidade Federal da Fronteira Sul, Av. Fernando Machado, 108E, Centro, Chapecó, Santa Catarina 89801-501, Brazil
| | - Naiara Barros Polita
- Universidade Estadual de Londrina, Rodovia Celso Garcia Cid, PR-445, Km 380, Campus Universitário, Londrina, Paraná, Brazil
| | | | - Paula Saud De Bortoli
- Escola de Enfermagem de Ribeirão Preto, Universidade de São Paulo, Av. dos Bandeirantes, 3900, Campus Universitário, Bairro Monte Alegre, Ribeirão Preto, São Paulo, Brazil
| | - Eufemia Jacob
- School of Nursing, University of California, Los Angeles, Factor Bldg, 700 Tiverton Dr, Los Angeles, CA 90095, United States
| | - Lucila Castanheira Nascimento
- Escola de Enfermagem de Ribeirão Preto, Universidade de São Paulo, Av. dos Bandeirantes, 3900, Campus Universitário, Bairro Monte Alegre, Ribeirão Preto, São Paulo, Brazil.
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Abdin S, Heath G, Neilson S, Byron‐Daniel J, Hooper N. Decision-making experiences of health professionals in withdrawing treatment for children and young people: A qualitative study. Child Care Health Dev 2022; 48:531-543. [PMID: 34994015 PMCID: PMC9306775 DOI: 10.1111/cch.12956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Revised: 12/20/2021] [Accepted: 12/31/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To explore factors that influence professionals in deciding whether to withdraw treatment from a child and how decision making is managed amongst professionals as an individual and as a team. STUDY DESIGN Semi-structured interviews were conducted with a purposive sample of health professionals working at a UK Children's Hospital, with children with life-limiting illnesses whose treatment has been withdrawn. Data were transcribed verbatim, anonymized and analysed using a thematic framework method. RESULTS A total of 15 participants were interviewed. Five interrelated themes with associated subthemes were generated to help understand the experiences of health professionals in decision making on withdrawing a child's treatment: (1) understanding the child's best interests, (2) multidisciplinary approach, (3) external factors, (4) psychological well-being and (5) recommendations to support shared decision making. CONCLUSION A shared decision-making approach should be adopted to support professionals, children and their families to make decisions collectively.
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Affiliation(s)
- Shanara Abdin
- Faculty of Health and Applied SciencesUniversity of the West of EnglandBristolUK,Public Health and WellbeingCity of Wolverhampton CouncilWolverhamptonUK
| | - Gemma Heath
- School of PsychologyAston UniversityBirminghamUK
| | - Susan Neilson
- School of NursingUniversity of BirminghamBirminghamUK
| | - James Byron‐Daniel
- Faculty of Health and Applied SciencesUniversity of the West of EnglandBristolUK
| | - Nic Hooper
- School of PsychologyCardiff UniversityCardiffUK
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Uuksulainen M, Rajala M, Kanste O, Pölkki T. Translation and cultural adaptation of the Family Centered Care Assessment Scale (FCCAS) for Finnish pediatric nursing. J Pediatr Nurs 2022; 62:51-59. [PMID: 34801323 DOI: 10.1016/j.pedn.2021.11.004] [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: 04/12/2021] [Revised: 11/01/2021] [Accepted: 11/05/2021] [Indexed: 11/24/2022]
Abstract
PURPOSE The purpose of this study was to translate and culturally adapt the Family Centered Care Assessment Scale (FCCAS) to evaluate family-centered care in the context of Finnish pediatric nursing. DESIGN AND METHODS The translation and cultural adaptation were done according guidelines of International Society for Pharmacoeconomics and Outcomes (ISPOR), which constitute a systematic process including ten phases. The presented research included cognitive interviews conducted with the end user of the scale: parents of hospitalized children. RESULTS The FCCAS was successfully translated and culturally adapted to the Finnish context. Translational, clinical and parental expertise were used to develop the scale. Conceptual equivalence was achieved in the translation. In the cultural adaptation, some of the items were modified based on experts' assessments to make them comprehensible and appropriate to the Finnish culture. The scale showed good evidence of content. Reporting of the study adheres to the COSMIN checklist. CONCLUSIONS Combining ISPOR guidelines and cognitive interviews are recommended to use in the translation and cultural adaptation process. Nursing staff and parents' involvement and awareness of family-centered care have been concretized. Systematic translation and cultural adaptation have prepared a Finnish version of the scale for psychometric testing. PRACTICE IMPLICATIONS The study outlines how rigorous methodological approaches can be applied to the translation and cultural adaptation of a measurement tool. The developed scale includes items which comprehensively cover family-centered care characteristics. In following study, it will be possible to evaluate the extent to which family-centered care is implemented in Finnish pediatric nursing.
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Affiliation(s)
- Minttu Uuksulainen
- Research Unit of Nursing Science and Health Management, University of Oulu, Oulu, Finland.
| | - Mira Rajala
- Research Unit of Nursing Science and Health Management, University of Oulu, Oulu, Finland
| | - Outi Kanste
- Research Unit of Nursing Science and Health Management, University of Oulu, Oulu, Finland
| | - Tarja Pölkki
- Research Unit of Nursing Science and Health Management, University of Oulu, Oulu, Finland; Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland
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Dien R, Benzies KM, Zanoni P, Kurilova J. Alberta Family Integrated Care™ and Standard Care: A Qualitative Study of Mothers' Experiences of their Journeying to Home from the Neonatal Intensive Care Unit. Glob Qual Nurs Res 2022; 9:23333936221097113. [PMID: 35707318 PMCID: PMC9189529 DOI: 10.1177/23333936221097113] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Revised: 03/17/2022] [Accepted: 03/19/2022] [Indexed: 12/04/2022] Open
Abstract
Globally, one in ten infants is born preterm. Most preterm infants require care in a level II Neonatal Intensive Care Unit (NICU), which are highly technological critical care environments that can be overwhelming for parents. Alberta Family Integrated Care (AB-FICare™) is an approach to care that provides strategies to integrate parents into their infant’s care team. This sub-study is the first to compare mothers’ experiences in the context of AB-FICare™ and standard care. Semi-structured interviews with mothers from AB-FICare™ (n = 14) and standard care (n = 12) NICUs were analyzed using interpretive description informed by grounded theory methods. We identified a major theme of Journeying to Home with six categories: Recovering from Birth, Adapting to the NICU, Caring for Baby, Coping with Daily Disruption, Seeing Progress, and Supporting Parenting. Mothers in the AB-FICare™ group identified an enhancement to standard care related to building reciprocal trust with healthcare providers that accelerated Journeying to Home.
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15
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Barratt M, Bail K, Paterson C. Children living with long-term conditions: A meta-aggregation of parental experiences of partnership nursing. J Clin Nurs 2021; 30:2611-2633. [PMID: 33829591 DOI: 10.1111/jocn.15770] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Revised: 03/02/2021] [Accepted: 03/16/2021] [Indexed: 01/30/2023]
Abstract
AIM To explore how parents of children with long-term conditions experience partnership in paediatric and neonatal nursing care and to identify existing partnership barriers and facilitators. BACKGROUND Parent-nurse partnership is fundamental to paediatric and neonatal nursing. Partnership is characterised by five attributes: parental participation, negotiation, mutual trust and respect, shared roles and decision-making, and communication. Little is known about the parental experiences of partnership nursing specific to children living with a long-term condition. DESIGN A qualitative meta-aggregation review following Joanna Briggs Institute meta-aggregation approach. METHODS A comprehensive search was conducted in six electronic databases. Studies were assessed according to the inclusion and exclusion criteria. Qualitative findings with illustrative quotes from included studies were extracted and grouped into categories which informed the synthesised findings. This review has been reported according to the PRISMA guidelines. FINDINGS A total of 4,404 studies were screened, 162 full-text studies were assessed against the inclusion and exclusion criteria, and a total of six studies were included. The meta-aggregation developed three overarching synthesised findings which were as follows: (a) empowering parents to become involved, (b) effective communication to recognise mutual expertise and (c) collaborative nurse-family relationships. CONCLUSION Parents valued collaboration where both parents and nurses are recognised equally for their skills and expertise. A power struggle existed between parents and nurses when expertise was not recognised. Parents appreciated nurses who empowered them to develop new skills and knowledge in the care of their own child. RELEVANCE TO CLINICAL PRACTICE Nurses need to recognise the skills and knowledge that parents have surrounding the care requirements of their own children. Collaboration and negotiation are key to successful partnership between nurses and parents. Nurses need to frequently reflect on how they are successfully partnering with both parents and children and ensure all parties in the nurse/parent/child triad feel supported and empowered.
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Affiliation(s)
- Macey Barratt
- School of Nursing, Midwifery and Public Health, University of Canberra, Bruce, ACT, Australia
| | - Kasia Bail
- School of Nursing, Midwifery and Public Health, University of Canberra, Bruce, ACT, Australia.,Canberra Health Services & ACT Health, SYNERGY Nursing & Midwifery Research Centre, Canberra Hospital, Canberra, ACT, Australia
| | - Catherine Paterson
- School of Nursing, Midwifery and Public Health, University of Canberra, Bruce, ACT, Australia.,Canberra Health Services & ACT Health, SYNERGY Nursing & Midwifery Research Centre, Canberra Hospital, Canberra, ACT, Australia.,Prehabilitation, Activity, Cancer, Exercises and Survivorship (PACES) Research Group, University of Canberra, Bruce, ACT, Australia.,Robert Gordon University, Aberdeen, UK
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16
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Knight Lozano R, May S, Clarkson C, Sarjeant R. Caregiver experiences of paediatric inpatient cardiac services: A qualitative systematic review. Eur J Cardiovasc Nurs 2020; 20:147-159. [PMID: 33849062 DOI: 10.1177/1474515120951974] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Revised: 07/04/2020] [Accepted: 08/02/2020] [Indexed: 11/15/2022]
Abstract
BACKGROUND Advances in paediatric care have contributed to an increasing survival of children with complex heart disease. Yet, life-saving management demands prolonged inpatient admissions, which contribute to emotional and psychological distress for parents and other caregivers in a role of main custody. AIM The purpose of this study was to identify, appraise and synthesise qualitative studies exploring caregivers' experiences of paediatric inpatient cardiac services, generating an understanding of their needs in hospital and informing priorities for change in healthcare delivery. METHODS Searches were conducted in Medline, Allied and Complimentary Medicine Database, Cumulative Index of Nursing and Allied Health Literature, EMCARE, Scopus, PsychINFO, Proquest, OpenGrey and ETHOs from 2008-2019, reflecting recent advances in cardiac healthcare. Articles were selected using predetermined eligibility criteria dictating qualitative inquiry into caregiver perspectives whilst their child received hospital-based interventions for heart disease. All eligible studies underwent quality appraisal. Framework synthesis was used to analyse and summarise findings. RESULTS Twenty-seven studies involving 689 caregivers from 11 countries were included. Three overarching themes were identified: 'emotional capacity to care', 'practicalities of caring', and 'the bigger picture of caring'. CONCLUSIONS Through analysis and summary of qualitative primary research, this review captures the emotional challenges that caregivers face and practicalities of undertaking a caregiver role, whilst looking after their child with heart disease in hospital. The results widen the context of the caregiver role, encompassing the whole family unit beyond the hospital environment. This review exposes the impact of these challenges on caregiver competence, wellbeing and attachment to their unwell child, informing priorities for development of family-centred paediatric inpatient cardiac services.
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Affiliation(s)
| | - Stephen May
- Faculty of Health and Wellbeing, Sheffield Hallam University, UK
| | - Carl Clarkson
- Department of Sport, Exercise and Rehabilitation, Northumbria University, UK
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Abstract
IntroductionBreastfeeding rates among children who have a serious illness or congenital condition are lower than the general population. There are many barriers to maintaining lactation during a child's illness, and specific training issues among staff working in pediatric departments.MethodThis is a narrative review of some of the most common challenges highlighted during a literature search prior to a research study that is being undertaken to explore this phenomenon in greater detail.ResultsThere are many identified challenges for families of sick children. Lactation may be threatened or discontinued if the barriers are not adequately addressed. Lactation professionals working in any setting may work with families who are coping with difficulties that require more support.ConclusionBreastfeeding sick children, and those with complex medical conditions, requires adaptations and more specialized skills. Many families feel unsupported by their medical teams. Recommendations are made for collaborative working between pediatric medicine and surgery, nursing, oncology, radiology, dietetics, anesthetics, pain management, play therapy, child psychology, palliative care, social support, and lactation support.
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18
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Koreska M, Petersen M, Andersen BL, Brødsgaard A. Supporting families on their journey towards a normal everyday life - facilitating partnership in an early discharge program for families with premature infants. J SPEC PEDIATR NURS 2020; 25:e12274. [PMID: 31576656 DOI: 10.1111/jspn.12274] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Revised: 09/06/2019] [Accepted: 09/13/2019] [Indexed: 01/07/2023]
Abstract
PURPOSE Several Danish neonatal intensive care units (NICUs) offer the possibility of an early discharge program (EDP) for families with premature infants, when the infant reaches the gestational age ≥ 34 weeks and a weight ≥ 1,500 g. The purpose of this study is to explore how the partnership with these families can be facilitated by the nurse based on the principles of the framework of family centered care (FCC). DESIGN AND METHODS The study was conducted as an ethnographic inquiry inspired by Spradley and based on participant observation of 12 contacts between nurse and family, one informal and three formal interviews with nurses in the EDP-unit of a Danish NICU. RESULTS This study illustrates how EDP-nurses facilitate a partnership with the families enrolled in EDP by using a range of complex strategies to adjust their care to the family's changing needs, while acknowledging the family's way of being. The partnership typically develops in three phases: "Settling in EDP," "Thriving in EDP," and "Leaving the EDP nest." The EDP-nurses have a clear understanding of whether a partnership is well functioning or challenging and they play a unique role by facilitating a partnership that supports the family on the journey towards a normal everyday life. PRACTICE IMPLICATIONS The knowledge unraveled in this study may prove helpful for training future EDP-nurses in the neonatal field of FCC, when improving the quality of an existing EDP or developing a new EDP based on the principles of FCC.
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Affiliation(s)
- Mai Koreska
- Unit of Neonatology, Department of Paediatrics and Adolescent Medicine, Copenhagen University Hospital Amager Hvidovre, Capital Region of Denmark, Denmark
| | - Mette Petersen
- Unit of Neonatology, Department of Paediatrics and Adolescent Medicine, Copenhagen University Hospital Amager Hvidovre, Capital Region of Denmark, Denmark
| | - Bente Lund Andersen
- Unit of Neonatology, Department of Paediatrics and Adolescent Medicine, Copenhagen University Hospital Amager Hvidovre, Capital Region of Denmark, Denmark
| | - Anne Brødsgaard
- Unit of Neonatology, Department of Paediatrics and Adolescent Medicine, Copenhagen University Hospital Amager Hvidovre, Capital Region of Denmark, Denmark.,Section for Nursing, Department of Public Health, University of Aarhus, Denmark
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19
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Al Mutair A, Al Ammary M, Brooks LA, Bloomer MJ. Supporting Muslim families before and after a death in neonatal and paediatric intensive care units. Nurs Crit Care 2019; 24:192-200. [PMID: 31124208 DOI: 10.1111/nicc.12434] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Revised: 04/11/2019] [Accepted: 04/24/2019] [Indexed: 11/28/2022]
Abstract
BACKGROUND The death of a child is regarded as one of the most devastating events for a family. Families are reliant on nurses to not only provide end-of-life care but also to support and care for grieving families in a way that is sensitive to their cultural and religious needs and preferences. AIMS The aim of this study was to explore the perceived impact and influence of cultural diversity on how neonatal and paediatric intensive care nurses care for Muslim families before and after the death of infants/children. DESIGN A qualitative descriptive approach was used in this study, conducted in Saudi Arabia. METHODS Semi-structured interviews were used to gather data from a convenience sample of registered nurses working in neonatal and paediatric intensive care, with experience in providing end-of-life care. Interviews were conducted between July and November, 2018. Interviews were audio-recorded and transcribed for analysis. RESULTS Thirteen registered nurses participated; all were born overseas, identified with various faiths and spoke English in the workplace. A respect for diversity and care of the family was prioritized yet impacted by communication challenges. Caring and respect was demonstrated by facilitating important cultural and religious practices important in the Muslim faith. Self-care was identified as important, transcending the culturally diverse nature of the nursing workforce. CONCLUSIONS Significant challenges exist for a culturally diverse nursing workforce in providing care to a Saudi Muslim population of infants/children and families, before and after a death. Their overriding commitment to respect for others, and an openness to cultural diversity and difference, aided in overcoming the inherent challenges in providing culturally sensitive end-of-life care that meets the needs of Muslim families. These findings provide valuable insights for intensive care clinicians in other countries to address challenges associated with cultural diversity.
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Affiliation(s)
- Abbas Al Mutair
- Research Center, Dr Sulaiman Al Habib Medical Group, Riyadh, Saudi Arabia.,School of Nursing, Wollongong University, Wollongong, New South Wales, Australia.,Alfaisal University, Riyadh, Saudi Arabia
| | - Maram Al Ammary
- Prince Sultan Medical City, Cardiac Center, Riyadh, Saudi Arabia
| | - Laura A Brooks
- School of Nursing and Midwifery, Deakin University, Geelong, Melbourne, Australia
| | - Melissa J Bloomer
- School of Nursing and Midwifery, Deakin University, Geelong, Melbourne, Australia.,Centre for Quality and Patient Safety Research, Deakin University, Geelong, Melbourne, Australia
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20
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Sarin E, Maria A. Acceptability of a family-centered newborn care model among providers and receivers of care in a Public Health Setting: a qualitative study from India. BMC Health Serv Res 2019; 19:184. [PMID: 30898170 PMCID: PMC6427855 DOI: 10.1186/s12913-019-4017-1] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2018] [Accepted: 03/15/2019] [Indexed: 12/27/2022] Open
Abstract
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.
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Affiliation(s)
| | - Arti Maria
- Department of Neonatology, PGIMER & assoc. Dr. RML Hospital, New Delhi, India
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21
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Impact of the mother–nurse partnership programme on mother and infant outcomes in paediatric cardiac intensive care unit. Intensive Crit Care Nurs 2019; 50:79-87. [DOI: 10.1016/j.iccn.2018.03.006] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2017] [Revised: 03/19/2018] [Accepted: 03/26/2018] [Indexed: 11/22/2022]
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22
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Dall'Oglio I, Mascolo R, Tiozzo E, Portanova A, Fiori M, Gawronski O, Dotta A, Piga S, Offidani C, Alvaro R, Rocco G, Latour JM. The current practice of family-centred care in Italian neonatal intensive care units: A multicentre descriptive study. Intensive Crit Care Nurs 2019; 50:36-43. [DOI: 10.1016/j.iccn.2018.07.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2018] [Revised: 07/08/2018] [Accepted: 07/09/2018] [Indexed: 10/28/2022]
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23
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Tatterton MJ, Walshe C. Understanding the bereavement experience of grandparents following the death of a grandchild from a life‐limiting condition: A meta‐ethnography. J Adv Nurs 2019; 75:1406-1417. [DOI: 10.1111/jan.13927] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Revised: 09/12/2018] [Accepted: 11/21/2018] [Indexed: 11/28/2022]
Affiliation(s)
- Michael J. Tatterton
- Martin House Children's Hospice Wetherby West Yorkshire UK
- International Observatory on End of Life Care Lancaster University Lancaster UK
| | - Catherine Walshe
- International Observatory on End of Life Care Lancaster University Lancaster UK
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24
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Vanhoy MA, Horigan A, Stapleton SJ, Valdez AM, Bradford JY, Killian M, Reeve NE, Slivinski A, Zaleski ME, Proehl J, Wolf L, Delao A, Gates L. Clinical Practice Guideline: Family Presence. J Emerg Nurs 2019; 45:76.e1-76.e29. [DOI: 10.1016/j.jen.2018.11.012] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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25
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Smith W. Concept Analysis of Family-Centered Care of Hospitalized Pediatric Patients. J Pediatr Nurs 2018; 42:57-64. [PMID: 30219300 DOI: 10.1016/j.pedn.2018.06.014] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2018] [Revised: 06/28/2018] [Accepted: 06/28/2018] [Indexed: 10/28/2022]
Abstract
AIM The purpose of this concept analysis is to provide a background of family-centered care of the hospitalized pediatric patient, clarify its components, and validate its significance to nursing practice and research. BACKGROUND The concept of family-centered care in the hospital environment has been discussed in the literature for over 60 years, yet its principles remain unclear and poorly implemented. Further analysis of this concept is warranted and has the potential to promote its integration into current nursing practice by increasing awareness and clarifying the essential attributes. DATA SOURCES A systematic review of the literature yielded thousands of resources which were narrowed to a comprehensive list of 37 sources rich in valuable and applicable content. REVIEW METHODS This analysis utilized the 8-step methodology of concept analysis described by Walker and Avant. FINDINGS The majority of research investigating the concept of family-centered care and the hospitalized pediatric patient found was focused on defining family-centered care and surveying both families and nurses on their understanding of the concept. Little research was found exploring the relationship of family-centered care with patient and family outcomes, or patient and family satisfaction. CONCLUSION Family-centered care of the pediatric patient in the hospital environment remains an abstract concept. It is recommended as a cornerstone of modern nursing practice, yet nurses report they lack sufficient education regarding its operationalization into practice. Elucidation of characteristics coupled with education regarding principles of the concept has the potential to augment further integration of family-centered care in the hospital environment.
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Affiliation(s)
- Wendi Smith
- Villanova University, Fitzpatrick College of Nursing, Villanova, PA, USA.
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26
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Hill C, Knafl KA, Docherty S, Santacroce SJ. Parent perceptions of the impact of the Paediatric Intensive Care environment on delivery of family-centred care. Intensive Crit Care Nurs 2018; 50:88-94. [PMID: 30061085 DOI: 10.1016/j.iccn.2018.07.007] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2018] [Revised: 06/22/2018] [Accepted: 07/12/2018] [Indexed: 01/24/2023]
Abstract
OBJECTIVES To examine parent perception of how the physical and cultural environment of the paediatric intensive care unit impacted the implementation of family-centred care as outlined by the Institute for Patient and Family Centered Care. RESEARCH DESIGN A qualitative descriptive design utilizing secondary analysis from a longitudinal study. Sixty-one interviews with three mothers and three fathers (31 interviews with mothers, 30 interviews with fathers) of infants with complex congenital heart defects treated in a paediatric intensive care unit were subjected to secondary analysis via content analysis. The previously completed individual interviews with parents took place at least monthly ranging from soon after birth of their infant to one year of age or infant death, whichever occurred first. FINDINGS The family-centred care core concepts of information sharing, participation, respect and dignity were present in parent interviews. Parents indicated that the physical and cultural environment of the pediatric intensive care unit impacted their perceptions of how each of the core concepts was implemented by clinicians. The unit environment both positively and negatively impacted how parents experienced their infant's hospitalisation. CONCLUSION In the paediatric intensive care unit, family centred care operationalised as policy differed from actual parent experiences. The impact of the physical and cultural environment should be considered in the delivery of critical care, as the environment was shown to impact implementation of each of the core concepts.
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Affiliation(s)
- Carrie Hill
- University of North Carolina at Chapel Hill, School of Nursing, Carrington Hall, Campus Box 7460, Chapel Hill, NC 27599-7460, United States.
| | - Kathleen A Knafl
- University of North Carolina at Chapel Hill, School of Nursing, Carrington Hall, Campus Box 7460, Chapel Hill, NC 27599-7460, United States
| | - Sharron Docherty
- Duke University School of Nursing, 307 Trent Drive, Durham, NC 27710, United States
| | - Sheila Judge Santacroce
- University of North Carolina at Chapel Hill, School of Nursing, Carrington Hall, Campus Box 7460, Chapel Hill, NC 27599-7460, United States
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Hill C, Knafl KA, Santacroce SJ. Family-Centered Care From the Perspective of Parents of Children Cared for in a Pediatric Intensive Care Unit: An Integrative Review. J Pediatr Nurs 2018; 41:22-33. [PMID: 29153934 PMCID: PMC5955783 DOI: 10.1016/j.pedn.2017.11.007] [Citation(s) in RCA: 72] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2017] [Revised: 11/08/2017] [Accepted: 11/08/2017] [Indexed: 10/18/2022]
Abstract
PROBLEM The Institute for Patient- and Family-Centered Care's (IPFCC) definition of family-centered care (FCC) includes the following four core concepts: respect and dignity, information sharing, participation, and collaboration. To date, research has focused on the provider experience of FCC in the PICU; little is known about how parents of children hospitalized in the pediatric intensive care unit (PICU) experience FCC. ELIGIBILITY CRITERIA Articles were included if they were published between 2006 and 2016, included qualitative, quantitative, or mixed methods results, related to care received in a PICU, and included results that were from a parent perspective. SAMPLE 49 articles from 44 studies were included in this review; 32 used qualitative/mixed methods and 17 used quantitative designs. RESULTS The concepts of respect and dignity, information sharing, and participation were well represented in the literature, as parents reported having both met and unmet needs in relation to FCC. While not explicitly defined in the IPFCC core concepts, parents frequently reported on the environment of care and its impact on their FCC experience. CONCLUSIONS As evidenced by this synthesis, parents of critically ill children report both positive and negative FCC experiences relating to the core concepts outlined by the IPFCC. IMPLICATIONS There is a need for better understanding of how parents perceive their involvement in the care of their critically ill child, additionally; the IPFCC core concepts should be refined to explicitly include the importance of the environment of care.
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Affiliation(s)
- Carrie Hill
- University of North Carolina at Chapel Hill, School of Nursing, Chapel Hill, NC, United States.
| | - Kathleen A Knafl
- University of North Carolina at Chapel Hill, School of Nursing, Chapel Hill, NC, United States
| | - Sheila Judge Santacroce
- University of North Carolina at Chapel Hill, School of Nursing, Chapel Hill, NC, United States
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28
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Guidelines of admission, discharge and organization of the pediatric intensive care. Med Intensiva 2018; 42:203-204. [PMID: 29463425 DOI: 10.1016/j.medin.2017.12.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2017] [Accepted: 12/25/2017] [Indexed: 11/23/2022]
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29
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Psychosocial Care Models for Families of Critically Ill Children in Pediatric Emergency Department Settings: A Scoping Review. J Pediatr Nurs 2018; 38:46-52. [PMID: 29167080 DOI: 10.1016/j.pedn.2017.10.014] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2017] [Revised: 10/21/2017] [Accepted: 10/22/2017] [Indexed: 11/23/2022]
Abstract
PROBLEM Critical illness in children is a significant and stressful life event for families. Within pediatric emergency department (ED) settings it is acknowledged that these crises are challenging for both the families of these children, and for the clinical staff treating the child. Literature recommends routine care should include an offer to the family to be present with their critically ill child, however there is a lack of clarity regarding specific family care models or evidence-based interventions to guide clinical practice. ELIGIBILITY CRITERIA Peer reviewed articles written in English, published between 2006 and 2016, proposing or testing psychosocial care models in pediatric (or mixed) emergency settings. SAMPLE Nine articles met inclusion criteria. RESULTS Search results showed limited evidence available in the literature at this time. Thematic analysis of article content and proposed model showed strong support for the benefit of family presence, including shifting the family role from passive to active, needing to be inclusive of the psychological impact of critical health events, importance of multidisciplinary education, and the need for additional exploratory and empirical research to evaluate and refine proposed care models. CONCLUSIONS Pediatric emergency health events are challenging for both families and staff, and care models provide staff with a consistent, evidence-informed approach to caring for families in challenging situations. IMPLICATIONS There is a need to find common ground from specific discipline guidelines into a multidisciplinary team approach for the care of families within emergency care.
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Foster M, Whitehead L. Family centred care in the paediatric high dependency unit: Parents' and Staff's perceptions. Contemp Nurse 2017; 53:489-502. [PMID: 29173077 DOI: 10.1080/10376178.2017.1410067] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
AIM This study explored parent and staff perceptions of family centred care (FCC) within a paediatric high dependency in one New Zealand hospital. BACKGROUND FCC is a partnership approach to healthcare delivery where the child's treatment is aligned to the family's needs. Despite widespread endorsement of FCC, variations between parents and staff in healthcare settings continues to be evident. METHOD A descriptive qualitative cross-sectional design was used with a convenience sample where written responses for one open ended question from 91 parents and 66 staff resident with their child or working within a paediatric high dependency unit in New Zealand. RESULTS The parents' responses generated three themes (family, treatment and relationships) and the staff's responses generated two themes (family and treatment). CONCLUSION Whilst there were similarities in describing the meaning of family centred care between parents and staff, their views on the central focus of this differed.
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Affiliation(s)
- Mandie Foster
- a School of Nursing and Midwifery , Edith Cowan University , 270 Joondalup Drive, Building 21, Joondalup , WA 6027 , Australia
| | - Lisa Whitehead
- a School of Nursing and Midwifery , Edith Cowan University , 270 Joondalup Drive, Building 21, Joondalup , WA 6027 , Australia.,b Centre for Postgraduate Nursing Studies , University of Otago , Christchurch , New Zealand
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31
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Moola FJ, Henry LA, Huynh E, Stacey JA, Faulkner GE. They know it's safe - they know what to expect from that face: perceptions towards a cognitive-behavioural counselling programme among caregivers of children with cystic fibrosis. J Clin Nurs 2017; 26:2932-2943. [PMID: 27805749 DOI: 10.1111/jocn.13622] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/26/2016] [Indexed: 11/30/2022]
Abstract
AIMS AND OBJECTIVES To explore the experiences of eight caregivers who provide care to children with cystic fibrosis in an eight-week cognitive-behavioural counselling programme at a children's hospital in Winnipeg, Canada. BACKGROUND Youth with cystic fibrosis experience significant behavioural and psychosocial challenges, such as depression, anxiety and poor treatment adherence. Caregivers are critical to the provision of care and treatment to young people living with cystic fibrosis. Caregivers of youth with cystic fibrosis experience psychosocial morbidity. Thus, the development of counselling interventions is required to enhance psychosocial well-being among the caregivers of youth with cystic fibrosis. DESIGN AND METHODS This study was informed by the thematic analytic qualitative research tradition. In-depth, semistructured interviews were conducted with eight caregivers who participated in our programme. The audiotaped interviews were then subject to thematic analysis. RESULTS The counselling sessions were experienced as 'distinctly different' from routine appointments at the hospital and were characterised by a sense of listening and bidirectional communication. In addition to acquiring a sense of trust and accountability through the programme, counselling appeared to enhance caregivers' perception of their time use, leading to greater temporal agency. CONCLUSION AND RELEVANCE TO CLINICAL PRACTICE From this evidence-based cognitive-behavioural counselling programme, insights about the complex psychosocial lives of the cystic fibrosis community are discussed within the context of the literature. Integrating cognitive-behavioural counselling into routine clinical CF care should be considered as a method to enhance caregiving capacity in the CF community and should be championed by nurses.
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Affiliation(s)
- Fiona J Moola
- Kinesiology and Recreation Management, University of Manitoba, Winnipeg, MB, Canada.,Children's Hospital Research Institute of Manitoba, Health Sciences Centre, Winnipeg, MB, Canada
| | | | | | - Jenna A Stacey
- Children's Hospital Research Institute of Manitoba, Health Sciences Centre, Winnipeg, MB, Canada
| | - Guy Ej Faulkner
- School of Kinesiology, Faculty of Education, University of British Columbia, Vancouver, BC, Canada.,Applied Public Health, Canada
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Caring for Long-Stay Critically Ill Children and Infants Refers Back to the Fundamentals of Patient- and Family-Centered Care. Pediatr Crit Care Med 2016; 17:575-6. [PMID: 27261652 DOI: 10.1097/pcc.0000000000000746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Abstract
OBJECTIVE Compared to shorter-stay patients, caring for long-stay patients in the ICU entails a disproportionate burden for staff. Our objective was to gain a deeper understanding of the impact on staff of caring for children who have a prolonged stay on the PICU. DESIGN Qualitative study based on semi-structured interviews. Data were analyzed using the Framework approach. SETTING Children's tertiary hospital. PARTICIPANTS Seventeen members of staff (7 psychosocial staff, 7 nurses, 3 consultants) working in the PICU, neonatal ICU, or cardiac ICU (PICU will be used to encompass neonatal ICU, cardiac ICU, and PICU for the remainder of this article). INTERVENTIONS Semi-structured, tape-recorded interviews. MEASUREMENTS AND MAIN RESULTS Staff reported both positive and challenging aspects of caring for long-stay patients in the PICU. Five key areas relating to the challenges of caring for long-stay patients were identified: staff expectations about their work, characteristics of the patient group, the impact on staff, the impact on the wider unit, and the availability of support. Staff views were often compounded by individual cases they had been involved with or had heard about which fell at either end of the spectrum of "good" and "bad". CONCLUSIONS Whilst there are reported benefits associated with caring for long-stay patients, there are a number of challenges reported that may have implications for staff and the wider unit. When caring for a particular sub-group of long-stay patients, staff may be more likely to experience negative impacts. A key priority for the PICU is to ensure that support mechanisms are timely, accessible, and allow staff to explore their own reactions to their work.
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Foster M, Whitehead L, Maybee P. The Parents', Hospitalized Child's, and Health Care Providers' Perceptions and Experiences of Family-Centered Care Within a Pediatric Critical Care Setting: A Synthesis of Quantitative Research. JOURNAL OF FAMILY NURSING 2016; 22:6-73. [PMID: 26706128 DOI: 10.1177/1074840715618193] [Citation(s) in RCA: 52] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Family-centered care (FCC) purports that unlimited presence and involvement of the family in the care of the hospitalized child will optimize the best outcome for the child, family, and institution. A systematic appraisal was conducted of peer-reviewed, English-language, primary quantitative research conducted within a pediatric critical care setting reported from 1998 to 2014. The aim of this review was to explore the parents', hospitalized child's, and health care providers' perception of FCC within pediatric critical care. Fifty-nine articles met the criteria that generated themes of stress, communication, and parents' and children's needs. This review highlighted that communication tailored to meet the parents' and child's needs is the key to facilitating FCC and positive health outcomes. Health care providers need to be available to provide clinical expertise and support throughout the health care journey. Future initiatives, education, and research are needed to evaluate the benefits of parent- and child-led FCC practice.
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Affiliation(s)
- Mandie Foster
- 1 University of Otago, Christchurch, New Zealand
- 2 Christchurch Hospital, New Zealand
| | - Lisa Whitehead
- 3 Edith Cowan University, Joondalup, Western Australia, Australia
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Butler AE, Hall H, Willetts G, Copnell B. Family Experience and PICU Death: A Meta-Synthesis. Pediatrics 2015; 136:e961-73. [PMID: 26371203 DOI: 10.1542/peds.2015-1068] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/29/2015] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVES The PICU is the most common site for inpatient pediatric deaths worldwide. The impact of this clinical context on family experiences of their child's death is unclear. The objective of the study was to review and synthesize the best available evidence exploring the family experience of the death of their child in the PICU. METHODS Studies were retrieved from CINAHL Plus, OVID Medline, Scopus, PsycINFO, and Embase. Gray literature was retrieved from greylit.com, opengrey.edu, Trove, Worldcat, and Google scholar. Study selection was undertaken by 4 reviewers by using a multistep screening process, based on a previously developed protocol (International Prospective Register of Systematic Reviews 2015:CRD42015017463). Data was extracted as first-order constructs (direct quotes) or second-order constructs (author interpretations) onto a predeveloped extraction tool. Data were analyzed by thematic synthesis. RESULTS One main theme and 3 subthemes emerged. "Reclaiming parenthood" encompasses the ways in which the parental role is threatened when a child is dying in the PICU, with the subthemes "Being a parent in the PICU," "Being supported," and "Parenting after death" elucidating the ways parents work to reclaim this role. The review is limited by a language bias, and by the limitations of the primary studies. CONCLUSIONS When a child dies in a PICU, many aspects of the technology, environment, and staff actions present a threat to the parental role both during and after the child's death. Reclaiming this role requires support from health care providers and the wider community.
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Affiliation(s)
- Ashleigh E Butler
- School of Nursing and Midwifery, Monash University, Victoria, Australia; and Adult and Paediatric ICU, Monash Health, Melbourne, Australia
| | - Helen Hall
- School of Nursing and Midwifery, Monash University, Victoria, Australia; and
| | - Georgina Willetts
- School of Nursing and Midwifery, Monash University, Victoria, Australia; and
| | - Beverley Copnell
- School of Nursing and Midwifery, Monash University, Victoria, Australia; and
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Butler A, Willetts G, Copnell B. Nurses' perceptions of working with families in the paediatric intensive care unit. Nurs Crit Care 2015; 22:195-202. [PMID: 26031857 DOI: 10.1111/nicc.12142] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2014] [Revised: 09/03/2014] [Accepted: 10/14/2014] [Indexed: 11/28/2022]
Abstract
BACKGROUND Research exploring nurses' experiences working with families in paediatric intensive care unit (PICU) is limited. No studies have been undertaken in a mixed adult-paediatric ICU. OBJECTIVES To explore nurses' perceptions of working with families of critically ill children in a mixed adult-paediatric intensive care unit (ICU). DESIGN Descriptive qualitative design. METHODOLOGY Five PICU nurses participated in semi-structured interviews. Data were analysed using thematic analysis. Trustworthiness was enhanced using an audit trail, member checks and peer review of all data. RESULTS Three main themes and one overarching theme emerged. Role confusion and delineation examined the roles which nurses ascribed to themselves and the families; and demonstrated the conflict which could arise if roles were challenged. Information sharing demonstrated the positive and negative ways in which nurses utilized information with families in their daily practice. The contextual environment of the PICU scrutinized the physical, cultural and institutional factors which impacted on the nurses' ability to work with families in the PICU. Finally, the overarching theme Competing values explores the interplay between the nurses' personal values and those of the PICU and the institution. CONCLUSIONS Working with families in a mixed adult-paediatric ICU is influenced by multiple personal and institutional factors. The value placed on families and on the time nurses spent with them often competed for priority with nurses' other values and the wider culture of the PICU. The potential for role confusion, the management of information and the physical environment of the PICU further contributed to variability in nurses' working with families. RELEVANCE TO CLINICAL PRACTICE The results highlighted a need for education for both nurses and medical staff who work with families of critically ill children. Additionally, the need for each PICU to have a written policy on family presence and participation is crucial to guide practice and maintain continuity of care.
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Affiliation(s)
- Ashleigh Butler
- Adult and Pediatric Intensive Care, Monash Medical Centre, Monash Health, Victoria, Australia.,School of Nursing and Midwifery, Monash University, Melbourne, Victoria, Australia
| | - Georgina Willetts
- School of Nursing and Midwifery, Monash University, Melbourne, Victoria, Australia
| | - Beverley Copnell
- School of Nursing and Midwifery, Monash University, Melbourne, Victoria, Australia
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Vasli P, Dehghan-Nayeri N, Borim-Nezhad L, Vedadhir A. Dominance of paternalism on family-centered care in the Pediatric Intensive Care Unit (PICU): An ethnographic study. ACTA ACUST UNITED AC 2015; 38:118-35. [DOI: 10.3109/01460862.2015.1035464] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Khangura SD, Karaceper MD, Trakadis Y, Mitchell JJ, Chakraborty P, Tingley K, Coyle D, Grosse SD, Kronick JB, Laberge AM, Little J, Prasad C, Sikora L, Siriwardena K, Sparkes R, Speechley KN, Stockler S, Wilson BJ, Wilson K, Zayed R, Potter BK. Scoping review of patient- and family-oriented outcomes and measures for chronic pediatric disease. BMC Pediatr 2015; 15:7. [PMID: 25886474 PMCID: PMC4334411 DOI: 10.1186/s12887-015-0323-x] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2014] [Accepted: 01/26/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Improvements in health care for children with chronic diseases must be informed by research that emphasizes outcomes of importance to patients and families. To support a program of research in the field of rare inborn errors of metabolism (IEM), we conducted a broad scoping review of primary studies that: (i) focused on chronic pediatric diseases similar to IEM in etiology or manifestations and in complexity of management; (ii) reported patient- and/or family-oriented outcomes; and (iii) measured these outcomes using self-administered tools. METHODS We developed a comprehensive review protocol and implemented an electronic search strategy to identify relevant citations in Medline, EMBASE, DARE and Cochrane. Two reviewers applied pre-specified criteria to titles/abstracts using a liberal accelerated approach. Articles eligible for full-text review were screened by two independent reviewers with discrepancies resolved by consensus. One researcher abstracted data on study characteristics, patient- and family-oriented outcomes, and self-administered measures. Data were validated by a second researcher. RESULTS 4,118 citations were screened with 304 articles included. Across all included reports, the most-represented diseases were diabetes (35%), cerebral palsy (23%) and epilepsy (18%). We identified 43 unique patient- and family-oriented outcomes from among five emergent domains, with mental health outcomes appearing most frequently. The studies reported the use of 405 independent self-administered measures of these outcomes. CONCLUSIONS Patient- and family-oriented research investigating chronic pediatric diseases emphasizes mental health and appears to be relatively well-developed in the diabetes literature. Future research can build on this foundation while identifying additional outcomes that are priorities for patients and families.
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Affiliation(s)
| | | | - Yannis Trakadis
- Montreal Children's Hospital, McGill University Health Centre, 2300 Tupper Street, Montreal, QC, Canada.
| | - John J Mitchell
- Montreal Children's Hospital, McGill University Health Centre, 2300 Tupper Street, Montreal, QC, Canada.
| | - Pranesh Chakraborty
- University of Ottawa, 451 Smyth Road, Ottawa, ON, Canada. .,Newborn Screening Ontario, Children's Hospital of Eastern Ontario, 415 Smyth Road, Ottawa, ON, Canada.
| | - Kylie Tingley
- University of Ottawa, 451 Smyth Road, Ottawa, ON, Canada.
| | - Doug Coyle
- University of Ottawa, 451 Smyth Road, Ottawa, ON, Canada.
| | - Scott D Grosse
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, 1600 Clifton Road, Atlanta, GA, USA.
| | - Jonathan B Kronick
- University of Toronto, 27 King's College Circle, Toronto, ON, Canada. .,Hospital for Sick Children, 555 University Avenue, Toronto, ON, Canada.
| | - Anne-Marie Laberge
- Centre Hospitalier Universitaire Sainte-Justine, 3175 Chemin de la Côte-Sainte-Catherine, Montreal, QC, Canada.
| | - Julian Little
- University of Ottawa, 451 Smyth Road, Ottawa, ON, Canada.
| | - Chitra Prasad
- Western University, 1151 Richmond Street, London, ON, Canada.
| | - Lindsey Sikora
- University of Ottawa, 451 Smyth Road, Ottawa, ON, Canada.
| | | | - Rebecca Sparkes
- Alberta Children's Hospital, 2888 Shaganappi Trail NW, Calgary, AB, Canada.
| | | | - Sylvia Stockler
- British Columbia Children's Hospital, 4480 Oak Street, Vancouver, BC, Canada.
| | | | - Kumanan Wilson
- Ottawa Hospital Research Institute, 725 Parkdale Avenue, Ottawa, ON, Canada.
| | - Reem Zayed
- University of Ottawa, 451 Smyth Road, Ottawa, ON, Canada.
| | - Beth K Potter
- University of Ottawa, 451 Smyth Road, Ottawa, ON, Canada.
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