Parents' experiences of their child being admitted to a paediatric intensive care unit: a qualitative study-like being in another world

Nurses' Experiences of the Prerequisites for Implementing Family-Centered Care to Prevent Pediatric Delirium

PURPOSE

The aim of this study was to describe nurses' experiences of the prerequisites for implementing family-centered care to prevent pediatric delirium.

DESIGN

The research employed a qualitative, descriptive study design.

METHODS

A total of 10 nurses working in the pediatric intensive care unit at 1 university hospital participated in the study. The quality data were collected using individual semistructured interviews, and the data were then analyzed by inductive content analysis.

RESULTS

The prerequisites for implementing family-centered care to prevent delirium among pediatric patients consisted of 30 subcategories that were grouped into 11 generic categories. The generic categories were further grouped into 5 main categories: (1) an environment that supports family presence, (2) psychosocial support for the family, (3) individual family involvement, (4) family participation in shared decision-making, and (5) nurses' professional competence.

CONCLUSIONS

According to the nurses' experiences, the implementation of a family-centered approach to preventing delirium in pediatric patients requires creating a supportive environment for families, providing psychosocial support, encouraging family involvement in decision-making, and ensuring that all nurses have the necessary skills.

Parent and staff experiences of a feasibility trial evaluating neurally adjusted ventilatory assist in infants with acute viral bronchiolitis: A qualitative study

BACKGROUND

There is limited literature regarding family and staff experiences of participating in clinical trials. A qualitative study was embedded in the NAVABronch feasibility trial evaluating the effectiveness of a novel mode of ventilation, neurally adjusted ventilatory assist (NAVA), in infants with acute viral bronchiolitis.

AIM

The aim of this qualitative study was to explore the experiences of parents and health care practitioners (HCPs) involved in the NAVABronch Trial.

STUDY DESIGN

Semi-structured interviews were conducted with two parents and two focus groups were held with six HCPs.

RESULTS

Four themes were identified from the focus groups: (1) Creating staff engagement, (2) Education to deliver NAVA, (3) Normalizing NAVA in clinical practice (4) Creating meaningful study outcomes and (5) support of parents during the trial, this theme was generated from the parent interviews. The findings indicated the need for education regarding NAVA for HCPs which would lead to increased confidence, better guidance around the use of NAVA and the need for NAVA to be normalized and embedded into the unit culture. Parents identified the need for further support around preparation for what may happen as a result of the interventions, particularly the weaning of sedation.

CONCLUSION

Our study indicates that staff and parents had no concerns regarding the trial methods and procedures.

RELEVANCE TO CLINICAL PRACTICE

Conducting clinical trials in Paediatric Intensive Care Units (PICUs) is challenging and complex. There is limited literature regarding family and staff experiences of participating in clinical trials. Understanding their experiences is crucial in ensuring trial success.

Parents' experience of children's transitions from intensive care unit after liver transplantation: A qualitative study

OBJECTIVE

The aim of this study was to understand parents' perspectives on caring for children who underwent liver transplantation in the intensive care unit transition period and to provide a reference for the development of targeted intervention strategies.

METHODS

Thirteen parents of children who underwent liver transplantation at a tertiary hospital in Hangzhou, Zhejiang Province were chosen for in-depth semi-structured interviews via purposive sampling. The interview data were analyzed and summarized via content analysis.

FINDINGS

Three themes were extracted, including a period of separation and suffering (being apart from child is tough, chilling atmosphere, and limited family access); being an overwhelming caregiver (hope coupled with worry, conflict of roles, and existential care dilemmas); and facing a new normal: searching for information and support (information on medical conditions, post-discharge care assistance, educational support, and peer support).

CONCLUSION

For parents whose child underwent liver transplantation, the transition period from the intensive care unit to the general ward is challenging. Parents are burdened with several caregiving responsibilities and require a variety of information and support. It is advised that nurses should offer sufficient information and suitable educational approaches to enhance these parents' capacity to care for their children and assist children and their parents in making a smooth transition.

IMPLICATIONS FOR CLINICAL PRACTICE

This study highlights parents' perspectives on caring for children with liver transplants transferred from the intensive care unit to a general ward. Transitional care is strenuous, evoking different feelings before and after transfer. The health care professionals should focus on the needs and challenges faced by parents who are caring for children with liver transplants during the intensive care unit transition period. To achieve this, it is critical to establish a supportive environment and provide suitable information and education for parents to enhance their caregiving abilities.

Parents' experiences of family and daily life after their child's stay in the pediatric intensive care unit: a qualitative descriptive study

INTRODUCTION

The stay of a critically ill child in a pediatric intensive care unit (PICU) is a significant experience for the family. Thus far, little is known regarding the impact of this stay on parents and their healthy children for whom no continuous aftercare services are offered. This study aimed to capture the post-stay experience and needs of parents after this traumatic event so that they could return to family and everyday life.

METHODS

This qualitative descriptive study was conducted in collaboration with four pediatric intensive care units in Switzerland. It included parents whose children had fully recovered after a stay and who did not require continuous medical follow-up. All children were hospitalized in the PICU for at least 48 h. Data were collected through narrative pairs (n = 6) and individual interviews (n = 8). Interviews were audio recorded, transcribed, coded inductively according to Saldaña, and analyzed.

RESULTS

The results showed three related phases that influence each other to restore normality in daily life: Trust and inclusion in the treatment process during the stay (1), processing after the stay (2), and returning to everyday life (3).

CONCLUSION

Follow-up meetings should be available to all parents whose children have been hospitalized in the PICU. In particular, it should also be available to parents whose children have fully recovered and no longer have any medical disabilities.

Supporting parents while their child is receiving neurocritical care

The post-intensive care syndrome (PICS) concept whereby the ICU experience of the patient as well as their family can have long-term deleterious health outcomes in both the patient and the family provides a rationale and impetus for modifying the ICU experience for the parents of patients receiving pediatric neurocritical care. This article uses the PICS framework to provide insight to that parental experience. Included are the words of parents who tell what they felt and what they most needed from their children's doctors while their children were receiving neurocritical care. Based on their and many other ICU parents' advice and the PICS research, we identify a short list of specific steps the medical team can take immediately to support these parents.

"I want to be there. I have to be there.": Parents' perceived barriers and facilitators to bedside presence in the pediatric intensive care unit

Introduction

Parental presence at the bedside during a stressful pediatric intensive care unit (PICU) admission may improve child comfort, reduce parental anxiety, and enable family engagement. We performed this study to identify factors that parents perceive impact their capability, opportunity, and motivation to be at the bedside in PICU.

Methods

We conducted a qualitative descriptive study using semi-structured interviews based on the Theoretical Domains Framework (TDF). We included parents of children admitted to the PICU for at least 24 h at IWK Health in Nova Scotia, Canada. Interviews were coded independently by two researchers using a directed content approach based on the TDF. We generated themes and subthemes, with the subthemes identified as factors impacting parental presence, and assigned TDF domains to each of the subthemes.

Results

Fourteen primary caregivers (8 mother figures, 6 father figures) participated in 11 interviews. The factors associated with parental presence were captured by 6 themes: Understanding the Medicalized Child; Maintaining the Parent Role; Life Beyond the Hospital; Parental Intrinsic Responses and Coping; Support Structures; and The PICU Environment. Fifty-two barriers and enablers were identified within 13 TDF domains; 10 TDF domains were determined to be relevant to parental presence, which may be used to guide design of future interventions. Participants emphasized the importance of self-care to enable them to remain physically at their child's bedside and to be engaged in their care.

Conclusions

Parents perceive multiple factors within 6 themes act as barriers or enablers to presence with their critically ill child in the PICU. Guided by relevant TDF domains, interventions may be designed to optimize presence, particularly engaged presence, which may improve health-related outcomes of children and their parents.

Understanding the co-construction of safety in the paediatric intensive care unit: A meta-ethnography of parents' experiences

BACKGROUND

Children experiencing critical illness or injury may require admission to a paediatric intensive care unit (PICU) to receive life-sustaining or life-saving treatment. Studies have explored the experience of parents with a child in PICU but tend to focus on subgroups of children or specific healthcare systems. Therefore, we aimed to undertake a meta-ethnography to draw together the published research.

METHODS

A systematic search strategy was developed to identify qualitative studies, which had explored the experiences of parents with a critically ill child treated in a PICU. A meta-ethnography was undertaken following the structured steps of identifying the topic; undertaking a systematic search; reading the research; determining how the studies relate and translate into each other; and synthesising and expressing the results.

RESULTS

We identified 2989 articles from our search and after a systematic series of exclusions, 15 papers remaining for inclusion. We explored the original parent voices (first order) and the interpretation of the study authors (second order) to identify three third-order concepts (our interpretation of the findings), which related to technical, relational and temporal factors. These factors influenced parents' experiences, providing both barriers and facilitators to how parents and caregivers experienced the time their child was in the PICU. The dynamic and co-constructed nature of safety provided an analytical overarching frame of reference.

CONCLUSION

This synthesis demonstrates novel ways in which parents and caregivers can contribute to the vital role of ensuring a co-created safe healthcare environment for their child when receiving life-saving care within the PICU.

Mothering children at a paediatric intensive care unit with strict visiting hours: A qualitative study

BACKGROUND

Although a child- and family-centred care (CFCC) philosophy has been emphasized and adopted for decades in paediatric critical care settings in several countries, numerous issues from parents' perspectives regarding the philosophy remain unresolved. To facilitate the full translation of CFCC into clinical practice, health care professionals need an in-depth understanding of family experiences. Real-life mothering experiences, including maternal roles and identities, remain largely unknown at paediatric intensive care units (PICUs) in the Republic of Korea, where family visitation, presence, and participation are restricted.

AIM

To explore mothering experiences at a PICU where family visitation is strictly constrained, and to identify maternal needs and values.

STUDY DESIGN

We conducted a qualitative descriptive study of eight individual in-depth interviews with seven mothers of hospitalized children. Qualitative data were analysed using inductive thematic analysis.

FINDINGS

Five major themes, along with four subthemes, emerged: (1) shifts in maternal roles and responsibilities, (2) shifts in interpersonal relationships, (3) desire for CFCC in the PICU, (4) practising self-defined mothering roles, and (5) reconstructing maternal identities. The themes revealed the experiences of becoming mothers of a child in a constrained PICU. Ultimately, mothers demanded that the unit improve its physical and cultural environments through, for example, liberalized family visitation and participation in the care of their children.

CONCLUSIONS

Nursing professionals should lead the charge for humanizing a restrictive PICU in the Republic of Korea by ensuring a safe and open environment and mothering continuity based on child- and family-centred holistic care.

RELEVANCE TO CLINICAL PRACTICE

Effective interventions must be developed and tested to globally establish and fully implement strong evidence-based CFCC in PICUs; constant co-commitment among children, families, health care professionals, and institutions is also necessary.

Hospital healthcare experiences of children and young people with life-threatening or life-shortening conditions, and their parents: scoping reviews and resultant conceptual frameworks

BACKGROUND

Patient experience is a core component of healthcare quality. Patient-reported experience measures (PREMs) are increasingly used to assess this, but there are few paediatric PREMs. This paper reports the first stage of developing two such measures, one for children and young people (0-18 years) (CYP) with a life-threatening or life-shortening condition (LT/LSC), and one for their parents. It comprised parallel scoping reviews of qualitative evidence on the elements of health service delivery and care that matter to, or impact on, CYP (Review 1) and parents (Review 2).

METHODS

Medline and PsychINFO (1/1/2010 - 11/8/2020) and CINAHL Complete (1/1/2010 - 4/7/2020) were searched and records identified screened against inclusion criteria. A thematic approach was used to manage and analyse relevant data, informed by existing understandings of patient/family experiences as comprising aspects of staff's attributes, their actions and behaviours, and organisational features. The objective was to identity the data discrete elements of health service delivery and care which matter to, or impact on, CYP or parents which, when organised under higher order conceptual domains, created separate conceptual frameworks.

RESULTS

18,531 records were identified. Sparsity of data on community-based services meant the reviews focused only on hospital-based (inpatient and outpatient) experiences. 53 studies were included in Review 1 and 64 in Review 2. For Review 1 (CYP), 36 discrete elements of healthcare experience were identified and organized under 8 higher order domains (e.g. staff's empathetic qualities; information-sharing/decision making; resources for socializing/play). In Review 2 (parents), 55 elements were identified and organized under 9 higher order domains. Some domains were similar to those identified in Review 1 (e.g. professionalism; information-sharing/decision-making), others were unique (e.g. supporting parenting; access to additional support).

CONCLUSIONS

Multiple and wide-ranging aspects of the way hospital healthcare is organized and delivered matters to and impacts on CYP with LT/LSCs, and their parents. The aspects that matter differ between CYP and parents, highlighting the importance of measuring and understanding CYP and parent experience seperately. These findings are key to the development of patient/parent experience measures for this patient population and the resultant conceptual frameworks have potential application in service development.

Concepts of family-centered care at the neonatal and paediatric intensive care unit: A scoping review

BACKGROUND

Understanding family-centred care (FCC) concepts is critical for its implementation in any context. The researchers synthesised studies on FCC in neonatal and paediatric critical care units in order to present its concepts and gaps in the literature to guide further research in the area.

METHOD

The study used the JBI methodology, and the PRISMA-ScR guidelines confirmed the final report. The search for material, with the use of library sources, used Medline via PubMed, Cumulative Index to Nursing and Allied Health Literature, Scopus, Google Scholar, and Wiley Library online for papers published in English from 2015 to 2019 and updated to 2023.

RESULTS

From 904 references, 61 studies were identified for inclusion. The majority of the studies (29; 55.77%) were qualitative ethnography and phenomenology. Four themes and ten subthemes emerged from the data to support the main concepts of FCC.

CONCLUSION

To guide its useful integration and implementation, more research on family-centred care in neonatal and paediatric intensive care units, involving families, staff, and managers, should be undertaken.

PRACTICE IMPLICATION

Findings presented in this review may provide a guide for nurses to adjust nursing interventions for critically ill neonates and children in intensive care units.

Staff perception of the implementation, enablers and barriers to pediatric intensive care unit diary writing: A qualitative study

OBJECTIVES

To explore how the multi-professional pediatric intensive care unit staff experienced the implementation of the diary.

RESEARCH METHODOLOGY/DESIGN

Qualitative study using the implementation research approach.

SETTING

a six-bed pediatric intensive care unit at a large Italian tertiary care pediatric hospital, treating patients with acute conditions from the Emergency Department or hospital wards.

MAIN OUTCOME MEASURES

Healthcare providers' experiences of the implementation of the diaries. Data was collected by focus groups and interviews and thematic analysis was performed.

FINDINGS

Three focus groups and four interviews with staff were conducted after the implementation of thediaries from August 2020 to June 2021. Staff describe an initial disbelief towards the effectiveness of diaries followed by an increasing perception of their relevance for parents' emotional expression through shared narration. Diaries are reported as a beneficial communication tool between the family, the child, and health care providers, increasing staff understanding of parents' experiences of their child's admission and parents' sense of the care received by their child. For staff, barriers for diary writing were logistics, lack of time, limited sense of ownership, fear of legal retaliation and fear of emotional labor.

CONCLUSION

Health care providers perceived diaries as beneficial for parents and the healthcare team, potentially supporting their partnership as recommended by Family Centered Care models. The enablers and barriers that emerged for diary writing can support the development of implementation strategies to prevent the reported challenges to diary writing in the healthcare team, enhancing their uptake in the pediatric intensive care unit setting.

Breastfeeding sick children in hospital: Exploring the experiences of mothers in UK paediatric wards

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.

Exploring trust development in families of children towards surgical and emergency care providers: A scoping review of the literature

BACKGROUND

Trust is central to the therapeutic relationship between patients and their providers, yet little is known about how it is developed in the unique context of children facing surgical emergencies. We sought to identify factors fostering trust development, gaps, and areas for improvement.

METHODS

We searched eight databases from inception to June 2021 to identify studies focusing on trust in pediatric surgical and urgent care settings. PRISMA-ScR protocols were followed, and screening carried out by two independent reviewers. Data collection included study characteristics, outcomes, and results.

RESULTS

Out of 5578 articles screened, 12 fulfilled the inclusion criteria. Four major trust constructs were identified: competence, communication, dependability, and caring. Despite various instruments used, all studies reported a high level of parental trust. Nearly all studies (11/12) noted trust depending on parents' sociodemographic background, with ethnicity (3/12) and level of education and language barriers (2/12) limiting parents' confidence in physicians. High trust levels significantly correlated with effective communication and perceived quality of care. Most effective interventions enhancing trust included communication and caring trust constructs (10/12) rather than competence and dependability (5/12). Parents' individual experiences, development of compassionate interactions, and practice of family-centered care appeared important in developing trust.

CONCLUSIONS

Improving communication and providing compassionate care, as well as encouraging a patient-centered approach, appear to be most effective in promoting trust in pediatric surgical and urgent settings. Our findings can guide future educational interventions towards strengthening parental trust and promoting child- and family-centered care in pediatric surgical settings.

Parental perceptions and experiences of an oral health care promotion intervention for children with congenital heart defects

Purpose

Congenital heart disease (CHD) is one of the most common congenital anomalies in children. Children with major CHD are at risk for developing endocarditis. Acute endocarditis may be life threatening and lead to heart failure. The purpose of this study was to explore parental perceptions and experiences of an early oral health promotion intervention (OHPI) targeting children with major CHD at risk for developing endocarditis later in life, and use this information to examine intervention feasibility.

Methods

Nine parents (three fathers and six mothers) participating in a one and a half year OHPI were purposefully selected for qualitative evaluation of intervention feasibility using semi-structured interviews. The interviews were analysed with an inductive content analysis method.

Results

The analysis resulted in four main categories and 14 subcategories that describe parental perceptions and experiences of the OHPI. The four main categories were timing of first intervention contact, effortlessness of intervention process, individuality of support, and relevancy of support.

Conclusion

Parents of children with CHD perceived the OHPI as important and feasible to be implemented in daily life in children with systemic diseases overall. Further studies on timing of first contact and use of additional Web-based support are needed.

Identifying parent anxiety and family distress of critically ill children in response to changes in hospital visitation policies during the COVID-19 pandemic

Purpose

This research study describes parent anxiety and family distress among three study groups of varying restrictions in parent presence for children in the PICU during a pandemic.

Design and methods

A retrospective study was conducted to describe differences in parent anxiety and family distress for parents of children hospitalized before and during the COVID-19 pandemic. Participants fell into three study groups based on the dates of the child's hospital stay and the level of parent and family presence or restriction they experienced. Participants were asked to complete a survey that included basic demographic information along with utilization of the GAD-7 and FDI measures. The data were assessed using descriptive statistics, Fisher's exact test, and the Kruskal-Wallis test.

Results

A total of 82 parents of children hospitalized during the specified times in the PICU participated. There was a statistically significant difference among the three cohorts in diagnoses (respiratory, cardiovascular, and medical-surgical), p ≤0.001. A larger percentage of children of the study participants were hospitalized with respiratory illnesses (62.5%) in the unrestricted study group when compared to the other study groups with higher patient acuity. There was also a statistical significance among the three study groups regarding whether the second parent was able to visit the child during the PICU admission (p = 0.007).

Conclusions

Our study suggests that restricting parent and visitor presence does not increase parent anxiety or family distress during a child's admission to the PICU. The literature widely supports that having a critically ill child is undoubtedly stressful for parents and families, but the most significant causation for the anxiety and stress remains unknown and is likely multifactorial.

Clinical and research implications

Parents who experienced rigid restrictions in parent and visitor presence did not have increased anxiety. Other impactful variables such as a child's mortality risk and the uncertainty of outcome may have impacted anxiety for parents whose children were critically ill. Further research is needed to understand which stressors are most significant, during a critically ill child's hospitalization, from a parent's perspective. Limiting staff and patient exposure to persons who may have contagious illness (restricting parent and family presence) may not in itself lead to increased anxiety and distress for parents and families. This study may provide context for careful development of hospital visitation policies to ensure balance between patient and family centered care and protection from infectious disease.

Stressful Experiences of Parents in the Paediatric Intensive Care Unit: Searching for the Most Intensive PICU Stressors

Hospitalization of a child in the paediatric intensive care unit (PICU) is extremely stressful, both for the child and for his or her family. The purpose of this study was to gain deeper insight into the stressful experiences of parents of children hospitalized in the PICU. This study included 96 parents. The data were collected using a translated and standardized scale "The Parental Stressor Scale: Paediatric Intensive Care Unit (PSS: PICU)". This study confirms high exposure of parents to numerous PICU stressors. The most intense PICU stressor for parents was child's breathing depending on the ventilator (4.22 ± 1.17), and the least intense was child's demanding behaviour (1.17 ± 0.33). A significant positive correlation between the level of parents' perceived stress and the number of their children was recorded (r = 0.240, p = 0.02), while there was no significant correlation between the level of stress and other sociodemographic variables. A significantly higher level of stress was experienced by parents with primary school education (p = 0.032) and parents who are not healthcare professionals (p < 0.01). It is necessary to establish a system that will enable continuous assessment of parents' stress levels and timely prevention of stressful experiences for parents in the PICU.

A Systematic Review of the Factors Associated with Post-Traumatic Growth in Parents Following Admission of Their Child to the Intensive Care Unit

This systematic review aims to identify the demographic, clinical and psychological factors associated with post-traumatic growth (PTG) in parents following their child's admission to the intensive care unit (ICU). Papers published up to September 2021 were identified following a search of electronic databases (PubMed, Medline, Web of Science, PsycINFO, CINAHL, PTSDpubs and EMBASE). Studies were included if they involved a sample of parents whose children were previously admitted to ICU and reported correlational data. 1777 papers were reviewed. Fourteen studies were eligible for inclusion; four were deemed to be of good methodological quality, two were poor, and the remaining eight studies were fair. Factors associated with PTG were identified. Mothers, and parents of older children, experienced greater PTG. Parents who perceived their child's illness as more severe had greater PTG. Strong associations were uncovered between PTG and post-traumatic stress, psychological well-being and coping. PTG is commonly experienced by this population. Psychological factors are more commonly associated with PTG in comparison with demographic and clinical factors, suggesting that parents' subjective ICU experience may be greater associated with PTG than the objective reality.

Hypothermia and cold injuries in children and young people

Although hypothermia and cold injuries are rare in children and young people in the UK, the risk is persistent and requires urgent medical management when it does occur. This article outlines some considerations for professionals who may be caring for hypothermic patients or those at risk of becoming hypothermic.

Percepção materna sobre a participação do pai na hospitalização do filho em unidade intensiva pediátrica

Objetivo: compreender a percepção materna sobre a participação do pai durante a hospitalização do filho em Unidade de Terapia Intensiva Pediátrica. Métodos: pesquisa qualitativa de inspiração fenomenológica, cujo referencial metodológico para análise dos discursos, advindos de 12 entrevistas com mães de crianças hospitalizadas no interior do estado de São Paulo, foi a análise da estrutura do fenômeno situado. Resultados: emergiram três categorias temáticas: Participando do processo de adoecimento do filho - a essencialidade da presença do pai; Sofrendo pelo filho - o pai sendo afetado pela hospitalização; Não podendo estar com o filho - o pai sendo impedido de ser acompanhante durante a hospitalização. As mães reconhecem a participação dos pais durante hospitalização do filho por meio de apoio, compartilhamento de atividades e na importância para a recuperação da criança. Contudo, o sofrimento advindo do adoecimento e da hospitalização, a necessidade de se dedicar ao trabalho, questões organizacionais do hospital e a ausência de legislações trabalhistas impedem a permanência dos pais no serviço de saúde. Conclusão: as unidades pediátricas precisam modificar as normas institucionais, acolhendo mãe e pai, oferecendo condições de permanência e apoiando-os durante a hospitalização do filho. É mister que a área de Enfermagem familiar discuta a participação do pai na vida do filho, em especial no ambiente hospitalar e de cuidados intensivos, de modo a impulsionar a elaboração de leis que garantam a manutenção do emprego em caso de acompanhamento do filho durante a hospitalização.

The Cry to Be Involved: Experiences of Caregivers on Participation in Decision Making and Care Provision at Mercy James PICU in Blantyre, Malawi

A child's illness and admission in a hospital are stressful and can negatively affect the child and his/her caregivers. The stress is further exacerbated when a child is critically ill and has been admitted to an intensive care unit (ICU). The effects can be reduced when caregivers of the sick children are present and involved in decision making and actual care of their hospitalized children, a care model called family-centered care. Malawi has adopted family-centered care model in the newly instituted Mercy James Pediatric ICU. Little is known about experiences of caregivers with FCC in Malawi. This qualitative study was therefore conducted to explore experiences of caregivers on their involvement in decision making and care at Mercy James Pediatric ICU in Blantyre, Malawi. This was a descriptive qualitative study with a sample size of fifteen participants, however, data saturation was reached with ten participants. One on one in-depth interviews were conducted among a purposively selected sample of ten caregivers whose children had been discharged from the PICU. Content analysis was deductively and manually undertaken to analyze data with the aid of delve software to organize the data. Findings show that not every caregiver was involved in the decision making of their children's care, and if they did, it was not adequate. Barriers to effective involvement such as using a foreign language had a negative impact on comprehensive involvement of caregivers in decision making for their children's care. All participants were, however, involved in the physical care of their children. It is important that health care workers should continuously encourage caregivers to get involved in the decision making and care of their children.

Parental experience of transition from a pediatric intensive care unit to a general ward: A Qualitative Study

AIM

To explore parental experience in transitioning from a pediatric intensive care unit to a general ward and to investigate parental involvement in caring for their critical illness children.

BACKGROUND

Parents have a major responsibility in caring for seriously ill children, but nursing staff fail to meet the expectations of parents regarding nursing care. Few studies have investigated the challenges and needs of Chinese parents during the transition from pediatric intensive care unit to general ward.

METHODS

Semi-structured interviews were conducted with 24 parents of children with critical illness in a pediatric hospital in Shanghai, mainland China to explore their views. Transcripts were entered into NVivo. Framework analysis was used to analyze the qualitative data.

RESULTS

Four themes were identified by data analysis: changes in the child during post pediatric intensive care unit periods; experiencing a wide range of emotions; factors involved in the transition; and suggestions for improving transitional care.

CONCLUSIONS

Due to the unmet needs of parents, a more flexible visiting policy and social media support were highly desirable. Getting accurate information, establishing family integrated care, and strengthening ward-based critical support services were also listed as important needs of parents caring for critically ill children.

IMPLICATIONS FOR NURSING MANAGEMENT

A profound understanding of parental experiences during the transitional period can help nursing staff to assess the effects on children and their families, improve ward-based intensive care, support parental participation, and improve visitation policies. Based on these findings, nurse managers can develop reasonable intervention programs in order to improve nursing quality and patient outcomes.

Caregiver Experiences During Their Child’s Acute Medical Hospitalization for a Mental Health Crisis

Adolescents in the United States are increasingly seeking treatment for mental health crises in emergency departments and general medical hospitals. Medical needs are often addressed quickly, yet youth remain hospitalized because further psychiatric treatment is not immediately available. We sought to better understand the experiences of caregivers whose children are "boarding" in a medical hospital while awaiting inpatient psychiatric treatment. We conducted semi-structured interviews with caregivers who were recruited, enrolled, and interviewed during their child's hospital stay. Interviews were audio-recorded, transcribed verbatim, and thematic analysis was facilitated by NVivo 12. Fourteen caregivers enrolled in the study. Themes that emerged included positive hospital and provider experiences; frustration with the medical and mental health care systems; information needs; fears about inpatient psychiatric units; practical challenges and emotional needs; difficulties with caregiver-child communication; difficulties with clinician-caregiver communication; and need for self-care and support. While many caregivers felt positively about the overall experience at the hospital, they also wished for more information about their child's treatment plan and future, as well as social support, emotional comfort for themselves, and self-care skills and resources. Their experiences illuminate ways in which clinical practice can ameliorate concerns and alleviate stress of caregivers related to their child's mental health crisis.

Parents’ Challenges beyond the Pediatric Intensive Care Unit: Fraying at the Seams while Balancing between Two Worlds, Home and Hospital

Background: The dominant tradition in studying parents’ responses to their child’s hospitalization in the pediatric intensive care unit (PICU) is to focus on their immediate environment and their children’s well-being. This view of the parents’ experiences fails to describe the broader set of concurrent challenges beyond the PICU that parents carry with them into the PICU. Objectives: This study describes (a) parents’ reactions to juggling their two worlds, home and hospital, when their child is hospitalized in the PICU, and (b) the impact of this juggling on their lives. Methods: Fifteen parents whose child was admitted into a PICU at a tertiary medical center for children in the Pacific Northwest participated in semi-structured interviews. Data analysis and interpretation were guided by grounded theory. Results: The theory grounded in the data and integrated with the core category was Fraying at the Seams while Balancing between Two Worlds, Home and Hospital. Analyses revealed two categories: Bringing My Life to a Halt and Throwing Our Whole Life Off. Conclusion: Even though parents were physically and emotionally present with their child in the PICU, they felt frayed as they concurrently struggled with their physical distance from other children at home. This strain of living in two worlds caused feelings of inadequacy to fulfill their parental role.

Da técnica à tékhnē: comunicação de notícias difíceis em unidade de terapia intensiva pediátrica

RESUMO Objetivo compreender as percepções de familiares de crianças hospitalizadas em Unidade de Terapia Intensiva Pediátrica diante da comunicação de notícias difíceis. Método estudo fenomenológico com 15 familiares de crianças hospitalizadas em Unidade de Terapia Intensiva Pediátrica de um hospital universitário público do estado de São Paulo. Entrevistas foram realizadas no período de outubro de 2018 a março de 2019. A compreensão dos discursos se deu à luz da fenomenologia existencial heideggeriana. Resultados duas categorias ontológicas emergiram: O familiar da criança existindo em um mundo impróprio; e O familiar da criança vislumbrando a essência da técnica. O familiar recebe as notícias difíceis dos profissionais de saúde na instrumentalidade, emergindo a necessidade de extrapolar a técnica em busca da sua essência. Conclusão e implicações para a prática os discursos revelam que a tecnologia moderna se sobrepõe à ontologia tradicional, uma vez que o profissional de saúde, ao comunicar as notícias difíceis, afasta-se do ser e perde-se de sua essência. O aprimoramento de competências interpessoais e de comunicação dos profissionais de saúde pode extrapolar a dimensão técnica, prevalente em terapia intensiva.

From technology to tékhnē: communication of bad news in pediatric intensive care unit

ABSTRACT Objective to understand the perceptions of family members of children hospitalized in the Pediatric Intensive Care Unit regarding the communication of bad news. Methods this is a phenomenological study with 15 family members of children hospitalized in the Pediatric Intensive Care Unit of a public university hospital in the state of São Paulo. Interviews were carried out from October 2018 to March 2019. The discourses were understood grounded Heidegger’s existential phenomenology. Results two ontological categories emerged: The child’s family member existing in an inappropriate world; and The child’s family member glimpsing the essence of technology. Family members receive difficult news from health professionals in the instrumentality, emerging the need to extrapolate the technology in search of its essence. Conclusions and implications for practice the discourses reveal that modern technology overlaps with traditional ontology, since health professionals, when communicating difficult news, move away from the being and lose their essence. Health professionals’ improving interpersonal and communication skills can extrapolate the technical dimension, prevalent in intensive care.

The Healthcare Staffs' Perception of Parents' Participation in Critical Incidents at the PICU, a Qualitative Study

BACKGROUND

Internationally, there are very few guidelines regarding how near relations can be taken care of on a children's intensive care unit. Despite knowledge about the positive effects of parental presence, staff frequently reject parents out of insecurity. This study aimed to investigate health professionals' understanding of letting parents be present throughout critical situations. A qualitative method with semi-structured interviews was used to answer the aim of his study. Nine persons participated in the study, both physicians and nurses. The result showed that health professionals' main view is that parents' presence is positive. However, their presence often has lower priority than the medical focus of the child and the health professionals' concern of failure.

CONCLUSION

Health professionals have the power to decide if parents can be present in critical situations. Only when a parent demands to be present does that demand beat the decisions made by health professionals. Lack of resources within the team and fear of parents becoming a disturbance or a distraction are cited as the primary reasons not to let parents be present.

Parents' experiences during and after their child's stay in the paediatric intensive care unit - A qualitative interview study

BACKGROUND

Having a child admitted to the paediatric intensive care unit (PICU) is often an emotional and stressful experience for parents.

AIM

The aim of the study was to explore parents' experiences during and after their child's hospitalization in the PICU and to investigate whether parents have a need for post-PICU follow-up.

MATERIAL AND METHODS

The research design was a qualitative study inspired by Ricoeur's phenomenological-hermeneutic approach. The context of the study was a six-bed PICU in a university hospital in Denmark. In 2017, semi-structured interviews were conducted with four couples and three mothers six to 14 weeks after their child had been discharged from the PICU. The data were analysed and interpreted through Ricoeur's three analytical levels and presented in themes and subthemes.

FINDINGS

Three themes were identified in the analytical process: "The challenging PICU stay", "The value of a network" and "The uncertain post-PICU trajectory".

CONCLUSION

Information, dialogue and interaction with familiar health professionals, the diary written by PICU nurses, the parents' personal network and social media supported the parents during and after the PICU stay. The parents expressed that post-PICU follow-up was not the most essential but that follow-up initiatives may be arranged individually.

Singapore's health outcomes after critical illness in kids: A study protocol exploring health outcomes of families 6 months after critical illness

AIM

To explore and understand the impact of paediatric intensive care unit (PICU) admission on longitudinal health outcomes, experiences and support needs of children and their parents in the first 6 months after PICU discharge and to examine the role of ethnicity.

DESIGN

This study uses a prospective, longitudinal design.

METHODS

The sample will include children (N = 110) and at least one parent (N = 110) admitted to the PICU (KKH-AM start-up fund, October 2020). Quantitative study: Participants will be recruited at PICU admission. Data will be collected at five time points: during PICU admission (T0), at PICU discharge (T1), 1 month (T2), 3 months (T3) and 6 months (T4) after PICU discharge. Questionnaires will assess physical and cognitive outcomes of the child survivor. Emotional and social health outcomes will be assessed for both the child and the parents. Qualitative study: At least 12 parents will take part in a semi-structured interview conducted at both 1 and 6 months after PICU to explore their experiences and support needs after PICU discharge. All interviews will be audio-recorded with verbatim transcription. We will use framework analysis for qualitative data analysis.

DISCUSSION

Understanding of Singapore health outcomes after critical illness in kids (SHACK) and their families is limited. There is an urgent need to comprehensively understand the health trajectory and consequences of the PICU child survivors and their families. This research will be the first to explore the health outcomes, needs and experiences after paediatric critical illness in Asia.

IMPACT

This study will provide an understanding of the health outcomes and trajectory of children and parents in the first 6 months after PICU discharge and examine the association between race and outcomes after PICU discharge. Identification of modifiable pre-disposing risk factors during the PICU admission will inform future interventions to improve long-term outcomes of children and parents following paediatric critical illness.

TRIAL REGISTRATION

Clinicaltrial.gov: ClinicalTrials.gov Identifier: NCT04637113.

Parents' experiences of caring for their child in a Paediatric Intensive Care Unit: A literature review

The objective is to identify the available literature on parents' experiences in caring for children in the Paediatric Intensive Care Unit (PICU). Original research on parents experience in caring their child in PICU were identified from five online databases, namely CINAHL, Science Direct, Proquest, Cochrane, and Pubmed (2008-2018) using the terms "parent," "experience," "children", "paediatric intensive care" and "caring." We included articles addressing the parent's experiences while their child was admitted to PICU their needs and participation in the care of the child. Twenty-two papers have met the criteria for inclusion. Further review of these articles resulted in summarised topics - PICU parents' experience, parental stressors, and parental needs. Current research demonstrates a diversity of parent's experiences while caring for their child; however, little is known about interventions to improve and support parents who are in a difficult situation when their child being treated in PICU.

Parental accommodation of symptoms in adolescents with chronic pain

Chronic pain in adolescents can be highly impairing. Parental reactions to their child's pain are important factors influencing pain perception and pain-related impairment in children and adolescents. The present study aimed to examine parental accommodation of pain symptoms using the Inventory of Parent Accommodations of Children's Symptoms (IPACS) to provide empirical support for the utility of this measure in parents of adolescents with chronic pain. We examined the prevalence, nature, and correlates of accommodation behaviors in 66 adolescents with chronic pain and their parents using the IPACS. All parents reported some level of accommodation of their child's pain symptoms. After controlling for pain severity, parental accommodation was associated with functional impairment. In addition, parental accommodation mediated the link between parental catastrophizing reactions to pain and child impairment and between child anxiety and depressive symptoms and child impairment. The IPACS appears to be a useful measure of parental accommodation of pain. Parental accommodation should be included as an intervention target when necessary. It is important to educate families about the negative consequences that can be related to excessive accommodation of pain symptoms and to provide effective resources to manage the impact of chronic pain and replace accommodation with more adaptive pain coping strategies.

Development of a parent experience measure for paediatric critical care transport teams

BACKGROUND

A third of children admitted to paediatric intensive care units (PICUs) in the United Kingdom (UK) are transported by paediatric critical care transport services (PCCTs). Parents have described the transfer journey as particularly stressful. Critical care nurses have a key role in mitigating the impact of the journey on parents. Evaluating parents' experiences is important to inform service improvements.

AIM AND OBJECTIVES

Our aim was to describe the development of a new measure of parents' experiences of PCCTs, derived from data collected in the Differences in access to Emergency Paediatric Intensive Care and care during Transport (DEPICT) study.

DESIGN

A descriptive cross-sectional survey was used.

METHODS

As part of the DEPICT study, a 17-item transport experience questionnaire was developed and given to parents of children transported by PCCTs to 24 UK PICUs during a 12-month period. Analyses included exploratory factor analysis and a validation review by a PCCT stakeholder group.

RESULTS

Families of 1722 children (1798 journeys) completed questionnaires. Five items were excluded from further analysis as correlation coefficients were <0.3. Two factors explained 53% of the variance and all 12 items loaded on one of these factors. Factor 1 (8 items) explained 47% of the variance, had excellent internal reliability and the clustered items were conceptually coherent with a specific relevance to PCCTs; these were offered for consideration, with other items possibly discarded. Twenty-eight PCCT clinicians reviewed the questions. Using a 70% agreement threshold, one additional, previously discarded, item was identified for inclusion, resulting in a nine-item experience measure.

CONCLUSION

Our brief measure of parents' experience of critical care transport provides a standardized measure that can be used across all PCCTs, enabling national benchmarking of services and potentially increasing the collection and use of parent experience data to improve services.

RELEVANCE TO CLINICAL PRACTICE

Being able to measure experience provides an opportunity to understand how to make services better to improve experience.

Nursing Interventions to Reduce Stress in Families of Critical Care Patients: An Integrative Review

BACKGROUND

Having a family member admitted to an intensive care unit is a stressful experience that may lead to psychological symptoms including depression, anxiety, and posttraumatic stress disorder.

OBJECTIVE

To better understand the phenomenon of stress experienced by families of intensive care unit patients and identify nursing interventions that may help reduce it.

METHODS

An integrative literature review was performed to identify principal stressors for families of patients receiving care in neonatal, pediatric, and adult intensive care units and recommended nursing interventions.

RESULTS

The principal stressors in the 3 types of intensive care units were change in parental role or family dynamics, appearance and behavior of the patient, the care setting, and communication with the health care staff. Nursing interventions should focus on valuing the role of family members in patient care, improving communication, and providing accurate information.

CLINICAL RELEVANCE

Family members of intensive care patients will benefit from nursing interventions that adequately acknowledge and address the stress they experience.

CONCLUSION

Nurses play a crucial role in helping to reduce the stress experienced by family members of intensive care unit patients.

From despair to hope: copying of relatives of hospitalized children before bad news report

OBJECTIVE

to understand the experiences of relatives of critically ill children before bad news report.

METHOD

a phenomenological study based on Heidegger's philosophical framework. Data collection was carried out from October 2018 to March 2019, through phenomenological interviews with 15 relatives of children hospitalized in a Pediatric Intensive Care Unit.

RESULTS

relatives, in their existentiality, experience the facticity thrown into unpredictable situations, regardless of their choices and are faced with feelings of shock, despair and fear before bad news. After emotional impact, especially regarding the possibility of death, relatives reveal hope as a mechanism for coping with the situation.

FINAL CONSIDERATIONS

solidarity and sensitivity by health professionals, especially nurses, are essential in understanding the existential dimension of relatives who experience such an experience, understanding the several facets of their existence and offering them opportunities to project themselves.

Relationship between negative emotions and perceived support among parents of hospitalized, critically ill children

Objectives

The purpose of this study was to describe relationships between negative emotions and perceived emotional support in parents of children admitted to the pediatric intensive care unit (PICU).

Methods

This cross-sectional descriptive study conducted face-to-face interviews between January 2019 and January 2020. Study variables included depression (PHQ-9 Scale), anxiety (Emotional Distress-Anxiety-Short Form 8a), anger (Emotional Distress-Anger-Short Form 5a), fear (Fear-Affect Computerized Adaptive Test), somatic fear (Fear-Somatic Arousal-Fixed Form), loneliness (Revised 20-item UCLA Loneliness Scale), and perceived emotional support (Emotional Support-Fixed Form).

Results

Eighty parents reported symptoms of depression 8.00(4.00, 13.75), anxiety (23.43 ± 7.80), anger (13.40 ± 5.46), fear (72.81 ± 27.26), somatic fear 9.00(6.00, 12.75), loneliness (39.35 ± 12.00), and low perceived emotional support (32.14 ± 8.06). Parents who were young, single, low-income, and with limited-post secondary education reported greater loneliness and lower perceived emotional support. Fear correlated with depression (r = 0.737, P < 0.01) and anxiety (r=0.900, P < 0.01). Inverse relationships were discovered between perceived emotional support and loneliness (r = −0.767, P < 0.01), anger (r=-0.401, P < 0.01), and depression (r = −0.334, P < 0.01).

Conclusions

The cluster of negative emotions identified will serve as potential targets for future interventions designed to enhance support for parents of critically ill children.

Impressions of aquatic therapy treatment in children with prolonged mechanical ventilation - clinician and family perspectives: a qualitative case study

PURPOSE

To describe the experiences of applying aquatic therapy (AT) to children with ventilation needs after discharge from the paediatric intensive care unit (PICU).

MATERIAL AND METHODS

A qualitative and descriptive case study with integrated units. Purposive sampling was carried out, including the parents of the children participating in the AT programme and the healthcare professionals treating them. Fourteen participants were included: four parents, five physicians, three physiotherapists and two nurses. The study was carried out as part of a program on AT in critically ill children. Semi-structured interviews were conducted. A thematic analysis was performed.

RESULTS

Three themes were identified. Theme (1) Difficulties for implementation: AT was not perceived as a viable therapeutic modality; lack of knowledge and resources. Theme (2) Risks and challenges: Perceptions of anxiety at the beginning; planning and precautions. Theme (3) AT facilitates new possibilities and benefits: The necessity of the presence of parents during the AT session; a sense of "normalcy;" outcomes of AT in relation to post-intensive care syndrome.

CONCLUSIONS

Our results will help to better understand a safe and feasible way to work with children with PPMV, even though this approach is not yet widespread due to its special circumstances. These results can be used in future AT programmes in children undergoing special treatments.IMPLICATIONS FOR REHABILITATIONChildren with ventilation needs after discharge from the intensive care unit present physical, cognitive, and mental alterations that decrease functional capacity and quality of life.In a relatively small sample, positive outcomes were found for AT in relation to post-intensive care syndrome, enabling children to participate in aquatic therapy activities with the involvement of parents.This study highlighted the positive impact on the quality of life of both children and their parents.Aquatic therapy is a feasible intervention in children requiring prolonged mechanical ventilation, although certain difficulties should be addressed in terms of implementation, together with challenges regarding safety and planning.These difficulties may be overcome by promoting coordination between professionals, creating security protocols, and/or facilitating specialised education for therapists.

A Qualitative Study of Parents' Experiences in the Pediatric Intensive Care Unit: Riding a Roller Coaster

PURPOSE

Post-traumatic stress disorder rates in parents following PICU admission ranged between 12.2% and 42%. Despite the numbers affected and the magnitude of parents' distress, little is known about parents' experience in the PICU that could be a source of their stress. This study sought to describe parents' experience of the PICU during their child's stay, including their perceived stressors.

DESIGN AND METHODS

Single occasion interviews with 15 parents of children with complex medical conditions admitted for 48 or more hours to a tertiary PICU in the USA. Interviews were inductively coded using methods adapted from Grounded Theory.

RESULTS

Riding a Roller Coaster was the core construct that explained parents' experiences. Analyses revealed four domains: Being in a New Stressful World, My Brain Is Burning All the Time, Going through a Hurricane of Emotions, and Being in a Safe Place with Great People.

CONCLUSION

Despite outstanding medical services, parents were traumatized by seeing their child in a life-threatening situation and were buffeted by a tidal wave of emotions. Parents lived in a constant state of uncertainty, helplessness and fear, not knowing if their child would survive or have devastating outcomes or permanent disabilities.

PRACTICE IMPLICATIONS

Supporting parents during their emotional roller coaster ride requires targeted services throughout the child's illness trajectory, including ways to interpret what is happening in the PICU, helping parents self-regulate their stress, and offering services around parents' fears, concerns, and strategies to manage their uncertainty and feelings of helplessness.

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

PROBLEM

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

ELIGIBILITY CRITERIA

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

SAMPLE

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

RESULTS

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

CONCLUSIONS

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

IMPLICATIONS

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

Increased Psychiatric Risk in Children After Pediatric Intensive Care Unit Admission

We aimed to assess psychiatric risk in children after admission to pediatric intensive care units (PICUs) and its association with greater psychiatric morbidity. We examined 130 children aged 6 to 13 years in a cross-sectional study divided into two groups: 65 children discharged from PICU and another 65 from general wards. The PICU group scored worse on all measured scales of psychiatric morbidities. The child-specific assessment methods included the posttraumatic stress disorder (PTSD) scale as per the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, and Impact of Event Scale Revised for PTSD; Revised Children's Manifest Anxiety Scale for anxiety; and Birleson Depression Scale for depression. The PICU group had significantly higher frequencies of PTSD compared with the general ward group (84.6% vs. 6.2%, respectively; p < 0.001). Hence, PICU survivors have higher risk of psychiatric morbidities such as PTSD, anxiety, and depression compared with general ward patients.

"Like Walking in a Fog"-Parents' perceptions of sleep and consequences of sleep loss when staying overnight with their child in hospital

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.

Parents and nurses telling their stories: the perceived needs of parents caring for critically ill children at the Kilimanjaro Christian Medical Centre in Tanzania

Background

Parents have significant responsibility in the care of their critically ill children who have been admitted to the intensive care unit (ICU). When staying with their children in the hospital, they also have particular needs that should be adequately acknowledged and responded to by healthcare providers. Moreover, when their needs are not identified and addressed, parents may experience stress and anxiety as a result. This study describes the needs of parents caring for hospitalized critically ill children, as perceived by parents and nurses.

Methods

This study used a descriptive qualitative research design. Five focus group discussions with nurses and parents of critically ill children, who were purposefully recruited, were conducted at the Kilimanjaro Christian Medical Centre Hospital. A qualitative content analysis guided the analysis of the data.

Results

Two themes emerged from the perceptions of parents and nurses about the needs of parents caring for hospitalized critically ill children. These were: "engaging parents in the care of their children" and "receiving psychosocial support". Both parents and nurses identified the importance of providing adequate information about their children's progress, encouraging and involving parents in the care of their children and having flexible visiting time for parents was vital when caring for critically ill children.

Conclusions

This study provides an in-depth understanding of parents' needs when caring for critically ill children in the hospital setting. Nurses caring for these children should understand the needs of parents and integrate the parents into the daily care of their children. Nurses should also continuously support, inform and engage parents during child-caring procedures. Finally, visiting times for intensive care units should be flexible and allow more time for parents to connect with their hospitalized children.

Mothers' needs regarding partnerships with nurses during care of infants with congenital heart defects in a paediatric cardiac intensive care unit

OBJECTIVES

We investigated mothers' needs in forming partnerships with nurses based on children's postoperative recovery in a paediatric cardiac intensive care unit.

DESIGN

This was a descriptive study using prospective data.

SETTING

Data were collected from 36 mothers enrolled in a mother-nurse partnership program.

MAIN OUTCOME MEASURES

We investigated mothers' need for information and participation activities using a self-made survey tool, as well as the duration of mothers' care participation and physical engagement and psychological connectedness.

RESULTS

The mothers desired information on their infants' postoperative stability in the early recovery phases and information on infants' transfer and care in the later phases. Mothers' mean duration of care participation increased as infants' recovery progressed (15.82 ± 8.76 minutes in the second phase of recovery to 29.46 ± 4.53 minutes in the fifth phase; F = 19.54, p < .001). Mothers' physical engagement and psychological connectedness also increased with infants' recovery (F = 200.95, p < .001; F = 93.27, p < .001, respectively). Mothers generally passively participated at first and gradually developed more positive and enthusiastic participation as infants recovered.

CONCLUSION

Infants' condition heavily influenced mothers' needs regarding partnerships. Thus, nurses must individually provide mothers with information and encourage them to participate in care.

A Case Report Examining Early Extubation Following Congenital Heart Surgery in a Low Resource Setting

This case report aims to critically analyse the evidence surrounding early extubation in the post-operative phase following complex congenital cardiac surgery. Child A was an 8 year old female who had undergone complex congenital cardiac surgery during an international surgical charity mission. On admission to the paediatric intensive care unit Child A appeared to be in good condition and no major complications had occurred intra-operatively. This was considered alongside the situational pressures of resource limitations and the mission's aim to offer surgery to as many children as possible during the available time frame. The decision was made by the team that Child A was a suitable candidate for 'early extubation.' Some members of the team were uncomfortable with this approach and felt it could lead to poorer outcomes for patients. Current evidence surrounding early extubation both within international surgical mission trips to low-income and middle-income countries and established cardiac centres within high-income countries is examined and discussed alongside the context of resource limitation. Although the process and implications of early extubation following cardiac surgery needs further research, on the basis of the evidence currently available clinicians could potentially encourage the use of early extubation within clinical practice (for appropriately selected patients) through the utilisation of a multidisciplinary approach, both within the UK and during international surgical charity missions to low-income and middle-income countries.

Parents' and carers' experiences of transition and aftercare following a child's discharge from a paediatric intensive care unit to an in-patient ward setting: A qualitative systematic review

OBJECTIVES

To explore parents' experiences of transition and aftercare following their child's discharge from a paediatric intensive care unit to an in-patient ward.

METHODS

A qualitative systematic review was conducted. Electronic databases CINAHL, MEDLINE, EMBASE, Psych INFO, and ASSIA were searched for qualitative studies with no date limits imposed. Methodological quality was assessed using the JBI QARI standardised critical appraisal instrument. Data were extracted into a standardised data extraction tool. Findings were pooled using a meta-aggregative approach.

RESULTS

Four studies were included in the final review that included a total of 95 participants. Forty-nine findings were extracted and through an iterative process resulting in four synthesised findings being developed. These included: (1) Dynamic emotional response pre, peri and post-transfer; (2) Involvement in care absent but fundamental to functioning; (3) Changes in care delivery and environment provoking adverse emotions and (4) Transition as a physical, emotional and social balancing act.

CONCLUSION

Transitioning from the paediatric intensive care unit to an in-patient ward can be a challenging time for parents, exposing them to a turbulent emotional and social status, and depleting their personal resources. Parents are aware of differences in the organisation and delivery of care between clinical areas which can compound the adversity experienced. Health professionals need to provide targeted support in order to mitigate these negative emotional, physical and social effects experienced.