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Krewulak KD, Jaworska N, Lee L, Louis JS, Dmitrieva O, Leia MP, Doig C, Niven DJ, Parhar KKS, Rochwerg B, West A, Stelfox HT, Leigh JP, Fiest KM. Impact of restricted family presence during the COVID-19 pandemic on critically ill patients, families, and critical care clinicians: a qualitative systematic review. BMC Health Serv Res 2024; 24:936. [PMID: 39148067 PMCID: PMC11328402 DOI: 10.1186/s12913-024-11398-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2024] [Accepted: 08/02/2024] [Indexed: 08/17/2024] Open
Abstract
BACKGROUND We aimed to synthesize the qualitative evidence on the impacts of COVID-19-related restricted family presence policies from the perspective of patients, families, and healthcare professionals from neonatal (NICU), pediatric (PICU), or adult ICUs. METHODS We searched MEDLINE, EMBASE, Cochrane Databases of Reviews and Clinical Trials, CINAHL, Scopus, PsycINFO, and Web of Science. Two researchers independently reviewed titles/abstracts and full-text articles for inclusion. Thematic analysis was completed following appraising article quality and assessing confidence in the individual review findings using standardized tools. RESULTS We synthesized 54 findings from 184 studies, revealing the impacts of these policies in children and adults on: (1) Family integrated care and patient and family-centered care (e.g., disruption to breastfeeding/kangaroo care, dehumanizing of patients); (2) Patients, families, and healthcare professionals (e.g., negative mental health consequences, moral distress); (3) Support systems (e.g., loss of support from friends/families); and (4) Relationships (e.g., loss of essential bonding with infant, struggle to develop trust). Strategies to mitigate these impacts are reported. CONCLUSION This review highlights the multifaceted impacts of restricted visitation policies across distinct care settings and strategies to mitigate the harmful effects of these policies and guide the creation of compassionate family presence policies in future health crises. REGISTRATION https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=290263 .
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Affiliation(s)
- Karla D Krewulak
- Department of Critical Care Medicine, Alberta Health Services & University of Calgary, Calgary, AB, Canada
| | - Natalia Jaworska
- Department of Critical Care Medicine, Alberta Health Services & University of Calgary, Calgary, AB, Canada
| | - Laurie Lee
- Department of Pediatrics, Cumming School of Medicine, Pediatric Intensive Care Unit, Children's Hospital Research Institute, Faculty of Nursing, University of Calgary, Calgary, Alberta, AB, Canada
| | - Julia St Louis
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON, Canada
| | - Olesya Dmitrieva
- Department of Critical Care Medicine, Alberta Health Services & University of Calgary, Calgary, AB, Canada
| | - Madison P Leia
- Department of Critical Care Medicine, Alberta Health Services & University of Calgary, Calgary, AB, Canada
| | - Christopher Doig
- Department of Critical Care Medicine, Alberta Health Services & University of Calgary, Calgary, AB, Canada
| | - Daniel J Niven
- Department of Critical Care Medicine, Alberta Health Services & University of Calgary, Calgary, AB, Canada
| | - Ken Kuljit S Parhar
- Department of Critical Care Medicine, Alberta Health Services & University of Calgary, Calgary, AB, Canada
| | - Bram Rochwerg
- Department of Medicine, Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
| | - Andrew West
- Canadian Society of Respiratory Therapists, Ottawa, ON, Canada
| | - Henry T Stelfox
- Department of Critical Care Medicine, Alberta Health Services & University of Calgary, Calgary, AB, Canada
- Department of Critical Care Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Jeanna Parsons Leigh
- Faculty of Health, School of Health Administration, Dalhousie University, Halifax, NS, Canada
| | - Kirsten M Fiest
- Department of Critical Care Medicine, Alberta Health Services & University of Calgary, Calgary, AB, Canada.
- Department of Community Health Sciences & O'Brien Institute for Public Health, University of Calgary, Calgary, AB, Canada.
- Department of Psychiatry & Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada.
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Campbell-Yeo M, Bacchini F, Alcock L, Mitra S, MacNeil M, Mireault A, Beltempo M, Bishop T, Campbell DM, Chilcott A, Comeau JL, Dol J, Grant A, Gubbay J, Hughes B, Hundert A, Inglis D, Lakoff A, Lalani Y, Luu TM, Morton J, Narvey M, O’Brien K, Robeson P, Science M, Shah P, Whitehead L. Practice recommendations regarding parental presence in NICUs during pandemics caused by respiratory pathogens like COVID-19. Front Pediatr 2024; 12:1390209. [PMID: 38983460 PMCID: PMC11232356 DOI: 10.3389/fped.2024.1390209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2024] [Accepted: 05/17/2024] [Indexed: 07/11/2024] Open
Abstract
Aim To co-create parental presence practice recommendations across Canadian NICUs during pandemics caused by respiratory pathogens such as COVID-19. Methods Recommendations were developed through evidence, context, Delphi and Values and Preferences methods. For Delphi 1 and 2, participants rated 50 items and 20 items respectively on a scale from 1 (very low importance) to 5 (very high). To determine consensus, evidence and context of benefits and harms were presented and discussed within the Values and Preference framework for the top-ranked items. An agreement of 80% or more was deemed consensus. Results After two Delphi rounds (n = 59 participants), 13 recommendations with the highest rated importance were identified. Consensus recommendations included 6 strong recommendations (parents as essential caregivers, providing skin-to-skin contact, direct or mothers' own expressed milk feeding, attending medical rounds, mental health and psychosocial services access, and inclusion of parent partners in pandemic response planning) and 7 conditional recommendations (providing hands-on care tasks, providing touch, two parents present at the same time, food and drink access, use of communication devices, and in-person access to medical rounds and mental health and psychosocial services). Conclusion These recommendations can guide institutions in developing strategies for parental presence during pandemics caused by respiratory pathogens like COVID-19.
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Affiliation(s)
- Marsha Campbell-Yeo
- Faculty of Health, School of Nursing, Dalhousie University, Halifax, NS, Canada
- Department of Pediatrics, IWK Health, Halifax, NS, Canada
| | | | - Lynsey Alcock
- Department of Pediatrics, IWK Health, Halifax, NS, Canada
| | - Souvik Mitra
- Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada
| | - Morgan MacNeil
- Faculty of Health, School of Nursing, Dalhousie University, Halifax, NS, Canada
- Department of Pediatrics, IWK Health, Halifax, NS, Canada
| | - Amy Mireault
- Department of Pediatrics, IWK Health, Halifax, NS, Canada
| | - Marc Beltempo
- Montreal Children’s Hospital, McGill University Health Centre, Montreal, QC, Canada
| | - Tanya Bishop
- Department of Pediatrics, IWK Health, Halifax, NS, Canada
| | | | | | - Jeannette L. Comeau
- Department of Pediatrics, IWK Health, Halifax, NS, Canada
- Faculty of Medicine, Dalhousie University, Halifax, NS, Canada
| | - Justine Dol
- Department of Pediatrics, IWK Health, Halifax, NS, Canada
| | - Amy Grant
- Maritime SPOR SUPPORT Unit, Nova Scotia Health, Halifax, NS, Canada
| | - Jonathon Gubbay
- Department of Laboratory Medicine & Pathobiology, University of Toronto, Toronto, ON, Canada
| | - Brianna Hughes
- Faculty of Health, School of Nursing, Dalhousie University, Halifax, NS, Canada
- Department of Nursing, University of Prince Edward Island, Charlottetown, PE, Canada
| | - Amos Hundert
- Department of Pediatrics, IWK Health, Halifax, NS, Canada
| | - Darlene Inglis
- Department of Pediatrics, IWK Health, Halifax, NS, Canada
| | | | - Yasmin Lalani
- Canadian Premature Babies Foundation, Toronto, ON, Canada
- Humber River Health, Toronto, ON, Canada
| | - Thuy Mai Luu
- Département de Pédiatrie, Centre Hospitalier Universitaire Sainte-Justine, Montréal, QC, Canada
| | - Jenna Morton
- Canadian Premature Babies Foundation, Toronto, ON, Canada
- Pickle Planet, Moncton, NB, Canada
| | - Michael Narvey
- Department of Pediatrics, Children’s Hospital Research Institute of Manitoba, Winnipeg, MB, Canada
| | - Karel O’Brien
- Department of Pediatrics, Mount Sinai Hospital, Toronto, ON, Canada
- Department of Department of Paediatrics, University of Toronto, Toronto, ON, Canada
| | | | - Michelle Science
- Department of Pediatrics, Mount Sinai Hospital, Toronto, ON, Canada
- Department of Paediatrics, SickKids Hospital, Toronto, ON, Canada
| | - Prakesh Shah
- Department of Pediatrics, Mount Sinai Hospital, Toronto, ON, Canada
- Department of Department of Paediatrics, University of Toronto, Toronto, ON, Canada
| | - Leah Whitehead
- Department of Pediatrics, IWK Health, Halifax, NS, Canada
- Canadian Premature Babies Foundation, Toronto, ON, Canada
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Tao X, Chen Y, Xu Y, Wang Z, Liu X. A Survey on the Knowledge, Attitudes, Behaviors and Influencing Factors of Caregivers for Newborns With COVID-19 in Chongqing, China. Cureus 2024; 16:e53046. [PMID: 38410285 PMCID: PMC10895903 DOI: 10.7759/cureus.53046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/26/2024] [Indexed: 02/28/2024] Open
Abstract
OBJECTIVE This study aimed to investigate the healthcare knowledge, attitudes, and behaviors of primary caregivers of newborns with coronavirus disease 2019 (COVID-19) during the pandemic in Chongqing, China, and analyze the influencing factors. METHODS The study included primary caregivers of COVID-19 newborns hospitalized in our institution from December 2022 to January 2023. A questionnaire survey was initiated to assess the caregivers' health-care knowledge, attitudes, and behaviors for COVID-19 and the influencing factors. The data were analyzed statistically. RESULTS A total of 195 caregivers were included, one for each infant with COVID-19. The questionnaire consisted of three dimensions. For the knowledge dimension, the top scoring items were wearing masks in public spaces (4.92 ± 0.087), strengthening hand hygiene (4.83 ± 0.164), and frequent ventilation in living environment (4.62 ± 0.331) in order; for the attitude dimension, the top three scoring items were wearing masks in public spaces (4.85 ± 0.353), strengthening hand washing and disinfection (4.72 ± 0.450), and regular ventilation (4.49 ± 0.501). For the behavior dimension, the top three were confidence in winning the challenge of the pandemic (4.71 ± 0.480), standardized wearing of masks in public spaces/confined spaces (4.68 ± 0.589), and high satisfaction with community epidemic prevention measures (4.67 ± 0.496). Among the influencing factors, fear of COVID-19 was the independent risk indicator for the caregivers' anxiety (OR = 38.085, 95% CI = 14.383-100.664) and fear of COVID-19 (OR = 8.170, 95%CI = 2.156-30.957) and fever (OR = 10.213, 95% CI = 1.972-52.892) were the independent risk indicators for depression. CONCLUSION The study shows a key link between caregiver knowledge, attitudes, behaviors, and neonatal COVID-19 infection, with a gap between knowledge, attitudes, and behaviors. Caregivers, especially those dealing with premature infants, worried about mother-to-child transmission and experienced multiple births, face significant psychological stress during this phase of the pandemic.
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Affiliation(s)
- Xiaojun Tao
- Department of Neonatology, Children's Hospital of Chongqing Medical University, Chongqing, CHN
| | - Yanhan Chen
- College of Nursing, Chongqing Medical University, Chongqing, CHN
| | - Ye Xu
- Department of Radiology, Children's Hospital of Chongqing Medical University, Chongqing, CHN
| | - Zhengjie Wang
- Department of Nuclear Medicine, The First Affiliated Hospital of Chongqing Medical University, Chongqing, CHN
| | - Xuexiu Liu
- Department of Neonatology, Children's Hospital of Chongqing Medical University, Chongqing, CHN
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Alcaraz Garcia-Tejedor G, Le M, Tackey T, Watkins J, Caldeira-Kulbakas M, Matava C. Experiences of Parental Presence in the Induction of Anesthesia in a Canadian Tertiary Pediatric Hospital: A Cross-Sectional Study. Cureus 2023; 15:e36246. [PMID: 36937125 PMCID: PMC10019788 DOI: 10.7759/cureus.36246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/16/2023] [Indexed: 03/18/2023] Open
Abstract
Background Parental presence at induction of anesthesia remains controversial and has been reported to provide mixed results. As such, parental presence at induction of anesthesia is not practiced routinely everywhere. There are currently limited data describing the practice of parental presence at induction of anesthesia or the experiences and perceptions of parents in Canada. Objectives We sought to investigate (1) the frequency of parental presence at induction of anesthesia and (2) the experiences and perceptions of parents accompanying their child into the operating room compared to those who did not at a tertiary Canadian pediatric hospital. Methods Institutional quality improvement approval was obtained. This study was a cross-sectional survey. Parents waiting in the parent surgical waiting room during the procedure were invited to complete a web-based survey. Consent was implied via completing the survey. The cross-sectional survey elicited the prevalence of parental presence during induction of anesthesia as well as their experience and perceptions. We also investigated the parents' preferences for preoperative education. Results Of the 448 parents approached, 403 completed the survey between May and June 2017. Sixty-eight (16.9% [13.4-20.9]) parents accompanied their child into the operating room (parental presence at induction of anesthesia), while 335/403 (83.1% [79.1-86.7]) did not (no-parental presence at induction of anesthesia). Reasons for not accompanying their child into the operating room included "not being aware they could" (158/335, 47.2% [41.9-52.5]), "I didn't think my child needed me" (107/335, 31.9% [27.2-37.1]), "my child was coping well" (46/335, 13.4% [10.5-17.8]), and "I was anxious" (47/335, 14.0% [10.7-18.2]). Most of the parents in the parental presence at induction of anesthesia cohort (66/67, 98.5% [95.6-101.2]) reported that they believed their child benefited/would have benefited from their presence during induction of anesthesia compared to those in the no-parental presence at induction of anesthesia cohort (137/335, 40.9% [35.8-46.2]), P < 0.001. Overall, 51/335 (14.7%) parents in the no-parental presence at induction of anesthesia cohort and 3/67 (4.5%) of those in the parental presence at induction of anesthesia cohort felt that offering parental presence at induction of anesthesia should depend on factors including child's age as well as the level of coping and anxiety. More patients in the no-parental presence at induction of anesthesia cohort felt that parental presence at induction of anesthesia should also depend on the child's age and whether the child was coping. Parents felt that face-to-face discussions with clinicians are most effective for discussing future parental presence at induction of anesthesia. Conclusions We have shown that most parents at our institution do not undergo parental presence at induction of anesthesia and are for the most part comfortable with their child going unaccompanied into the operating room. Administrators and clinicians seeking to implement parental presence policies should consider navigating parental presence at induction of anesthesia with evidence-based approaches tailored to each parent and their child.
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Affiliation(s)
| | - Matthew Le
- Anesthesia and Pain Medicine, Hospital for Sick Children, Toronto, CAN
| | - Theophilus Tackey
- Anesthesia and Pain Medicine, Hospital for Sick Children, Toronto, CAN
| | - Jessica Watkins
- Anesthesia and Pain Medicine, Hospital for Sick Children, Toronto, CAN
| | | | - Clyde Matava
- Anesthesiology and Pain Medicine, University of Toronto, Toronto, CAN
- Anesthesia and Pain Medicine, Hospital for Sick Children, Toronto, CAN
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