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Nenningsland TS, Asadi-Azarbaijani B, Alfheim HB, Hansen EH. Parents' perceptions of factors influencing sleep in pediatric intensive care units: A qualitative study. J Pediatr Nurs 2024; 77:e225-e230. [PMID: 38641456 DOI: 10.1016/j.pedn.2024.04.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2024] [Revised: 04/08/2024] [Accepted: 04/09/2024] [Indexed: 04/21/2024]
Abstract
PURPOSE The purpose of this study is to explore factors influencing sleep in pediatric intensive care units as perceived by parents of critically ill children. DESIGN AND METHODS This descriptive qualitative study used individual semistructured interviews. Parents were recruited through purposive sampling from two pediatric intensive care units at two locations in one university hospital in Norway. Ten parents were interviewed. The interviews were analyzed using a six-phase reflexive thematic analysis. FINDINGS The analysis produced 17 subthemes under four main themes: environmental factors in the pediatric intensive care unit disturb children's sleep, children need trust and safety to sleep, nurses' cooperation with parents influences children's sleep, and nurses' structuring of their practices is fundamental to sleep promotion. CONCLUSION The parents found that the environment disturbed their children's sleep, and environmental factors were easier to control in single rooms than in multibed rooms. Children slept better when they felt safe and trusted the nurses, and parents desired more cooperation in promoting sleep for their children, which may be an essential and overlooked part of sleep promotion. Nurses varied considerably in how they prioritized sleep and structured their practices to promote sleep. PRACTICE IMPLICATIONS Nurses should take parents' experiences into account to better promote sleep for patients. By limiting environmental disturbances, building relationships with children to make them feel safe, including parents in sleep promotion, and prioritizing sleep in their practices, nurses could improve sleep quality and limit the consequences of sleep disturbance.
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Affiliation(s)
- Tomas Slåtten Nenningsland
- Centre of Diaconia and Professional Practice, VID Specialized University, Diakonveien 14, 0370 Oslo, Norway; Institute for Nursing, Faculty of Health Sciences, VID Specialized University, Diakonveien 14, 0370 Oslo, Norway.
| | - Babak Asadi-Azarbaijani
- Institute for Nursing, Faculty of Health Sciences, VID Specialized University, Diakonveien 14, 0370 Oslo, Norway.
| | - Hanne Birgit Alfheim
- Department of Anesthesia and Intensive Care, Bærum Hospital, Vestre Viken Hospital Trust, Postbox 800, 3004 Drammen, Norway.
| | - Elisabeth Holm Hansen
- Institute for Nursing, Faculty of Health Sciences, VID Specialized University, Diakonveien 14, 0370 Oslo, Norway; Department of Nursing and Health Sciences, University of South-Eastern Norway, Kjølnes Ring 56, 3918 Porsgrunn, Norway.
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Tarbi EC, Broden EG, Rosa WE, Hayden A, Morgan BE. Existential Care in Daily Nursing Practice. Am J Nurs 2023; 123:42-48. [PMID: 37732668 PMCID: PMC10805359 DOI: 10.1097/01.naj.0000979092.39243.d4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/22/2023]
Abstract
ABSTRACT Relationship-centered palliative nursing during serious illness requires existential care. Yet, multilevel systemic barriers hinder nurses' ability to provide this care. The authors suggest ways to navigate these barriers, highlighting existential care priorities that nurses can attend to in their daily practice. These include 1) maintaining a strengths-based orientation, 2) taking a life course perspective, 3) grounding care firmly in relationships, and 4) responding moment to moment. They propose that by emphasizing existential care in palliative nursing, we can create a more compassionate and human-centered health system.
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Affiliation(s)
- Elise C Tarbi
- Elise C. Tarbi is an assistant professor in the Department of Nursing at the University of Vermont in Burlington. Elizabeth G. Broden is a fellow in the Yale National Clinician Scholars Program in New Haven, CT, and has received funding from a National Institutes of Health training grant (5T32HS017589) to the Yale School of Public Health. William E. Rosa is assistant attending behavioral scientist, Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York City. Adam Hayden is an independent scholar and unaffiliated patient advocate. Brianna E. Morgan is a postdoctoral fellow in the Division of Geriatric Medicine and Palliative Care, Department of Medicine, NYU Langone Health in New York City. Contact author: Elise C. Tarbi, . The authors have disclosed no potential conflicts of interest, financial or otherwise
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Chasweka G, Majamanda MD, Namathanga A. The Cry to Be Involved: Experiences of Caregivers on Participation in Decision Making and Care Provision at Mercy James PICU in Blantyre, Malawi. Compr Child Adolesc Nurs 2022; 46:20-32. [PMID: 36971888 DOI: 10.1080/24694193.2022.2085821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
Abstract
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.
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Affiliation(s)
- Grace Chasweka
- Department of Nursing, Zomba Central Hospital, Zomba, Malawi
| | - Maureen Daisy Majamanda
- Department of Nursing, Kamuzu University of Health Sciences, Blantyre, Malawi
- Research Department, Consortium for Advanced Research Training in Africa, Nairobi, Kenya
| | - Annie Namathanga
- Department of Nursing, Kamuzu University of Health Sciences, Blantyre, Malawi
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Kongnetiman-Pansa L, Haines-Saah RJ. When a Child Dies: Racialized Father's Experiences of Objectification During Hospital Care. OMEGA-JOURNAL OF DEATH AND DYING 2022:302228221093464. [PMID: 35473421 DOI: 10.1177/00302228221093464] [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: 11/15/2022]
Abstract
Understanding the meaning of loss for racialized immigrant fathers and addressing their experiences in a culturally competent manner is important in an increasingly ethnoculturally diverse country like Canada. Culture, customs and rituals influence fathers' grief and culture impacts how individuals discuss death and dying as well as how they perceive the death of a child. This article is part of a qualitative research project, which examined the experiences of racialized immigrant fathers who experienced the death of a child. Guided by Charmaz's constructivist grounded theory, the methodological aim was to develop a theoretical framework grounded in fathers' experiences of child death within the hospital setting. Findings suggest that for racialized immigrant fathers their migration experience compounds their losses in unexpected ways and that experiences of objectification or 'othering' in hospital and by health care staff were significant.
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Affiliation(s)
| | - Rebecca J Haines-Saah
- 2129University of Calgary, Department of Community Health Sciences, Cumming School of Medicine, Calgary, AB, Canada
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Lipson-Smith R, McLaughlan R. Mapping Healthcare Spaces: A Systematic Scoping Review of Spatial and Behavioral Observation Methods. HERD-HEALTH ENVIRONMENTS RESEARCH & DESIGN JOURNAL 2022; 15:351-374. [PMID: 35356828 DOI: 10.1177/19375867221089702] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To provide a taxonomy of spatial observation methods that are commonly used in healthcare environments research and to describe their relative success. BACKGROUND Spatial observation is a valuable but resource intensive research method that is often used in healthcare environments research, but which frequently fails to deliver conclusive results. There is no existing catalog of the different spatial and behavioral observation methods that are used in healthcare design research and their benefits or limitations. METHODS The review adheres to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. Ten key databases were searched, and articles were screened by both authors. RESULTS Across 67 included studies, 79 observation methods were reported. We categorized those into four, distinct methodological approaches, outlining the benefits, limitations, and suitability of each for obtaining different types of results. Common limitations included difficulty generalizing to other contexts and a lack of detailed description during data collection which led to key environment variables not being recorded. More concrete conclusions were drawn when observation methods were combined with complimentary methods such as interview. CONCLUSIONS The relative success of spatial observation studies is dependent on the fit of the method selected relative to the research question, approach, and healthcare setting; any complimentary methods delivered alongside it; and the analysis model employed. This article provides researchers with practical advice to guide the appropriate selection of spatial observation methods.
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Affiliation(s)
- Ruby Lipson-Smith
- School of Architecture and the Built Environment, University of Newcastle, Australia
| | - Rebecca McLaughlan
- School of Architecture and the Built Environment, University of Newcastle, Australia.,Sydney School of Architecture, Design & Planning, The University of Sydney, Australia
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Broden EG, Werner-Lin A, Curley MA, Hinds RPS. Shifting and intersecting needs: Parents’ experiences during and following the withdrawal of life sustaining treatments in the paediatric intensive care unit. Intensive Crit Care Nurs 2022; 70:103216. [DOI: 10.1016/j.iccn.2022.103216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Revised: 01/29/2022] [Accepted: 02/03/2022] [Indexed: 11/05/2022]
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Mitteregger E, Wehrli M, Theiler M, Logoteta J, Nast I, Seliner B, Latal B. Parental experience of the neuromotor development of children with congenital heart disease: an exploratory qualitative study. BMC Pediatr 2021; 21:430. [PMID: 34598680 PMCID: PMC8485514 DOI: 10.1186/s12887-021-02808-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Accepted: 07/08/2021] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Children with severe congenital heart disease (CHD) are a group of children at risk for neurodevelopmental impairments. Motor development is the first domain to show a delay during the first year of life and may significantly contribute to parental concerns, stress, and difficulties in early child-parent attachment. Thus, the aim of the study was to better understand the wishes and concerns of parents of children with CHD and explore their experience of their children's neuromotor development in the first year of life. METHODS In this qualitative study, fourteen families were recruited. Their children were aged 1-3 years and had undergone open heart surgery within the first 6 months of life. Semi-structured interviews were audio-recorded and transcribed. The data was explored within an expert group, and a qualitative content analysis was conducted using VERBI MAXQDA software 2020. The study was conducted in accordance with the COREQ checklist. RESULTS Parents of children with CHD reported several burdens and needs. Parental burdens concerned the child's motor development, their own physical and psychological strain, and difficulties in communication with healthcare professionals. The needs, parents reported included supporting their child's motor development, a medical coordinator, and better communication between healthcare professionals and parents. During the first phase of their children's illness, parents underwent a dynamic transitional phase and expressed the need to rely on themselves, to trust their children's abilities, and to regain self-determination in order to strengthen their self-confidence. CONCLUSIONS It is essential to involve parents of children with CHD at an early stage of decision-making. Parents are experts in their children and appreciate medical information provided by healthcare professionals. Interprofessional teamwork, partnering with parents, and continuous support are crucial to providing the best possible care for children and their families. Family-centred early motor intervention for CHD children might counteract the effect of parental overprotection and improve children's motor development and thus strengthen child-parent interaction. In future work, we aim to evaluate a family-centred early motor intervention for children with CHD developed on the basis of this qualitative study. TRIAL REGISTRATION Not applicable.
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Affiliation(s)
- Elena Mitteregger
- Child Development Center, University Children's Hospital Zurich, Steinwiesstrasse 75, CH-8032, Zürich, Switzerland. .,Children's Research Center, University Children's Hospital Zurich, Zurich, Switzerland. .,School of Health Professions, Zurich University of Applied Sciences, Winterthur, Switzerland. .,Faculty of Medicine, University of Zurich, Zurich, Switzerland.
| | - Martina Wehrli
- Child Development Center, University Children's Hospital Zurich, Steinwiesstrasse 75, CH-8032, Zürich, Switzerland
| | - Manuela Theiler
- Swiss parents' association for the child with heart disease (Elternvereinigung für das herzkranke Kind), Mülligen, Switzerland
| | - Jana Logoteta
- Department of Pediatric Cardiology, University Children's Hospital Zurich, Zurich, Switzerland
| | - Irina Nast
- School of Health Professions, Zurich University of Applied Sciences, Winterthur, Switzerland
| | - Brigitte Seliner
- Swiss Children's Rehab, University Children's Hospital Zurich, Zurich, Switzerland
| | - Beatrice Latal
- Child Development Center, University Children's Hospital Zurich, Steinwiesstrasse 75, CH-8032, Zürich, Switzerland.,Children's Research Center, University Children's Hospital Zurich, Zurich, Switzerland.,Faculty of Medicine, University of Zurich, Zurich, Switzerland
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Verderber S, Gray S, Suresh-Kumar S, Kercz D, Parshuram C. Intensive Care Unit Built Environments: A Comprehensive Literature Review (2005-2020). HERD-HEALTH ENVIRONMENTS RESEARCH & DESIGN JOURNAL 2021; 14:368-415. [PMID: 34000842 PMCID: PMC8597197 DOI: 10.1177/19375867211009273] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Revised: 03/15/2021] [Accepted: 03/23/2021] [Indexed: 11/17/2022]
Abstract
BACKGROUND The intensive care environment in hospitals has been the subject of significant empirical and qualitative research in the 2005-2020 period. Particular attention has been devoted to the role of infection control, family engagement, staff performance, and the built environment ramifications of the recent COVID-19 global pandemic. A comprehensive review of this literature is reported summarizing recent advancements in this rapidly expanding body of knowledge. PURPOSE AND AIM This comprehensive review conceptually structures the recent medical intensive care literature to provide conceptual clarity and identify current priorities and future evidence-based research and design priorities. METHOD AND RESULT Each source reviewed was classified as one of the five types-opinion pieces/essays, cross-sectional empirical investigations, nonrandomized comparative investigations, randomized studies, and policy review essays-and into nine content categories: nature engagement and outdoor views; family accommodations; intensive care unit (ICU), neonatal ICU, and pediatric ICU spatial configuration and amenity; noise considerations; artificial and natural lighting; patient safety and infection control; portable critical care field hospitals and disaster mitigation facilities including COVID-19; ecological sustainability; and recent planning and design trends and prognostications. CONCLUSIONS Among the findings embodied in the 135 literature sources reviewed, single-bed ICU rooms have increasingly become the norm; family engagement in the ICU experience has increased; acknowledgment of the therapeutic role of staff amenities; exposure to nature, view, and natural daylight has increased; the importance of ecological sustainability; and pandemic concerns have increased significantly in the wake of the coronavirus pandemic. Discussion of the results of this comprehensive review includes topics noticeably overlooked or underinvestigated in the 2005-2020 period and priorities for future research.
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Affiliation(s)
- Stephen Verderber
- Centre for Design + Health Innovation, John H. Daniels Faculty of Architecture, Landscape and Design, University of Toronto, Ontario, Canada
- Institute for Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Ontario, Canada
| | - Seth Gray
- Department of Critical Care Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada
- The Hospital for Sick Children, Toronto, Ontario, Canada
- Center for Safety Research, Toronto, Ontario, Canada
| | - Shivathmikha Suresh-Kumar
- John H. Daniels Faculty of Architecture, Landscape and Design, University of Toronto, Ontario, Canada
| | - Damian Kercz
- John H. Daniels Faculty of Architecture, Landscape and Design, University of Toronto, Ontario, Canada
| | - Christopher Parshuram
- Institute for Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Ontario, Canada
- Department of Critical Care Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada
- The Hospital for Sick Children, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Ontario, Canada
- Child Health Evaluative Sciences, SickKids Research Institute, Toronto, Ontario, Canada
- Center for Safety Research, Toronto, Ontario, Canada
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Lessa AD, Cabral FC, Tonial CT, Costa CAD, Andrades GRH, Crestani F, Einloft PR, Bruno F, Sganzerla D, Matte MCC, Fiori HH, Latour JM, Garcia PCR. Brazilian Translation, Cross-Cultural Adaptation, Validity, and Reliability of the EMpowerment of PArents in THe Intensive Care 30 (EMPATHIC-30) Questionnaire to Measure Parental Satisfaction in PICUs. Pediatr Crit Care Med 2021; 22:e339-e348. [PMID: 33044413 DOI: 10.1097/pcc.0000000000002594] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To conduct the Brazilian translation, cross-cultural adaptation, validation, and reliability testing of the EMpowerment of PArents in THe Intensive Care (EMPATHIC-30). DESIGN Prospective study. SETTING PICU of a tertiary-care teaching hospital. PATIENTS Parents (n = 141) completed the translated EMPATHIC-30 questionnaire 72 hours after their child's PICU discharge. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS The translation and cultural adaptation were performed in accordance with the principles of good practice for the translation and cultural adaptation process for patient-reported outcomes measures. Sentences were adapted according to the Brazilian syntax. Total content validity coefficient was above the established average (> 0.8). Reliability was evaluated with the coefficients McDonald omega and Cronbach alpha. The lowest Cronbach alpha found was 0.47 (CI 95%, 0.35-0.59) in the organization domain, where the lowest response rate was also concentrated. The values of the other domains were as follows: 0.64 (95% CI, 0.55-0.73) for information, 0.77 (95% CI, 0.71-0.83) for care and treatment, 0.72 (95% CI, 0.66-0.78) for parent participation, and 0.72 (95% CI, 0.65-0.79) for professional attitudes. The total internal consistency independent of the domain was 0.90 (CI 95%, 0.88-0.92). With regard to McDonald Omega, values were identified: 0.68 (95% CI, 0.49-0.88) for information, 0.73 (95% CI, 0.61-0.85) for care and treatment, 0.85 (95% CI, 0.47-0.80) for parent participation, 0.85 (95% CI, 0.76-0.93), and 0.72 (95% CI, 0.58-0.86) for professional attitudes. CONCLUSIONS EMPATHIC-30 has been translated and culturally adapted for the Brazilian population. Validation demonstrated an above-average total content validity coefficient, confirming the instrument content validity. A sufficient reliability was observed in both analyzed coefficients. The results support the use of the Brazilian version of EMPATHIC-30 for the evaluation of parents' satisfaction of children admitted to the PICU.
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Affiliation(s)
- Alessandra D Lessa
- Department of Pediatrics, School of Medicine and Pediatric Intensive Care of Hospital São Lucas, Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Porto Alegre, Brazil
| | - Felipe C Cabral
- Department of Pediatrics, School of Medicine and Pediatric Intensive Care of Hospital São Lucas, Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Porto Alegre, Brazil
- Digital Health Coordinator, Hospital Moinhos de Vento, Porto Alegre, Brazil
| | - Cristian T Tonial
- Department of Pediatrics, School of Medicine and Pediatric Intensive Care of Hospital São Lucas, Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Porto Alegre, Brazil
| | - Caroline A D Costa
- School of Health and Life Sciences, Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Porto Alegre, Brazil
| | - Gabriela R H Andrades
- Post-graduate Program in Pediatrics and Child Health, School of Medicine and Pediatric Intensive Care of Hospital São Lucas, Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Porto Alegre, Brazil
| | - Francielly Crestani
- Post-graduate Program in Pediatrics and Child Health, School of Medicine and Pediatric Intensive Care of Hospital São Lucas, Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Porto Alegre, Brazil
| | - Paulo R Einloft
- Department of Pediatrics, School of Medicine and Pediatric Intensive Care of Hospital São Lucas, Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Porto Alegre, Brazil
| | - Francisco Bruno
- Department of Pediatrics, School of Medicine and Pediatric Intensive Care of Hospital São Lucas, Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Porto Alegre, Brazil
| | - Daniel Sganzerla
- Digital Health Coordinator, Hospital Moinhos de Vento, Porto Alegre, Brazil
| | - Maria C C Matte
- Digital Health Coordinator, Hospital Moinhos de Vento, Porto Alegre, Brazil
| | - Humberto H Fiori
- Department of Pediatrics, Post-graduate Program in Pediatrics and Child Health, School of Medicine and Neonatal Intensive Care of Hospital São Lucas, Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Porto Alegre, Brazil
| | - Jos M Latour
- School of Nursing and Midwifery, Faculty of Health, University of Plymouth, Plymouth, United Kingdom
| | - Pedro Celiny R Garcia
- Department of Pediatrics, Post-graduate Program in Pediatrics and Child Health, School of Medicine and Pediatric Intensive Care of Hospital São Lucas, Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Porto Alegre, Brazil
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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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Spazzapan M, Vijayakumar B, Stewart CE. A bit about me: Bedside boards to create a culture of patient-centered care in pediatric intensive care units (PICUs). J Healthc Risk Manag 2020; 39:11-19. [PMID: 31452293 DOI: 10.1002/jhrm.21387] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2019] [Revised: 06/21/2019] [Accepted: 07/11/2019] [Indexed: 06/10/2023]
Abstract
INTRODUCTION This project assessed whether the introduction of personalized bedside boards containing nonmedical information about patients in a pediatric intensive care unit (PICU) help provide health care professionals (HCPs) better insight about each child's personal qualities and preferences and thereby help improve patient-centered care and patient safety. METHODS Staff and parents of children in a PICU unit completed a questionnaire assessing how well HCPs knew their patients and their design preferences for the board. The questionnaire was completed before and after board introduction, and patient involvement was central to the design of the board. RESULTS There was an improvement in all parameters assessed. Significant improvements include the perception of PICU as a welcoming environment, nurses' understanding about what comforts their patients, and doctors' ability to recognize their patients outside the hospital. Doctors and nurses felt they knew their patients better. Parents' views regarding whether HCPs know what comforts their child and would recognize them outside the hospital also improved. Feedback about board aesthetics and usefulness was positive. CONCLUSION Personalized bedside boards significantly improved how well HCPs knew their patients across various elements. Patient-centered care and, in turn, patient safety in PICUs can be promoted by using personalized bedside boards containing nonmedical information to help HCPs understand their patients' individual needs and tailor their treatment.
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Frechette J, Lavoie-Tremblay M, Kilpatrick K, Bitzas V. When the paediatric intensive care unit becomes home: A hermeneutic-phenomenological study. Nurs Crit Care 2019; 25:140-148. [PMID: 31799741 DOI: 10.1111/nicc.12491] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Revised: 10/29/2019] [Accepted: 11/14/2019] [Indexed: 11/29/2022]
Abstract
BACKGROUND Family-centred care is the dominant model for providing nursing care in paediatrics. Unit layout has been shown to impact nurses' ability to provide family-centred care. Little is known about the meanings and experiences of paediatric intensive care unit nurses concerning the care they provide to families within their unique physical setting. AIM This study examined paediatric intensive care unit nurses' lived experience of caring for families following a major hospital transformation project, which included the construction of a new unit and quality improvement changes. STUDY DESIGN A hermeneutic-phenomenological design was selected to study a paediatric intensive care unit in a large Canadian paediatric teaching hospital. METHODS Data were collected over a 6-month period through individual interviews, photographs, participant observation, and document review. The sample consisted of 15 paediatric intensive care unit nurses who experienced the unit both pre- and post-transformation. Data were analysed in an ongoing fashion using the method described by Benner to identify common and divergent meanings. RESULTS Despite pride in offering a family-friendly environment, nurses' practice prejudiced a family focus in favour of patient-centred care. Nurses in this study negotiated physical and practice spaces with families by interpreting that nurses do not belong in the home-like patient room and exhibiting gatekeeping comportments. CONCLUSION Although similar nurse comportments have been identified in prior works, no previous studies have identified these as forming a pattern of negotiating spaces with families. RELEVANCE TO CLINICAL PRACTICE This study provides insights into the lived experience of paediatric intensive care unit nurses in relation to family care, which can stimulate reflections at an organizational level about creating environments where nurses and families can both feel at home.
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Affiliation(s)
- Julie Frechette
- McGill University Ingram School of Nursing, Montreal, Quebec, Canada
| | | | - Kelley Kilpatrick
- McGill University Ingram School of Nursing, Montreal, Quebec, Canada
| | - Vasiliki Bitzas
- McGill University Ingram School of Nursing, Montreal, Quebec, Canada.,Quebec Integrated University Centre for Health and Social Services of Western Central Montreal Island, Montreal, Quebec, Canada
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Rennick JE, St-Sauveur I, Knox AM, Ruddy M. Exploring the experiences of parent caregivers of children with chronic medical complexity during pediatric intensive care unit hospitalization: an interpretive descriptive study. BMC Pediatr 2019; 19:272. [PMID: 31387555 PMCID: PMC6683527 DOI: 10.1186/s12887-019-1634-0] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Accepted: 07/17/2019] [Indexed: 12/03/2022] Open
Abstract
Background Children with medical complexity (CMC) account for an increasing proportion of pediatric intensive care unit (PICU) admissions across North America. Their risk of unscheduled PICU admission is threefold compared to healthy children, and they are at higher risk of prolonged length of stay and PICU mortality. As a result of their sophisticated home care needs, parents typically develop significant expertise in managing their children’s symptoms and tending to their complex care needs at home. This can present unique challenges in the PICU, where staff may not take parents’ advanced expertise into account when caring for CMC. The study aimed to explore the experiences of parents of CMC during PICU admission. Methods This interpretive descriptive study was performed in the PICU of one Canadian, quaternary care pediatric hospital. Semi-structured interviews were conducted with 17 parent caregivers of 14 CMC admitted over a 1-year period. Results Parents of CMC expected to continue providing expert care during PICU admission, but felt their knowledge and expertise were not always recognized by staff. They emphasized the importance of parent-staff partnerships. Four themes were identified: (1) “We know our child best;” (2) When expertise collides; (3) Negotiating caregiving boundaries; and (4) The importance of being known. Results support the need for a PICU caregiving approach for CMC that recognizes parent expertise. Conclusions Partnership between staff and parents is essential, particularly in the case of CMC, whose parents are themselves skilled caregivers. In addition to enhanced partnerships with health care professionals, needs expressed by parents of CMC during PICU hospitalization included improved communication with staff, and more attention to continuity of care in the PICU and across hospital services. Parent-staff partnerships must be informed by ongoing communication and negotiation of caregiving roles throughout the course of the child’s PICU hospitalization.
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Affiliation(s)
- Janet E Rennick
- The Montreal Children's Hospital, McGill University Health Centre (MUHC), 1001 Decarie Boulevard, Montreal, Quebec, H4A 3J1, Canada. .,Ingram School of Nursing, Faculty of Medicine, McGill University, 680 Sherbrooke West, #1800, Montreal, Quebec, H3A 2M7, Canada. .,Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, 5252 de Maisonneuve West, 3F.47, Montreal, Quebec, H4A 3S5, Canada.
| | - Isabelle St-Sauveur
- The Montreal Children's Hospital, McGill University Health Centre (MUHC), 1001 Decarie Boulevard, Montreal, Quebec, H4A 3J1, Canada.,Ingram School of Nursing, Faculty of Medicine, McGill University, 680 Sherbrooke West, #1800, Montreal, Quebec, H3A 2M7, Canada
| | - Alyssa M Knox
- Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, 5252 de Maisonneuve West, 3F.47, Montreal, Quebec, H4A 3S5, Canada
| | - Margaret Ruddy
- The Montreal Children's Hospital, McGill University Health Centre (MUHC), 1001 Decarie Boulevard, Montreal, Quebec, H4A 3J1, Canada
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Butler AE, Copnell B, Hall H. The impact of the social and physical environments on parent–healthcare provider relationships when a child dies in PICU: Findings from a grounded theory study. Intensive Crit Care Nurs 2019; 50:28-35. [DOI: 10.1016/j.iccn.2017.12.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2017] [Revised: 11/30/2017] [Accepted: 12/21/2017] [Indexed: 10/18/2022]
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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 2019; 50:88-94. [PMID: 30061085 PMCID: PMC7159251 DOI: 10.1016/j.iccn.2018.07.007] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [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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16
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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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17
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Abstract
OBJECTIVES To examine the circumstance of death in the PICU in the setting of ongoing curative or life-prolonging goals. DATA SOURCES Multidisciplinary author group, international expert opinion, and use of current literature. DATA SYNTHESIS We describe three common clinical scenarios when curative or life-prolonging goals of care are pursued despite a high likelihood of death. We explore the challenges to providing high-quality end-of-life care in this setting. We describe possible perspectives of families and ICU clinicians facing these circumstances to aid in our understanding of these complex deaths. Finally, we offer suggestions of how PICU clinicians might improve the care of children at the end of life in this setting. CONCLUSIONS Merging curative interventions and optimal end-of-life care is possible, important, and can be enabled when clinicians use creativity, explore possibilities, remain open minded, and maintain flexibility in the provision of critical care medicine. When faced with real and perceived barriers in providing optimal end-of-life care, particularly when curative goals of care are prioritized despite a very poor prognosis, tensions and conflict may arise. Through an intentional exploration of self and others' perspectives, values, and goals, and working toward finding commonality in order to align with each other, conflict in end-of-life care may lessen, allowing the central focus to remain on providing optimal support for the dying child and their family.
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18
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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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19
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Giles T, de Lacey S, Muir-Cochrane E. How do clinicians practise the principles of beneficence when deciding to allow or deny family presence during resuscitation? J Clin Nurs 2018; 27:e1214-e1224. [PMID: 29266508 DOI: 10.1111/jocn.14222] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/09/2017] [Indexed: 11/28/2022]
Abstract
AIMS AND OBJECTIVES To examine how clinicians practise the principles of beneficence when deciding to allow or deny family presence during resuscitation. BACKGROUND Family presence during resuscitation has important benefits for family and is supported by professional bodies and the public. Yet, many clinicians restrict family access to patients during resuscitation, and rationales for decision-making are unclear. DESIGN Secondary analysis of an existing qualitative data set using deductive category application of content analysis. METHODS We analysed 20 interview transcripts from 15 registered nurses, two doctors and three paramedics who had experienced family presence during resuscitation in an Australian hospital. The transcripts were analysed for incidents of beneficent decision-making when allowing or denying family presence during resuscitation. RESULTS Decision-making around family presence during resuscitation occurred in time poor environments and in the absence of local institutional guidelines. Clinicians appeared to be motivated by doing "what's best" for patients and families when allowing or denying family presence during resuscitation. However, their individual interpretations of "what's best" was subjective and did not always coincide with family preferences or with current evidence that promotes family presence during resuscitation as beneficial. CONCLUSIONS The decision to allow or deny family presence during resuscitation is complex, and often impacted by personal preferences and beliefs, setting norms and tensions between clinicians and consumers. As a result, many families are missing the chance to be with their loved ones at the end of life. The introduction of institutional guidelines and policies would help to establish what safe and effective practice consists of, reduce value-laden decision-making and guide beneficent decision-making. RELEVANCE TO CLINICAL PRACTICE These findings highlight current deficits in decision-making around FPDR and could prompt the introduction of clinical guidelines and policies and in turn promote the equitable provision of safe, effective family-centred care during resuscitation events.
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Affiliation(s)
- Tracey Giles
- Flinders University School of Nursing and Midwifery, Adelaide, SA, Australia
| | - Sheryl de Lacey
- Flinders University School of Nursing and Midwifery, Adelaide, SA, Australia
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20
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Foster M, Whitehead L. Parent and staff perceptions of parental needs during a child's hospital admission to a paediatric high-dependency unit: A New Zealand study. J Paediatr Child Health 2017; 53:1167-1175. [PMID: 28799260 DOI: 10.1111/jpc.13645] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2016] [Revised: 05/07/2017] [Accepted: 05/28/2017] [Indexed: 11/27/2022]
Abstract
AIM This study aimed to identify parents' and staff's perceptions of parents' needs during a paediatric high-dependency unit admission and the relationships between needs, socio-demographic and clinical variables and explores if these perceptions have changed. METHODS This study uses a cross-sectional descriptive correlational design, and 104 parents whose children received care and 88 staff who worked within a paediatric high-dependency unit at a tertiary hospital in New Zealand completed the Needs of Parents' Questionnaire in 2011. RESULTS Parents' and staff's perceptions of the importance of needs were congruent, but differences arose between parents and staff on whether these needs were met. Parents were more likely to rate needs as having been met than staff members. Admission type, age and gender influenced parents' and staff's perceptions of parents' needs. CONCLUSION Synergy between parent and staff satisfaction scores will be enhanced when care delivery is more closely aligned to parents' priorities for care and staff receive feedback on positive health-care experiences.
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Affiliation(s)
- Mandie Foster
- Christchurch Public Hospital, Child and Family Health, Paediatrics, Christchurch Hospital, Christchurch, New Zealand.,Centre for Postgraduate Nursing Studies, University of Otago, Christchurch, New Zealand.,School of Nursing and Midwifery, Edith Cowan University, Perth, Western Australia, Australia
| | - Lisa Whitehead
- Centre for Postgraduate Nursing Studies, University of Otago, Christchurch, New Zealand.,School of Nursing and Midwifery, Edith Cowan University, Perth, Western Australia, Australia
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21
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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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22
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Dahav P, Sjöström-Strand A. Parents' experiences of their child being admitted to a paediatric intensive care unit: a qualitative study-like being in another world. Scand J Caring Sci 2017; 32:363-370. [PMID: 28833379 DOI: 10.1111/scs.12470] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2016] [Accepted: 03/29/2017] [Indexed: 11/26/2022]
Abstract
BACKGROUND There is very little research on the parent's experiences of having a child admitted to a paediatric intensive care unit. Identifying and describing 'such experiences' could facilitate better parental support from the paediatric intensive care team and help the parents manage a stressful situation. AIMS This study aimed to describe parents' experiences of having their child admitted to a paediatric intensive care unit. METHODS Interviews were conducted with 12 parents whose children had been admitted to a paediatric intensive care unit. A qualitative design was used, and the interviews were analysed based on content analysis. RESULT The analysis revealed two categories: 'being involved' and 'being informed' with seven subcategories: 'caring for the parents', 'security and trust', 'altering the parental role', 'stress and fear', 'the importance of knowing', 'interaction in the care process' and 'being prepared'. An overarching theme emerged: the experience was 'like being in another world'. The study concludes that a child's admission to a paediatric intensive care unit is a stressful situation, and for the parents to be able to handle the anxiety and stress, they need to be informed of and involved in their child's care. CONCLUSIONS The parents' experience when their child is admitted to a paediatric intensive care unit is fraught with a range of emotion and fear. There are indications that things such as good information, involvement and a positive experience of the transfer to the paediatric ward reduce the stress and anxiety associated with paediatric intensive care admission. The result of this study could be used as a basis for a post-paediatric intensive care follow-up service for the children and their families.
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Affiliation(s)
- Pia Dahav
- Department of Pediatrics, PICU, Lund University Hospital, Lund, Sweden
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23
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Using Qualitative Research to Inform Development of Professional Guidelines: A Case Study of the Society of Critical Care Medicine Family-Centered Care Guidelines. Crit Care Med 2017; 45:1352-1358. [PMID: 28598866 DOI: 10.1097/ccm.0000000000002523] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To explore the importance, challenges, and opportunities using qualitative research to enhance development of clinical practice guidelines, using recent guidelines for family-centered care in the ICU as an example. METHODS In developing the Society of Critical Care Medicine guidelines for family-centered care in the neonatal ICU, PICU, and adult ICU, we developed an innovative adaptation of the Grading of Recommendations, Assessments, Development and Evaluations approach to explicitly incorporate qualitative research. Using Grading of Recommendations, Assessments, Development and Evaluations and the Council of Medical Specialty Societies principles, we conducted a systematic review of qualitative research to establish family-centered domains and outcomes. Thematic analyses were undertaken on study findings and used to support Population, Intervention, Comparison, Outcome question development. RESULTS We identified and employed three approaches using qualitative research in these guidelines. First, previously published qualitative research was used to identify important domains for the Population, Intervention, Comparison, Outcome questions. Second, this qualitative research was used to identify and prioritize key outcomes to be evaluated. Finally, we used qualitative methods, member checking with patients and families, to validate the process and outcome of the guideline development. CONCLUSIONS In this, a novel report, we provide direction for standardizing the use of qualitative evidence in future guidelines. Recommendations are made to incorporate qualitative literature review and appraisal, include qualitative methodologists in guideline taskforce teams, and develop training for evaluation of qualitative research into guideline development procedures. Effective methods of involving patients and families as members of guideline development represent opportunities for future work.
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24
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Sjostrom-Strand A, Terp K. Parents' Experiences of Having a Baby With a Congenital Heart Defect and the Child's Heart Surgery. Compr Child Adolesc Nurs 2017; 42:10-23. [PMID: 28786702 DOI: 10.1080/24694193.2017.1342104] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
The incidence of children born with congenital heart disease is 1%. Congenital heart disease is among the birth defects that lead to the longest hospital stays, and children with congenital heart disease often require frequent hospitalization and several heart operations, along with lifelong follow-up visits. This study aims to describe parents' experiences when their child has a heart defect and undergoes open heart surgery. A total of 10 parents were interviewed: 8 mothers and 2 fathers. The interviews took place 2 years after the heart surgery. The interviews were analyzed using a content analysis method, which resulted in 4 categories: maintaining belief, experiencing the surgery as a turning point, experiencing the pediatric intensive care unit with anxiety and fear, and perception of support. When parents face their child having a congenital heart defect and plan heart surgery, the whole family is living through a stressful time and has to handle many difficult situations. Parents need support from the health care team.
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Affiliation(s)
| | - Karina Terp
- a Department of Nursing , Lund University , Lund , Sweden
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25
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Elements of Family-Centered Care in the Pediatric Intensive Care Unit: An Integrative Review. J Hosp Palliat Nurs 2017; 19:238-246. [PMID: 28496382 DOI: 10.1097/njh.0000000000000335] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
This paper reports result from a systematic search and thematic analysis of qualitative literature to identify key issues related to family-centered care, behaviors, and communication skills that support the parental role and improve patient and family outcomes in the PICU. Five themes were identified: 1) sharing information; 2) hearing parental voices; 3) making decisions for or with parents; 4) negotiating roles; and 5) individualizing communication. These themes highlight several gaps between how parents want to be involved and perceive clinicians engage them in the care of their child. Parental preferences for involvement differ in the domains of information sharing, decision making, and power-sharing across a spectrum of parental roles from parents as care provider to care recipient. The PICU setting may place clinicians in a double bind trying to both engage families and protect them from distress. Asking families of critically ill children about their preferences for participation across these domains may improve clinician-family relationships.
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26
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Boztepe H, Kerimoğlu Yıldız G. Nurses perceptions of barriers to implementing family-centered care in a pediatric setting: A qualitative study. J SPEC PEDIATR NURS 2017; 22. [PMID: 28198079 DOI: 10.1111/jspn.12175] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2016] [Revised: 10/05/2016] [Accepted: 01/16/2017] [Indexed: 11/28/2022]
Abstract
PURPOSE This was a qualitative study conducted to explore the views of nurses regarding the practice of family-centered care (FCC). DESIGN AND METHODS Eighteen nurses working in different units of a children's hospital in Turkey were included in the study. In-depth interviews were conducted with the nurses to obtain detailed information about their perspectives on FCC activities. RESULTS Two main themes emerged from the data, each with subthemes. The first theme pertained to the nurses' opinions on FCC, and the second theme included their views on parents' participation during nursing rounds. PRACTICE IMPLICATIONS This study indicated that nurses had positive views of FCC activities and that they recognized the need for the family's continuing presence in the child's life, which were important findings. However, they stated that families' cultural characteristics were an obstacle. Therefore, to better implement this model, nurses should not only understand the model conceptually but also understand the rights, roles, and responsibilities of parents. To practice FCC appropriately, nurses need to have sufficient resources, appropriate education, and support from their managers.
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Affiliation(s)
- Handan Boztepe
- Assistant Professor, Pediatric Nursing Department, Nursing Faculty, Hacettepe University, Ankara, Turkey
| | - Gizem Kerimoğlu Yıldız
- Research Assistant, Pediatric Nursing Department, Florence Nightingale Nursing Faculty, Istanbul University, Istanbul, Turkey
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27
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28
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Cuzzocrea F, Costa S, Gugliandolo MC, Larcan R. Psychologists in preoperative programmes for children undergoing surgery. J Child Health Care 2016; 20:164-73. [PMID: 25469004 DOI: 10.1177/1367493514557726] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This study aimed to verify whether psychologists and game activities could reduce preoperative anxiety and promote compliance in paediatric patients. More specifically, we sought to evaluate whether it would be better to propose contextualized games or just distracting activities. A total of 104 children undergoing surgery were assigned to the following 4 conditions of treatment: (1) contextual games and psychological accompaniment, (2) only contextual games, (3) distracting activities, and (4) only psychological accompaniment. Observed children's anxiety was assessed using modified Yale Preoperative Anxiety Scale and compliant behaviours with modified form of Induction Compliance Checklist. Children in the first condition (complete intervention - contextual games and psychological accompaniment) were less anxious and more cooperative in the preoperative period and during the induction of anaesthesia than in the other three conditions. In particular, contextual activities (second condition) were found to be more efficient than psychological accompaniment (fourth condition), whereas the worst condition was proposing only distracting activities (third condition). In order to help young hospitalized patients in paediatric surgery structures, it is necessary to propose games that can prepare them for what will happen as well as the support of a psychologist.
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Affiliation(s)
- Francesca Cuzzocrea
- Department of Human and Social Sciences, University of Messina, Messina, Italy
| | - Sebastiano Costa
- Department of Human and Social Sciences, University of Messina, Messina, Italy
| | | | - Rosalba Larcan
- Department of Human and Social Sciences, University of Messina, Messina, Italy
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29
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Lines LE, Mannix T, Giles TM. Nurses' experiences of the hospitalisation of their own children for acute illnesses. Contemp Nurse 2015; 50:274-85. [PMID: 26340162 DOI: 10.1080/10376178.2015.1089180] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND The hospitalisation of a child is a stressful event for parents. Parents who are also nurses may face additional challenges not encountered by other parents; yet, scant attention has been given to this issue in the literature. AIM To explore the experiences of Nurse-Parents whose children were hospitalised for acute illnesses. METHODS/DESIGN Using a case-study design, semi-structured interviews were conducted with six registered nurses and thematically analysed. RESULTS/FINDINGS Nurse-Parents experienced significant conflicts between their parental role and nurse persona as they were 'torn between dual roles'. Nurse-Parents' specialised knowledge prompted them to elevate the care their child needed, leading to increased stress and anxiety as they struggled to balance these roles. CONCLUSION Nurse-Parents want and need a different type of input into their children's care than non-nurse-parents. An increased awareness among healthcare professionals is the first step to ensuring that effective and individualised support is provided to Nurse-Parents.
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Affiliation(s)
- Lauren E Lines
- a School of Nursing & Midwifery , Flinders University , GPO Box 2100, Adelaide , SA , 5001 , Australia
| | - Trudi Mannix
- a School of Nursing & Midwifery , Flinders University , GPO Box 2100, Adelaide , SA , 5001 , Australia
| | - Tracey M Giles
- a School of Nursing & Midwifery , Flinders University , GPO Box 2100, Adelaide , SA , 5001 , Australia
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30
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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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Stremler R, Adams S, Dryden-Palmer K. Nurses' views of factors affecting sleep for hospitalized children and their families: A focus group study. Res Nurs Health 2015; 38:311-22. [PMID: 25970699 DOI: 10.1002/nur.21664] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/14/2015] [Indexed: 11/09/2022]
Abstract
Light, noise, and interruptions from hospital staff lead to frequent awakenings and detrimental changes to sleep quantity and quality for children who are hospitalized and their parents who stay with them overnight. An understanding of nurses' views on how care affects sleep for the hospitalized child and parent is crucial to the development of strategies to decrease sleep disturbance in hospital. The purpose of this descriptive qualitative study was to gain an understanding of nurses' views on their role in and influence on sleep for families; perceived barriers and facilitators of patient and parent sleep at night; strategies nurses use to preserve sleep; the distribution, between parent and nurse, of care for the child at night; views of the parent as a recipient of nursing care at night; and the nature of interactions between nurses and families at night. Thirty registered nurses from general pediatric and critical care units participated in one of four semi-structured focus groups. Four main influences on sleep were identified: child factors; environmental factors; nurse-parent interaction factors; and nursing care factors. Some of these restricted nurses' ability to optimize sleep, but many factors were amenable to intervention. Balancing strategies to preserve sleep with the provision of nursing assessment and intervention was challenging and complicated by the difficult nature of work outside of usual waking hours. Nurses highlighted the need for formal policy and mentoring related to provision of nursing care at night in pediatric settings.
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Affiliation(s)
- Robyn Stremler
- Associate Professor, Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Room 288, 155 College Street, Toronto, Ontario, Canada, M5T 1P8.,Adjunct Scientist, The Hospital for Sick Children, Toronto, Canada
| | - Sherri Adams
- Nurse Practitioner, Paediatric Medicine Complex Care Program, The Hospital for Sick Children, Toronto, Canada
| | - Karen Dryden-Palmer
- Clinical Nurse Specialist, Bereavement Coordinator, Critical Care, The Hospital for Sick Children, Toronto, Canada
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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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Joyce CN, Libertin R, Bigham MT. Family-centered care in pediatric critical care transport. Air Med J 2015; 34:32-36. [PMID: 25542725 DOI: 10.1016/j.amj.2014.09.007] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2014] [Revised: 09/03/2014] [Accepted: 09/12/2014] [Indexed: 06/04/2023]
Abstract
OBJECTIVE Family-centered care (FCC) in medicine highlights mutually beneficial partnerships among providers, patients, and families. In the field of specialty pediatric critical care transport (SPCCT), FCC includes family presence during transport. We sought to describe family presence and family/staff perspectives of FCC in transport. METHODS This institutional review board-approved study established family presence rates among 5 SPCCT teams. At the top-performing family presence team, parents of transported children were interviewed. A staff survey measured perspectives on FCC using SurveyMonkey (Palo Alto, CA). Statistical tests including chi-square and Fisher exact tests for comparative data were applied using SPSSv17.0 software (SPSS Inc, Chicago, IL). RESULTS The cohort-wide range of family presence was 23% to 66%. Parents were 4 times more likely to accompany their child if transported by ground versus air (ground: 26 [59%] vs. air: 6 [26%]). Sex, race, travel distance from referral hospital, and child's age did not influence the rate of family accompaniment. Most staff (76%) received education on FCC. CONCLUSIONS This study informs how transport factors and parent/staff perceptions influence parental presence on transport at a single center. Opportunities to optimize transport FCC include defining protocols for ground and air transport, establishing a more welcoming attitude toward parents, and designing an FCC educational module specific for transport staff.
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Affiliation(s)
- Crystal N Joyce
- Department of Pediatrics, Akron Children's Hospital, Akron, OH
| | | | - Michael T Bigham
- Department of Pediatrics, Division of Critical Care Medicine, Akron Children's Hospital, Akron, OH.
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Involving parents in managing their child's long-term condition-a concept synthesis of family-centered care and partnership-in-care. J Pediatr Nurs 2015; 30:143-59. [PMID: 25458112 DOI: 10.1016/j.pedn.2014.10.014] [Citation(s) in RCA: 92] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2014] [Revised: 10/16/2014] [Accepted: 10/19/2014] [Indexed: 11/23/2022]
Abstract
UNLABELLED BACKGROUNG: Fostering effective engagement, collaboration and empowerment are central to supporting parents caring for children with long-term conditions. METHODS A concept synthesis was undertaken to identify the shared antecedents and attributes underpinning models of family-centered care and partnership-in-care. RESULTS Thirty studies were reviewed; antecedents of models related to unclear roles, entrenched professional practices, and lack of guidelines supporting their implementation; with central attributes being building trust, listening to parent concerns and valuing parents' knowledge of their child. CONCLUSION The key attributes are outlined in a practical framework of involvement which may promote parent-professional collaboration for families of children with long-term conditions.
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Mattsson JY, Arman M, Castren M, Forsner M. Meaning of caring in pediatric intensive care unit from the perspective of parents: A qualitative study. J Child Health Care 2014; 18:336-45. [PMID: 23939721 DOI: 10.1177/1367493513496667] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
When children are critically ill, parents still strive to be present and participate in the care of their child. Pediatric intensive care differs from other realms of pediatric care as the nature of care is technically advanced and rather obstructing than encouraging parental involvement or closeness, either physically or emotionally, with the critically ill child. The aim of this study was to elucidate the meaning of caring in the pediatric intensive care unit from the perspective of parents. The design of this study followed Benner's interpretive phenomenological method. Eleven parents of seven children participated in observations and interviews. The following aspects of caring were illustrated in the themes arising from the findings: being a bridge to the child on the edge, building a sheltered atmosphere, meeting the child's needs, and adapting the environment for family life. The overall impression is that the phenomenon of caring is experienced exclusively when it is directed toward the exposed child. The conclusion drawn is that caring is present when providing expert physical care combined with fulfilling emotional needs and supporting continuing daily parental care for the child in an inviting environment.
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Knapp C, Chakravorty S, Madden V, Baron-Lee J, Gubernick R, Kairys S, Pelaez-Velez C, Sanders LM, Thompson L. Association between medical home characteristics and staff professional experiences in pediatric practices. Arch Public Health 2014; 72:36. [PMID: 25364502 PMCID: PMC4216343 DOI: 10.1186/2049-3258-72-36] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2014] [Accepted: 07/01/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The patient-centered medical home (PCMH) model has been touted as a potential way to improve primary care. As more PCMH projects are undertaken it is critical to understand professional experiences as staff are key in implementing and maintaining the necessary changes. A paucity of information on staff experiences is available, and our study aims to fill that critical gap in the literature. METHODS Eligible pediatric practices were invited to participate in the Florida Pediatric Medical Home Demonstration Project out which 20 practices were selected. Eligibility criteria included a minimum of 100 children with special health care needs and participation in Medicaid, a Medicaid health plan, or Florida KidCare. Survey data were collected from staff working in these 20 pediatric practices across Florida. Ware's seven-point scale assessed satisfaction and burnout was measured using the six-point Maslach scale. The Medical Home Index measured the practice's medical home characteristics. Descriptive and multivariate analyses were conducted. In total, 170 staff members completed the survey and the response rate was 42.6%. RESULTS Staff members reported high job satisfaction (mean 5.54; SD 1.26) and average burnout. Multivariate analyses suggest that care coordination is positively associated (b = 0.75) and community outreach is negatively associated (b = -0.18) with job satisfaction. Quality improvement and organizational capacity are positively associated with increased staff burnout (OR = 1.37, 5.89, respectively). Chronic condition and data management are associated with lower burnout (OR = 0.05 and 0.20, respectively). Across all models adaptive reserve, or the ability to make and sustain change, is associated with higher job satisfaction and lower staff burnout. CONCLUSIONS Staff experiences in the transition to becoming a PCMH are important. Although our study is cross-sectional, it provides some insight about how medical home, staff and practice characteristics are associated with job satisfaction and burnout. Many PCMH initiatives include facilitation and it should assist staff on how to adapt to change. Unless staff needs are addressed a PCMH may be threatened by fatigue, burnout, and low morale.
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Affiliation(s)
- Caprice Knapp
- />Department of Health Outcomes and Policy, University of Florida, 1329 SW 16th St, Gainesville, FL 32608 USA
| | - Shourjo Chakravorty
- />Department of Health Outcomes and Policy, University of Florida, 1329 SW 16th St, Gainesville, FL 32608 USA
| | - Vanessa Madden
- />Department of Health Outcomes and Policy, University of Florida, 1329 SW 16th St, Gainesville, FL 32608 USA
| | - Jacqueline Baron-Lee
- />Department of Health Outcomes and Policy, University of Florida, 1329 SW 16th St, Gainesville, FL 32608 USA
| | | | - Steven Kairys
- />School of Public Health, University of Medicine and Dentistry of New Jersey, Newark, NJ USA
| | | | - Lee M Sanders
- />Center for Health Policy, Stanford University, Stanford, CA USA
| | - Lindsay Thompson
- />Department of Health Outcomes and Policy, University of Florida, 1329 SW 16th St, Gainesville, FL 32608 USA
- />Department of Pediatrics, University of Florida, Gainesville, FL USA
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LeGrow K, Hodnett E, Stremler R, Cohen E. Evaluating the feasibility of a parent-briefing intervention in a pediatric acute care setting. J SPEC PEDIATR NURS 2014; 19:219-28. [PMID: 24612588 DOI: 10.1111/jspn.12073] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2013] [Revised: 01/29/2014] [Accepted: 01/29/2014] [Indexed: 11/28/2022]
Abstract
PURPOSE The purpose of this study was to test the feasibility of a parent-briefing intervention for parents of hospitalized children with complex healthcare needs. DESIGN AND METHODS A phase I, single-group, posttest study. There were 18 physicians, 25 nurses, and 31 parents who participated in the study. Participants were asked to sit while carrying out the briefings with parents. Parents and clinicians completed a feasibility questionnaire post briefings. RESULTS Sixty-eight briefings were carried out. Parents and nurses evaluated the briefings in a favorable manner, whereas physicians' ratings were mixed. PRACTICE IMPLICATIONS Further inquiry is recommended to understand the effects of a structured communication intervention on parent-professional decision-making practices.
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Affiliation(s)
- Karen LeGrow
- Daphne Cockwell School of Nursing, Ryerson University, Toronto, Ontario, Canada
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Majdalani MN, Doumit MA, Rahi AC. The lived experience of parents of children admitted to the pediatric intensive care unit in Lebanon. Int J Nurs Stud 2014; 51:217-25. [DOI: 10.1016/j.ijnurstu.2013.06.001] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2012] [Revised: 06/04/2013] [Accepted: 06/04/2013] [Indexed: 10/26/2022]
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LeGrow K, Hodnett E, Stremler R, McKeever P, Cohen E. Bourdieu at the bedside: briefing parents in a pediatric hospital. Nurs Inq 2014; 21:327-335. [PMID: 24467272 DOI: 10.1111/nin.12063] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/20/2013] [Indexed: 11/30/2022]
Abstract
The philosophy of family-centered care (FCC) promotes partnerships between families and staff to plan, deliver, and evaluate services for children and has been officially adopted by a majority of pediatric hospitals throughout North America. However, studies indicated that many parents have continued to be dissatisfied with their decision-making roles in their child's care. This is particularly salient for parents of children with chronic ongoing complex health problems. These children are dependent upon medical technology and require frequent hospitalizations during which parents must contribute to difficult decisions regarding their child's care. Given this clinical issue, an alternative theoretical perspective was explored to redress this problem. Pierre Bourdieu's theoretical concepts of field, capital, and habitus were used to analyze the hierarchical relationships in pediatric acute care hospitals and to design a briefing intervention aimed at improving parents' satisfaction with decision making in that health care setting.
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Affiliation(s)
- Karen LeGrow
- Daphne Cockwell School of Nursing, Faculty of Community Services, Ryerson University, Toronto, ON, Canada; The Hospital for Sick Children, Toronto, ON, Canada
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Pickler RH, Tubbs-Cooley HL. Patient-centered outcomes research: a "new" research agenda. J Pediatr Health Care 2014; 28:101-4. [PMID: 24100007 DOI: 10.1016/j.pedhc.2013.08.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2013] [Revised: 08/12/2013] [Accepted: 08/13/2013] [Indexed: 11/16/2022]
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Abstract
Patient-centered and family-centered care (PFCC) has been endorsed by many professional health care organizations. Although variably defined, PFCC is an approach to care that is respectful of and responsive to the preferences, needs, and values of individual patients and their families. Research regarding PFCC in the pediatric intensive care unit has focused on 4 areas including (1) family visitation; (2) family-centered rounding; (3) family presence during invasive procedures and cardiopulmonary resuscitation; and (4) family conferences. Although challenges to successful implementation exist, the growing body of evidence suggests that PFCC is beneficial to patients, families, and staff.
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Affiliation(s)
- Kathleen L. Meert
- Department of Pediatrics, Critical Care Medicine, Children’s Hospital of Michigan, 3901 Beaubien Boulevard, Detroit, MI 48201, USA, Corresponding author.
| | - Jeff Clark
- Department of Pediatrics, Critical Care Medicine, Children’s Hospital of Michigan, 3901 Beaubien Boulevard, Detroit, MI 48201, USA
| | - Susan Eggly
- Department of Internal Medicine, Karmanos Cancer Institute, Wayne State University, 4100 John R MMO3CB, Detroit, MI 48201, USA
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Uhl T, Fisher K, Docherty SL, Brandon DH. Insights into Patient and Family‐Centered Care Through the Hospital Experiences of Parents. J Obstet Gynecol Neonatal Nurs 2013; 42:121-31. [DOI: 10.1111/1552-6909.12001] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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