Factors associated with parents' levels of stress in pediatric wards

The factors associated with paediatric medical post-traumatic stress: A systematic review

We examined and synthesised existing literature on factors associated with paediatric medical-related posttraumatic stress among children and their parents. Children experiencing a broad spectrum of medical conditions, diseases and injuries were of interest. A search of relevant literature concerning PMTS in children and their parents, as well as factors associated with PMTS, was conducted using Medline, PubMed and Scopus. Only studies published in English between January 2018 and November 2023 were included. Twelve articles met inclusion criteria. A broad range of correlates of PMTS were identified for children and parents, which were thematically organised into six key areas: hospital practices and environments; the parent-child relationship; parental mental wellbeing; psychological factors; sociodemographic factors; and the physical consequences of the condition. Bearing in mind constraints on causal inference due to the design of the included studies, knowledge of the factors associated with PMTS may enable clinicians to identify at-risk children and parents, with a view to intervention.

The Estimate of Parental Quality of Life Loss Due to Respiratory Syncytial Virus (RSV) Hospitalization

BACKGROUND

Respiratory syncytial virus (RSV) is one of the leading causes of pediatric hospitalizations, mainly in children under 2 years of age. Hospitalization affects the caregivers' quality of life (QoL). We assessed the caregivers' QoL during RSV-confirmed hospitalizations of children under 2 years old, identified the most affected QoL dimensions and calculated utilities focusing on the assessment methods and potential confounders.

METHODS

The caregivers filled out the EQ-5D questionnaire, consisting of a descriptive system (assessing 5 QoL dimensions) and a visual analog scale (EQ VAS). Utility, utility loss and quality-adjusted life years (QALY) loss were calculated, and a concordance between the two systems was assessed.

RESULTS

A disturbance in any of the five assessed dimensions was reported by 42% (55 out of 132) of the caregivers, mostly anxiety/depression (37%) and pain/discomfort (17%). The utilities varied between 0.17 and 1 in the descriptive system and 0.33-1 (median 0.86) in the EQ VAS, with a utility loss of 0.14 (IQR: 0.1-0.2). The calculated QALY loss reached a median of 2.45 × 10-3 (IQR: 1.37 × 10-3-4.56 × 10-3) and was not influenced by the patient's age or the final clinical diagnosis (QALY loss for bronchiolitis: 2.74 × 10-3, pneumonia: 1.84 × 10-3, bronchitis: 1.78 × 10-3, differences statistically insignificant). Only a moderate concordance between the descriptive system and the EQ VAS was seen (Spearman's rank correlation coefficient = 0.437, p < 0.05), with the latter revealing a higher degree of QoL disturbances.

CONCLUSIONS

RSV hospitalization influences parental QoL significantly, and anxiety/depression is the most commonly reported issue. Utility impairment scores depend on the assessment method but not on the patient's age or final diagnosis. Thus, the impact of RSV on caregivers' QoL cannot be underestimated.

Factors Associated With Parenting Stress in Parents of Children With Nephrotic Syndrome: A Cross-Sectional Study

Limited empirical studies were identified to quantify parenting stress in parents of children with nephrotic syndrome (NS). This cross-sectional study aimed to address this gap by examining the prevalence and factors associated with parenting stress. Two hundred two Chinese parents of children with NS were investigated by using the Parenting Stress Index-Short Form (PSI-SF), the Parenting Sense of Competence Scale (PSCS), the Social Support Rating Scale (SSRS), and a demographic questionnaire. The results showed that parents of children with NS experienced higher parenting stress, and 67.8% of participants reported clinical levels of parenting stress. Fathers, parents with a primary education background, low social support and parenting sense of competence, and children with a prolonged treatment childhood NS reported higher parenting stress. Developing corresponding improvement interventions targeting parenting sense of competence, or providing extra disease-related support and education for parents might lessen parenting stress.

Optimizing Resident Education during Family-centered Rounds: An Educational Improvement Initiative

Family-centered rounding (FCR) allows the medical team to partner with patients in medical decision-making, improving communication, and enhancing safety. However, FCR may compromise aspects of the resident education experience. In a survey of pediatric residents at our children's hospital, only 20% felt FCR provided the best educational experience. We designed this project to increase the percentage of residents with a positive perception of the educational experience on FCR from 20% to 80% in 6 months.

METHODS

This project utilized The Model for Improvement and sequential plan-do-study-act cycles. A needs assessment identified educational activities negatively impacted by FCR. We then designed a hybrid FCR process with formal presentations outside patient rooms followed by traditional bedside FCR. Our primary measure was the percentage of residents positively perceiving the FCR educational experience. Our balancing measures included rounding duration and family satisfaction and comprehension.

RESULTS

Residents who perceive FCR to be the best educational experience improved from a baseline of 21% to 76%, with a calculated response rate of 79%. Patients receiving FCR remained above 80%. All surveyed families understood their care plans and remained satisfied with the information provided, although 21% were concerned about the number of people present on rounds during the COVID-19 pandemic. Forty-three percent of hospitalist rounds exceeded the allotted time.

CONCLUSIONS

The hybridization of FCR to include formal presentations may improve the resident learning experience while preserving family satisfaction and comprehension.

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

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

Elevated Parental Stress Is Associated With Lower Self-Efficacy in Provider Communication During a Pandemic

BACKGROUND

Effective communication between physician and parent promotes a successful alliance with families. The association of parental stress with self-efficacy when communicating during parent-physician interactions is unknown in the context of a pandemic.

OBJECTIVES

Objectives of this study include quantifying and comparing the stress experienced by parents of hospitalized children before and after onset of the COVID-19 pandemic and examining the relationship of stress with self-efficacy in parent-physician communication during interactions throughout hospitalization.

METHODS

We conducted in-person surveys of parents of children aged 3 months to 17 years hospitalized at a quaternary-level children's hospital, before and after onset of COVID-19. Parents completed 2 validated tools: Parenting Stress Index (PSI-SF) and the Perceived Efficacy in Parent-Physician Interactions (PEPPI), measuring self-efficacy in communicating with physicians. Socioeconomic data were collected. Fisher exact test and t test were used to compare score proportions and means; linear regression was used to evaluate association between PSI-SF and PEPPI with confounder adjustments.

RESULTS

Forty-nine parents were recruited; the majority identified as non-White and female. An inverse relationship was noted between the total stress score and parental self-efficacy, which only attained statistical significance in the post-COVID-19 cohort (P = .02, multivariate P = .044). A significant increase in the mean was observed for subscale scores of Difficult Child (P = .019) and Parent-Child Dysfunctional Interaction after COVID-19 (P = .016).

CONCLUSIONS

Elevated parental stress is associated with decreased self-efficacy during parent-physician interactions and it worsened during the pandemic. Future studies should examine the effect of different communication styles on parental stress and self-efficacy during hospitalization.

Facilitating Engagement on Family-Centered Rounds for Families With Limited Comfort With English

OBJECTIVE

Conducting family-centered rounds (FCR) for families with limited comfort with English (LCE) presents communication challenges. The objective of this study was to characterize the preferences of Spanish-speaking parents with LCE around interpretation and communication with the medical team during FCR to promote family engagement during rounds.

METHODS

This qualitative study was conducted at a tertiary care children's hospital in New York, New York. Eighteen Spanish-speaking parents of patients admitted to the hospital medicine service participated. Bilingual investigators conducted semistructured interviews over a secure virtual platform. Interview transcriptions were coded and analyzed by using a grounded theory approach and constant comparative method. Parents were recruited until thematic saturation was achieved.

RESULTS

Most participants were mothers (72%) from the Dominican Republic (61%). Responses from participants yielded a conceptual model depicting parents' perspectives on family engagement and bidirectional communication during FCR. Three major themes emerged: (1) importance of interpreter use, (2) understanding of medical information, and (3) participation in FCR. Within each theme, factors that facilitate or impede engagement in FCR were identified. Interpreters facilitated information sharing and parent understanding of medical care, increasing parent appreciation of FCR. Lack of language-concordant care and parents' perceived responsibility for the language barrier limited engagement.

CONCLUSIONS

Families with LCE value involvement during FCR, but face difficulties due to language barriers. Providers can support these families by empowering families' participation and by consistently using an interpreter. Understanding the preferences of families with LCE for participation in FCR will help providers deliver more equitable family-centered care.

Family Involvement in Caring for Inpatients in Acute Care Hospital Settings: A Systematic Review of Literature

Family members, also known as patients' guardians (PG) are involved in caring for inpatients in acute care hospital settings. The practice is adopted from Family Centred Care (FCC) approach. This literature review aimed to provide an overview of key findings in literature on the practice of involving PGs in acute care hospital settings We used a systematic literature search to select original research articles or systematic reviews published in English between 2008 and 2019 that discussed PGs in acute care hospital settings. Studies that discussed PGs in long-term care hospital or in-home settings were excluded from this literature review. Literature was sought from CINAHL, MEDLINE, and PsycINFO. CASP and JBI checklist was used to appraise the full-text articles for inclusion in the literature review. Twenty-six articles were included. Findings show that there is limited literature on this topic although healthcare institutions involve PGs in their routine inpatient care. Three themes emerged from the review; the FCC approach, roles of PGs in acute care hospitals, and implications of involving PGs in acute care hospitals. PGs offer any care that is left undone by nurses in acute care hospitals to ensure that their patients' needs are met. However, their involvement is not consistent with FCC principles. This leads to physical, psychosocial, and economic implications for PGs. We recommend that nurse practitioners should consistently implement FCC principles to enable PGs to offer meaningful care to their inpatients.

Are emotional intelligence and compassion associated with nursing safety and quality care? A cross-sectional investigation in pediatric settings

PURPOSE

To assess and compare the perceptions of emotional intelligence, compassion, and safety and quality care held by parents of hospitalized children and nurses, and to examine the association between emotional intelligence, compassion, and safety and quality care among nurses.

DESIGN AND METHODS

This cross-sectional study comprised 80 parents whose children were hospitalized for at least three days, and 71 nurses who treated these children. The data were collected during April-June 2018 using a self-administered questionnaire addressing socio-demographic characteristics, safety and quality care in the ward, emotional intelligence, and compassion. A hierarchical multiple regression model was used to assess whether emotional intelligence and compassion could be associated with safety and quality care among pediatric nurses.

RESULTS

Parents considered the safety and quality care in the ward to be significantly (p = .003) higher (M = 4.23 ± 0.61) than did nurses (M = 3.97 ± 0.46). Compassion had a significant positive effect on safety and quality of care (β = 0.260; p = .041), while seniority in nursing had a significant negative effect on safety and quality care (β = -0.289;p = .021). Null effect was found between emotional intelligence and safety and quality care.

CONCLUSION

Compassionate care should be targeted to improve the safety and quality of nursing care delivered to children and their parents.

PRACTICE IMPLICATIONS

Nurse ward managers should promote procedures and guidelines concerning safety and quality care processes among older nurses. Specifically, we recommend nurse ward managers to leverage the results and dedicate efforts to continue to provide compassionate care in pediatric settings as an integral part of safety and quality care.

Selected predictors of parental satisfaction with child nursing care in paediatric wards in Poland-Cross-sectional study

BACKGROUND

Assessment of parental satisfaction with child nursing is the key issue in evaluation of the care quality, enabling the adjustment of the services provided to the needs and expectations of recipients, and thus ensuring safety and achieving better long-term health effects.

AIM

Assessment of parental satisfaction with child nursing in paediatric wards including its determinants.

MATERIAL AND METHODS

The study covered 1030 parents of children hospitalised in paediatric and surgical wards of seven hospitals of different levels of health security in Poland. The Polish adaptation of the Empathic standardised questionnaire for assessment of the level of parents' satisfaction with nursing care, developed by Latour et al. and the self-constructed summary of socio-demographic data were applied in the study.

RESULTS

More than 90% of respondents expressed high level of satisfaction with nurses' Availability, the lowest, but still high score of respondents' satisfaction was observed for Parental Participation. The highest satisfaction was observed among the parents of children at the preschool, early school and puberty stage, admitted to the hospital on the elective basis, referred for diagnostic assessment and with the length of hospital stay less than 7 and longer than 28 days. Achieving preschool age was the strongest factor which increased assessment of satisfaction in most domains.

CONCLUSIONS

There is a need for optimising nursing care especially in the area of parental participation. The nursing care' quality improvement plan in paediatric departments should focus particularly on early childhood patients and their parents who are the most critical in satisfaction' assessment.

Parent's Stress Predictors during a Child's Hospitalization

A child’s illness and hospitalization are particularly difficult and most often an unpredictable situation in a family’s life cycle. The level of stress of a parent of a hospitalized child depends on many factors, such as the psychological characteristics of the child and the parent, the child’s health condition, and support from the family and medical staff. Our research aimed to search for interactions between the stress experienced by the parent and the temperamental variables of both the child and the parent, and the support received from the family and hospital staff. Using three pencil-paper questionnaires—PSS, EAS-D, EAS-C—and interview questionnaire, we tested 203 parent–child dyads at the time of children hospitalization. It was revealed that the most notable moderator of the relationship between temperamental traits and the characteristics of the hospital-related situation is the child’s age. When analyzing the situation of a family with a hospitalized child, particular attention should be paid to parental emotional distress, which, regardless of the child’s age, predicts a high level of parental stress.

Longitudinal Changes in the Sensorimotor Pathways of Very Preterm Infants During the First Year of Life With and Without Intervention: A Pilot Study

Objective: Evaluate longitudinal changes in brain microstructure and volumes in very preterm infants during the first year of life with and without intervention.Design: Descriptive pilot study.Methods: Five preterm infants in a three-arm clinical trial, one SPEEDI Early, two SPEEDI Late, and two usual care. Brain structural and diffusion MRI's were acquired within 72 hours after neonatal intensive care unit discharge (n = 5), three months post-baseline (n = 5), and six months post-baseline (n = 3). Fractional anisotropy (FA), Mean diffusivity (MD), and volume metrics were computed for five brain regions.Results: More than 60% of eligible participants completed 100% of the scheduled MRIs. FA and volume increased from baseline to six months across all brain regions. Rate of white matter volume change from baseline to six months was highest in SPEEDI Early.Conclusions: Non-sedated longitudinal MRI is feasible in very preterm infants and appears to demonstrate longitudinal changes in brain structure and connectivity.

Bridging the Gap: Exploring the Impact of Hospital Isolation on Peer Relationships Among Children and Adolescents with a Malignant Brain Tumor

Children and adolescents with complex medical conditions are often uprooted from their environments and isolated in hospital while undergoing treatment. Little is known about how they perceive this isolation and its subsequent impact on their relationships with peers, both during and after isolation for treatment. This study describes the experience of hospital isolation from the perspectives of children and adolescents with a malignant brain tumor. The use and impact of information and communication technologies (ICT) as a possible bridge for contact is also explored. Following a qualitative approach utilizing interpretive phenomenological analysis, in-depth interviews were conducted with eight youth participants who had undergone treatment for medulloblastoma. Data analysis generated three main themes: (1) transforming children and relationships, (2) hospitalization in a digital world, and (3) ICTs as a promising bridge back to school. Study findings provide insight into the experience of hospital isolation for children and adolescents, while highlighting the positive social as well as academic outcomes of frequent, open ended ICT use throughout hospital isolation. This is timely, given the context of the COVID-19 pandemic and its resulting isolation. Considerations for hospital social workers to promote relationships and connection, while facilitating a smooth transition as these children return to school are included.

Antenatal and Postnatal Maternal Depressive Symptoms and Trajectories and Child Hospitalization up to 24 Months of Life: Findings From the 2015 Pelotas (Brazil) Birth Cohort Study

Objective

To examine the association between antenatal and postnatal maternal depression symptoms, and child hospitalization during the first 2 years of life in the 2015 Pelotas Birth Cohort Study.

Study design

This is an observational study. Maternal depressive symptoms of 4275 mothers were measured using the Edinburgh Postnatal Depression Scale. Hospitalization of the child for any reason was assessed using maternal report. Bivariate analysis and multivariate Poisson regressions were used to assess the association between maternal depressive symptoms and child hospitalization.

Results

Compared with children of mothers with low depressive symptoms, children whose mothers experienced significant antenatal depressive symptoms were 1.74 (95% CI, 1.16-2.60) times more likely to be hospitalized by 3 months of age, and 2.14 (95% CI, 1.46-3.14) times more likely up to 24 months. For children whose mothers experienced severe postnatal depressive symptoms at 3 months, the risks for hospitalization by age 12 months were 1.84 (95% CI, 1.39-2.45) higher than children whose mothers had low depressive symptoms. There was an increased risk of hospitalization for children according to the severity of depressive trajectories across time.

Conclusions

Maternal depressive symptoms are a risk factor for hospitalization in children up to 2 years of age, and this risk increases with increased severity of depression. These results have public health relevance for decreasing the risk factors in mothers that can lead to hospitalization in children.

Healthcare professionals' perspectives on infant feeding support in paediatric inpatients: single-centre qualitative study

OBJECTIVE

To provide information on baseline knowledge, skills and attitudes (KSA) of paediatric staff to formulate a plan for improving infant feeding support in hospitals.

DESIGN

Semistructured interviews assessed baseline infant feeding KSA and experiences in 14 paediatric health professionals of various grades (medical students, healthcare assistants, ward nurses and specialist nurses). Audio recordings were transcribed verbatim and underwent thematic analysis. An online questionnaire gathered descriptive statistics about participants.

SETTING

A single large hospital trust, North East England.

RESULTS

Seven major themes were identified in KSA: culture and trends, roles and working practice, training and resources, the health professional, understanding the parent, effective communication and the challenges of feeding the ill child.Staff discussed various organisational and personal barriers to acquiring infant feeding support training and experience, and to delivering feeding support. Staff were keen to support families with feeding but often felt constrained by a belief that this required specialist knowledge and skills. Although staff believed they actively promoted breastfeeding-friendly messages, it was evident that marketing communications and personal experiences inadvertently influenced their approach to families.

CONCLUSIONS

The development of clear, evidence-based infant feeding education and training for paediatric staff delivered by experienced mentors is warranted. Training should cover background theory, delivering practical support, communication skills and creating a baby-friendly hospital environment. UNICEF Baby Friendly Standards would be suitable to inform content. Training is likely to be received positively by staff and benefit women and babies in this setting.

Predictors of Resilience Among Parents of Children with Cancer: Cross-Sectional Study

Purpose

Resilience is an ability to overcome adversities in response to a potentially traumatic event. It relieves parents’ discomfort and builds personal capacity when facing a stressful situation like childhood cancer. Therefore, the study’s objective is to assess the magnitude of resilience and its predictors among the parents of children with cancer at Jimma medical center, Ethiopia, 2020.

Methods

The institutional-based cross-sectional design was employed on 126 parents of children with cancer at Jimma Medical Center. All study populations who attend the hospital from February 25 to April 25, 2020, and fulfill the inclusion criteria were included. Data were entered into Epi data version 4.6.0.2 and analyzed by SPSS version 25. Descriptive analysis was used to describe the study variables. Furthermore, linear regression analysis was calculated to assess predictors of resilience.

Results

The level of resilience among parents’ children with cancer were a mean scored 51.41±12.02. In this study, factors associated with resilience were receiving support from friends (β=5.67, 95% CI=1.58, 9.77; P=0.007), attend recreational activities (β=13.8, 95% CI=5.32, 22.37; P=0.03) and receiving health information from health care professionals (β=6.37; 95% CI= (1.75, 11.00), P=0.007), parents depression (β= −0.827, 95% CI= (−1.619,-0.034), P=0.041) and parents stress (β =−0.88,95% CI (−1.54,-0.23), P=0.031).

Conclusion

The magnitude of resilience among parents of children with cancer was low relative to other studies. Support from friends, attending recreational activities, and receiving health information from health care professionals were positively associated with resilience. In contrast, parents’ depression and stress were negatively associated with resilience.

Patient and Family Member Violent Situations in a Pediatric Hospital: A Descriptive Study

PURPOSE

The intent of this study is to report on violent situations involving the pediatric patient and/or the patient's family member in the inpatient hospital setting.

DESIGN AND METHODS

This descriptive study used two independent samples: Behavioral Emergency Response Team (BERT) recipients and surveyed pediatric healthcare staff at a pediatric hospital within a large urban Midwestern academic hospital in the United States.

RESULTS

Per BERT recipients (N = 26) and staff survey respondents (N = 91), common physical patient behaviors were, respectively, hitting (60%, 77%) and kicking (53%, 82%). Fifteen (75%) patient BERT responses were for violent situations. The most common mental health condition among patients in violent situations was behavior dyscontrol (n = 8, 53%), which was absent among calls for non-violent situations (n = 5). Seizures, which was the most common medical condition among patients in BERT violent situations (n = 6, 40%), was proportionately slightly greater than among non-violent situations (n = 1, 20%). Staff who reported experience with violent situations (n = 64, 73%) were from general medical units (n = 48, 75%), and registered nurses (n = 53, 79%).

CONCLUSIONS

This study helped illuminate demographic, medical and mental health clues about violent situations with patients and family members on pediatric inpatient hospital units.

PRACTICE IMPLICATIONS

Pediatric patients and families may struggle to cope during hospitalization. Healthcare providers' knowledge about co-occurring conditions, stress related to hospitalization and use of BERT as a resource may help prevent violent situations.

Systematic Review of Behaviour Change Techniques within Interventions to Reduce Environmental Tobacco Smoke Exposure for Children

Children are particularly vulnerable to environmental tobacco smoke (ETS). There is no routine support to reduce ETS in the home. We systematically reviewed trials to reduce ETS in children in order to identify intervention characteristics and behaviour change techniques (BCTs) to inform future interventions. We searched Medline, EMBASE, CINAHL, PsycINFO, ERIC, Cochrane Central Register of Controlled Trials, and Cochrane Tobacco Addiction Group Specialised Register from January 2017 to June 2020 to update an existing systematic review. We included controlled trials to reduce parent/caregiver smoking or ETS in children <12 years that demonstrated a statistically significant benefit, in comparison to less intensive interventions or usual care. We extracted trial characteristics; and BCTs using Behaviour Change Technique Taxonomy v1. We defined "promising" BCTs as those present in at least 25% of effective interventions. Data synthesis was narrative. We included 16 trials, of which eight were at low risk of bias. All trials used counselling in combination with self-help or other supporting materials. We identified 13 "promising" BCTs centred on education, setting goals and planning, or support to reach goals. Interventions to reduce ETS in children should incorporate effective BCTs and consider counselling and self-help as mechanisms of delivery.

Children's and parents' views on hospital contact isolation: A qualitative study to highlight children's perspectives

BACKGROUND

To date, there has been a paucity of studies conducted on the experiences of children under hospital contact isolation precautions. Furthermore, the studies that have examined children's experiences at the hospital typically reflect the perspectives of their parents, and few have directly involved interviews with children themselves, and even fewer with children in isolation.

METHODS

To address this gap, we conducted semi-structured, open-ended interviews with hospitalized children to assess their experiences of being placed in isolation. Where possible, the children's parents also completed written surveys to assess parental perspectives on their child's experiences.

RESULTS

Two important findings of the study were the children's resilience during a difficult time and children's varying awareness of the pathophysiology of infections as it relates to isolation precautions. Examination of the parent-child dyads elucidated some discordance between parents' and children's perspectives on how children experienced their isolation, on what the children's preferred activities were while in isolation, and how much children understood about the reasons they were in isolation.

CONCLUSION

This study supports earlier studies that suggest that the benefits of isolation procedures may be outweighed by how negatively isolation is experienced by patients, particularly when the patients are children. It also highlights the need for child-friendly isolation signs. Because parental and child perceptions differed in cases where data from both were available, this study suggests larger studies on children's perspectives and/or on parent-child dyads are needed.

Caregivers' Perceptions and Hospital Experience After a Brief Resolved Unexplained Event: A Qualitative Study

BACKGROUND AND OBJECTIVES

The American Academy of Pediatrics published guidelines for evaluation and management of lower-risk infants for a brief resolved unexplained event (BRUE). The guideline identified gaps in knowledge related to caregiver satisfaction, anxiety, and family-centered educational strategies to improve caregiver experience and patient outcomes. The objective of this study was to understand caregivers' experience with hospitalization for infants with BRUE, including their perception of the hospital stay, the diagnosis of BRUE, and their feelings toward the upcoming discharge from the hospital.

METHODS

We conducted a qualitative study using semistructured interviews with caregivers of infants aged 0 to 12 months who were admitted to a quaternary care children's hospital for a BRUE. Interviews were conducted within 24 hours of discharge. Two investigators coded transcripts and identified themes using consensus.

RESULTS

Eighteen caregivers of 13 infants were interviewed. No infants met criteria for being low risk according to the American Academy of Pediatrics guidelines. The coding scheme produced 3 major themes. First, parents felt reassured by hospital monitoring, diagnostic evaluation, and staff support in the hospital. Second, parents felt unsettled by the uncertainty of the child's condition and whether BRUE's "unexplainable" quality is understood as being part of normal infant behavior. Third, these themes manifested as conflicting emotions about caregivers' readiness for discharge.

CONCLUSIONS

Although hospital monitoring may provide reassurance for some caregivers, they continue to struggle with the uncertainty of the diagnosis. Caregiver perspectives can inform physicians' strategies to improve hospital experience and discharge readiness.

Understanding mothers' perception of child's illness: Adapting the CONNECT Instrument for pediatrics

AIMS AND OBJECTIVES

To adapt the CONNECT Instrument for use in the paediatric population, to assess validity of this instrument after its adaptation and to assess concordance between mothers' perception of their child's illness and providers' understanding of mothers' perceptions.

BACKGROUND

The CONNECT Instrument (Patient Education and Counseling, 73, 2008, 232-239) was validated in an adult outpatient population to characterise both patients' perspectives and physicians' understanding of their patients' perspectives for several dimensions of the illness experience. However, this did not include the paediatric population or advanced practice providers.

DESIGN

A two-part prospective, cross-sectional, observational study to assess the validity of CONNECT for Pediatrics and to assess perception of illness.

METHODS

The CONNECT Instrument (Patient Version) was adapted from its original form and modified to CONNECT for Pediatrics to facilitate use in the inpatient paediatric population. Eighty-five participants were enrolled including mothers, advanced practice providers and physicians from 2013-2014 during a child's scheduled admission to a paediatric epilepsy monitoring unit. Principal components analysis and inter-item reliability were analysed, and differences in the six mean domain scores were assessed using repeated measures analysis of variance (RM-ANOVA). Reporting of this research adheres to the STROBE guidelines (See Appendix S1).

RESULTS

Our analysis indicated that the modifications made provided a relatively valid and reliable instrument. There were overall statistically significant differences between the mother and physician groups, specifically in the domains of meaning and preference for partnership.

CONCLUSIONS

Paediatric advanced practice providers and physicians do have an understanding of mothers' perception of illness.

RELEVANCE TO CLINICAL PRACTICE

The ability of physicians and advanced practice providers to understand mothers' perceptions of illness is increasingly important in a changing healthcare environment. CONNECT for Pediatrics facilitates the identification of mothers' perception of their child's illness and provides the opportunity for paediatric advanced practice providers and physicians to understand parents' perception of illness.

Determinants of Parental Satisfaction with Nursing Care in Paediatric Wards-A Preliminary Report

Background: The quality of medical services for a child and their parents are tantamount to a sense of satisfaction with care. Purpose: The assessment of determinants of parental satisfaction with nursing care in paediatric wards. Methods: The study covered 336 parents of children hospitalised in paediatric departments and was based on the “EMPHATIC” questionnaire, standardized and adapted to Polish conditions. Results: The mean score of the overall parental satisfaction was high, amounting to 4.19 points. The lower level of satisfaction with nursing care was reported in parents of children under the age of 6 years, admitted in an emergency mode with a diagnosed post-trauma condition and those with higher education. The duration of hospitalisation, sex and age of parents did not have an influence on the satisfaction with care. Conclusions: The age of the child, admission mode and education of respondents are determinants of parental satisfaction with nursing care.