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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: 56] [Impact Index Per Article: 11.2] [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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Denis-Larocque G, Williams K, St-Sauveur I, Ruddy M, Rennick J. Nurses' perceptions of caring for parents of children with chronic medical complexity in the pediatric intensive care unit. Intensive Crit Care Nurs 2017; 43:149-155. [PMID: 28539204 DOI: 10.1016/j.iccn.2017.01.010] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2016] [Accepted: 01/06/2017] [Indexed: 10/19/2022]
Abstract
OBJECTIVES The aim of this study was to explore nurses' perceptions of caring for parents of children with medical complexity [CMC] in the pediatric intensive care unit [PICU]. RESEARCH METHODOLOGY An interpretive descriptive design was used to explore nurses' perceptions of caring for parents of CMC in the PICU. Semi-structured interviews were conducted with ten nurses. Interview data were collected and analyzed using qualitative inductive content analysis. FINDINGS Nurses revealed that their experiences of caring for parents of CMC evolved over time as they learned to tailor a caregiving partnership based on trust. Although various circumstances could challenge this partnership, nurses strove to maintain and nurture it through self-reflection and optimal communication. Three themes were identified in the data that captured PICU nurses' perceptions: (i) "Thrown to the wolves": Adjusting to a new caregiving role; (ii) "Getting to know each other": Merging caregiving roles; (iii) "Keeping connected": Working to preserve the partnership. CONCLUSIONS Findings shed new light on the importance of a trusting nurse-parent partnership in caring for parents of CMC in the PICU. Results will be used to develop strategies to enhance this partnership, with the goal of supporting parents and staff in their caregiving roles.
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Affiliation(s)
| | - Karl Williams
- Ingram School of Nursing, Faculty of Medicine, McGill University, Montreal, QC, Canada
| | - Isabelle St-Sauveur
- Ingram School of Nursing, Faculty of Medicine, McGill University, Montreal, QC, Canada; Montreal Children's Hospital, Montreal University Health Centre, Montreal, QC, Canada
| | - Margaret Ruddy
- Montreal Children's Hospital, Montreal University Health Centre, Montreal, QC, Canada
| | - Janet Rennick
- Ingram School of Nursing, Faculty of Medicine, McGill University, Montreal, QC, Canada; Montreal Children's Hospital, Montreal University Health Centre, Montreal, QC, Canada; Department of Pediatrics, Faculty of Medicine, McGill University, Montreal, QC, Canada.
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