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Govindaswamy P, Laing S, Spence K, Waters D, Walker K, Badawi N. Neonatal medical trainee doctors' perceptions and parents' self-reported needs and stressors in a surgical neonatal intensive care unit: An individualised approach. J Paediatr Child Health 2022; 58:687-696. [PMID: 34725877 DOI: 10.1111/jpc.15819] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Revised: 10/04/2021] [Accepted: 10/18/2021] [Indexed: 11/30/2022]
Abstract
AIM As more infants survive surgery in the newborn period for major congenital anomalies, the focus has shifted to the quality of care for parents as well as infants. In contemporary neonatal intensive care units (NICUs), doctors are encouraged to practice family-centred care and partner with parents in their infant's care. This study explored doctors' perceptions and parents' self-reported needs and stressors in a surgical NICU. METHODS From January 2014 to September 2015, parents of infants admitted for general surgery for a major congenital anomaly who were present in the NICU between 48 and 72 h of admission and doctors caring for their infant at the time of data collection were invited to participate. Matched data were provided using the Neonatal Family Needs Inventory and the Parental Stressor Scale:NICU. RESULTS Matched data for 12 doctor-parent dyads showed that doctors (neonatal medical trainees) consistently under-rated the importance of parents' needs and identified fewer of mothers' than fathers' most important needs. Doctors also consistently under-rated parents' stressors. They perceived few of fathers', but all of mothers', greatest stressors. Thematic analysis revealed four themes: infant pain management; parental autonomy; empathy; and communicating reassurance and education to parents. CONCLUSION The findings suggest incongruences between doctors' perceptions and parents' self-reported needs and stressors. While there is hesitation in making recommendations with this sample size, the findings highlight issues that may inform further research and contribute to a dialogue regarding the role of doctors in family-centred relationship-based models of care in the NICU.
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Affiliation(s)
- Priya Govindaswamy
- Grace Centre for Newborn Care, Children's Hospital at Westmead, Sydney, New South Wales, Australia.,Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
| | - Sharon Laing
- Grace Centre for Newborn Care, Children's Hospital at Westmead, Sydney, New South Wales, Australia
| | - Kaye Spence
- Grace Centre for Newborn Care, Children's Hospital at Westmead, Sydney, New South Wales, Australia
| | - Donna Waters
- Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia.,Sydney Nursing School, University of Sydney, Sydney, New South Wales, Australia
| | - Karen Walker
- Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia.,Newborn Care, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Nadia Badawi
- Grace Centre for Newborn Care, Children's Hospital at Westmead, Sydney, New South Wales, Australia.,Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
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Páramo-Cano T, Ortiz MI, Gómez-Busto FJ, Espinoza-Ramírez AL. Management of Procedural Pain in Children. Curr Pediatr Rev 2021; 17:288-328. [PMID: 33820520 DOI: 10.2174/1573396317666210405150526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Revised: 11/02/2020] [Accepted: 01/25/2021] [Indexed: 11/22/2022]
Abstract
In recent years, there has been increased interest in the study of pain in children and its treatment. It is known that when facing diagnostic and therapeutic procedures similar to those performed on adults, children either do not receive specific pain treatment or receive it on a significantly lower scale. However, recent research suggests a change in attitude and an improvement in the current treatment of children's pain. Although current knowledge demonstrates the falsity of many preconceived ideas about pain and its management, our results suggest that attitudinal change towards childhood pain remains slow and that real improvement in the training and practical application of the pediatrician who has to treat childhood pain is urgently needed. In this context, this manuscript has prepared standards and guidelines to improve pain management practices in a large number of national and international professional settings.
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Affiliation(s)
- Tatjana Páramo-Cano
- Academic Area of Medicine, Institute of Health Sciences, Universidad Autónoma del Estado de Hidalgo, Pachuca, Hidalgo, Mexico., Dr. Eliseo Ramírez Ulloa 400, Col. Doctores, 42090, Pachuca, Hidalgo,Mexico
| | - Mario I Ortiz
- Academic Area of Medicine, Institute of Health Sciences, Universidad Autónoma del Estado de Hidalgo, Pachuca, Hidalgo, Mexico., Dr. Eliseo Ramírez Ulloa 400, Col. Doctores, 42090, Pachuca, Hidalgo,Mexico
| | - Federico J Gómez-Busto
- Academic Area of Medicine, Institute of Health Sciences, Universidad Autónoma del Estado de Hidalgo, Pachuca, Hidalgo, Mexico., Dr. Eliseo Ramírez Ulloa 400, Col. Doctores, 42090, Pachuca, Hidalgo,Mexico
| | - Ana L Espinoza-Ramírez
- Academic Area of Medicine, Institute of Health Sciences, Universidad Autónoma del Estado de Hidalgo, Pachuca, Hidalgo, Mexico., Dr. Eliseo Ramírez Ulloa 400, Col. Doctores, 42090, Pachuca, Hidalgo,Mexico
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3
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Parents want to attend pediatric fracture reductions. J Pediatr Orthop B 2021; 30:32-36. [PMID: 31725536 DOI: 10.1097/bpb.0000000000000693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Pediatric fracture reductions can create anxiety for the child and parent. While cross-cultural evidence supports parental presence during some pediatric procedures, no study addresses parental presence during fracture reductions. This study investigates parent experiences during their child's reduction and provides guidance regarding parental attendance during fracture reductions. Sixty consecutive parents were retrospectively surveyed about their experience during their child's fracture reduction. Parents were grouped according to presence or absence during the reduction and were compared. Forty parents attended the reduction and 20 parents were absent. All parents attending the reduction were satisfied with their experience. Thirty-nine parents (98%) believed their presence was helpful for their child and 36 (90%) believed it was personally helpful. Of the 20 absent parents, four (20%) were dissatisfied with their experience, five (25%) believed it was personally harmful, and two (10%) thought it was harmful to their child. All parents reporting negative experiences were prohibited from attending the reduction. When deciding about parental presence during reductions, 55 (92%) parents wanted to be included in this process. Overall, 47 parents (78%) wanted to attend the reduction and 52 (87%) would prefer to attend a future reduction. Most parents prefer to attend their child's fracture reduction and believe their presence is helpful personally and for their child. Parents in attendance report a positive experience, while parents prohibited from attending report dissatisfaction with the experience and believe their absence is harmful to themselves and their children. It is recommended that healthcare workers consider parental attendance during pediatric reductions.
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Hall SL, Hynan MT, Phillips R, Lassen S, Craig JW, Goyer E, Hatfield RF, Cohen H. The neonatal intensive parenting unit: an introduction. J Perinatol 2017; 37:1259-1264. [PMID: 28796241 PMCID: PMC5718987 DOI: 10.1038/jp.2017.108] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2017] [Revised: 05/23/2017] [Accepted: 05/26/2017] [Indexed: 01/06/2023]
Abstract
This paper describes a paradigm shift occurring in neonatal intensive care. Care teams are moving from a focus limited to healing the baby's medical problems towards a focus that also requires effective partnerships with families. These partnerships encourage extensive participation of mothers and fathers in their baby's care and ongoing bi-directional communication with the care team. The term Newborn Intensive Parenting Unit (NIPU) was derived to capture this concept. One component of the NIPU is family-integrated care, where parents are intimately involved in a baby's care for as many hours a day as possible. We describe six areas of potentially better practices (PBPs) for the NIPU along with descriptions of NIPU physical characteristics, operations, and a relationship-based culture. Research indicates the PBPs should lead to improved outcomes for NIPU babies, better mental health outcomes for their parents, and enhanced well-being of staff.
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Affiliation(s)
- S L Hall
- St. John’s Regional Medical Center, Oxnard, CA, USA
| | - M T Hynan
- Department of Psychology, University of Wisconsin-Milwaukee, Milwaukee, WI, USA
| | - R Phillips
- Division of Neonatology, Department of Pediatrics, Loma Linda University Children’s Hospital, Loma Linda, CA, USA
| | - S Lassen
- Department of Pediatrics, University of Kansas Medical Center, Kansas City, KS, USA
| | - J W Craig
- School of Occupational Therapy, Brenau University, Gainesville, GA, USA
| | - E Goyer
- Family Advocacy Network, National Perinatal Association, Austin, TX, USA
| | - R F Hatfield
- Newborn Intensive Care Unit, University of Utah Medical Center, Salt Lake City, UT, USA
| | - H Cohen
- Neonatal Intensive Care Unit, Salem Hospital, Salem, OR, USA
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5
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Mougianis ID, Cohen LL, Shih SW. Parent-Child Behavioral Interactions during Pediatric Immunizations in a Latino Sample. CLINICAL PRACTICE IN PEDIATRIC PSYCHOLOGY 2017; 5:209-220. [PMID: 29250477 PMCID: PMC5726593 DOI: 10.1037/cpp0000190] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
A number of studies have found that specific parent behaviors are strong predictors of child medical procedural distress or coping. These findings have informed treatment protocols to lower children's distress during invasive medical events. However, the vast majority of this research has been conducted on predominately North American, English-speaking, Caucasian samples. One growing population that faces healthcare disparities is Latinos living in the U.S. The purpose of this study was to explore the types and frequencies of parent and child behavior, as well as the association between parent behavior and child distress and coping in a sample of Spanish-speaking Latino-American parent-child dyads. Nineteen 4- to 6-year-old Latino children receiving routine immunizations and their parents were video recorded, and behaviors were coded with commonly used schemes. The findings suggest that there may be differences in Latino parent and child behavior when compared to the extant - predominately English-speaking, Caucasian North American - literature. This study provides an initial examination of how cultural constructs may relate to parent-child behavior in Spanish-speaking Latino families in the U.S. Future research is warranted as findings can inform culturally sensitive clinical practice.
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Morley J, Holman N, Murray CD. Dressing changes in a burns unit for children under the age of five: A qualitative study of mothers' experiences. Burns 2017; 43:757-765. [PMID: 28069342 DOI: 10.1016/j.burns.2016.11.015] [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: 04/05/2016] [Revised: 11/17/2016] [Accepted: 11/29/2016] [Indexed: 01/17/2023]
Abstract
This study aimed to investigate the experiences of mothers who had attended their child's burn dressing changes. Participants were recruited from a burns unit based within a children's hospital. Face-to-face interviews were conducted with five mothers of children under the age of five who had undergone a series of dressing changes taking place on the burns unit. The interview guide explored parents' experience of initial and subsequent dressing changes. Participants were prompted to explore their expectations, thoughts, feelings and behaviours associated with these experiences. The interviews were recorded and transcribed verbatim. Transcripts were analysed using interpretative phenomenological analysis. The analysis identified four themes: 'needing to fulfil the responsibilities associated with being a mother'; 'emotional synchrony between mother and child'; 'being informed and knowing what to expect'; and 'the importance of establishing rapport with nurses performing dressing changes'. Findings from this research can inform services to help optimise mothers' experiences of dressing changes in this stage of pediatric burn care.
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Affiliation(s)
- Jessica Morley
- Faculty of Health & Medicine, Lancaster University, Lancaster, UK
| | - Natalie Holman
- Alder Hey Children's NHS Foundation Trust, Liverpool, UK
| | - Craig D Murray
- Faculty of Health & Medicine, Lancaster University, Lancaster, UK.
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Wright KD, Stewart SH, Finley GA, Buffett-Jerrott SE. Prevention and Intervention Strategies to Alleviate Preoperative Anxiety in Children. Behav Modif 2016; 31:52-79. [PMID: 17179531 DOI: 10.1177/0145445506295055] [Citation(s) in RCA: 105] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Preoperative anxiety (anxiety regarding impending surgical experience) in children is a common phenomenon that has been associated with a number of negative behaviors during the surgery experience (e.g., agitation, crying, spontaneous urination, and the need for physical restraint during anesthetic induction). Preoperative anxiety has also been associated with the display of a number of maladaptive behaviors postsurgery, including postoperative pain, sleeping disturbances, parent-child conflict, and separation anxiety. For these reasons, researchers have sought out interventions to treat or prevent childhood preoperative anxiety and possibly decrease the development of negative behaviors postsurgery. Such interventions include sedative premedication, parental presence during anesthetic induction, behavioral preparation programs, music therapy, and acupuncture. The present article reviews the existing research on the various modes of intervention for preoperative anxiety in children. Clinical implications and future directions are discussed.
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Affiliation(s)
- Kristi D Wright
- Department of Psychiatry, Dalhousie University, Halifax, Nova Scotia, Canada
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Hall SL, Cross J, Selix NW, Patterson C, Segre L, Chuffo-Siewert R, Geller PA, Martin ML. Recommendations for enhancing psychosocial support of NICU parents through staff education and support. J Perinatol 2015; 35 Suppl 1:S29-36. [PMID: 26597803 PMCID: PMC4660046 DOI: 10.1038/jp.2015.147] [Citation(s) in RCA: 82] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2015] [Accepted: 09/23/2015] [Indexed: 12/25/2022]
Abstract
Providing psychosocial support to parents whose infants are hospitalized in the neonatal intensive care unit (NICU) can improve parents' functioning as well as their relationships with their babies. Yet, few NICUs offer staff education that teaches optimal methods of communication with parents in distress. Limited staff education in how to best provide psychosocial support to families is one factor that may render those who work in the NICU at risk for burnout, compassion fatigue and secondary traumatic stress syndrome. Staff who develop burnout may have further reduced ability to provide effective support to parents and babies. Recommendations for providing NICU staff with education and support are discussed. The goal is to deliver care that exemplifies the belief that providing psychosocial care and support to the family is equal in importance to providing medical care and developmental support to the baby.
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Affiliation(s)
- S L Hall
- Division of Neonatology, St John's Regional Medical Center, Oxnard, CA, USA
| | - J Cross
- Department of Social Work, Widener University, Chester, PA, USA
| | - N W Selix
- School of Nursing and Health Professions, University of San Francisco, San Francisco, CA, USA
| | - C Patterson
- Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - L Segre
- College of Nursing and Department of Psychological and Brain Sciences, University of Iowa, Iowa City, IA, USA
| | - R Chuffo-Siewert
- Department of Nursing, University of Iowa Children's Hospital, Iowa City, IA, USA
| | - P A Geller
- Departments of Psychology, Obstetrics/Gynecology and Public Health, Drexel University, Philadelphia, PA, USA
| | - M L Martin
- Department of Nursing, McLeod Regional Medical Center, Florence, SC, USA
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10
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Maconochie IK, Bingham R, Eich C, López-Herce J, Rodríguez-Núñez A, Rajka T, Van de Voorde P, Zideman DA, Biarent D, Monsieurs KG, Nolan JP. European Resuscitation Council Guidelines for Resuscitation 2015. Resuscitation 2015; 95:223-48. [DOI: 10.1016/j.resuscitation.2015.07.028] [Citation(s) in RCA: 217] [Impact Index Per Article: 24.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
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Angel Solà J, Sagué Bravo S, Parra Cotanda C, Trenchs Sainz de la Maza V, Luaces Cubells C. Has the presence of parents during invasive procedures in the emergency department increased in the last few years? ANALES DE PEDIATRÍA (ENGLISH EDITION) 2015. [DOI: 10.1016/j.anpede.2014.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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12
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Karlsson K, Englund ACD, Enskär K, Rydström I. Parents' perspectives on supporting children during needle-related medical procedures. Int J Qual Stud Health Well-being 2014; 9:23759. [PMID: 25008196 PMCID: PMC4090367 DOI: 10.3402/qhw.v9.23759] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/02/2014] [Indexed: 11/25/2022] Open
Abstract
When children endure needle-related medical procedures (NRMPs), different emotions arise for the child and his/her parents. Despite the parents’ own feelings, they have a key role in supporting their child through these procedures. The aim of this study is to describe the meanings of supporting children during NRMPs from the perspective of the parents. Twenty-one parents participated in this study. A reflective lifeworld research (RLR) approach was used and phenomenological analysis was applied. The essential meaning of the phenomenon—supporting children during an NRMP—is characterized as “keeping the child under the protection of one’s wings,” sometimes very close and sometimes a little further out under the wingtips. The essential meaning is additionally described through its constituents: paying attention to the child’s way of expressing itself, striving to maintain control, facilitating the child’s understanding, focusing the child’s attention, seeking additional support, and rewarding the child. The conclusion is that parents’ ability to be supportive can be affected when seeing their child undergo an NRMP. To regain the role as the child’s protector and to be able to keep the child “under the protection of one’s wings,” parents need support from the staff.
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Affiliation(s)
- Katarina Karlsson
- School of Health Sciences, University of Borås, Borås, Sweden; Department of Nursing Sciences, CHILD Research Group, School of Health Sciences, Jönköping University, Jönköping, Sweden;
| | | | - Karin Enskär
- Department of Nursing Sciences, CHILD Research Group, School of Health Sciences, Jönköping University, Jönköping, Sweden
| | - Ingela Rydström
- School of Health Sciences, University of Borås, Borås, Sweden
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Abstract
OBJECTIVE The aim of this study was to observe the proportion of family members who choose to remain present during children's pediatric emergency department procedures in actual clinical situations. METHODS Family members of a convenience sample of children undergoing invasive procedures in a pediatric emergency department were observed. Data were collected on whether family members chose to remain present or leave during the procedure and family member and health care worker behaviors. Consent to participate in the study was obtained after the observation, and family members were surveyed regarding demographics, anxiety, and previous experiences. RESULTS Fifty-nine children undergoing 66 procedures and accompanied by 83 family members were enrolled. The median age of the children was 69 months; 47% were female and 73% were Hispanic. The family members consisted of 64% mothers and 24% fathers, with a median age of 33 years. The most common procedures were vascular access (25), laceration repair (11), and urethral catheterization (9). Overall, 73% of the family members stayed during the child's procedure, 18% left, and 9% showed some mixture of staying and leaving. Health care workers asked the family members to leave twice, encouraged them to leave once, and used nonverbal cues to exclude the family members twice. Caregivers helped to restrain the child 35% of the time. CONCLUSIONS Family members remain present during actual children's emergency department procedures less often than they indicate they would in hypothetical scenario surveys.
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Angel Solà J, Sagué Bravo S, Parra Cotanda C, Trenchs Sainz de la Maza V, Luaces Cubells C. [Has the presence of parents during invasive procedures in the emergency department increased in the last few years?]. An Pediatr (Barc) 2014; 82:6-11. [PMID: 24629904 DOI: 10.1016/j.anpedi.2014.02.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2013] [Revised: 01/23/2014] [Accepted: 02/03/2014] [Indexed: 10/25/2022] Open
Abstract
INTRODUCTION In the recent years, parents are playing an important role in Pediatric Emergency Department (PED), and wish to be present when invasive procedures (IP) are performed. OBJECTIVES 1) To compare the presence of parents during IP in PED in Spain between 2008 and 2012. 2) To compare the arguments to restrict the presence and problems arising from this, and 3) To determine whether the views of health personnel have changed on this subject. METHODOLOGY A descriptive multicenter comparative study was conducted in 2008 and 2012. A total of 42 questionaires were sent by email to PED managers, with the responding hospitals being included in the 2 periods of the study. RESULTS A total of 22 hospitals participated in the study. The presence of parents in the PED increased between 2008 and 2012 for all IP, significantly in the blood test and urine catheterization. In 2012, managers state that children are not so nervous, and anxiety of the parents and staff fear of a poorer performance, as an argument to restrict family presence. There were few problems during the 2 periods, with the poor behavior of the children decreasing. According to managers, the opinion of health personnel has not changed in the last four years. CONCLUSIONS The presence of parents during the IP in the PED has increased in the last four years, although the presence is low for more invasive procedures. Managers argue the presence of fewer behavior problems to restrict family presence. The opinion of the staff has not changed in the last four years, although more studies are required on this issue.
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Affiliation(s)
- J Angel Solà
- Servicio de Urgencias, Hospital Universitario de Sant Joan de Déu, Esplugues de Llobregat, Barcelona, España
| | - S Sagué Bravo
- Servicio de Urgencias, Hospital Universitario de Sant Joan de Déu, Esplugues de Llobregat, Barcelona, España
| | - C Parra Cotanda
- Servicio de Urgencias, Hospital Universitario de Sant Joan de Déu, Esplugues de Llobregat, Barcelona, España.
| | - V Trenchs Sainz de la Maza
- Servicio de Urgencias, Hospital Universitario de Sant Joan de Déu, Esplugues de Llobregat, Barcelona, España
| | - C Luaces Cubells
- Servicio de Urgencias, Hospital Universitario de Sant Joan de Déu, Esplugues de Llobregat, Barcelona, España
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Fortier MA, Gomez SH, Kain A. Motivation and parental presence during induction of anesthesia: an examination of the role of ethnicity and language. Paediatr Anaesth 2012; 22:1094-9. [PMID: 22458854 DOI: 10.1111/j.1460-9592.2012.03841.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To examine the role of ethnicity and language in parental desire and motivation to be present for children's anesthesia induction. AIM To compare motivation for parental presence at induction of anesthesia (PPIA) between English- and Spanish-speaking White and Hispanic parents of children undergoing outpatient surgery. BACKGROUND The effectiveness of PPIA may depend, in part, on parental motivation and desire to be present at children's anesthesia induction; however, cultural variables such as ethnicity and language have not previously been explored in this relationship. METHODS/MATERIALS Participants included 258 parents of children undergoing outpatient surgery and general anesthesia. Parents were grouped by self-reported ethnicity and primary language spoken into English-speaking White (ESW, n = 55), English-speaking Hispanic (ESH, n = 108), and Spanish-speaking Hispanic (SPH, n = 95) groups. Measures included the Motivation for Parental Presence during Induction of Anesthesia (MPPIA) and a 4-item measure of preference for PPIA. RESULTS The majority of parents (73%) expressed a preference for PPIA. Analyses controlling for group differences in socioeconomic status and demographic variables revealed that English-(P = 0.03) and Spanish-speaking (P = 0.06) Hispanic parents reported significantly greater levels of desire to be present for their child's anesthesia induction compared to English-speaking White parents. English-speaking Hispanic parents also reported greater levels of beliefs about the impact of anxiety on children's anesthesia induction compared to English-speaking White parents (P = 0.07). CONCLUSIONS Parental ethnicity and language may impact desire and motivation for PPIA, which may subsequently impact the effectiveness of PPIA and child anxiety at anesthesia induction. Future research should examine the impact of parental characteristics, including cultural variables, on children's preoperative anxiety.
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Affiliation(s)
- Michelle A Fortier
- Department of Anesthesiology and Perioperative Care, University of California-Irvine, Orange, CA, USA.
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Fein JA, Zempsky WT, Cravero JP. Relief of pain and anxiety in pediatric patients in emergency medical systems. Pediatrics 2012; 130:e1391-405. [PMID: 23109683 DOI: 10.1542/peds.2012-2536] [Citation(s) in RCA: 196] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Control of pain and stress for children is a vital component of emergency medical care. Timely administration of analgesia affects the entire emergency medical experience and can have a lasting effect on a child's and family's reaction to current and future medical care. A systematic approach to pain management and anxiolysis, including staff education and protocol development, can provide comfort to children in the emergency setting and improve staff and family satisfaction.
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Carroll R, Wood JN. Sudden Unexpected Infant Death: A Compassionate Forensic Approach to Care. CLINICAL PEDIATRIC EMERGENCY MEDICINE 2012. [DOI: 10.1016/j.cpem.2012.06.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Narchi H, Ghatasheh G, Al Hassani N, Al Reyami L, Khan Q. Why do some parents refuse consent for lumbar puncture on their child? A qualitative study. Hosp Pediatr 2012; 2:93-8. [PMID: 24510955 DOI: 10.1542/hpeds.2011-0034] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
OBJECTIVE Qualitative analysis of the attitudes, beliefs, and perceptions of parents who refuse consent for lumbar puncture (LP) on their child. METHODS We performed prospective, semistructured, face-to-face interviews with 24 families declining consent for LP in their child (aged between 1 month and 10 years of age), in 2 hospitals, over a 1-year period in the United Arab Emirates. The questionnaire included open-ended questions to allow parents to discuss their beliefs, concerns, and expectations. Content analysis of the transcripts was performed on how parents experienced the issue: their behavior, perceptions, and beliefs, as well as their opinions on what might have made them consent. Identified themes resulting from that analysis were labeled and coded before reducing them into categories and generating a Pareto chart. RESULTS Seven (29%) families were unfamiliar with LP indications and 3 had the impression that LP was also therapeutic. The emerged themes were fear of complications by 18 (75%), perception that LP was unnecessary by 5 (21%), and distrust of the motives behind the request for consent. Fear of paralysis and conviction that LP is unnecessary encompassed 80% of the causes for refusal. Eleven families (46%) stated that nothing would have made them consent, and 10 (42%) would agree only if the child looked unwell or deteriorated. CONCLUSIONS A better understanding of parents' perceptions, beliefs, and fears will help develop appropriate solutions to their refusal of LP consent.
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Affiliation(s)
- Hassib Narchi
- Department of Pediatrics, Faculty of Medicine & Health Sciences, Al Ain, United Arab Emirates
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A Systematic Review of Cross-Cultural Comparison Studies of Child, Parent, and Health Professional Outcomes Associated With Pediatric Medical Procedures. THE JOURNAL OF PAIN 2012; 13:207-19. [DOI: 10.1016/j.jpain.2011.12.008] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/23/2011] [Revised: 12/05/2011] [Accepted: 12/13/2011] [Indexed: 11/17/2022]
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Shaw K, Ritchie D, Adams G. Does witnessing resuscitation help parents come to terms with the death of their child? A review of the literature. Intensive Crit Care Nurs 2011; 27:253-62. [DOI: 10.1016/j.iccn.2011.05.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2010] [Revised: 05/03/2011] [Accepted: 05/09/2011] [Indexed: 11/29/2022]
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Biarent D, Bingham R, Eich C, López-Herce J, Maconochie I, Rodríguez-Núñez A, Rajka T, Zideman D. European Resuscitation Council Guidelines for Resuscitation 2010 Section 6. Paediatric life support. Resuscitation 2011; 81:1364-88. [PMID: 20956047 DOI: 10.1016/j.resuscitation.2010.08.012] [Citation(s) in RCA: 151] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Dominique Biarent
- Paediatric Intensive Care, Hôpital Universitaire des Enfants, 15 av JJ Crocq, Brussels, Belgium.
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Mind the gap and narrowing it: family presence during pediatric resuscitation and invasive procedures. Resuscitation 2011; 82:655-6. [PMID: 21514713 DOI: 10.1016/j.resuscitation.2011.03.028] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2011] [Accepted: 03/24/2011] [Indexed: 11/21/2022]
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de Caen AR, Kleinman ME, Chameides L, Atkins DL, Berg RA, Berg MD, Bhanji F, Biarent D, Bingham R, Coovadia AH, Hazinski MF, Hickey RW, Nadkarni VM, Reis AG, Rodriguez-Nunez A, Tibballs J, Zaritsky AL, Zideman D. Part 10: Paediatric basic and advanced life support: 2010 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science with Treatment Recommendations. Resuscitation 2011; 81 Suppl 1:e213-59. [PMID: 20956041 DOI: 10.1016/j.resuscitation.2010.08.028] [Citation(s) in RCA: 87] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Affiliation(s)
- Allan R de Caen
- Stollery Children's Hospital, University of Alberta, Canada.
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Family presence during invasive procedures at the emergency department: what is the opinion of Spanish medical staff? Pediatr Emerg Care 2011; 27:86-91. [PMID: 21252814 DOI: 10.1097/pec.0b013e3182094329] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVES Family presence (FP) during invasive procedures (IPs) in children remains controversial among pediatric emergency department (PED) staff. The authors aimed to determine health care providers' attitudes toward FP during IPs in Spain, to learn whether parents are given the option of being present during different IPs, and to study which factors influence the providers' opinions. METHODS Observational study. Physicians and nurses were asked to answer a questionnaire, which was sent to 43 PEDs and was available at the Spanish Pediatric Emergency Society Web site. RESULTS We obtained 222 questionnaires from 36 Spanish hospitals. A total of 65.8% of the surveys were answered by physicians (66.4% pediatricians) and 34.2% by nurses. The median age of the respondents was 32 years, and 69.2% were women. Parents were given the option of being present during blood sampling (36.4%), intravenous line placement (32.7%), urethral catheterization (32.1%), lumbar puncture (13.5%), and resuscitation (1%). More than 60% of providers approved of FP during blood sampling, sutures, intravenous line placement, and urethral catheterization; however, only 10.8% of providers encourages FP during resuscitation. Against FP, health care staff argue procedural invasiveness (75.6%), parents' anxiety (87.6%), and worsened performance of the procedure (66%). Commonly expressed advantages were reducing patient distress (72.9%) and parent anxiety (62.3%). Physicians, especially the older ones, are more likely to encourage FP than nurses for some IPs. CONCLUSIONS The PED staff tend to prefer parents not to be present during IPs as the level of invasiveness increases. Family presence is not common in Spanish PEDs. Older physicians are more likely to support FP than nurses.
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Biarent D, Bingham R, Eich C, López-Herce J, Maconochie I, Rodrίguez-Núñez A, Rajka T, Zideman D. Lebensrettende Maßnahmen bei Kindern („paediatric life support“). Notf Rett Med 2010. [DOI: 10.1007/s10049-010-1372-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Kleinman ME, Chameides L, Schexnayder SM, Samson RA, Hazinski MF, Atkins DL, Berg MD, de Caen AR, Fink EL, Freid EB, Hickey RW, Marino BS, Nadkarni VM, Proctor LT, Qureshi FA, Sartorelli K, Topjian A, van der Jagt EW, Zaritsky AL. Part 14: Pediatric Advanced Life Support. Circulation 2010; 122:S876-908. [DOI: 10.1161/circulationaha.110.971101] [Citation(s) in RCA: 473] [Impact Index Per Article: 33.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
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Kleinman ME, de Caen AR, Chameides L, Atkins DL, Berg RA, Berg MD, Bhanji F, Biarent D, Bingham R, Coovadia AH, Hazinski MF, Hickey RW, Nadkarni VM, Reis AG, Rodriguez-Nunez A, Tibballs J, Zaritsky AL, Zideman D. Pediatric basic and advanced life support: 2010 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science with Treatment Recommendations. Pediatrics 2010; 126:e1261-318. [PMID: 20956433 PMCID: PMC3784274 DOI: 10.1542/peds.2010-2972a] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Kleinman ME, de Caen AR, Chameides L, Atkins DL, Berg RA, Berg MD, Bhanji F, Biarent D, Bingham R, Coovadia AH, Hazinski MF, Hickey RW, Nadkarni VM, Reis AG, Rodriguez-Nunez A, Tibballs J, Zaritsky AL, Zideman D. Part 10: Pediatric basic and advanced life support: 2010 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations. Circulation 2010; 122:S466-515. [PMID: 20956258 PMCID: PMC3748977 DOI: 10.1161/circulationaha.110.971093] [Citation(s) in RCA: 143] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Note From the Writing Group: Throughout this article, the reader will notice combinations of superscripted letters and numbers (eg, “Family Presence During ResuscitationPeds-003”). These callouts are hyperlinked to evidence-based worksheets, which were used in the development of this article. An appendix of worksheets, applicable to this article, is located at the end of the text. The worksheets are available in PDF format and are open access.
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Latour JM, Hazelzet JA, Duivenvoorden HJ, van Goudoever JB. Perceptions of parents, nurses, and physicians on neonatal intensive care practices. J Pediatr 2010; 157:215-220.e3. [PMID: 20359714 DOI: 10.1016/j.jpeds.2010.02.009] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2009] [Revised: 01/27/2010] [Accepted: 02/05/2010] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To identify satisfaction with neonatal intensive care as viewed by parents and healthcare professionals and to explore similarities and differences between parents and healthcare professionals. STUDY DESIGN A 3-round Delphi method to identify neonatal care issues (round 1) and to determine the importance of these issues (rounds 2 and 3) was conducted among nurses (n = 84) and physicians (n = 14), followed by an exploratory survey among parents (n = 259). Main outcome measures were 92 neonatal care-related items. RESULTS Sixty-eight nurses and 13 physicians completed all 3 rounds. The first round yielded 419 neonatal care related statements, which were clustered into 92 items. The survey was completed by 148 (57%) parents. Parents rated 25 of 92 care items significantly higher than did the professionals (effect size of Cohen's d, 0.31 to 1.14, P <or= .02). Two items related to medication administration had the largest effect size. Professionals rated 7 items significantly higher than did parents (Cohen's d, -0.31 to -0.58, P <or= .04). One of these was assigning a physician and a nurse to the parents. Three were related to multicultural care. CONCLUSIONS This study revealed disparities between parents and neonatal intensive care unit staff on a number of care issues reflecting incongruity in recognizing parents' desires.
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Affiliation(s)
- Jos M Latour
- Department of Pediatrics, Erasmus MC - Sophia Children's Hospital, Rotterdam, The Netherlands
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Abstract
OBJECTIVE The objective was to study parental fever management and attitude toward fever from the perspective of the child's ethnicity and age. PATIENTS AND SETTING Children with fever presenting at the pediatric emergency department (PED) of the Erasmus MC-Sophia Children's Hospital, Rotterdam, the Netherlands, in the period from February 2002 to March 2004. DESIGN Prospective observational. MAIN OUTCOME MEASURES Parental fever attitude and management assessed by a questionnaire. RESULTS Two hundred eleven children with fever (median age, 1.2 years; interquartile range, 0.7-2.0 years) were included, of whom 108 (55%) were boys. One hundred fourteen children (54%) were self-referrals at the PED. Accompanying symptoms were reported in 95% (50% had > or = 3); median temperature measured at PED was 39.5 degrees C (interquartile range, 38.9 degrees C-40.8 degrees C). One hundred fifty-five parents (74%) had used antipyretics to reduce fever, and 155 parents (74%) were worried about fever and its possible complications. Differences between Dutch and non-Dutch ethnicities were seen in temperature-reducing techniques, self-referral, and parental anxiety of fever and its complications. Age did not influence parental fever attitude and management. CONCLUSIONS For most children in our population, the use of antipyretics was justified, as the majority of our children visiting the PED for an acute febrile episode are young infants, in particular with a high degree of fever and accompanying symptoms. We confirm and extend previous findings of ethnicity influencing parental fever management.
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Kain ZN, Maclaren J, Weinberg M, Huszti H, Anderson C, Mayes L. How many parents should we let into the operating room? Paediatr Anaesth 2009; 19:244-9. [PMID: 19143951 DOI: 10.1111/j.1460-9592.2008.02889.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE This study compared anxiety of children with one and two parents present at anesthesia induction. METHODOLOGY Baseline measures of parent and child anxiety were obtained; parents were randomly assigned to the two study groups. Validated and reliable tools were used to assess the outcomes of interest. RESULTS We found that observed anxiety of children as well as compliance of children with the induction process was not different between the two study groups. Parent's anxiety was also evaluated using two-way ANOVA with repeated measures. A group by time interaction was demonstrated and parents in the one-parent group reported significantly higher anxiety than parents in the two-parents group (M = 48.6, SD = 13.1 vs M = 39.7, SD = 11.5, P < 0.02). CONCLUSIONS We conclude that while allowing two parents into the operating rooms does not affect observed child anxiety, it does reduce parent self-reported anxiety. As the presence of multiple parents during invasive medical procedures is in congruence with family centered-care we recommend that institutions examine this modality.
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Affiliation(s)
- Zeev N Kain
- Department of Anesthesiology at University of California, Irvine, CA, USA.
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Parra Cotanda C, Luaces Cubells C, Pou Fernández J. ¿Deberían estar presentes los padres durante los procedimientos invasivos en urgencias? An Pediatr (Barc) 2009; 70:293-6. [DOI: 10.1016/j.anpedi.2008.09.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2008] [Revised: 09/08/2008] [Accepted: 09/09/2008] [Indexed: 10/20/2022] Open
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