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McKenna L, Shimoinaba K, Copnell B. Family-centered care and pediatric death in the emergency department: A qualitative study using framework analysis. J Pediatr Nurs 2022; 64:18-23. [PMID: 35131715 DOI: 10.1016/j.pedn.2022.01.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Revised: 12/15/2021] [Accepted: 01/22/2022] [Indexed: 11/18/2022]
Abstract
BACKGROUND Family-centered care is an important concept underpinning care of children. Although much researched in some settings, little research has explored specialist settings, or areas where both children and adults are cared for, such as the emergency department. METHODS This study sought to explore how nurses employ family-centered care in delivering care to children and families when a child dies in the emergency department. Using a descriptive, qualitative approach, semi-structured interviews were conducted with 24 emergency nurses from six Australian states. Interviews were audio-recorded and transcribed verbatim. Framework analysis was applied to examine alignment with family-centered care principles. FINDINGS Nurses described providing support and education, and encouraged families to engage in care decisions, including about ceasing resuscitation efforts. Commonly, senior staff members were allocated during emergencies to support parents. DISCUSSION Emergency nurses should be offered education on family-centered care, and research undertaken to explore families' experiences of their child dying in the emergency department. PRACTICE IMPLICATION Family-centered care should be a focus for the care of children and their families in the emergency department, regardless of the pressure from rapidly occurring events.
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Affiliation(s)
- Lisa McKenna
- School of Nursing and Midwifery, La Trobe University, Australia.
| | | | - Beverley Copnell
- School of Nursing and Midwifery, La Trobe University, Australia.
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Shapiro-Mendoza CK, Palusci VJ, Hoffman B, Batra E, Yester M, Corey TS, Sens MA. Half Century Since SIDS: A Reappraisal of Terminology. Pediatrics 2021; 148:peds.2021-053746. [PMID: 34544849 PMCID: PMC8487943 DOI: 10.1542/peds.2021-053746] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
After a sudden infant death, parents and caregivers need accurate and open communication about why their infant died. Communicating tragic news about a child's death to families and caregivers is difficult. Shared and consistent terminology is essential for pediatricians, other physicians, and nonphysician clinicians to improve communication with families and among themselves. When families do not have complete information about why their child died, pediatricians will not be able to support them through the process and make appropriate referrals for pediatric specialty and mental health care. Families can only speculate about the cause and may blame themselves or others for the infant's death. The terminology used to describe infant deaths that occur suddenly and unexpectedly includes an assortment of terms that vary across and among pediatrician, other physician, or nonphysician clinician disciplines. Having consistent terminology is critical to improve the understanding of the etiology, pathophysiology, and epidemiology of these deaths and communicate with families. A lack of consistent terminology also makes it difficult to reliably monitor trends in mortality and hampers the ability to develop effective interventions. This report describes the history of sudden infant death terminology and summarizes the debate over the terminology and the resulting diagnostic shift of these deaths. This information is to assist pediatricians, other physicians, and nonphysician clinicians in caring for families during this difficult time. The importance of consistent terminology is outlined, followed by a summary of progress toward consensus. Recommendations for pediatricians, other physicians, and nonphysician clinicians are proposed.
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Affiliation(s)
| | - Vincent J. Palusci
- Department of Pediatrics, Grossman School of Medicine, New York University, New York, New York
| | - Benjamin Hoffman
- Department of Pediatrics, School of Medicine, Oregon Health & Science University, Portland, Oregon
| | - Erich Batra
- Departments of Pediatrics and Family and Community Medicine, College of Medicine, Pennsylvania State University, Hershey, Pennsylvania
| | - Marc Yester
- Department of Pediatrics, Children’s Hospital of Pittsburgh, Pittsburgh, Pennsylvania
| | - Tracey S. Corey
- Florida Districts 5 & 24 Medical Examiner’s Office, Leesburg, Florida
| | - Mary Ann Sens
- Department of Pathology, School of Medicine and Health Sciences, University of North Dakota, Grand Forks, North Dakota
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Lahmini W, Bourrous M. Mortality at the pediatric emergency unit of the Mohammed VI teaching hospital of Marrakech. BMC Emerg Med 2020; 20:57. [PMID: 32703150 PMCID: PMC7376937 DOI: 10.1186/s12873-020-00352-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Accepted: 07/09/2020] [Indexed: 12/04/2022] Open
Abstract
Background The death of a child at the emergency ward is one of the most difficult problems that the clinicians of these wards have to deal with. In our country the published data concerning the causes and the factors related to pediatric mortality especially in the pediatric emergency wards is very rare. This study aimed to study the epidemiology of the pediatric mortality in the pediatric emergency department (PED), to determine its rate and identify its most frequent causes. Methods It is a retrospective and descriptive study, over five years (1st January 2012 and 31st December 2016) including all children aged from 0 to 15 years old who died at the PED in the Mohamed VI Hospital in Marrakech. Results During the period of the study a total of 172.691 patients presented to the PED, among which 628 died (pediatric mortality rate: 3.63%). The masculine gender was predominant (n = 383) with a gender ratio of 1.59. Two-thirds of the patients died in the first 24 h (n = 421). The median of time from admission to death was around 12 h. Majority of the deceased children (n = 471, 75%) were from a low socioeconomic status. The most frequent cause of admissions for deceased patients in the PED was respiratory distress (n = 296, 47%) followed by neurological disorders (n = 70, 11%). Neonatal mortality (≤ 1 month of age) was predominant (n = 472, 75.1%), followed by postnatal mortality (1 month to 1 year old) (n = 73, 11.6%). The most frequent causes of pediatric mortality, whatever the age range, were dominated by neonatal pathologies (n = 391, 62.3%), followed by infecious causes bronchopulmonary infections included (n = 49, 7.7%), birth deformities (n = 46, 7.3%) while traumas were merely at 0.9% (n = 6). The most frequent causes of neonatal mortality were neonatal infections (n = 152, 32.2%) and prematurity (n = 115, 24.4%). Conclusion Our data once again underline the crucial importance of prevention. This requires correct follow-up of the pregnancies, an adequate assistance of births, and perfecting healthcare provision to newborns in order to attain proper assistance.
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Affiliation(s)
- W Lahmini
- Department of Paediatric Emergency, UHC Mohamed VI, Cadi Ayyad University, PO Box: 7010, Sidi Abbad Street, 40000, Marrakech, Morocco
| | - M Bourrous
- Department of Paediatric Emergency, UHC Mohamed VI, Cadi Ayyad University, PO Box: 7010, Sidi Abbad Street, 40000, Marrakech, Morocco.
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Remick K, Gausche-Hill M, Joseph MM, Brown K, Snow SK, Wright JL, Wright J, Adirim T, Agus MS, Callahan J, Gross T, Lane N, Lee L, Mazor S, Mahajan P, Timm N, Joseph MM, Alade K, Amato C, Avarello JT, Baldwin S, Barata IA, Benjamin LS, Berg K, Brown K, Bullard-Berent J, Dietrich AM, Friesen P, Gerardi M, Heins A, Holtzman DK, Homme J, Horeczko T, Ishimine P, Lam S, Long K, Mayz K, Mehta S, Mellick L, Ojo A, Paul AZ, Pauze DR, Pearson NM, Perina D, Petrack E, Rayburn D, Rose E, Russell WS, Ruttan T, Saidinejad M, Sanders B, Simpson J, Solari P, Stoner M, Valente JH, Wall J, Wallin D, Waseem M, Whiteman PJ, Woolridge D, Young T, Foresman-Capuzzi J, Johnson R, Martin H, Milici J, Brandt C, Nelson N. Pediatric Readiness in the Emergency Department. J Emerg Nurs 2019; 45:e3-e18. [DOI: 10.1016/j.jen.2018.10.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Remick K, Gausche-Hill M, Joseph MM, Brown K, Snow SK, Wright JL, Adirim T, Agus MS, Callahan J, Gross T, Lane N, Lee L, Mazor S, Mahajan P, Timm N, Heiss KF, Beierle E, Besner GE, Downard CD, Fallat ME, Gow KW, Alade K, Amato C, Avarello JT, Baldwin S, Barata IA, Benjamin LS, Berg K, Bullard-Berent J, Dietrich AM, Friesen P, Gerardi M, Heins A, Holtzman DK, Homme J, Horeczko T, Ishimine P, Lam S, Long K, Mayz K, Mehta S, Mellick L, Ojo A, Paul AZ, Pauze DR, Pearson NM, Perina D, Petrack E, Rayburn D, Rose E, Russell WS, Ruttan T, Saidinejad M, Sanders B, Simpson J, Solari P, Stoner M, Valente JH, Wall J, Wallin D, Waseem M, Whiteman PJ, Woolridge D, Young T, Foresman-Capuzzi J, Johnson R, Martin H, Milici J, Brandt C, Nelson N. Pediatric Readiness in the Emergency Department. Pediatrics 2018; 142:peds.2018-2459. [PMID: 30389843 DOI: 10.1542/peds.2018-2459] [Citation(s) in RCA: 82] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
This is a revision of the previous joint Policy Statement titled "Guidelines for Care of Children in the Emergency Department." Children have unique physical and psychosocial needs that are heightened in the setting of serious or life-threatening emergencies. The majority of children who are ill and injured are brought to community hospital emergency departments (EDs) by virtue of proximity. It is therefore imperative that all EDs have the appropriate resources (medications, equipment, policies, and education) and capable staff to provide effective emergency care for children. In this Policy Statement, we outline the resources necessary for EDs to stand ready to care for children of all ages. These recommendations are consistent with the recommendations of the Institute of Medicine (now called the National Academy of Medicine) in its report "The Future of Emergency Care in the US Health System." Although resources within emergency and trauma care systems vary locally, regionally, and nationally, it is essential that ED staff, administrators, and medical directors seek to meet or exceed these recommendations to ensure that high-quality emergency care is available for all children. These updated recommendations are intended to serve as a resource for clinical and administrative leadership in EDs as they strive to improve their readiness for children of all ages.
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Affiliation(s)
- Katherine Remick
- National Emergency Medical Services for Children Innovation and Improvement Center, Baylor College of Medicine, Houston, Texas
- Department of Pediatrics, Dell Medical School, The University of Texas at Austin, Austin, Texas
- Dell Children’s Medical Center, Austin, Texas
| | - Marianne Gausche-Hill
- Los Angeles County Emergency Medical Services Agency, Santa Fe Springs, California
- Department of Emergency Medicine and Pediatrics, David Geffen School of Medicine and Harbor–University of California, Los Angeles Medical Center, University of California, Los Angeles, Los Angeles, California
- Department of Emergency Medicine, Los Angeles Biomedical Research Institute, Los Angeles, California
| | - Madeline M. Joseph
- Division of Pediatric Emergency Medicine, Department of Emergency Medicine and Pediatrics, University of Florida College of Medicine–Jacksonville, Jacksonville, Florida
- University of Florida Health Sciences Center–Jacksonville, Jacksonville, Florida
| | - Kathleen Brown
- Departments of Pediatrics and Emergency Medicine, School of Medicine and Health Sciences, George Washington University and Children’s National Medical Center, Washington, District of Columbia
| | | | - Joseph L. Wright
- University of Maryland Capital Region Health, University of Maryland Medical System, Cheverly, Maryland; and
- Department of Family Science, University of Maryland School of Public Health, College Park, Maryland
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Abstract
BACKGROUND Analysis of the causes of death in children in the pediatric emergency department (ED) may aid the development of management and prevention practices. OBJECTIVE To identify the causes of death in Spanish pediatric EDs and to analyze the management of these children in the prehospital and hospital settings. METHODS This was a retrospective descriptive multicenter survey including all patients whose death was certified in 18 Spanish pediatric EDs between 2008 and 2013. RESULTS During the study period, 3 542 426 episodes were registered in the EDs. Of these, 54 patients died (mortality rate: 1.5/100 000 visits). Data of 53 patients are analyzed (male 36, 67%, 31 younger than 2 years old and 43.3% nonpreviously healthy children). The main causes of death were related to their previous illnesses (24.5%), sudden infant death syndrome (20.7%), and traumatism (18.8%).Prehospital cardiopulmonary resuscitation (CPR) was performed in 31 patients, and exclusively by health workers in 19 patients. In 35 patients, the parents witnessed the event and seven began CPR.Thirty children were transferred to the pediatric EDs by medical transport (56.6%) and all of them received prehospital CPR (vs. one patient out of 23 arrived in a nonmedical transportation).In 37 patients, CPR was performed in the pediatric EDs. Overall, CPR lasted 40±23 min (range, 10-120 min). CPR was not performed in seven patients at any time. CONCLUSION The main causes of death in Spanish pediatric EDs are related to previous illnesses, sudden infant death syndrome, and nonintentional lesions. Several actions have to be considered to improve the quality of care of these children in prehospital and emergency settings.
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Abstract
The American Academy of Pediatrics, American College of Emergency Physicians, and Emergency Nurses Association have collaborated to identify practices and principles to guide the care of children, families, and staff in the challenging and uncommon event of the death of a child in the emergency department in this policy statement and in an accompanying technical report.
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