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Latour JM, Rennick JE, van den Hoogen A. Editorial: Family-centered care in pediatric and neonatal critical care settings. Front Pediatr 2024; 12:1402948. [PMID: 38606367 PMCID: PMC11007701 DOI: 10.3389/fped.2024.1402948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2024] [Accepted: 03/19/2024] [Indexed: 04/13/2024] Open
Affiliation(s)
- Jos M. Latour
- Faculty of Health, University of Plymouth, Plymouth, United Kingdom
- Department of Nursing, Zhongshan Hospital, Fudan University, Shanghai, China
- The Curtin School of Nursing, Curtin University, Perth, WA, Australia
| | - Janet E. Rennick
- Department of Nursing, The Montreal Children’s Hospital, McGill University Health Centre, Montreal, QC, Canada
- Ingram School of Nursing, Faculty of Medicine and Health Sciences, McGill University, Montreal, QC, Canada
- Department of Pediatrics, Faculty of Medicine and Health Sciences, McGill University, Montreal, QC, Canada
| | - Agnes van den Hoogen
- Department Woman and Baby, Wilhelmina Children’s Hospital, University Medical Centre Utrecht, Utrecht, Netherlands
- Clinical Health Science, Utrecht University, Utrecht, Netherlands
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Curley MAQ, Watson RS, Killien EY, Kalvas LB, Perry-Eaddy MA, Cassidy AM, Miller EB, Talukder M, Manning JC, Pinto NP, Rennick JE, Colville G, Asaro LA, Wypij D. Design and rationale of the Post-Intensive Care Syndrome - paediatrics (PICS-p) Longitudinal Cohort Study. BMJ Open 2024; 14:e084445. [PMID: 38401903 PMCID: PMC10895227 DOI: 10.1136/bmjopen-2024-084445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Accepted: 01/31/2024] [Indexed: 02/26/2024] Open
Abstract
INTRODUCTION As paediatric intensive care unit (PICU) mortality declines, there is growing recognition of the morbidity experienced by children surviving critical illness and their families. A comprehensive understanding of the adverse physical, cognitive, emotional and social sequelae common to PICU survivors is limited, however, and the trajectory of recovery and risk factors for morbidity remain unknown. METHODS AND ANALYSIS The Post-Intensive Care Syndrome - paediatrics Longitudinal Cohort Study will evaluate child and family outcomes over 2 years following PICU discharge and identify child and clinical factors associated with impaired outcomes. We will enrol 750 children from 30 US PICUs during their first PICU hospitalisation, including 500 case participants experiencing ≥3 days of intensive care that include critical care therapies (eg, mechanical ventilation, vasoactive infusions) and 250 age-matched, sex-matched and medical complexity-matched control participants experiencing a single night in the PICU with no intensive care therapies. Children, parents and siblings will complete surveys about health-related quality of life, physical function, cognitive status, emotional health and peer and family relationships at multiple time points from baseline recall through 2 years post-PICU discharge. We will compare outcomes and recovery trajectories of case participants to control participants, identify risk factors associated with poor outcomes and determine the emotional and social health consequences of paediatric critical illness on parents and siblings. ETHICS AND DISSEMINATION This study has received ethical approval from the University of Pennsylvania Institutional Review Board (protocol #843844). Our overall objective is to characterise the ongoing impact of paediatric critical illness to guide development of interventions that optimise outcomes among children surviving critical illness and their families. Findings will be presented at key disciplinary meetings and in peer-reviewed publications at fixed data points. Published manuscripts will be added to our public study website to ensure findings are available to families, clinicians and researchers. TRIALS REGISTRATION NUMBER NCT04967365.
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Affiliation(s)
- Martha A Q Curley
- School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - R Scott Watson
- University of Washington School of Medicine, Seattle, Washington, USA
- Seattle Children's Research Institute, Seattle, Washington, USA
| | - Elizabeth Y Killien
- University of Washington School of Medicine, Seattle, Washington, USA
- Seattle Children's Research Institute, Seattle, Washington, USA
| | - Laura Beth Kalvas
- School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Mallory A Perry-Eaddy
- School of Nursing, University of Connecticut, Storrs, Connecticut, USA
- School of Medicine, University of Connecticut, Farmington, Connecticut, USA
| | - Amy M Cassidy
- School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Erica B Miller
- Seattle Children's Research Institute, Seattle, Washington, USA
| | - Mritika Talukder
- School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Joseph C Manning
- School of Healthcare, University of Leicester, Leicester, UK
- Nottingham Children's Hospital, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Neethi P Pinto
- The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Janet E Rennick
- McGill University Health Centre, Montreal Children's Hospital, Montreal, Québec, Canada
- Ingram School of Nursing, McGill University, Montreal, Québec, Canada
| | | | - Lisa A Asaro
- Boston Children's Hospital, Boston, Massachusetts, USA
| | - David Wypij
- Boston Children's Hospital, Boston, Massachusetts, USA
- Harvard T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts, USA
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3
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Bolduc ME, Rennick JE, Gagnon I, Sokol E, Majnemer A, Brossard-Racine M. Navigating the healthcare system with my child with CHD: parental perspectives on developmental follow-up practices. Cardiol Young 2024; 34:37-43. [PMID: 37138527 DOI: 10.1017/s1047951123001051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
BACKGROUND Parents of children with CHD face several barriers when trying to access the services needed to support their child's development. In fact, current developmental follow-up practices may not identify developmental challenges in a timely manner and important opportunities for interventions may be lost. This study aimed to explore the perspectives of parents of children and adolescents with CHD with respect to developmental follow-up in Canada. METHODS Interpretive description was used as a methodological approach for this qualitative study. Parents of children aged 5-15 years with complex CHD were eligible. Semi-structured interviews that aimed to explore their perspectives regarding their child's developmental follow-up were conducted. RESULTS Fifteen parents of children with CHD were recruited for this study. They expressed that the lack of systematic and responsive developmental follow-up services and limited access to resources to support their child's development placed an undue burden on their families, and as a result, they needed to assume new roles as case managers or advocates to address these limitations. This additional burden resulted in a high level of parental stress, which, in turn, affected the parent-child relationship and siblings. CONCLUSIONS The limitations of the current Canadian developmental follow-up practices put undue pressure on the parents of children with complex CHD. The parents stressed the importance of implementing a universal and systematic approach to developmental follow-up to allow for the timely identification of challenges, enabling the initiation of interventions and supports and promoting more positive parent-child relationships.
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Affiliation(s)
- Marie-Eve Bolduc
- School of Physical and Occupational Therapy, McGill University, Montreal, Canada
- Research Institute of the McGill University Health Centre, Montreal, Canada
| | - Janet E Rennick
- Research Institute of the McGill University Health Centre, Montreal, Canada
- Department of Nursing, The Montreal Children's Hospital, McGill University Health Centre, Montreal, Canada
- Ingram School of Nursing, McGill University, Montreal, Canada
- Department of Pediatrics, McGill University, Montreal, Canada
| | - Isabelle Gagnon
- School of Physical and Occupational Therapy, McGill University, Montreal, Canada
- Research Institute of the McGill University Health Centre, Montreal, Canada
| | - Eva Sokol
- Research Institute of the McGill University Health Centre, Montreal, Canada
| | - Annette Majnemer
- School of Physical and Occupational Therapy, McGill University, Montreal, Canada
- Research Institute of the McGill University Health Centre, Montreal, Canada
- Department of Pediatrics, McGill University, Montreal, Canada
- Department of Neurology and Neurosurgery, McGill University, Montreal, Canada
| | - Marie Brossard-Racine
- School of Physical and Occupational Therapy, McGill University, Montreal, Canada
- Research Institute of the McGill University Health Centre, Montreal, Canada
- Department of Pediatrics, McGill University, Montreal, Canada
- Department of Neurology and Neurosurgery, McGill University, Montreal, Canada
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Bolduc ME, Rennick JE, Gagnon I, Sokol E, Brossard-Racine M, Majnemer A. Identifying developmental challenges of youth with congenital heart defects: A patient-oriented perspective. Child Care Health Dev 2023; 49:258-267. [PMID: 35945137 DOI: 10.1111/cch.13037] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Revised: 07/08/2022] [Accepted: 08/01/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND Youth with congenital heart disease (CHD) are at high risk for a range of developmental impairments that become evident at different times across childhood and adolescence. This study aimed to explore perspectives of youth with CHD with respect to their developmental follow-up across childhood. METHODS Interpretive description was used as a methodological approach for this qualitative study. Youth aged 12-22 years with CHD requiring open-heart surgery before 2 years of age and who had received health services in Canada since birth were enrolled. RESULTS Ten youth with CHD, two males and eight females, aged 13-22 years (mean 19.8) participated in this study. With higher social and academic demands as well as increased level of autonomy associated with older age, some youth faced new challenges that they had not encountered as children. Youth with CHD identified four aspects of the continuum of care as needing to be changed to better respond to their needs. First, the format of developmental follow-up needs to be adapted to their unique challenges. Second, resources must be more easily accessible throughout childhood and adolescence. Third, planning for transition to adult care is essential to ensure continuity of services. Finally, they identified that the school system is an essential component of the continuum of care. CONCLUSIONS Adolescents and young adults with CHD are at high risk of developing physical, academic and psychosocial challenges; however, timely identification of challenges does not appear to be optimal across domains and transition points, from the perspective of the youth themselves. Youth with CHD reported not having the resources and supports they required to optimize their functioning. Our findings suggest that several approaches could be adopted to enhance identification and outcomes to address the limitations of current Canadian practices.
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Affiliation(s)
- Marie-Eve Bolduc
- School of Physical and Occupational Therapy, McGill University, Montreal, Canada.,Research Institute of the McGill University Health Centre, Montreal, Canada
| | - Janet E Rennick
- Research Institute of the McGill University Health Centre, Montreal, Canada.,Department of Nursing, The Montreal Children's Hospital, McGill University Health Centre, Montreal, Canada.,Ingram School of Nursing, McGill University, Montreal, Canada.,Department of Pediatrics, McGill University, Montreal, Canada
| | - Isabelle Gagnon
- School of Physical and Occupational Therapy, McGill University, Montreal, Canada.,Research Institute of the McGill University Health Centre, Montreal, Canada
| | | | - Marie Brossard-Racine
- School of Physical and Occupational Therapy, McGill University, Montreal, Canada.,Research Institute of the McGill University Health Centre, Montreal, Canada.,Department of Pediatrics, McGill University, Montreal, Canada.,Department of Neurology and Neurosurgery, McGill University, Montreal, Canada
| | - Annette Majnemer
- School of Physical and Occupational Therapy, McGill University, Montreal, Canada.,Research Institute of the McGill University Health Centre, Montreal, Canada.,Department of Pediatrics, McGill University, Montreal, Canada.,Department of Neurology and Neurosurgery, McGill University, Montreal, Canada
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5
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Bolduc ME, Rennick JE, Gagnon I, Majnemer A, Brossard-Racine M. Canadian Developmental Follow-up Practices in Children With Congenital Heart Defects: A National Environmental Scan. CJC Pediatr Congenit Heart Dis 2022; 1:3-10. [PMID: 37969558 PMCID: PMC10642138 DOI: 10.1016/j.cjcpc.2021.11.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Accepted: 11/05/2021] [Indexed: 11/17/2023]
Abstract
Background Developmental follow-up is central to the timely identification of delays in at-risk children. Throughout Canada, data are currently lacking on the follow-up of children with congenital heart disease (CHD) after open-heart surgery. The objective of this study was to describe current Canadian developmental follow-up practices and to explore barriers to optimal follow-up. Methods A cross-sectional study was implemented with health professionals involved with the developmental follow-up of children with CHD in the 8 specialized hospitals that perform pediatric open-heart surgery in Canada. A questionnaire collected descriptive information about the setting and current follow-up practices. In addition, an interview was conducted to explore what would be considered optimal developmental follow-up in Canada and identify potential barriers. Results Four of the 8 tertiary care centres had a systematic developmental follow-up program that included screening and formal evaluation. These programs were only accessible to a subset of children with CHD identified to be at higher risk. Participants described current practices as suboptimal and aimed to develop a more systematic developmental follow-up program or expand an existing one. Participants emphasized the lack of human resources, financial supports, and limited dedicated time as major barriers to offering optimal follow-up care. Conclusions Current follow-up practices in Canada are considered suboptimal by health care specialists involved in treating children with CHD. These practices may fail to promptly identify children and adolescents with CHD who have developmental challenges. It is essential that we develop national recommendations to optimize the developmental follow-up practices in Canada for this high-risk population.
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Affiliation(s)
- Marie-Eve Bolduc
- School of Physical and Occupational Therapy, McGill University, Montréal, Québec, Canada
- Advances in Brain and Child Development Research Laboratory, Research Institute of the McGill University Health Centre, Montréal, Québec, Canada
| | - Janet E. Rennick
- Department of Nursing, The Montreal Children’s Hospital, McGill University Health Centre, Montréal, Québec, Canada
- Ingram School of Nursing, McGill University, Montréal, Québec, Canada
- Department of Pediatrics, McGill University, Montréal, Québec, Canada
| | - Isabelle Gagnon
- School of Physical and Occupational Therapy, McGill University, Montréal, Québec, Canada
- Department of Pediatrics, McGill University, Montréal, Québec, Canada
| | - Annette Majnemer
- School of Physical and Occupational Therapy, McGill University, Montréal, Québec, Canada
- Department of Pediatrics, McGill University, Montréal, Québec, Canada
- Department of Neurology and Neurosurgery, McGill University, Montréal, Québec, Canada
| | - Marie Brossard-Racine
- School of Physical and Occupational Therapy, McGill University, Montréal, Québec, Canada
- Advances in Brain and Child Development Research Laboratory, Research Institute of the McGill University Health Centre, Montréal, Québec, Canada
- Department of Pediatrics, McGill University, Montréal, Québec, Canada
- Department of Neurology and Neurosurgery, McGill University, Montréal, Québec, Canada
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6
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Aita M, Héon M, Lavallée A, De Clifford Faugère G, Altit G, Le May S, Dorval V, Lippé S, Larone Juneau A, Remmer E, Rennick JE. Nurturing and quiet intervention (NeuroN-QI) on preterm infants' neurodevelopment and maternal stress and anxiety: A pilot randomized clinical trial protocol. J Adv Nurs 2021; 77:3192-3203. [PMID: 33719093 DOI: 10.1111/jan.14819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Accepted: 02/02/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVES Primary objective of this pilot study is to evaluate the feasibility and acceptability of the NeuroN-QI and the study procedures. Secondary objectives are to assess the feasibility and acceptability of the NeuroN-QI by the nurses, assess the nurses' training needs about the components of the NeuroN-QI, and estimate the preliminary effects of the NeuroN-QI on infants' neurodevelopment as well as maternal stress and anxiety at infants' 36 weeks of gestational age. DESIGN A two-group pilot parallel randomized clinical trial stratified by center. METHODS The pilot study will be conducted in two neonatal intensive care units (NICUs). A sample of 24 mother-infant dyads born between 26 and 316/7 gestational age will be randomized into an experimental or control group. Fifty nurses will be recruited. The NeuroN-QI consists of four 2-hour skin-to-skin contact sessions/week with a 15-minute auditory stimulation by mothers with controlled ambient levels of light and noise. A 1-hour quiet period will follow where infants will rest in their incubator/crib with their mother's milk for olfactory stimulation and where the light and noise control will be continued. In the control group, mother-infant dyads will do four skin-to-skin contacts per week and receive standard care. Acceptability and feasibility of the NeuroN-QI in addition to maternal stress and anxiety will be measured through questionnaires, while infants' neurodevelopment will be assessed with Assessment of Preterm Infant Behaviour and General Movement Assessment. CONCLUSIONS This pilot trial will address knowledge gaps and generate evidence in neonatal care by evaluating the feasibility and acceptability of a multi-component developmental care intervention. IMPACT This project is an innovative step towards optimizing the neurodevelopmental trajectory of infants in NICUs and consequently promoting their long-term health outcomes. TRIAL REGISTRATION NCT04593095.
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Affiliation(s)
- Marilyn Aita
- Faculty of Nursing, Université de Montréal, Montréal, Canada.,CHU Sainte-Justine Research Centre, Montréal, Canada.,Quebec Network on Nursing Intervention Research (RRISIQ), Montréal, Canada
| | - Marjolaine Héon
- Faculty of Nursing, Université de Montréal, Montréal, Canada.,Quebec Network on Nursing Intervention Research (RRISIQ), Montréal, Canada
| | - Andréane Lavallée
- Faculty of Nursing, Université de Montréal, Montréal, Canada.,CHU Sainte-Justine Research Centre, Montréal, Canada.,Quebec Network on Nursing Intervention Research (RRISIQ), Montréal, Canada
| | | | - Gabriel Altit
- Department of Pediatrics, Division of Neonatology, Montreal Children's Hospital - McGill University Health Center (MUHC), Montréal, Canada.,Research Institute MUHC, Montréal, Canada.,Department of Pediatrics, Faculty of Medicine and Health Sciences, McGill University, Montréal, Canada
| | - Sylvie Le May
- Faculty of Nursing, Université de Montréal, Montréal, Canada.,CHU Sainte-Justine Research Centre, Montréal, Canada.,Quebec Network on Nursing Intervention Research (RRISIQ), Montréal, Canada
| | | | - Sarah Lippé
- CHU Sainte-Justine Research Centre, Montréal, Canada.,Faculty of Arts and Science, Department of Psychology, Université de Montréal, Montréal, Canada
| | | | - Elissa Remmer
- NICU, Montreal Children's Hospital (MCH, MUHC), Montréal, Canada
| | - Janet E Rennick
- Quebec Network on Nursing Intervention Research (RRISIQ), Montréal, Canada.,Research Institute MUHC, Montréal, Canada.,Department of Pediatrics, Faculty of Medicine and Health Sciences, McGill University, Montréal, Canada.,Ingram School of Nursing, Faculty of Medicine and Health Sciences, McGill University, Montréal, Canada.,Department of Nursing, MCH, MUHC, Montréal, Canada
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Rennick JE, Knox AM, Treherne SC, Dryden-Palmer K, Stremler R, Chambers CT, McRae L, Ho M, Stack DM, Dougherty G, Fudge H, Campbell-Yeo M. Family Members' Perceptions of Their Psychological Responses One Year Following Pediatric Intensive Care Unit (PICU) Hospitalization: Qualitative Findings From the Caring Intensively Study. Front Pediatr 2021; 9:724155. [PMID: 34557460 PMCID: PMC8452961 DOI: 10.3389/fped.2021.724155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2021] [Accepted: 08/06/2021] [Indexed: 11/13/2022] Open
Abstract
Introduction: PICU hospitalization can have a profound impact on child survivors and their families. There is limited research on children's long-term recovery within the context of the family following critical illness. This study aimed to explore children's and parents' perceptions of long-term psychological and behavioral responses within the context of the family one year following PICU hospitalization. Materials and Methods: Caring Intensively is a mixed methods multi-site prospective cohort study that aims to examine children's psychological and behavioral responses over a 3-year period following PICU hospitalization. In this study, part of the qualitative arm of Caring Intensively, an interpretive descriptive design was used to explore children's recovery one year post-discharge. Purposive sampling was used to select 17 families, including 16 mothers, 6 fathers, and 9 children. Semi-structured, audio-recorded interviews were conducted. Data were analyzed iteratively using the constant comparison method. Results: Families described efforts to readapt to routine life and find a new normal following PICU hospitalization. Finding a New Normal consisted of four major themes: (1) Processing PICU Reminders and Memories, (2) Changing Perceptions of Health and Illness, (3) We Are Not the Same, and (4) Altered Relationships. Participants described significant emotional and behavioral changes during the year following discharge. The psychological impact of individual family members' experiences led to changes in their sense of self, which affected family dynamics. PICU memories and reminders impacted participants' perceptions of childhood health and illness and resulted in increased vigilance. Parents and siblings demonstrated increased concern for the child survivor's health, and the experience of long absences and new or altered caregiving roles resulted in changes in relationships and family dynamics. Conclusion: PICU hospitalization impacted the psychological well-being of all family members as they sought to re-establish a sense of normalcy one year following discharge. Parent and child experiences and responses were closely interconnected. Findings highlight the importance of increased follow-up care aimed at supporting the family's psychological recovery.
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Affiliation(s)
- Janet E Rennick
- Department of Nursing, The Montreal Children's Hospital, McGill University Health Centre (MUHC), Montreal, QC, Canada.,Ingram School of Nursing, Faculty of Medicine and Health Sciences, McGill University, Montreal, QC, Canada.,Department of Pediatrics, Faculty of Medicine and Health Sciences, McGill University, Montreal, QC, Canada.,Child Health and Human Development, Research Institute of the MUHC, Montreal, QC, Canada
| | - Alyssa M Knox
- Child Health and Human Development, Research Institute of the MUHC, Montreal, QC, Canada
| | - Stephanie C Treherne
- Child Health and Human Development, Research Institute of the MUHC, Montreal, QC, Canada
| | - Karen Dryden-Palmer
- Department of Critical Care, Hospital for Sick Children, Toronto, ON, Canada.,Child Health Evaluative Sciences, Research Institute, Hospital for Sick Children, Toronto, ON, Canada
| | - Robyn Stremler
- Child Health Evaluative Sciences, Research Institute, Hospital for Sick Children, Toronto, ON, Canada.,Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON, Canada
| | - Christine T Chambers
- Department of Psychology and Neuroscience and Department of Pediatrics, Dalhousie University, Halifax, NS, Canada
| | - Lyndsey McRae
- Department of Neurosciences and Trauma, Hospital for Sick Children, Toronto, ON, Canada
| | - Michelle Ho
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON, Canada.,Division of Paediatric Medicine, Complex Care Program, Hospital for Sick Children, Toronto, ON, Canada
| | - Dale M Stack
- Department of Psychology and Centre for Research in Human Development, Concordia University, Montreal, QC, Canada
| | - Geoffrey Dougherty
- Department of Pediatrics, Faculty of Medicine and Health Sciences, McGill University, Montreal, QC, Canada.,Child Health and Human Development, Research Institute of the MUHC, Montreal, QC, Canada.,Department of Epidemiology and Biostatistics, Faculty of Medicine and Health Sciences, McGill University, Montreal, QC, Canada
| | - Hailey Fudge
- School of Nursing, Faculty of Health, Dalhousie University, Halifax, NS, Canada
| | - Marsha Campbell-Yeo
- School of Nursing, Faculty of Health, Dalhousie University, Halifax, NS, Canada.,Department of Nursing and Department of Pediatrics, IWK Health, Halifax, NS, Canada
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Bolduc ME, Dionne E, Gagnon I, Rennick JE, Majnemer A, Brossard-Racine M. Motor Impairment in Children With Congenital Heart Defects: A Systematic Review. Pediatrics 2020; 146:peds.2020-0083. [PMID: 33208496 DOI: 10.1542/peds.2020-0083] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/23/2020] [Indexed: 11/24/2022] Open
Abstract
CONTEXT With improvements in survival rates in newborns with congenital heart defects (CHDs), focus has now shifted toward enhancing neurodevelopmental outcomes across their life span. OBJECTIVE To systematically review the prevalence and extent of motor difficulties in infants, children, and adolescents with CHD requiring open-heart surgery. DATA SOURCES Data sources included Embase, Medline and the Cumulative Index to Nursing and Allied Health Literature. STUDY SELECTION Original studies published between 1997 and 2019 examining gross and/or fine motor skills in children born with a CHD requiring open-heart surgery were selected. DATA EXTRACTION The prevalence of motor impairments and mean scores on standardized motor assessments were extracted. Findings were grouped in 5 categories on the basis of the age of the children. RESULTS Forty-six original studies were included in this systematic review. The prevalence of mild to severe motor impairments (scores <-1 SD below normative data or controls) across childhood ranged from 12.3% to 68.6%, and prevalence ranged from 0% to 60.0% for severe motor impairments (<-2 SDs). Although our results suggest that the overall prevalence of motor impairments <-1 SD remains rather constant across childhood and adolescence, severe motor impairments (<-2 SDs) appear to be more prevalent in younger children. LIMITATIONS Variability in sampling and methodology between the reviewed studies is the most important limitation of this review. CONCLUSIONS The results of this review highlight that infants with CHD have an increased risk of motor impairments across infancy, childhood, and adolescence. These findings stress the importance of systematic screening or evaluation of motor skills across childhood and adolescence in children with CHD.
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Affiliation(s)
- Marie-Eve Bolduc
- School of Physical and Occupational Therapy.,Advances in Brain and Child Development Research Laboratory, The Research Institute of the McGill University Health Centre, Montreal, Canada; and
| | - Eliane Dionne
- School of Physical and Occupational Therapy.,Advances in Brain and Child Development Research Laboratory, The Research Institute of the McGill University Health Centre, Montreal, Canada; and
| | | | - Janet E Rennick
- Ingram School of Nursing, and.,Departments of Pediatrics and.,Department of Nursing, Montreal Children's Hospital, McGill University Health Centre, Montreal, Canada
| | - Annette Majnemer
- School of Physical and Occupational Therapy.,Departments of Pediatrics and.,Neurology and Neurosurgery, McGill University, Montreal, Canada
| | - Marie Brossard-Racine
- School of Physical and Occupational Therapy, .,Departments of Pediatrics and.,Neurology and Neurosurgery, McGill University, Montreal, Canada.,Advances in Brain and Child Development Research Laboratory, The Research Institute of the McGill University Health Centre, Montreal, Canada; and
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Manning JC, Latour JM, Curley MAQ, Draper ES, Jilani T, Quinlan PR, Watson RS, Rennick JE, Colville G, Pinto N, Latif A, Popejoy E, Coad J. Study protocol for a multicentre longitudinal mixed methods study to explore the Outcomes of ChildrEn and fAmilies in the first year after paediatric Intensive Care: the OCEANIC study. BMJ Open 2020; 10:e038974. [PMID: 32423943 PMCID: PMC7239532 DOI: 10.1136/bmjopen-2020-038974] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Revised: 04/16/2020] [Accepted: 04/21/2020] [Indexed: 01/18/2023] Open
Abstract
INTRODUCTION Annually in the UK, 20 000 children become very ill or injured and need specialist care within a paediatric intensive care unit (PICU). Most children survive. However, some children and their families may experience problems after they have left the PICU including physical, functional and/or emotional problems. It is unknown which children and families experience such problems, when these occur or what causes them. The aim of this mixed-method longitudinal cohort study is to understand the physical, functional, emotional and social impact of children surviving PICU (aged: 1 month-17 years), their parents and siblings, during the first year after a PICU admission. METHODS AND ANALYSIS A quantitative study involving 300 child survivors of PICU; 300 parents; and 150-300 siblings will collect data (using self-completion questionnaires) at baseline, PICU discharge, 1, 3, 6 and 12 months post-PICU discharge. Questionnaires will comprise validated and reliable instruments. Demographic data, PICU admission and treatment data, health-related quality of life, functional status, strengths and difficulties behaviour and post-traumatic stress symptoms will be collected from the child. Parent and sibling data will be collected on the impact of paediatric health conditions on the family's functioning capabilities, levels of anxiety and social impact of the child's PICU admission. Data will be analysed using descriptive and inferential statistics. Concurrently, an embedded qualitative study involving semistructured interviews with 24 enrolled families at 3 months and 9 months post-PICU discharge will be undertaken. Framework analysis will be used to analyse the qualitative data. ETHICS AND DISSEMINATION The study has received ethical approval from the National Health Services Research Ethics Committee (Ref: 19/WM/0290) and full governance clearance. This will be the first UK study to comprehensively investigate physical, functional, emotional and social consequences of PICU survival in the first-year postdischarge.Clinical Trials Registration Number: ISRCTN28072812 [Pre-results].
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Affiliation(s)
- Joseph C Manning
- Children and Young People Health Research, School of Health Sciences, University of Nottingham, Nottingham, Nottinghamshire, UK
- Nottingham Children's Hospital, Nottingham University Hospitals NHS Trust, Nottingham, Nottinghamshire, UK
- Health Data Research UK, University of Nottingham, Nottingham, Nottinghamshire, UK
| | - Jos M Latour
- School of Nursing and Midwifery, University of Plymouth, Plymouth, UK
- Nursing Department, Hunan Children's Hospital, Changsha, Hunan, China
| | - Martha A Q Curley
- Department of Family and Community Health, School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Anesthesia and Critical Care Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- The Research Institute, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Elizabeth S Draper
- Department of Health Sciences, University of Leicester, Leicester, Leicestershire, UK
| | - Tahseen Jilani
- Health Data Research UK, University of Nottingham, Nottingham, Nottinghamshire, UK
- Advanced Data Analysis Centre, University of Nottingham, Nottingham, Nottinghamshire, UK
| | - Philip R Quinlan
- Health Data Research UK, University of Nottingham, Nottingham, Nottinghamshire, UK
- Advanced Data Analysis Centre, University of Nottingham, Nottingham, Nottinghamshire, UK
| | - R Scott Watson
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, University of Washington, Seattle, Washington, USA
- Centre for Child Health, Behaviour, and Development, Seattle Children's Research Institute, Seattle, Washington, USA
| | - Janet E Rennick
- Ingram School of Nursing, McGill University Faculty of Medicine, Montreal, Quebec, Canada
- Centre for Outcomes Research & Evaluation, Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada
| | - Gillian Colville
- Paediatric Psychology Service, St Georges University Hospitals NHS Foundation Trust, London, UK
- Population Health Research Institute, University of London St George's, London, UK
| | - Neethi Pinto
- Section of Pediatric Critical Care, Department of Pediatrics, University of Chicago, Chicago, Illinois, USA
| | - Asam Latif
- School of Health Sciences, University of Nottingham, Nottingham, Nottinghamshire, UK
| | - Emma Popejoy
- Children and Young People Health Research, School of Health Sciences, University of Nottingham, Nottingham, Nottinghamshire, UK
- Nottingham Children's Hospital, Nottingham University Hospitals NHS Trust, Nottingham, Nottinghamshire, UK
| | - Jane Coad
- Children and Young People Health Research, School of Health Sciences, University of Nottingham, Nottingham, Nottinghamshire, UK
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Khan S, Mancini J, Hopper C, Rennick JE. Perceptions of Methotrexate Intolerance and Its Impact on Daily Life in School-Age Children with Juvenile Idiopathic Arthritis. J Pediatr Nurs 2019; 48:49-54. [PMID: 31254860 DOI: 10.1016/j.pedn.2019.06.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Revised: 06/05/2019] [Accepted: 06/06/2019] [Indexed: 11/16/2022]
Abstract
PURPOSE Methotrexate (MTX) is a disease modifying anti-rheumatic drug commonly used to treat children with Juvenile Idiopathic Arthritis (JIA). Unfortunately, half of children taking MTX will experience MTX intolerance, which includes distressing gastrointestinal and behavioural symptoms associated with weekly MTX treatment. This qualitative study aimed to explore the perceptions of school-age children with JIA experiencing MTX intolerance, how they managed MTX intolerance, and how it impacted their daily life. DESIGN AND METHODS An interpretive descriptive design was used. Twelve children participated in one individual 30-minute semi-structured interview using a storyboard technique to elicit their perceptions through storytelling. Interview transcripts and observational data collected during the interviews were analyzed using inductive content analysis. RESULTS Children described MTX intolerance as extremely challenging. Three themes emerged from the data: (1) "No kid likes taking MTX". This theme was comprised of two subthemes related to: (a) associative MTX intolerance; namely, "Talking about it sometimes makes me feel sick"; and (b) anticipatory MTX intolerance, "Before [I take it], I have a little stomach ache". Other themes included: (2) The importance of strategies and routines; and (3) Working hard to live with MTX intolerance. CONCLUSIONS This study sheds new light on MTX intolerance as perceived by school-aged children with JIA. Results highlight the importance of providing families and healthcare professionals with the necessary information for early recognition of MTX intolerance and optimizing care through the development of early intervention strategies. PRACTICE IMPLICATIONS Study findings highlight the importance of prioritizing early identification and prevention of MTX intolerance.
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Affiliation(s)
- Sarah Khan
- Ingram School of Nursing, Faculty of Medicine, McGill University, Montreal, Quebec, Canada; The Montreal Children's Hospital, McGill University Health Centre, Montreal, Quebec, Canada.
| | - Jacqueline Mancini
- Ingram School of Nursing, Faculty of Medicine, McGill University, Montreal, Quebec, Canada.
| | - Charlene Hopper
- The Montreal Children's Hospital, McGill University Health Centre, Montreal, Quebec, Canada.
| | - Janet E Rennick
- Ingram School of Nursing, Faculty of Medicine, McGill University, Montreal, Quebec, Canada; The Montreal Children's Hospital, McGill University Health Centre, Montreal, Quebec, Canada; Centre for Outcomes Research & Evaluation, Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada.
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11
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Rennick JE, St-Sauveur I, Knox AM, Ruddy M. Exploring the experiences of parent caregivers of children with chronic medical complexity during pediatric intensive care unit hospitalization: an interpretive descriptive study. BMC Pediatr 2019; 19:272. [PMID: 31387555 PMCID: PMC6683527 DOI: 10.1186/s12887-019-1634-0] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [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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12
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De Almeida Vicente A, Shadvar S, Lepage S, Rennick JE. Experienced pediatric nurses' perceptions of work-related stressors on general medical and surgical units: A qualitative study. Int J Nurs Stud 2016; 60:216-24. [PMID: 27297382 DOI: 10.1016/j.ijnurstu.2016.05.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2015] [Revised: 05/02/2016] [Accepted: 05/06/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND Experienced pediatric nurses caring for increasingly sick and vulnerable children on medical and surgical units may be at particular risk for work-related stress. In view of their positive impact on quality of care, and the fact that they are particularly difficult to retain, it is imperative to understand the work-related stressors these nurses encounter in order to develop effective organizational interventions to minimize stressors and promote retention. OBJECTIVE To explore experienced pediatric nurses' perceptions of work-related stressors in medical and surgical units. DESIGN Qualitative descriptive design with semi-structured interviews. SETTING Medical and surgical units at a quaternary care pediatric hospital in Montreal, Canada. PARTICIPANTS Nurses recognized as experienced by the nursing leadership team as reflected by having been 'in charge' of the unit, or having trained junior staff, and who had been practicing full-time for three years or more on a general medical or surgical pediatric unit were eligible to participate. Purposive sampling was used, and nurses recruited until data saturation was reached (n=12). There were no refusals to participate. METHODS Semi-structured interviews were conducted between August and December 2013. RESULTS Nurses described a strong sense of responsibility for providing excellent patient care, and identified stressor that negatively impacted their ability to do so. Stressors are reflected in three themes: (1) "The kids are getting sicker and sicker": Difficulty ensuring excellent patient care to an increasingly vulnerable population, (2) Feeling powerless to provide quality care, and (3) Being a "Jack-of-all-trades": Struggling with competing demands. CONCLUSION Experienced pediatric nurses felt powerless to provide quality care to an increasingly acute and vulnerable population. Dealing with multiple and diverse responsibilities, and limited resources and support, were important stressors. Nurse Managers and educators could mitigate stressors and improve retention of experienced pediatric nurses by offering targeted continuing education to those newly responsible for additional roles, and building supportive working environments that encourage collaboration and empower experienced nurses.
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Affiliation(s)
- Alexandra De Almeida Vicente
- The Montreal Children's Hospital, McGill University Health Centre, 1001 boul. Decarie, Montréal, Québec, Canada H3A 3J1.
| | - Sanaz Shadvar
- The Montreal Children's Hospital, McGill University Health Centre, 1001 boul. Decarie, Montréal, Québec, Canada H3A 3J1.
| | - Stephanie Lepage
- Department of Nursing, The Montreal Children's Hospital, McGill University Health Centre, 1001 boul. Decarie, Montréal, Québec, Canada H3A 3J1.
| | - Janet E Rennick
- Department of Nursing and Department of Pediatrics, Division of Critical Care, The Montreal Children's Hospital, McGill University Health Centre, 1001 boul. Decarie, Room BS1.2566, Montréal, Québec, Canada H3A 3J1; Ingram School of Nursing and Department of Pediatrics, Faculty of Medicine, McGill University, Wilson Hall, 3506 University Street, Montreal, Québec, Canada H3A 2A7.
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13
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Obas KA, Leal JM, Zegray M, Rennick JE. Parental perceptions of transition from intensive care following a child's cardiac surgery. Nurs Crit Care 2015; 21:e1-9. [DOI: 10.1111/nicc.12202] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2015] [Revised: 05/28/2015] [Accepted: 07/03/2015] [Indexed: 11/30/2022]
Affiliation(s)
- Katrina A. Obas
- Department of Nursing, Royal Victoria Hospital; McGill University Health Centre; Montreal Canada
| | - Jessica M. Leal
- Department of Nursing, Montreal Children's Hospital; McGill University Health Centre; Montreal Canada
| | - Michele Zegray
- Department of Nursing, Montreal Children's Hospital; McGill University Health Centre; Montreal Canada
| | - Janet E. Rennick
- Department of Nursing, Montreal Children's Hospital; McGill University Health Centre; Montreal Canada
- Ingram School of Nursing and Department of Pediatrics, Faculty of Medicine; McGill University; Montreal Canada
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14
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Affiliation(s)
- Janet E Rennick
- Department of Nursing, The Montreal Children's Hospital, McGill University Health Centre, and Ingram School of Nursing and Department of Pediatrics, Faculty of Medicine, McGill University, Montreal, Quebec, Canada; and
| | - Janet E Childerhose
- Center for Bioethics and Social Sciences in Medicine, University of Michigan, Ann Arbor, Michigan
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Rennick JE, Dougherty G, Chambers C, Stremler R, Childerhose JE, Stack DM, Harrison D, Campbell-Yeo M, Dryden-Palmer K, Zhang X, Hutchison J. Children's psychological and behavioral responses following pediatric intensive care unit hospitalization: the caring intensively study. BMC Pediatr 2014; 14:276. [PMID: 25344699 PMCID: PMC4286947 DOI: 10.1186/1471-2431-14-276] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2014] [Accepted: 10/10/2014] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Pediatric intensive care unit (PICU) hospitalization places children at increased risk of persistent psychological and behavioral difficulties following discharge. Despite tremendous advances in medical technology and treatment regimes, approximately 25% of children demonstrate negative psychological and behavioral outcomes within the first year post-discharge. It is imperative that a broader array of risk factors and outcome indicators be explored in examining long-term psychological morbidity to identify areas for future health promotion and clinical intervention. This study aims to examine psychological and behavioral responses in children aged 3 to 12 years over a three year period following PICU hospitalization, and compare them to children who have undergone ear, nose and/or throat (ENT) day surgery. METHODS/DESIGN This mixed-methods prospective cohort study will enrol 220 children aged 3 to 12 years during PICU hospitalization (study group, n = 110) and ENT day surgery hospitalization (comparison group, n = 110). Participants will be recruited from 3 Canadian pediatric hospitals, and followed for 3 years with data collection points at 6 weeks, 6 months, 1 year, 2 years and 3 years post-discharge. Psychological and behavioral characteristics of the child, and parent anxiety and parenting stress, will be assessed prior to hospital discharge, and again at each of the 5 subsequent time points, using standardized measures. Psychological and behavioral response scores for both groups will be compared at each follow-up time point. Multivariate regression analysis will be used to adjust for demographic and clinical variables at baseline. To explore baseline factors predictive of poor psychological and behavioral scores at 3 years among PICU patients, correlation analysis and multivariate linear regression will be used. A subgroup of 40 parents of study group children will be interviewed at years 1 and 3 post-discharge to explore their perceptions of the impact of PICU hospitalization on their children and enhance our understanding of findings generated from standardized measures in the larger cohort study. An interpretive descriptive approach will guide qualitative data collection and analysis. DISCUSSION This study aims to generate new information regarding the magnitude and duration of psychological and behavioral disturbances among children admitted to PICUs, potentially leading to remedial or preventive interventions.
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Affiliation(s)
- Janet E Rennick
- The Montreal Children's Hospital, McGill University Health Centre, 2300 Tupper Street, Montreal, Quebec, Canada.
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16
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Johnston CC, Rennick JE, Filion F, Campbell-Yeo M, Goulet C, Bell L, Tucci M, Ranger M. Maternal touch and talk for invasive procedures in infants and toddlers in the pediatric intensive care unit. J Pediatr Nurs 2012; 27:144-53. [PMID: 22341193 DOI: 10.1016/j.pedn.2010.12.016] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2010] [Revised: 12/21/2010] [Accepted: 12/22/2010] [Indexed: 11/24/2022]
Abstract
The aim of this single-blind, randomized, crossover trial was to test the effect of Touch & Talk (T&T) for infants and toddlers less than 36 months of age (N = 65) in the pediatric intensive care unit on their physiological stability and recovery to an invasive procedure. In the T&T condition, mothers touched, sang, or told stories or rhymes to their child during an invasive procedure. In the control condition, the mothers did not have contact with their child. Physiological measures included heart rate, heart rate variability, and oxygen saturation range during the procedure and change from baseline. Time from the end of the procedure until the heart rate returned to baseline levels gave the recovery time. Analysis was conducted using repeated-measures analysis of covariance. There were no significant differences on any of the physiological parameters by condition during the procedure. However, when controlling for severity of illness, recovery was faster with mothers.
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Herbert RJ, Gagnon AJ, O'Loughlin JL, Rennick JE. Testing an empowerment intervention to help parents make homes smoke-free: a randomized controlled trial. J Community Health 2011; 36:650-7. [PMID: 21234793 DOI: 10.1007/s10900-011-9356-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The objective of this randomized controlled trial was to test if parents' participation in an intervention based on an empowerment ideology and participatory experiences decreased the number of cigarettes smoked in homes. Sixty families were randomized to the intervention (n = 30) or control (n = 30) group. The intervention included three weekly group sessions followed by three weekly follow-up telephone calls over six consecutive weeks. During group sessions, parents shared experiences about environmental tobacco smoke, identified personal strengths and resources, and developed action plans. Data were collected in interviewer-administered questionnaires at baseline and 6 months follow-up. Ninety-three percent of the sample consisted of mothers, 77% of whom smoked during pregnancy. Forty-two percent of the total sample reported a household income of <$15,000. The median number of cigarettes smoked in the home daily decreased from 18 to 4 in the total sample however no statistically significant difference was detected between groups at 6 months follow-up. Participation in the study, independent of group, may have resulted in parents decreasing the number of cigarettes smoked in the home. Valuable lessons were learned about recruiting and working with this group of parents, all of whom faced the challenges of tobacco and almost half of whom lived in poverty.
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Affiliation(s)
- Rosemary J Herbert
- School of Nursing, University of Prince Edward Island, Charlottetown, PE C1A4P3, Canada.
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18
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MacDonald JAM, Gagnon AJ, Mitchell C, Di Meglio G, Rennick JE, Cox J. Include them and they will tell you: learnings from a participatory process with youth. Qual Health Res 2011; 21:1127-1135. [PMID: 21508252 DOI: 10.1177/1049732311405799] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Encouraging youth voice, visibility, and active participation in adolescent-related research is strongly advocated in the literature. In this article, we describe how participatory approaches informed by arts-based methods (e.g., reflective writing, dramatization) were used with adolescents to enhance the research process in an exploratory study designed to develop and evaluate prevention resources for sexual risk-taking behaviors.Youth aged 15 to 17 years participated in iterative focus groups conducted over a 1-year period in school settings in Prince Edward Island, Canada. Descriptions of our experiences, strategies, and insights provide evidence for guiding practice to optimize adolescent participation in research.
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Affiliation(s)
- Jo-Ann M MacDonald
- University of Prince Edward Island, Charlottetown, Prince Edward Island, Canada.
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Ames KE, Rennick JE, Baillargeon S. A qualitative interpretive study exploring parents’ perception of the parental role in the paediatric intensive care unit. Intensive Crit Care Nurs 2011; 27:143-50. [DOI: 10.1016/j.iccn.2011.03.004] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2010] [Revised: 03/10/2011] [Accepted: 03/15/2011] [Indexed: 10/18/2022]
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Rennick JE, Lambert S, Childerhose J, Campbell-Yeo M, Filion F, Johnston CC. Mothers' experiences of a Touch and Talk nursing intervention to optimise pain management in the PICU: a qualitative descriptive study. Intensive Crit Care Nurs 2011; 27:151-7. [PMID: 21511475 DOI: 10.1016/j.iccn.2011.03.005] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2010] [Revised: 02/23/2011] [Accepted: 03/15/2011] [Indexed: 10/18/2022]
Abstract
BACKGROUND Parents consistently express a desire to support their child and retain a care-giving role in the paediatric intensive care unit (PICU). Qualitative data gathered as part of a PICU intervention study were analysed to explore mothers' experiences using a Touch and Talk intervention to comfort their children during invasive procedures. OBJECTIVES To describe how mothers experienced involvement in their children's care through a Touch and Talk intervention and whether they would participate in a similar intervention again. RESEARCH METHODOLOGY AND SETTING: A qualitative descriptive design was used and semi-structured interviews conducted with 65 mothers in three Canadian PICUs. Data were subjected to thematic analysis. RESULTS The overarching theme centred on the importance of comforting the critically ill child. This included being there for the child (the importance of parental presence); making a difference in the child's pain experience; and feeling comfortable and confident about participating in care. All but two mothers would participate in the intervention again and all would recommend it to others. CONCLUSIONS Giving parents the choice of being involved in their child's care using touch and distraction techniques during painful procedures can provide an invaluable opportunity to foster parenting and support the child during a difficult PICU experience.
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Affiliation(s)
- Janet E Rennick
- Department of Nursing, The Montreal Children's Hospital, McGill University Health Centre, Canada.
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21
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Herbert RJ, Gagnon AJ, Rennick JE, O'Loughlin JL. 'Do it for the kids': barriers and facilitators to smoke-free homes and vehicles. Pediatr Nurs 2011; 37:23-29. [PMID: 21485618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Despite abundant evidence about the adverse effects of secondhand smoke exposure on children's health, few reports describe barriers and facilitators encountered by parents in making their homes and vehicles smoke-free. This article describes perceptions of barriers and facilitators to making homes and vehicles smoke-free among 36 parents with a child five years of age or younger. Qualitative data were collected in interviews with parents in the context of a randomized controlled trial that tested an intervention to empower parents to make their homes and vehicles smoke-free. Themes that emerged in the analysis were congruent with an ecological conceptualization of health. The greatest barriers were intrapersonal factors, and nicotine addiction was the intrapersonal barrier identified most frequently. The most frequently reported facilitators were intrapersonal factors, such as quitting smoking. Parents reported not seeking advice from health care providers. The transition process to make homes and vehicles smoke-free is complex and individualistic; nurses may need to tailor strategies to take the specific contexts of each individual into account.
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Affiliation(s)
- Rosemary J Herbert
- School of Nursing, University of Prince Edward Island, Charlottetown, Prince Edward Island, Canada
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Abstract
The objective of this systematic review was to identify questionnaires that measure health-related empowerment in adults or families and demonstrated the best evidence of reliability and validity. A search of nine data bases identified 8,269 abstracts that referred to empowerment. Full article review was completed for abstracts that met the inclusion criteria or that could not be excluded with certainty (n = 124). Fifty distinct, modified, or translated questionnaires measuring empowerment were identified in 74 articles. Each was rated in terms of reliability and validity. One questionnaire had good evidence of reliability and validity, four had moderate evidence, and 45 had limited or no evidence. Limited or no evidence for reliability and validity for many questionnaires could relate in part to lack of consensus on the theoretical definition of, and indicators for measuring empowerment. We recommend that researchers use the questionnaire rated as having good evidence and that data on reliability and validity continue to be reported for other questionnaires.
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Affiliation(s)
- Rosemary J Herbert
- School of Nursing, University of Prince Edward Island, Charlottetown, Canada.
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Rennick JE, Rashotte J. Psychological outcomes in children following pediatric intensive care unit hospitalization: a systematic review of the research. J Child Health Care 2009; 13:128-49. [PMID: 19458168 DOI: 10.1177/1367493509102472] [Citation(s) in RCA: 101] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
A systematic review of published research on children's psychological outcomes following Pediatric Intensive Care Unit (PICU) hospitalization was conducted. Of the 275 papers published between 1970 and April 2008 which were identified using keywords, reference lists and one author's collections, a total of 28 papers met the inclusion criteria for this review. The papers fell into four categories based on the focus of the research: (1) children's PICU perceptions and recall; (2) children's psychological outcomes, broadly defined; (3) post-traumatic stress responses; and (4) general health status and quality of life. The findings suggest that PICU hospitalization can result in negative psychological sequelae in children, which can manifest themselves up to one year post-discharge. While a small number of studies have attempted to identify predictors of psychological outcome, this work remains in its infancy. The importance of the child's interpretation of the illness experience in influencing subsequent behavioral and emotional responses is highlighted.
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Affiliation(s)
- Janet E Rennick
- Montreal Children's Hospital, McGill University Health Centre; Assistant Professor, School of Nursing, McGill University, Montreal, Canada.
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Dell'Api M, Rennick JE, Rosmus C. Childhood chronic pain and health care professional interactions: shaping the chronic pain experiences of children. J Child Health Care 2007; 11:269-86. [PMID: 18039730 DOI: 10.1177/1367493507082756] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Children with chronic pain meet numerous healthcare professionals during their search to understand their pain. Through semi-structured interviews, this qualitative study sought to understand the experiences of five children with chronic pain as they encountered healthcare professionals. In the majority of these interactions, children reported feeling misunderstood, disbelieved and abandoned. The findings of this study demonstrate that children's experiences with professionals influence their approach towards current and future healthcare encounters. All children discussed their guarded relationships with healthcare providers. Children also developed negative perceptions about their pain, in particular believing that their experience with chronic pain was life-threatening, and demanded major life adjustments. Interactions with healthcare professionals have a tremendous influence on children's perceptions and chronic pain experiences. In order to better understand and care for children with chronic pain, it is essential that healthcare professionals provide children with the opporunity to communicate their unique experiences with pain.
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Affiliation(s)
- Melissa Dell'Api
- Dartmouth Hitchcock Medical Center, Intensive Care Nursery, Lebanon, NH 03756-0001, USA.
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Abstract
A quasi-experimental, pretest/posttest study was conducted to explore nurses' perceptions of the impact of the 15-minute family interview on the pediatric hospital admission process. The intervention consisted of two in-depth teaching sessions, and hands-on coaching in the use of the 15-minute family interview. Each of the 6 nurses was interviewed twice using a semi-structured questionnaire: once before receiving the intervention and once after they had completed 6 family interviews. In addition, nurses kept field notes on their impressions of the family interviewing process. A thematic analysis of the data was conducted. Findings revealed that the nurses perceived the genogram, therapeutic questions, and commendations as having a positive impact on their ability to conduct family assessment and family interventions. Overall, nurses felt that the 15-minute family interview should be routinely incorporated into practice at the time of a child's admission.
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Abstract
There are few studies that focus on children's subjective responses to home ventilation and how this in turn affects their daily lives. This multiple case study explored the experience of home ventilation from the children's perspective. Data were collected from five children through observation and audiotaped interviews. Children expressed their physical and emotional relationship with the ventilator, stating: 'It's okay. It helps me to breathe' - a theme that had a number of distinct dimensions. Other themes included the medicalization of childhood, being a child and hopes for the future. Unlike other study findings to date, the children in this study concluded that the technology was only one small part of their lives. Nurses must ensure that these children have an opportunity to communicate their perspectives, in order to provide care that is clinically effective and child-centered.
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Affiliation(s)
- Rebecca J Earle
- Pediatric Medicine, IWK Health Centre, Halifax, Nova Scotia, Canada.
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Macdonald ME, Liben S, Carnevale FA, Rennick JE, Wolf SL, Meloche D, Cohen SR. Parental perspectives on hospital staff members' acts of kindness and commemoration after a child's death. Pediatrics 2005; 116:884-90. [PMID: 16199697 DOI: 10.1542/peds.2004-1980] [Citation(s) in RCA: 100] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES Acts of kindness and commemoration by staff members often follow the death of a patient. Acts include attending funerals, sending sympathy cards, sending cards on birthdays/anniversaries, telephoning/visiting family homes, and attending memorial services. This study explores the significance of these acts for bereaved parents. METHODS Twelve parents whose children died in the ICU of a tertiary care pediatric hospital were interviewed, to explore their experiences of the death. Investigators reviewed transcripts and observational field notes. Multidisciplinary team triangulation was used to corroborate themes, with cross-case analysis. RESULTS Three themes emerged regarding parental experiences of staff members' acts, ie, (1) parents placed great importance on the hospital's memorial service and on staff members' presence at the service; (2) parents found it difficult to return to the hospital after the child's death but all attended the memorial service, finding some closure in the return; and (3) parents appreciated receiving cards and greatly valued staff members' efforts to telephone/visit and to attend the funeral. Months later, parents remembered positively which staff members engaged in which activities. Conversely, parents expressed disappointment when staff members did not engage in these activities and/or were absent from memorial/funeral services. CONCLUSIONS Efforts to support families and to commemorate deceased children are appreciated by bereaved parents. Staff members' absences at commemorative events and a lack of supportive acts are noticed and regretted by families. Staff members and program administrators should attempt to arrange workloads to ensure meaningful contact between staff members and parents during the bereavement period.
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Affiliation(s)
- Mary Ellen Macdonald
- Pediatric Palliative Care Program, Montreal Children's Hospital, McGill University Health Centre, Montreal, Quebec, Canada.
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Chin-Peuckert L, Rennick JE, Jednak R, Capolicchio JP, Salle JLP. SHOULD WARM INFUSION SOLUTION BE USED FOR URODYNAMIC STUDIES IN CHILDREN? A PROSPECTIVE RANDOMIZED STUDY. J Urol 2004; 172:1657-61; discussion 1661. [PMID: 15371784 DOI: 10.1097/01.ju.0000138520.95101.02] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
PURPOSE We hypothesized that warm infusion solution should be used for urodynamic studies in children because it more closely simulates normal physiology. Thus, we conducted a prospective randomized study comparing consecutive room temperature (RT) and body temperature (BT) cystometrograms (CMG) in the same child. MATERIALS AND METHODS Subjects underwent identical CMGs using RT and BT saline in random order. Maximum cystometric bladder capacity (CBC), pressure at CBC, uninhibited detrusor contractions, detrusor leak point pressure, maximum flow rate, pressure at maximum flow, maximum voiding pressure, residual urine and pressure specific volumes below 20 and 30 cm water were compared. Data were analyzed using ANOVA, t test, and chi-square. RESULTS RT and BT CMGs in 44 males and 47 females with a mean age of 8.6 years were compared. Of the children 58 (64%) had spinal dysraphism, 8 (9%) had cerebral palsy, 5 (6%) had posterior urethral valves and 20 (21%) had recurrent urinary tract infection, daytime incontinence or frequency/urgency symptoms. Maximum CBC, pressure at CBC, and pressure specific volumes below 20 and 30 cm water were significantly lower (10% to 15%) during BT cystometry. Maximum flow rate was higher with BT saline. Detrusor leak point pressure, pressure at maximum flow, maximum voiding pressure, and residual urine did not differ. Uninhibited detrusor contractions were more frequent during RT infusions. No gender differences were found. The discrepancies between RT and BT cystometry were most prominent in infants, children with spinal dysraphism and children with large bladders. CONCLUSIONS There is a difference between cystometries performed using RT and BT saline. Capacity, storage variables and detrusor activity are diminished during BT cystometry. Although statistically significant differences were found between consecutive RT and BT CMGs, the magnitude of the difference may not be clinically relevant to change management. As such, we do not believe it is necessary to use warm infusion solution on a systematic basis for urodynamic studies in children. However, for children younger than 2 years when the magnitude was more relevant, the use of warm solution is recommended.
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Affiliation(s)
- Lily Chin-Peuckert
- Division of Pediatric Urology, The Montreal Children's Hospital/McGill University Health Center, Montreal, Canada.
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Rennick JE, Morin I, Kim D, Johnston CC, Dougherty G, Platt R. Identifying children at high risk for psychological sequelae after pediatric intensive care unit hospitalization. Pediatr Crit Care Med 2004; 5:358-63. [PMID: 15215006 DOI: 10.1097/01.pcc.0000128603.20501.0d] [Citation(s) in RCA: 71] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVE To identify those patients in a pediatric intensive care unit who may be at highest risk for developing persistent psychological sequelae after hospital discharge. DESIGN A secondary data analysis was conducted to examine data gathered in an earlier study of children's psychological responses after critical illness. The current study focused exclusively on patients who required pediatric intensive care unit hospitalization. PATIENTS Sixty children, aged 6 to 17 yrs, hospitalized in two Canadian pediatric intensive care units. PROCEDURES Children were categorized as either high risk or low risk for developing persistent psychological sequelae after discharge based on their level of illness severity and the number of invasive procedures to which they were exposed. Outcome data were analyzed using descriptive statistics, followed by an assessment of group differences at baseline, 6 wks, and 6 mos postdischarge. Combined effects of invasive procedures and illness severity on the outcome variables were explored. OUTCOME MEASURES Three questionnaires were completed by all children 6 wks and 6 mos postdischarge, including the Children's Impact of Events Scale, the Children's Medical Fears Scale, and the Children's Health Locus of Control Scale. RESULTS Children in the high risk group demonstrated more psychological sequelae 6 wks and 6 mos postdischarge. Exposure to high numbers of invasive procedures was the most important predictor of group differences 6 wks postdischarge. CONCLUSIONS Findings suggest there is a group of children in the pediatric intensive care unit who are at higher risk for developing persistent psychological sequelae postdischarge. Exposure to high numbers of invasive procedures may be the driving force behind group differences, particularly at 6 wks postdischarge. These children warrant closer observation and follow-up.
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Affiliation(s)
- Janet E Rennick
- Department of Nursing Research and the Intensive Ambulatory Care Service, Montreal Children's Hospital of the McGill University Health Centre, Montreal, Quebec, Canada.
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Abstract
PURPOSE We compared the results of 2 cystometrograms (CMGs) performed during a single session in the same child to determine the variability between consecutive cystometries. MATERIALS AND METHODS Subjects underwent 2 consecutive bladder fillings performed at the same rate and position. Maximum cystometric bladder capacity (CBC), pressure at CBC, leak point pressure, maximum flow rate, pressure at maximum flow, maximum voiding pressure, residual urine and pressure specific volumes (PSV) less than 20, 30 and 40 cm water were compared between studies. Uninhibited detrusor contractions (UICs), defined by the previous and new International Children's Continence Society definitions of UIC, were also compared. Data were analyzed using paired t test, chi-square and interclass correlation. RESULTS CMGs in 32 male and 34 female children were available for analysis. Mean subject age was 7.4 years (range 1 month to 18 years). Of the children 43 (65%) had spinal dysraphism, 4 (6%) had cerebral palsy, 5 (8%) had posterior urethral valves, and 14 (21%) had recurrent urinary tract infection, daytime incontinence and frequency/urgency symptoms. Maximum CBC, pressure at CBC, leak point pressure, maximum flow rate, pressure at maximum flow, maximum voiding pressure and residual urine did not differ between the 2 studies. PSVs less than 20, 30 and 40 cm water were highly correlated between the 2 CMGs (interclass correlation coefficients 0.795, 0.683 and 0.850, respectively). There were more UICs on the first than the second study (p = 0.02 and 0.03) as defined by the previous and new definitions of UIC. UIC threshold volume was less on the first CMG (p = 0.00 and 0.03). UICs were either present or absent on both studies in 56 of the 66 (85%) children by the previous UIC definition and in 51 (77%) by the new UIC definition. CONCLUSIONS There is no difference in CBC, PSV and pressure flow parameters when performing consecutive urodynamic studies in the same child. However, UICs are more frequent on the first study. We conclude that repeat cystometry is not indicated in the absence of UICs on the first study and suggest that the second consecutive CMG be used for clinical interpretation when repeat studies are performed in the same session.
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Affiliation(s)
- L Chin-Peuckert
- Department of Urology, Pediatric Urology Section, University of Texas Southwestern Medical Center and Children's Hospital Medical Center of Dallas, 75235, USA
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Alexander E, Rennick JE, Carnevale F, Davis M. Daily struggles: living with long-term childhood technology dependence. Can J Nurs Res 2002; 34:7-14. [PMID: 12619473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/01/2023] Open
Abstract
With advances in technology, children with chronic illnesses are surviving longer. This improved survival rate has resulted in a growing population of families caring for their children with complex needs at home. This grounded theory study explored how caring for a child who requires home ventilation affects family members. Families moved through a process of struggling daily as they cared for their child with complex needs. This ongoing struggle was characterized by three distinct dimensions: getting over the hump, starting to breathe, and having to deal with a subsequent event. Implications for practice and future directions for nursing research are discussed.
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Affiliation(s)
- Eren Alexander
- School of Nursing, McGill University, Montreal, Quebec, Canada
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Abstract
Children hospitalized in pediatric intensive care units (PICUs) are subjected to highly invasive interventions necessary in overcoming the critical period of their illness, yet little is known about their subsequent psychological adjustment. The purposes of this study were to compare the psychological responses of children hospitalized in a PICU with those of children hospitalized on a general ward and to identify clinically relevant factors that might be associated with psychological outcome. A prospective cohort design was used to follow 120 children for 6 months after PICU and ward discharge. Groups were compared on the children's sense of control over their health, their medical fears, posttraumatic stress, and changes in behavior. Relationships between children's responses and their age, the invasive procedures to which they were exposed, severity of illness, and length of hospital stay were also examined. No significant group differences were found. However, children who were younger, more severely ill, and who endured more invasive procedures had significantly more medical fears, a lower sense of control over their health, and ongoing posttraumatic stress responses for 6 months postdischarge. Findings indicate that regardless of the hospital setting, invasiveness coupled with length of stay and severity of illness in young children may have adverse long-term effects.
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Affiliation(s)
- Janet E Rennick
- Department of Nursing Research, The Montreal Children's Hospital, McGill University Health Centre, School of Nursing, McGill University, Montreal, Quebec, Canada
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Abstract
The profile of the acutely ill child and family has undergone dramatic changes in recent years. Advances in medical technology have substantially altered the life-death trajectory for ill children and their families; however, they have also left families to endure increasingly difficult situations with uncertain outcomes for prolonged periods of time. Nurses are interested in understanding how families manage in the face of serious illness, yet a review of the literature has revealed little progress in this area. While the importance of the family has been repeatedly documented, theoretical developments regarding family process during acute illness have been limited. This paper analyses those factors that have limited nursing knowledge development and, as a result, contributed to gaps in current thinking regarding the acutely ill child. They include: (a) a history of theoretical nursing models which, until recently, focused on the individual; (b) research that has focused on the individual parent or child while virtually ignoring family variables; (c) an outdated definition of acute illness which does not reflect the current population of hospitalized children; (d) limited use of theoretical frameworks borrowed from other disciplines; and (e) unresolved methodological issues related to the study of families in nursing.
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Affiliation(s)
- J E Rennick
- School of Nursing, McGill University, Montreal, Canada
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