Preparing parents for their child's transfer from the PICU to the pediatric floor.

The experimental study described here was conducted to examine a nursing intervention intended to diminish the anxiety level of parents of children being transferred from a pediatric intensive care unit (PICU) to a general pediatric floor. The convenience sample included 50 parents of patients in a PICU at a southeastern U.S. tertiary medical center. The sample was randomly assigned to control and experimental groups. All subjects' anxiety levels were measured using Spielberger's State-Trait Anxiety Inventory (STAI) 24 to 48 hours prior to the child's impending transfer. The experimental group subsequently was given a transfer-preparation letter along with a verbal explanation. Finally, both groups were retested using the STAI immediately prior to the child's transfer. After controlling for trait anxiety, the analysis of covariant results showed significantly lower anxiety levels among the subjects who received the transfer-preparation letter than among those who did not, F(1,47) = 18.65, p < .0005. The study concludes that effective transfer preparation can significantly reduce the anxiety experienced by parents who are facing the imminent transfer of their child out of the PICU.     

The most important needs of parents of critically ill children: parents' perceptions.

Research studies have identified the needs of relatives when they have had an adult family member in the intensive care unit. However little similar work has been done within the paediatric setting. Therefore the aim of this study was to examine what parents considered to be their most important needs, when they have a child ill in the intensive care environment (PICU). A questionnaire was designed, and was distributed to parents of 30 children admitted into a PICU. The questionnaire identified needs items which may be important to parents of sick children. The parents were required to indicate how important each need was to them during the time of the child's stay in the PICU. Results obtained indicate that parents have a strong need for information and relief of anxieties that they may have about their child's condition. A conclusion reached in this study is that if the critical care staff can go some way to assess and meet the needs of parents of critically ill children, then these parents may be more able to become effective partners in care, which may have therapeutic effects upon the child's health recovery.     

Effects of the nursing Mutual Participation Model of Care on parental stress in the pediatric intensive care unit--a replication.

The pediatric intensive care unit (PICU) hospitalization of a child is stressful for parents. Helping parents to decrease their stress is warranted so that they can function in a vital role that is therapeutic to them and their critically ill child. Although many interventions have been recommended to help parents decrease their stress, only the Nursing Mutual Participation Model of Care (NMPMC) has been tested in the clinical setting. This article reports a study that expands on Curley's original work by investigating the effects of the NMPMC on parental stress when implemented by PICU staff nurses. Fifty-six parents participated in the study, which used a quasi-experimental design. Sequential sampling placed the first 31 subjects into the control group and the next 25 subjects in the experimental group. The experimental group received care from staff nurses instructed in the NMPMC. The dependent measure was the Parental Stressor Scale:Pediatric Intensive Care Unit (PSS:PICU) administered within 24 to 48 hours of PICU admission, every 48 hours thereafter, and 24 hours after PICU discharge. The results indicated that parents in the experimental group perceived less stress than the control group, specifically the stress related to alterations in parental role in the PICU setting. Implications for nursing care are discussed.     

Efficient or family-centred? Practitioners' goals in decisions regarding parental presence during invasive procedures

Little is currently documented about how health care professionals determine when parental presence is appropriate during an invasive procedure. The research profiled in this article was a qualitative study of the decision-making by 10 nurses and five physicians in PICU regarding when and how to include parents as witnesses to invasive procedures. This article includes one aspect of the research findings: practitioners' goals in such decisions. Specifically, the authors will detail how practitioners' perspectives about the primacy of particular goals of the child's care influenced their decisions to encourage or discourage parents from remaining with their children during invasive procedures. It was found that participants' decisions whether or not to permit parents to remain during invasive procedures were primarily determined by what the practitioner held as the priority goal of his/her practice (i.e., efficiency or family-centred care). The authors conclude by identifying some clinical and research directives that arise from the research findings.     

Mommy first

Parents of children with special health care needs are often required to assume responsibility for the complex care of their children. It is important for pediatric nurses to remember these parents are, first and foremost, the child's parents and primarily responsible for loving their child, providing a safe and secure home, and fostering their child's development as a person. Pediatric nurses should support the parents in the medical/nursing care of their child in whatever way possible so the parents have more time to parent. This account from a mother of a child with developmental delay helps remind us of our need to help support parents in being "parents first."     

The child's advocate in donor conceptions: the telling of the story

Parents who use donor gametes should feel firm and entitled to say they are this child's parents. Health care providers (doctors, nurses, and social workers) must help these parents. Their decision to bring a child into the world creates continuous consequences for the whole family. The parents' responsibility is to attach, parent, and educate, and the child's responsibility is to ask questions to form an identity and find ways to feel secure about the individual he or she is becoming. Participating as the child's advocate presents many joys and celebrations, as well as many challenges. Pediatric nurses can help families resolve infertility issues and obtain education about donor conception. This advocacy provides the freedom for parents to be proud of their decision, attach to the process, and rejoice for the child who comes to their family. This is a true blessing for everyone.     

Parent involvement in children''s pain care: views of parents and nurses

AIM OF THE STUDY: This study investigated the views of parents and nurses about the involvement of parents in the management of their child's pain during the first 48 hours after surgery. BACKGROUND: Children's pain management has been found to be problematic and in need of improvement. Nurses are the key health care professionals with responsibility for managing children's pain. Parents can make important contributions to assessment and management of their child's pain. METHODS: Using a phenomenological approach, nurses and parents were interviewed about their perceptions of parent involvement in pain management. FINDINGS: The findings indicated that parental involvement in their child's pain management is superficial and limited in nature. Parents described a passive role in relation to their child's pain care and conveyed feelings of frustration. Only a minority of parents expressed satisfaction with their child's pain care. Nurses perceived that there was adequate involvement of parents and adequate pain management for children. CONCLUSIONS: These findings may be somewhat explained by differing views and a lack of effective communication between parents and nurses. There is a clear need for nurses to discuss parent involvement with parents and negotiate roles in relation to pain management.     

Supporting families of technology-dependent patients hospitalized in a pediatric intensive care unit

Having a child hospitalized in the PICU is a stressful event and may be even worse for parents when their child is technology dependent. These parents are often experts at knowing their child, are used to being strong caregivers and advocates for their child, and may experience long-term sorrow or grief over their child's lifespan. Although there is little research about effective PICU nursing interventions for this parent group, several suggestions can be inferred. Armed with this knowledge, the PICU nurse can be instrumental in helping these parents decrease their stress and improve coping skills not only for dealing with the child's PICU stay but also for improving their experiences at home.     

Parents' support and satisfaction with their child's postoperative care

It is recognized that parents' presence during their child's hospitalization is of benefit to the parents and the child. However, the level of parental involvement in their child's care may be influenced by many factors, such as the amount of support nurses provide for parents. This article reports on two themes from the findings of a larger study on parental involvement in children's postoperative pain management - parental support and parents' satisfaction with their child's postoperative pain management. The aim of the larger study was to explore both nurses' and parents' perceptions of parental involvement in their child's postoperative pain management. The methods used were both qualitative and quantitative. The qualitative method of phenomenology was used to guide 20 nurse and 20 parent interviews. Quantitative methods involved surveying the nurses and parents on their perceptions of how supportive the nurses were towards the parents. The charts of 20 children were reviewed for pain-related data. This article reports on the issues of parent support from the results of the survey, and on satisfaction relating to their child's postoperative pain management from the parent interviews. The findings demonstrated that nurses perceived that parents were receiving more support from them than that which parents felt they were receiving. Parents were more satisfied with their child's pain management and children received more analgesia when they were cared for by a lower grade nurse.     

Effectiveness of a tool to improve role negotiation and communication between parents and nurses

Family-centred care philosophies are promoted by policy makers and nurse leaders, although how this ideal is put in practice often remains unclear. Checklists or guidelines may be useful tools to assist nurses in determining a parent's desire for involvement in their child's care. AIM: To evaluate the effectiveness of a documentary tool designed to formalise role negotiation and improve communication between parents and nurses. METHODS: A quasi-experimental pre/post-intervention study design was used to determine nurses' perceptions of the effectiveness of a documentary tool in facilitating nurse-parent discussion about parental desire for involvement in the daily care activities of their child while in hospital. Nurses in randomly selected wards were assigned to usual practice (control group) or the implementation of a Negotiated Care Tool (intervention group) during a three-month period. RESULTS: Pre- and post-intervention surveys were completed by 69 nurses. The tool was associated with attitudinal changes in the desired direction for 12 of the 24 nurse responses: nurses in the intervention group were significantly more likely to include parents in decision making (p = 0.007); encourage parents to ask questions during their child's hospital stay (p = 0.005); and invite extended family members to participate in care with parental permission (p = 0.03). CONCLUSION: The Negotiated Care Tool raised staff awareness of the importance of effective communication and negotiation of care with parents in busy clinical practice areas. Transparent communication and negotiation of roles between nurses and parents are integral to family-centred care provision.     

A study of role negotiation between nurses and the parents of hospitalized children

The role of the parent of a hospitalized child has changed considerably over the past 30 years. Where parents were previously expected to had responsibility for care over to their child's nurses, there is now an expectation that parents will be extensively involved in the care of their hospitalized children. The negotiation of roles between nurses and parents has been advocated by workers concerned about conflicts between nurses and parents. However, it is not known whether such negotiation takes place between nurses and parents. It is clear that power is not evenly distributed between nurses and parents: issues of territory, stress, anxiety, uncertainty, control and conflicts arising from parental competence all place the parent in a weaker position. It is argued that the nurse holds the initiative in the decision about whether negotiation takes place. A small study is described in which nurses were invited to describes their response to their perception that a parent wanted to increase or decrease her or his involvement in her or his child's care. The critical incident technique (Flanagan 1954) was used to collect data. Nurses' responses were categorized into categories of 'encouragement', 'explanation/advice' and 'negotiation'. Responses were then placed in more specific subcategories. The inter-rater reliability of the categorization was measured. Owing to the limitations of the study, the results can only be regarded as suggestive. Nevertheless, significant association was found between the category of response and the grade of staff, with a stratified pattern of category of response demonstrated. The implications of the study for future research are discussed.     

Nurses' perceptions of parental involvement in hospital care

Parental involvement is an essential element of quality of care for children in hospital. However, there is often confusion in role perception between parents and nurses which may be affected by nurses' attitudes, their ability to provide information, their communication and interpersonal skills and willingness to relinquish control. AIM: This study examined nurses' perceptions of parental involvement and communication with parents of children in hospital and explored differences in perceptions of recent graduate nurses and more experienced nurses. METHOD: Two focus groups were carried out at a university paediatric hospital in Sweden, one with experienced paediatric nurses (n = 7) and one with recent nursing graduates (n = 6). FINDINGS: Analysis of the discussions identified five themes: clarifying roles, information, work environment, support and clinical competence. These nurses confirmed the belief that involving parents in the child's care is an important part of nursing in paediatric care and suggested that the nurses should play the role of being the communicator with the parents. CONCLUSION: Nurses need to be aware of the impact their communication has on parents and help them to clarify their role as parents in hospital.     

Hospitalized children with chronic illness: parental caregiving needs and valuing parental expertise

Parents who care for a child with a chronic illness are forced to relinquish much of the control of the child's care when the child is hospitalized. By using the family systems theory as the underlying framework, the amount of control that parents of children with chronic illness wanted over their hospitalized child's care, and the degree to which parents felt health care professionals valued their expertise, was examined in a national sample of 50 parent caregivers. Participation in information sharing and technical care were areas over which parents wanted the most control. Nurses and attending physicians were rated highest in valuing parental expertise. Content analysis of an open-ended question on parental control revealed that parents felt a higher quality care was given at home than in the hospital; nurses were too busy or understaffed to provide optimal care in the hospital; and the child's control of care and decision making should increase as the child grew older.     

Parent and teacher perceptions of the impact of school nurse interventions on children's self-management of diabetes

Diabetes is a common chronic illness among school-age children. The school nurse collaborates with the student, parents, and teachers to help the child manage their diabetes effectively. Very little is known about the relationship between school nurse interventions and parent/teacher perceptions of the child's self-management. We examined this relationship in a sample of 69 school-age children who received case management from school nurses. Our findings suggest that teachers and parents do not always agree on how well a child manages their illness. When school nurses provide more education and counseling, parents are more likely to perceive an improvement in their child's self-management. Teachers are more likely to perceive an improvement when the nurse provides more classroom visits and includes the physical education teacher and guidance counselor. These findings suggest that the roles of educator, counselor, and collaborator are important for school nurses who provide care to school-age children with diabetes.     

Nurses as moral practitioners encountering parents in neonatal intensive care units

Historically, the care of hospitalized children has evolved from being performed in isolation from parents to a situation where the parents and the child are regarded as a unit, and parents and nurses as equal partners in the child's care. Parents are totally dependent on professionals' knowledge and expertise, while nurses are dependent on the children's emotional connection with their parents in order to provide optimal care. Even when interdependency exists, nurses as professionals hold the power to decide whether and to what extent parents should be involved in their child's care. This article focuses on nurses' responsibility to act ethically and reflectively in a collaborative partnership with parents. To illuminate the issue of nurses as moral practitioners, we present an observation of contemporary child care, and discuss it from the perspective of the Danish moral philosopher KE L?gstrup and his book The ethical demand.     

Looking at childhood obesity through the lens of Baumrind's parenting typologies

Obesity is becoming the leading negative health outcome for the current generation of children to a greater degree than for any previous generation. Pediatric orthopaedic nurses encounter many patients and families with concerns about obesity and need the ability to promote parenting capacity in order to detect, prevent, or treat childhood obesity. Parenting is a complex process with numerous two-way interactions between the parent and child. Pediatric orthopaedic nurses affect parenting capacity daily as they care for families in all care settings. Many family researchers use Baumrind's parenting typologies (styles) and their correlations to child health outcomes in research. Understanding Baumrind's theories can help pediatric orthopaedic nurses understand the mechanisms parents use to affect the health outcomes related to the obesity of their children. Baumrind's is one parenting theory that can help demonstrate how parental behaviors and practices affect a child's self-concept and self-care development and ultimately a child's health promotion beliefs and practices related to obesity prevention and care that continue into adulthood. Nurses can use reviews of literature and application to practice of parenting styles to expand their repertoire of parent guidance and anticipatory teaching directed to the prevention and care of childhood obesity.     

Parents’ experiences during and after their child’s stay in the paediatric intensive care unit – A qualitative interview study

BackgroundHaving a child admitted to the paediatric intensive care unit (PICU) is often an emotional and stressful experience for parents.AimThe aim of the study was to explore parents’ experiences during and after their child’s hospitalization in the PICU and to investigate whether parents have a need for post-PICU follow-up.Material and methodsThe research design was a qualitative study inspired by Ricoeur’s phenomenological-hermeneutic approach. The context of the study was a six-bed PICU in a university hospital in Denmark. In 2017, semi-structured interviews were conducted with four couples and three mothers six to 14 weeks after their child had been discharged from the PICU. The data were analysed and interpreted through Ricoeur’s three analytical levels and presented in themes and subthemes.FindingsThree themes were identified in the analytical process: “The challenging PICU stay”, “The value of a network” and “The uncertain post-PICU trajectory”.ConclusionInformation, dialogue and interaction with familiar health professionals, the diary written by PICU nurses, the parents’ personal network and social media supported the parents during and after the PICU stay. The parents expressed that post-PICU follow-up was not the most essential but that follow-up initiatives may be arranged individually.