Danish parents' experiences when their new born or critically ill small child is transferred to the PICU-a qualitative study

The aim of this study was to describe Danish parents' experiences when their newborn or small child was critically ill. Thirteen parents were interviewed. Data were analysed using qualitative content analysis. The child's transfer to the paediatric intensive care unit (PICU) meant either help or death for the parents. The back transfer was experienced as joy and despair. The parents had confidence in most nurses, and they were kind, helpful, informative and capable. Less capable and distressed nurses made the parents feel uncomfortable and insecure. Parents need help and support during their child's transfer to and from the PICU. Critical care nurses have to discuss the policy of family-centred care.     

A comparison of the stressors experienced by parents of intubated and non-intubated children

When children are ill enough to require admission to paediatric intensive care, parents may become distressed about their child's medical condition and this distress may be compounded by the unfamiliar nature of the highly technological environment Parents of children who are sick enough to warrant intubation are particularly likely to be exposed to a frightening array of technological equipment Seventy-one parents of intubated and non-intubated children completed the Parental Stressor Scale Paediatnc Intensive Care Unit (PSS PICU) Overall the findings suggest that parents were most distressed (a) by the painful procedures to which their children were subjected, (b) by the sights and sounds of the intensive care unit and (c) by their children's reactions to intensive care The behaviour of staff towards parents and the way that staff communicated with them caused the least distress When the levels of stress reported by parents of intubated children were compared with those reported by parents of non-intubated children, different patterns of stress were found Painful procedures were a source of greater stress to parents of intubated children whereas the behaviour of staff and the children's reactions to the intensive care experience caused greater stress to the parents of the non-intubated children In general the findings suggest that the needs of parents of non-intubated children are being overlooked, with staff focusing more of their attention on the parents of intubated children     

Examining the Needs of Bereaved Parents in the Pediatric Intensive Care Unit: A Qualitative Study

The pediatric intensive care unit (PICU) is a high-tech setting aimed at restoring health to critically ill children. When childhood death occurs in the PICU, it constitutes a special context for parent bereavement. The purpose of this interdisciplinary qualitative research was to gain a deeper understanding of parents' needs around the time of their child's death in the PICU. Through interviews and focus groups with bereaved parents and hospital chaplains, categories of parents' needs emerged. Deeper understanding of parents' needs will allow health professionals to better support parents during bereavement as well as to provide more customized care.     

Family involvement in end-of-life care in a paediatric intensive care unit

End-of-life care (ELC) on a paediatric intensive care unit (PICU) is a fundamental aspect of clinical practice and yet often remains a highly emotive and challenging issue. Every year, many children die in PICU often following the withdrawal of life-sustaining treatment, and as health professionals we have a duty to provide ELC that meets the needs of the dying child and their family. To achieve this, there is a growing emphasis on incorporating parental views on withdrawal of intensive care especially in time and place. Home care of the dying child enables the child to die at home in familiar surroundings and with the people who love them the most. This service is essentially child centred and acknowledges the unique and pivotal position that parents have in their child's life by empowering them to have control over the time and place of death. This is a vitally important aspect of end-of-life in PICU and underpins the ethos of this area of practice. We present a series of case reviews of patients cared for within a 12-month period, where intensive care was withdrawn distant from the PICU environment and address the challenges and considerations surrounding this area of practice.     

儿科ICU患儿家长的需求及其影响因素

目的分析儿科重症监护室(intensive care unit,ICU)患儿家长的需求现状,探讨其影响因素。方法便利抽样法选取2015年6-10月在长春市某三级甲等医院儿科ICU住院患儿的家长100名为研究对象,应用一般资料调查表、中文版重危患者家属需求量表对其进行问卷调查。结果儿科ICU患儿家长总体需求得分为(138.34±16.96)分,儿童重症监护室(pediatric intensive care unit,PICU)与新生儿重症监护室(neonatel intensive care unit,NICU)患儿家长一致认为保证患儿的病情是最重要的需求;文化程度、家庭月收入及患儿是否早产是儿科ICU患儿家长需求的影响因素,可解释患儿家长需求得分29.0%的变异量。结论儿科ICU患儿家长的需求总体处于较高水平,护理人员应根据不同影响因素给予针对性的健康指导,尽可能满足患儿家长的需求。     

Improvements in the outcome of children with meningococcal disease

Recent years have seen a marked reduction in the mortality of children with meningococcal disease in paediatric intensive care units (PICU); the reasons for this improvement are multifactorial. The mortality rates for critically ill children overall have improved and reasons for this are probably increased centralisation of PICU services and that fewer critically ill children are now looked after on adult units. Specific treatment pathways for sepsis have improved with the publication of clinical guidelines for children and initiatives such as the Surviving Sepsis Campaign. There is a continuing need to focus on the care delivered to children before reaching PICU and to minimise the morbidity suffered by survivors of this disease.     

Chronic sorrow: a parental response

It is important to recognize that parents of disabled, premature, or chronically ill children may never fully resolve the grief associated with their child's special condition. Nurses need to identify the emotional responses of parents and assist them in coping with their special needs and concerns, thus helping to prevent major adjustment or psychological problems of both the child and parents.     

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.     

Helping mothers cope with a critically ill child: A pilot test of the COPE intervention

The purpose of this study was to pilot test the effects of a theoretically driven intervention program (COPE = Creating Opportunities for Parent Empowerment) on the coping outcomes of critically ill children and their mothers. Thirty mothers of 1- to 6-year-old children in a pediatric intensive care unit (PICU) were randomly assigned to receive COPE or a comparison program. Mothers who received the COPE program: (a) provided more support to their children during intrusive procedures; (b) provided more emotional support to their children; (c) reported less negative mood state and less parental stress related to their children's emotions and behaviors; and (d) reported fewer post-traumatic stress symptoms and less parental role change four weeks following hospitalization. Results indicate the need to educate parents regarding their children's responses as they recover from critical illness and how they can assist their children in coping with the stressful experience. © 1997 John Wiley & Sons, Inc. Res Nurs Health 20: 3–14, 1997     

Training needs of psychiatric intensive care staff

AIM: A survey was carried out to identify the education and training needs of psychiatric intensive care staff and the preferred type of training course. Demand for a specific psychiatric intensive care unit (PICU)/lowsecure training course was also examined. METHOD: A convenience sample was taken from delegates attending a National Association of Psychiatric Intensive Care Units (NAPICUs) conference. Questionnaires were given to 130 delegates and a mail-shot was sent to ward managers on 13 PICUs in London. RESULTS: The findings were that staff wanted further training in four main areas: the management of violence and aggression; psychological therapies; communication and engagement skills; and rapid tranquillisation. Most respondents indicated that they would like a course developed specifically for PICU staff at degree level in modular format. CONCLUSION: This small-scale study highlights the need for further provision of training for PICU staff and provides an insight into their education and training needs. The findings could have significant implications for developing new approaches to education and training for practitioners working with severely ill psychiatric patients.     

The COPE program: a strategy to improve outcomes of critically ill young children and their parents

Critically ill young children and their parents are subjected to multiple stressors during hospitalization, which may predispose them to short- and long-term negative outcomes. Nurses who care for children who are critically ill and their families during and following their intensive care unit stay must be knowledgeable of the impact of a child's critical illness on the family and factors influencing adjustment to the stressful experience. Knowledge of these issues is essential in planning effective intervention strategies to enhance coping outcomes in this population. This article (a) discusses how young children and their parents are affected by critical illness; (b) outlines major sources of stress for families; (c) identifies factors influencing coping outcomes; and (d) describes the COPE program, a newly devised early intervention program for critically ill young children and their parents.     

Perceptions of spiritual care among nurses undertaking postregistration education

Previous research has suggested that qualified nurses recognize that patients have spiritual needs and consider meeting those needs to be important. However, there is also evidence suggesting that nurses feel ill prepared for, and uncertain about, their role as spiritual care providers. A questionnaire on spiritual care and the nurse's role was distributed to a group of 59 registered nurses (of varying ages and levels of experience) undertaking a palliative care module as part of a post-registration degree programme in Scotland. The findings demonstrated that respondents regarded spiritual care as important, especially for certain patient groups. They also thought nurses had a significant responsibility in spiritual caregiving. Individuals varied in how difficult they found identifying patients in need of spiritual care and in meeting those needs. However, analysis of responses revealed considerable insight into possible signs of patient need, examples of nursing interventions and potential barriers to effective spiritual care. Some areas of relative lack of knowledge were identified and may indicate where future efforts to raise awareness of spiritual care among similar groups of nurses should be concentrated.     

Understanding the supportive care needs of parents of children with cancer: an approach to local needs assessment.

The objective of this study was to conduct an assessment of supportive care needs from the perspective of parents of children diagnosed with cancer within an urban-rural region in Eastern Ontario, Canada. Guided by a conceptual framework for supportive care, the exploratory, mixed-method study used a standard needs survey and semistructured interviews. Fifteen parents completed (75% response rate) the survey, and 3 parents participated as key informants in the follow-up interview. Parents reported needs in all 6 of the need categories outlined within the Supportive Care Needs Framework. The proportion of parents expressing a need ranged from 23% to 39%. Dealing with the fear of their child's cancer spreading was frequently identified by parents. Emotional and informational needs were the 2 most frequently acknowledged categories of need. With further refinement, the use of the conceptual framework will provide a methodology for planning care based on the individual needs identified by parents of children with cancer.     

Admissions for critically ill children: where and why?

INTRODUCTION: Planning services for critically ill children requires identification of overall critical care activity as well as an assessment of population needs. METHOD AND OBJECTIVES: This prospective needs assessment took a census approach to estimating population-based admission rates for paediatric critical care irrespective of where care was provided. A survey form was completed for every child in the study population for all of their admissions. CRITERIA: The need for tracheal intubation was used as a proxy for defining need for intensive care in this study. Critical illness was defined by clinical criteria adapted from the Advanced Paediatric Life Support Guidelines. STUDY POPULATION: All children under 17 years resident in south-east England (Thames regions) who required care for a critical illness in any inpatient setting between 1 December 1996 and 30 November 1997. Critical illness was the presence of acute body-system or multi-system failure. RESULTS: A wide variation in the rates of critical care admission to different types of care settings was reported ranging from 1.2 admissions per 1000 resident children per year for PIC units (general and cardiothoracic units) to 0.02 admissions per 1000 children per year for children admitted from the community to neonatal units. The age of children and their rates of admission were directly related to the type of ward or unit where children received care. Tracheal intubation occurred in all care settings. The proportion of intubated children transferred to paediatric intensive care units (PICUs) or paediatric cardiothoracic intensive care units (PCICUs) varied according to the type of referring unit. The proportion of episodes involving tracheal intubation where the child was not transferred to a PICU or PCICU was 52% for children in stand-alone neurosurgical units, 41% for those in adult intensive care units (AICUs), and 4% for those in children's wards. CONCLUSIONS: This baseline study shows a significant number of critically ill children who are never cared for in PIC units. With national changes in UK policy to regionalise care for these children, monitoring care in all locations by cause of admission remains important. While the data were collected in 1997, the findings from this study remain relevant and provide the basis for planning regional critical care services for children. Results are also relevant to other geographical areas in that measuring the use of services for critically ill children must go beyond documenting admission to ICUs for children and adults. All settings for critical care must be identified, the activity documented, and the use of services measured against existing resources. Clear clinical criteria are needed to identify children who can be cared for appropriately on high dependency units.     

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."