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.     

The impact of knowing your child is critically ill: a qualitative study of mothers' experiences

Discussion in this paper is drawn from an exploratory study designed to elicit mothers' lived experiences of crisis and coping, and their experiences of nursing following the unexpected emergency admission of their child to the paediatric intensive care unit (PICU). An in-depth critique of literature supporting this study has been published. Two theoretical perspectives serve as a basis for this exploratory study: firstly, the idea that in a crisis situation, a mother's ability to cope and function is influenced by therapeutic interventions of nurses by meeting her needs in a holistic way; and secondly, symbolic interactionism, that focuses on the meaning of events to mothers. Data were elicited through focused interviews with 10 mothers of children aged between 3 months and 15 years who had been admitted unexpectedly to the PICU with a life threatening condition. Findings reveal the major impact of crisis on mothers immediately following their child's critical illness and admission to PICU, and this specific aspect therefore warrants in-depth discussion and analysis. The study did not generate a theory; however, important recommendations are made for nursing practice and research in relation to the impact of crisis experienced by mothers. Nursing practice issues include meeting the psychosocial needs of parents prior to and immediately after admission, and the importance of family-centred nursing care. Issues for nursing research include exploring how families cope with the impact of crisis and critical illness.     

Parental experiences in neonatal intensive care unit in Ethiopia: a phenomenological study

IntroductionNeonatal intensive care unit is important to save the lives of a sick neonate; however, parents are challenged by several stressful conditions during their stay. Therefore, this study aimed to explore the lived experiences of parents in neonatal intensive care units in Ethiopia.MethodsWe used a phenomenological study design. The data were collected using an in-depth interview method from purposively selected parents. In addition, we followed a thematic analysis approach and used Open Code Software Version 4.02 to process the data.ResultsIn this study, 18 parents were interviewed. The researchers have identified six themes. Parents complained of psychological problems like anxiety, stress, worries, hopelessness, and a state of confusion. In addition, anger, crying, sadness, frustration, dissatisfaction, regret, disappointment, feeling bad, self-blaming, nervousness, disturbance, and lack of self-control were major emotional problems raised by the parents. Parents expressed that health care providers showed indiscipline, lack of commitment, and uncooperative behaviour. Likewise, shortage of medicines, money, and limited time to visit their neonates were the other concerns of many parents. At the same time, parents were provided minimal information and limited cooperation from health care providers.ConclusionParents whose infants admitted to the NICU were suffered from various psychological and emotional problems. Researchers recommend that health care providers should be supported parents with psycho-emotional problems, strengthen parents–healthcare workers'' interaction, and scale up neonatal intensive care unit services to the primary health care centres.

KEY MESSAGES

• Parents whose infants admitted to the NICU were suffered from psychological and emotional problems.
• Poor NICU environment, shortage of equipment, long hospital stay, the presence of pandemic COVID-19, and lack of parental involvement in the care were identified barriers that affected parents'' stay.

     

Living through the death of a child: a qualitative study of bereaved parents' experiences

Design

Cross-sectional qualitative study.

Data sources

Interviews with purposeful sample of 25 recently bereaved parents.

Methods

Semi-structured in-depth interviews.

Results

Four analytically distinct processes were identified in the responses of parents to the death of a child. These are referred to as ‘piloting’, ‘providing’, ‘protecting’ and ‘preserving’. Regardless of individual circumstances, these processes were integral to all parents’ coping, enabling an active ‘doing’ for their child and family throughout the trajectory of their child's illness and into bereavement.

Conclusions

Facilitating the capacity of parents to ‘do’ is central to coping with the stress and uncertainty of living through the death of a child. The provision of informational, instrumental and emotional support by health care professionals in the context of ‘doing’ is core to quality palliative care.     

Is bolus or continuous enteral feeding better in critically ill children: An evidence-based review

Inadequate nutrition can lead to increased morbidity and mortality for mechanically ventilated children in the paediatric intensive care unit (PICU). Enteral feeding can either be delivered by gravity bolus (intermittent) feeding or continuously via a pump and in UK PICUs variable practice exists. This evidence-based review therefore aimed to examine the evidence surrounding the two feeding methods for ventilated children, to determine whether one provides better enteral nutrition. Four papers were included, three randomized controlled trials and a systematic review, which provide conflicting evidence. There is some suggestion that bolus feeding may be superior in medical children on PICU to achieve their energy and protein goals faster, however, the clinical significance of the results is questionable and further research is needed to identify whether one method of feeding can impact on patient outcomes.     

Being invigorated in parenthood: parents' experiences of being supported by professionals when having a disabled child

The purpose of the study was to know the meaning of parents' experiences of being supported by professionals when having a child with disability. Data were obtained through unstructured interviews with 16 parents within 10 families and analyzed by a phenomenological-hermeneutic approach. Parents narrated experiences of being supported and not being supported, and the findings are presented as contrasting meanings. Being supported by professionals means gaining confidence as a parent and having the child seen as valuable. This is interpreted as being invigorated in parenthood, where sharing the mutual task and goal, which is the child's best, with professionals is a crucial aspect. The meaning of experiences of lack of support illuminates the consequences for the entire family's well-being and the struggle parents experience to gain confidence as parents and recognition of the child as valuable.     

Mothers' experiences of having their newborn child in a neonatal intensive care unit

BACKGROUND: From birth the child has an ability to respond to the environment, which influences the interaction between mother and child. If this attachment is interrupted, the child's emotional development is negatively influenced. When the child needs care in a neonatal intensive care unit (NICU) it is difficult to establish contacts between mother and child. Separation from the child is found to be the most difficult aspect for mothers when their newborn child is hospitalized in a NICU. AIM: The aim of this study was to describe mothers' experiences when their full-term newborn child was cared for in a NICU during the postpartum maternity care period. METHOD: A phenomenological hermeneutic interview study was performed. Ten mothers were interviewed once, 6 months to 6 years after the experience. RESULTS: The essence of the experience is understood as an alternation between two opposite concepts, exclusion and participation, with emphasis on exclusion. A feeling of exclusion dominates when the new mother feels a lack of interaction and a sense of not belonging to either the maternity care unit or the NICU. This has a negative effect on her maternal feelings. On the contrary, when a feeling of participation dominates, a continuous dialogue exists and the mother is cared for as a unique person with unique needs. This supports her maternal feelings in a positive direction. The implication of the result for nurses is that it is important to decrease mothers' experience of exclusion and to increase their feeling of participation when their child is cared for in a NICU. A return visit to the responsible nurse to go through the treatment and experiences should be offered to all parents whose child has been cared for in a NICU.     

Welcoming expertise: Bereaved parents’ perceptions of the parent–healthcare provider relationship when a critically ill child is admitted to the paediatric intensive care unit

Background

Entering the paediatric intensive care unit with a critically ill child is a stressful experience for parents. In addition to fearing for their child’s well-being, parents must navigate both a challenging environment and numerous new relationships with healthcare staff. How parents form relationships with staff and how they perceive both their own and the healthcare providers’ roles in this early stage of their paediatric intensive care journey is currently unknown.

South Asian patients' lived experience of acute care in an English hospital: a phenomenological study

Studies on utilization of hospital services by South Asian patients in the United Kingdom have consistently demonstrated levels of dissatisfaction with care in relation to meeting religious and cultural needs, although there are few studies on minority ethnic patients' utilization of acute hospital services. This study aimed to describe and interpret from the consumer's view the 'lived experience' of acute hospital care from the perspectives of South Asian patients and their family carers. The purposive sample of 10 patients and six carers consisted of 13 females and three males (five Hindus, six Muslims and five Sikhs) who were interviewed at home 2 to 3 weeks after discharge from hospital. Data were gathered through semi-structured interviews that were tape recorded and transcribed. A phenomenological approach was used, and data were analysed using the principles of Heideggerian hermeneutics. Five themes were identified, ranging from feelings of satisfaction with care, unhappy about the service, fitting-in strategies and post-discharge coping mechanisms. Patients seemed to want to cause as little disruption as possible to the ward environment and tried to fit in to what they refer to as an 'English place'. The findings, although not generalizable, offer important insights into how South Asian patients survive their journey through their hospital stay and have implications for the provision of nursing care for minority ethnic patients.     

Being family: the family experience when an adult member is hospitalized with a critical illness

Aims and objectives. The purpose of this qualitative study was to understand and interpret the ‘family experience’ with an adult member hospitalized with a critical illness. Background. Nursing practice in critical care settings has traditionally focused on individual patient needs with only tangential recognition of family needs. Investigation to describe the family experience to illuminate family nursing practice has been lacking. The majority of studies thus far related to critical illness and family are quantitative and reveal constraints to family care and problematic nurse–family interactions. The logical next step is a new kind of family research to enhance nursing of the family as a whole. Design. Family systems theory and existential phenomenology provided the frameworks guiding the study. Methods. Semi‐structured ‘family as a group’ interviews were performed with 11 families. Data were analysed using Van Manen's hermeneutic method. Rigor was addressed with trustworthiness criteria. Results. The family experience was analysed within Van Manen's framework of lived space, lived relation, lived body and lived time. A constitutive pattern of being family was revealed. Conclusions. Being family bonds families and makes them exceedingly strong during the critical illness experience. Being a family unit is what gives most families the ability to endure the emotional upheaval and suffering that come with the critical illness experience. Relevance to clinical practice. Nurses have profound power to help families bear this experience. Family caring is enhanced with the presence of nurses who recognize the importance of ‘Being Family’ for the family, acknowledge the significance of the nurse–family relationship and act on a commitment to be with and for the family.     

Being overweight or obese is associated with decreased mortality in critically ill patients: A retrospective analysis of a large regional Italian multicenter cohort

Purpose

To describe the epidemiology of obesity in a large cohort of intensive care unit (ICU) patients and study its impact on outcomes.

Methods

All 3902 patients admitted to one of 24 ICUs in the Piedmont region of Italy from April 3 to September 29, 2006, were included in this retrospective analysis of data from a prospective, multicenter study.

Results

Mean body mass index (BMI) was 26.0 ± 5.4 kg/m²: 32.8% of patients had a normal BMI, 2.6% were underweight, 45.1% overweight, 16.5% obese, and 2.9% morbidly obese. ICU mortality was significantly (P < .05) lower in overweight (18.8%) and obese (17.5%) patients than in those of normal BMI (22%). In multivariate logistic regression analysis, being overweight (OR = 0.73; 95%CI: 0.58-0.91, P = .007) or obese (OR = 0.62; 95%CI: 50.45-0.85, P = .003) was associated with a reduced risk of ICU death. Being morbidly obese was independently associated with an increased risk of death in elective surgery patients whereas being underweight was independently associated with an increased risk of death in patients admitted for short-term monitoring and after elective surgery.

Conclusions

In this cohort, overweight and obese patients had a reduced risk of ICU death. Being underweight or morbidly obese was associated with an increased risk of death in some subgroups of patients.