Does Family Presence in the Trauma Bay Help or Hinder Care?

Resuscitation Team Members' Perceptions of Supporting Parents During Cardiopulmonary Resuscitation of Children: A Systematic Review

INTRODUCTION

Supporting parents is a crucial part of family-centered care in pediatric and neonate resuscitation.

OBJECTIVES

The aim of this systematic review was to appraise and synthesize studies conducted to determine resuscitation team members' perspectives of support for parents during pediatric and neonate resuscitation.

METHODS

The PRISMA model guided the systematic literature search of Google Scholar, PubMed, MEDLINE, CINAHL, Cochrane, and Scopus for studies published until May 2022. The authors independently screened all titles, abstracts, and full-text articles for eligibility. There was agreement about screened articles for inclusion. Full texts of all potentially relevant studies were evaluated for the rigor of the study design, sample, and analysis. This review included quantitative, qualitative, and mixed-methods studies. The quality of evidence across the included studies was assessed using the risk of bias in non-randomized studies of interventions (ROBINS-I) tool as part of GRADE's (Recommendations Assessment, Development, and Evaluations) certainty rating process.

RESULTS

There were 978 articles located. After reviewing for relevancy, 141 full-text articles were assessed, and 13 articles met criteria and were included in this review (4 quantitative, 7 qualitative, and 2 mixed-methods design). Five themes were revealed to summarize resuscitation team members' perspectives of parental support in pediatric resuscitation: providing information to parents, family facilitator, emotional support, presence of parents during resuscitation, and spiritual and religious support.

CONCLUSIONS

The results of this systematic review can be used to improve support for parents by informing the education of resuscitation team members and clarifying policies and guidelines of resuscitation team roles to include support for parents.

Management of Sudden Unexpected Infant Deaths in the Emergency Department:

Objective

To establish a standardized, trauma informed and family-centered emergency department (ED) sudden and unexpected infant death (SUID) management protocol at Nemours Children’s Health, Delaware for medical professionals and multidisciplinary team (MDT) collaborators, informed by national clinical practice guidance, and respective of both family and investigative needs. SUID are emotionally distressing for involved family members, often precipitated by profound grief and confusion as the family interacts with many mandated public agencies during the course of a medicolegal death investigation. Although SUID necessitates consideration of child abuse and neglect as a contributory factor, and accurate determination of death cause may have critical implications for other family members and public health, prioritizing family needs in a trauma informed manner is paramount. Collaboration between MDT partners to provide optimal care to families following SUID involves transparent family communication, attending to medical and mental health needs of surviving family (especially siblings), and respecting medicolegal investigative constraints. Many institutions lack standardized approaches to SUID cases, which may precipitate increased family distress and delay initiation of necessary medicolegal death procedures.

Methods

An MDT expert panel consisting of medical, legal, law enforcement, and child welfare professionals was convened at Nemours Children’s Health, Delaware in 2018 over a 3-month period to analyze and implement an enhanced, family-centered, trauma informed hospital protocol.

Results

Using exploratory inquiry and dialogue to elicit important protocol goals, a family-centered protocol with revised, coordinated roles for MDT members was developed with enhanced focus on communication, family-, and team-oriented care.

Conclusions

Implementation of a family-centered, ED-based protocol standardizing the approach to SUID effectively supports medicolegal death investigative procedures while prioritizing trauma informed, supportive, sensitive ED care for grieving families.

Policy implications

Health care institutions serving children and their families should develop and implement trauma informed, family-centered protocols to ensure sensitivity during medicolegal death investigations.

Ethical challenges with decisions to withhold or withdraw resuscitation in pediatric surgery

Providers often dispute the ethical equivalence of withholding and withdrawing care, despite theoretical frameworks that support equivalency. We highlight two cases, one where providers express concern with initiation of aggressive resuscitation and another where providers experience emotional distress from the decision to cease resuscitation. Both cases illustrate how the ethical challenges encountered can result in high levels of provider distress. Mitigation of this moral distress by team members will require an improved understanding of available evidence in the literature and active discussion by debriefing after a child dies. Medical staff and national organizations can help recognize that these patient events contribute to provider burnout and facilitate the design and support of programs to increase provider resiliency.

Engaging patients and families in pediatric radiology

While patient and family-centered care (PFCC) is currently a hot topic in medicine, it has long been a specific focus of pediatrics. The concept of PFCC includes a change in culture where physicians and patients move away from paternalism and instead view patients and families as partners in care. Although there are many ways in which adult-focused radiologists can learn from pediatric radiologists as leaders in PFCC, there remain many opportunities for improvement for all radiologists.

Family presence during paediatric resuscitation and invasive procedures: the parental experience: An integrative review: An integrative review

BACKGROUND

The evolvement of family-centred care has been an ongoing process since the Platt Report 1959. Family-centred care has become the modern working model in paediatrics and obstetrics. Parental participation is central to family-centred care. Whether it is applied consistently remains to be concluded.

AIM

The aim of the study was to describe the family experiences of being present during paediatric resuscitation and invasive procedures.

METHOD

The design used in this study is an integrative review by Whittemore & Knafl. Databases PubMed and CINAHL were searched for primary research concerning the parental experiences of participating in paediatric resuscitation and invasive procedures. Eighteen studies were included in the study. A quality assessment tool was applied.

FINDINGS

A pro-parental presence was the results of 17 of the 18 included studies. Six common themes were found: 'Being there', 'Calming child', 'Calming parent', 'Having the right', 'Do it again' and 'Seeing is believing'.

CONCLUSION

Including family in resuscitation and invasive procedures requires openness as a working model and demands organisational changes and the updating of guidelines. The inseparability of parent-child is attachment theory practised, an innate quality of being a child as well as a parent. Recommendations are to have a facilitator present during resuscitation and invasive procedures to alleviate stress on everyone's part, enabling family participation.