Family-Centered Care in the PICU: Strengthening Partnerships in Pediatric Critical Care Medicine

Exploring 'family' in paediatric intensive care family-centred-care research: A concept analysis

OBJECTIVES

Family-Centred Care (FCC) is a cornerstone of Paediatric Intensive Care Unit (PICU) care. While FCC is well defined, debate exists as to how 'family' is or should be defined. FCC research commonly focuses on parents, particularly mothers. To ensure PICU research represents all family members' voices, understanding how family is currently used and understood within PICU research is required. Therefore, this systematic concept analysis explored the concept of 'family' within PICU FCC research.

METHODS

Following Rodgers' Evolutionary Concept Analysis method, a systematic search of Cumulative Index of Nursing and Allied Health Literature, OVID Medline, Allied and Complementary Medicine Database, PsycINFO, and Nursing and Allied Health Database (ProQuest) was conducted in November 2023. All citations underwent two stage screening based on a pre-developed protocol. Data related to attributes, antecedents, and consequences were extracted and analysed using open coding.

RESULTS

Twenty-four articles were included. Attributes of 'family' in PICU FCC research included: Family characteristics; Recognition of adversity and vulnerability, and Evolving expectations of family. Antecedents included: A child in PICU; (Child)- and Family-Centred Care; and Hospital culture and environment. Consequences included impacts on delivery of care in PICU; and impact on PICU research.

CONCLUSIONS

Despite addressing a range of important issues, FCC research in PICUs lacks a clear definition and operationalisation of the concept of 'family'. This impacts on subsequent care and research design. Addressing this gap is key to developing an inclusive FCC culture in PICU research.

IMPLICATIONS FOR CLINICAL PRACTICE

A historically narrow definition of family means that most PICU family support is aimed at parents. To meet the needs of a changing society, clinical support services should consider extended family, including grandparents and siblings. More broadly, PICUs should challenge the definition and operationalisation of "family centred care" to ensure families are properly supported during a PICU admission.

Area-Level Socioeconomic Disadvantage and Post-PICU Outcomes in Children With an Acquired Brain Injury: Single-Center Retrospective Cohort, 2016-2023

OBJECTIVES

To examine associations between measures of area-level socioeconomic disadvantage and disability outcomes in children with acquired brain injuries (ABIs) after PICU hospitalization.

DESIGN

Retrospective cohort study.

SETTING

Tertiary academic children's hospital.

PATIENTS

Children 3-19 years old admitted to the PICU for ABI (2016-2023) who completed a post-PICU follow-up clinic visit 1-3 months after discharge.

INTERVENTIONS

None.

MEASUREMENTS AND MAIN RESULTS

In 455 children with ABI, median age of 10.8 years (interquartile range, 6.6-14.2 yr), we measured area-level socioeconomic disadvantage with the Child Opportunity Index (COI; higher scores equal less disadvantage) and Area Deprivation Index (ADI; higher scores equal more disadvantage) referenced to state. COI was categorized by quintile (very low to very high) and ADI was grouped into the lowest three, middle four, and highest three deciles. New disability was defined as greater than or equal to 1 point increase from baseline in Functional Status Scale total score at follow-up. New disability was present in 97 of 455 children (21.3%). New disability, low COI, and high ADI were independently associated with severity of illness. Multivariable logistic regression controlling for demographic and clinical covariates showed very high vs. very low COI was associated with 60% lesser odds of new disability at follow-up (adjusted odds ratio [aOR], 0.41; 95% CI, 0.17-0.99). We failed to identify such an association comparing the low to high ADI group (aOR, 0.59; 95% CI, 0.30-1.16), but we are unable to exclude the possibility that living in advantaged areas was associated with up to 70% lesser odds of new disability at follow-up.

CONCLUSIONS

In children with ABI, we have found that area-level socioeconomic disadvantage is associated with greater odds of post-PICU disability, when controlling for other demographic and severity of illness characteristics. Future research is needed to identify modifiable targets to reduce disparities in PICU outcomes after ABI.

Engaging family members in nutrition care during recovery from critical illness

PURPOSE OF REVIEW

The delivery of high-quality personalized nutrition care both during ICU and throughout post-ICU recovery is limited by multifactorial barriers. As families are often a present and consistent resource, family engagement may help to optimize nutrition support during hospitalization and after recovery from critical illness. In this review, we summarize the evidence base for family engagement in nutrition care and hypothesize future roles families may play, throughout the critical illness recovery trajectory.

RECENT FINDINGS

Family members may be best placed to convey patients' personal nutritional preferences, and premorbid nutrition intake and status, as well as promote and minimize barriers to nutrition intake. The engagement of families in nutrition care is an emerging concept, and as such, few studies have explored the role of family engagement in the delivery of nutritional care. Those that do have shown high levels of family engagement and feasibility but have not yet translated to improved clinical and patient-related outcomes.

SUMMARY

Further research should identify how and where families may best engage to support, or advocate for, improved nutrition care.