Supporting families during pediatric critical illness: Opportunities identified in a multicenter, qualitative study

Transition and Aftercare Following a Child's Discharge From ICU to a General Ward: A Qualitative Meta-Synthesis of Parental Experiences

BACKGROUND

Transitions from the intensive care unit (ICU) to the general ward cause great impairment of physical and psychosocial functioning in children and their parents. Better understanding of parental experiences during children's ICU-to-ward transitions is required to inform the development of ICU transitional care.

AIM

To examine the parental experiences during their children's ICU-to-ward transitions through the synthesis of original qualitative studies.

DESIGN

This study follows the preferred reporting items for systematic reviews and meta-analyses (PRISMA) and the enhancing transparency in reporting the synthesis of qualitative research (ENTREQ) statements, uses Thomas and Harden's thematic synthesis framework rooted in a critical realist philosophy to present qualitative meta-synthesis.

DATA SOURCES

We conducted a systematic review in June 2024 and searched nine electronic databases including Pubmed, Embase, CINAHL, PsycINFO, Cochrane Library, Sinomed, CNKI, Wanfang and VIP. Eligible studies contained parents quotes about their children's ICU-to-ward transitions and published in either English or Chinese since 2005.

METHODS

Systematic searches yielded 2825 identified studies. Two reviewers screened titles, abstracts and full text and reached consensus through critical discussion with a third reviewer. Eighteen studies were finally agreed for inclusion. Data were extracted into a Microsoft Excel spreadsheet and synthesised through line-by-line coding of relevant quotes with the help of NVivo.

RESULTS

The qualitative synthesis resulted in four descriptive themes followed later by two analytical themes. Specifically, these were (1) the nature of the parental experience during ICU-to-ward transition (challenging but responded proactively) and (2) factors involved in the ICU-to-ward transition (both facilitators and barriers).

CONCLUSIONS

This study indicates the nature of parental experiences and factors involved during the critically ill child's ICU-to-ward transition. Healthcare providers serve as the primary support network for parents and should collaborate closely with them to facilitate a smooth transition by providing tailored support.

NO PATIENT OR PUBLIC CONTRIBUTION

This is a meta-synthesis of previously published qualitative studies.

TRIAL REGISTRATION

We have registered in the PROSPERO and the number is CRD42023422055.

Healthcare Burden and Resource Utilization After Pediatric Acute Respiratory Distress Syndrome: A Secondary Analysis of the Collaborative Pediatric Critical Care Research Network Acute Respiratory Distress Syndrome Study

OBJECTIVES

To describe family healthcare burden and health resource utilization in pediatric survivors of acute respiratory distress syndrome (ARDS) at 3 and 9 months.

DESIGN

Secondary analysis of a prospective multisite cohort study.

SETTING

Eight academic PICUs in the United States (2019-2020).

PATIENTS

Critically ill children with ARDS and follow-up survey data collected at 3 and/or 9 months after the event.

INTERVENTIONS

None.

METHODS AND MEASUREMENT

We evaluated family healthcare burden, a measure of healthcare provided by families at home, and child health resource use including medication use and emergency department (ED) and hospital readmissions during the initial 3- and 9-month post-ARDS using proxy-report. Using multivariable logistic regression, we evaluated patient characteristics associated with family healthcare burden at 3 months.

MAIN RESULTS

Of 109 eligible patients, 74 (68%) and 63 patients (58%) had follow-up at 3- and 9-month post-ARDS. At 3 months, 46 families (62%) reported healthcare burden including (22%) with unmet care coordination needs. At 9 months, 33 families (52%) reported healthcare burden including 10 families (16%) with unmet care coordination needs. At month 3, 61 patients (82%) required prescription medications, 13 patients (18%) had ED visits and 16 patients (22%) required hospital readmission. At month 9, 41 patients (65%) required prescription medications, 19 patients (30%) had ED visits, and 16 (25%) required hospital readmission were reported. Medication use was associated with family healthcare burden at both 3 and 9 months. In a multivariable analysis, preillness functional status and chronic conditions were associated with healthcare burden at month 3 but illness characteristics were not.

CONCLUSIONS

Pediatric ARDS survivors report high rates of healthcare burden and health resource utilization at 3- and 9-month post-ARDS. Future studies should assess the impact of improved care coordination to simplify care (e.g., medication management) and improve family burden.

"I want to be there. I have to be there.": Parents' perceived barriers and facilitators to bedside presence in the pediatric intensive care unit

Introduction

Parental presence at the bedside during a stressful pediatric intensive care unit (PICU) admission may improve child comfort, reduce parental anxiety, and enable family engagement. We performed this study to identify factors that parents perceive impact their capability, opportunity, and motivation to be at the bedside in PICU.

Methods

We conducted a qualitative descriptive study using semi-structured interviews based on the Theoretical Domains Framework (TDF). We included parents of children admitted to the PICU for at least 24 h at IWK Health in Nova Scotia, Canada. Interviews were coded independently by two researchers using a directed content approach based on the TDF. We generated themes and subthemes, with the subthemes identified as factors impacting parental presence, and assigned TDF domains to each of the subthemes.

Results

Fourteen primary caregivers (8 mother figures, 6 father figures) participated in 11 interviews. The factors associated with parental presence were captured by 6 themes: Understanding the Medicalized Child; Maintaining the Parent Role; Life Beyond the Hospital; Parental Intrinsic Responses and Coping; Support Structures; and The PICU Environment. Fifty-two barriers and enablers were identified within 13 TDF domains; 10 TDF domains were determined to be relevant to parental presence, which may be used to guide design of future interventions. Participants emphasized the importance of self-care to enable them to remain physically at their child's bedside and to be engaged in their care.

Conclusions

Parents perceive multiple factors within 6 themes act as barriers or enablers to presence with their critically ill child in the PICU. Guided by relevant TDF domains, interventions may be designed to optimize presence, particularly engaged presence, which may improve health-related outcomes of children and their parents.

A review on factors related to patient comfort experience in hospitals

The creation of a welcoming hospital atmosphere is necessary to improve patient wellbeing and encourage healing. The goal of this study was to examine the variables affecting hospitalised patients' comfort. The study procedure included a thorough search of the Web of Science and Scopus databases, as well as the use of software analytic tools to graphically map enormous literature data, providing a deeper understanding of the linkages within the literature and its changing patterns. Insights from a range of disciplines, including engineering, psychology, immunology, microbiology, and environmental science, were included into our study using content analysis and clustering approaches. The physical environment and the social environment are two crucial factors that are related to patient comfort. The study stress the need of giving patient comfort a top priority as they heal, especially by tackling indoor air pollution. Our research also emphasises how important hospital care and food guidelines are for improving patient comfort. Prioritising patients who need specialised care and attention, especially those who have suffered trauma, should be the focus of future study. Future research in important fields including trauma, communication, hospital architecture, and nursing will be built on the findings of this study. To enhance research in these crucial areas, worldwide collaboration between experts from other nations is also advised. Although many studies stress the significance of patient comfort, few have drawn conclusions from a variety of disciplines, including medicine, engineering, immunology, microbiology, and environmental science, the most crucial issue of thoroughly researching the improvement of patient comfort has not been addressed. Healthcare workers, engineers, and other professions will benefit greatly from this study's investigation of the connection between hospital indoor environments and patient comfort.