Parent Advocacy Group for Events of Resuscitation

A Scoping Review of the Impact of Family Presence on Pediatric Resuscitation Team Members

OBJECTIVES

The purpose of this scoping review was to identify the extent, range, and nature of information currently available on family presence during pediatric resuscitation on resuscitation team members and their performance.

DATA SOURCES

A comprehensive search strategy was created and executed by identifying primary keywords in central articles, pretesting key words and combinations of them in databases to confirm articles returned fell within the search parameters, and checking that key articles were returned which confirmed the search strategy was not too narrow.

STUDY SELECTION

Two members of the research team independently conducted relevance screening using predetermined inclusion and exclusion parameters. Titles and abstracts of retrieved articles were reviewed using the set criteria involving. From the refined list of selected articles, full texts of each article were considered for final determination of inclusion.

DATA EXTRACTION

Key items of information were gathered from each article selected using a predefined extraction list. The extracted information was then sorted into themes and relevant issues.

DATA SYNTHESIS

Of the 3,012 studies initially identified, 48 met the inclusion criteria. Themes identified included as follows: 1) attitudes and opinions on family presence during pediatric resuscitation; 2) reasons in support of or against family presence during pediatric resuscitation; 3) education, training, and support; and 4) resuscitation performance and outcomes. Our review of the available information highlighted that the majority of work done to this point has focused heavily on healthcare provider opinions and relied mainly on survey method.

CONCLUSIONS

We propose that future research employ more rigorous research techniques, such as randomized control trials, place greater emphasis on healthcare provider behaviors and clinical outcomes during family presence during pediatric resuscitation, and increase exploration into the education and training needs of healthcare providers who already currently manage family presence during pediatric resuscitation.

Parents' Experience During a Child's Resuscitation: Getting Through It

PURPOSE

The purpose of this study was to elucidate the experiences of parents during their child's resuscitation in the hospital setting.

DESIGN AND METHODS

This qualitative descriptive study took place in a 280 bed children's hospital with parents whose children experienced resuscitation while they were present in the room or nearby. Semi-structured interviews were conducted between one and twelve months following a child's resuscitation. A rigorous thematic analysis was performed.

RESULTS

This study elucidates parent experience during a child's resuscitation using four overarching themes; "Overwhelming chaos", "Getting through it", "Cognitive presence" and "Joy mixed with heartache". Parents described their experience to be stressful, yet identified things that helped them get through it and make sense of the experience.

CONCLUSIONS

During a child's resuscitation parents perceived a sense of overwhelming chaos, yet still had an innate need to be present and know what was going on. While emotional support was appreciated, most important was to receive real time clinical information from healthcare staff and to see and feel that the team was personally invested in their child.

PRACTICE IMPLICATIONS

During a child's resuscitation, parents should be allowed to choose their level of presence to meet their individual needs. A clinical staff member should answer questions and share clinical information with parents. In addition, clinicians should allow themselves to connect with parents on a personal level. This research provides a foundation for further study, including parents' experience after experiencing a child's resuscitation.

Quality improvement in pediatric intensive care: A systematic review of the literature

IMPORTANCE

Measuring and improving performance is an essential component of any high-risk industry, including intensive care medicine. We undertook this systematic review to describe the current state of quality improvement efforts in pediatric intensive care medicine.

OBJECTIVE

To evaluate the quality and rigor of all published literature on quality improvement efforts in the pediatric intensive care unit in the current era.

METHODS

We conducted a literature search on MEDLINE, Embase, and Cochrane for studies that met two broad inclusion criteria: 1) the terms "pediatric critical care" and "quality improvement" and 2) they were completed in the past ten years. In the initial search, we also included academic and professional societies or organizations devoted to providing resources on quality improvement in intensive care medicine. We excluded studies that examined quality improvement processes exclusively for neonatal or adult patients receiving intensive care.

RESULTS

Forty-nine of 332 identified articles were selected for final review by two reviewers who independently rated the quality of the methodology and rigor of the evidence reported for each study. Of these, 23 studies targeted structural issues, 14 studies targeted process issues, and 12 targeted an outcome as the focus of the intensive care quality improvement effort.

INTERPRETATION

Our review of the published literature on quality improvement efforts in the pediatric intensive care unit in the current era found that 85% of studies were limited in methodology or analysis. Fifteen high-quality studies are reported here and serve as helpful examples of rigorous research methodology in this domain going forward.

Family presence during resuscitation: A narrative review of the practices and views of critical care nurses

BACKGROUND

The option of family presence during resuscitation was first presented in the late 1980s. Discussion and debate about the pros and cons of this practice has led to an abundant body of international research.

AIM

To determine critical care nurses' experiences of, and support for family presence during adult and paediatric resuscitation and their views on the positive and negative effects of this practice.

METHODS

A narrative literature review of primary research published 2005 onwards. The search strategy comprised an electronic search of three bibliographic databases, supplemented by exploration of a web-based search engine and hand-searching.

RESULTS

Twelve studies formed the review. Research primarily originated from Europe. The findings were obtained from a moderately small number of nurses, and their views were mostly based on conjecture. Among the factors influencing family presence during resuscitation were dominant concerns about harmful effects. There was a noticeable absence of compliance with recommended guidelines for practice, and the provision of a unit protocol or policy to assist decision-making.

CONCLUSION

A commitment to family-centred care, educational intervention and the uptake of professional guidance are recommended evidence-informed strategies to enhance nurses' support for this practice in critical care.

Parents’ Experience When Present During a Child’s Resuscitation: An Integrative Review

Understanding perceptions of parents is necessary to meet parents’ needs during a child’s resuscitation. Parent presence at pediatric resuscitations has been slow to become consistent practice in all hospital settings and remains controversial. The purpose of this integrative review was to synthesize research on parents’ experience while present during a child’s resuscitation to improve understanding for health care providers and to facilitate application in practice. Nine studies met inclusion criteria, identifying four major themes. Parents experienced conflicting emotions, articulated a need for communication and support, reported that being physically present was comforting, and described their reactions to the experience. The available research on parents’ experience during presence at their child’s resuscitation offers a foundation for further detailed study. Further study is needed about parents’ perspective of support needed while present during a child’s resuscitation, as well as about any long-term effects of presence on parent stress and coping.

Validation of instruments about family presence on invasive procedures and cardiopulmonary resuscitation in pediatrics

OBJECTIVE

to develop and validate instruments to identify health professionals' beliefs related to the presence of the child's family in invasive procedures and in cardiopulmonary resuscitation.

METHOD

study based on Psychometrics to conduct the theoretical, empirical and analytical stages, developed in a neonatal unit of a university hospital. The two instruments were constructed based on the literature and applied to 96 health professionals.

RESULTS

the Cronbach's Alpha of the instrument related to the professionals' beliefson invasive procedures was 0.863 and the instrument on cardiopulmonary resuscitation was 0.882. In both instruments, the tests performed indicated a correlation between the items. From the factorial analysis, four factors were generated: (1) benefits of the presence of the family; (2) impairment for professional practice; (3) strategies for the inclusion of the family; and (4) limitation of learning and decision making by the professional.

CONCLUSION

the instruments analyzed obtained a good internal consistency and are indicators of the professionals' beliefs with the potential to evaluate the quality of family care in this context.

Psychosocial Care Models for Families of Critically Ill Children in Pediatric Emergency Department Settings: A Scoping Review

PROBLEM

Critical illness in children is a significant and stressful life event for families. Within pediatric emergency department (ED) settings it is acknowledged that these crises are challenging for both the families of these children, and for the clinical staff treating the child. Literature recommends routine care should include an offer to the family to be present with their critically ill child, however there is a lack of clarity regarding specific family care models or evidence-based interventions to guide clinical practice.

ELIGIBILITY CRITERIA

Peer reviewed articles written in English, published between 2006 and 2016, proposing or testing psychosocial care models in pediatric (or mixed) emergency settings.

SAMPLE

Nine articles met inclusion criteria.

RESULTS

Search results showed limited evidence available in the literature at this time. Thematic analysis of article content and proposed model showed strong support for the benefit of family presence, including shifting the family role from passive to active, needing to be inclusive of the psychological impact of critical health events, importance of multidisciplinary education, and the need for additional exploratory and empirical research to evaluate and refine proposed care models.

CONCLUSIONS

Pediatric emergency health events are challenging for both families and staff, and care models provide staff with a consistent, evidence-informed approach to caring for families in challenging situations.

IMPLICATIONS

There is a need to find common ground from specific discipline guidelines into a multidisciplinary team approach for the care of families within emergency care.