Empowerment of Parents in the Intensive Care: A journey discovering parental experiences and satisfaction with care

The aim of this thesis – the EMPATHIC studies – was to develop and implement validated parent satisfaction questionnaires for pediatric and neonatal intensive care units. Part I presents the general introduction, which justifies the construction, validation, and utilization of parent satisfaction instruments. Part II provides a review about the few existing parent and family satisfaction instruments. A theoretical framework incorporating family-centered care, parental needs and experiences, as well as parent satisfaction are described. Part III describes three explorative studies conducted to identify the parental and professionalist's experiences related to intensive care services. First, an interview study among parents of 41 children revealed 63 sub-themes divided into six major themes. Second, a Delphi study among 364 healthcare professionals identified and prioritized 78 meaningful items of pediatric intensive care services. Third, a survey study among 559 parents identified the most important care items. Part IV presents the differences of perceptions between parents and healthcare professionals by comparing the results of the Delphi and the survey studies. Parents rated 31 items as more important than the professionals. Ten of these were related to communication. Caregivers rated 12 items as more important than the parents. A comparable method among parents and professionals of a neonatal intensive care unit revealed that parents rated 25 of 92 items as significantly more important than did the professionals. Two of these were related to medication administration. Caregivers rated seven items as more important. Part V considers two validation studies of the EMPATHIC and EMPATHIC-N questionnaires. The psychometric properties of both questionnaires were satisfactory. Several issues in pediatric intensive care were identified as being below acceptable standards, such as having daily talks with the physician, the physicians preparing the parents about the children's discharge, and the noise levels in the units. For the neonatal intensive care, low ratings were given to the physician's information about expected health outcomes, the distraction of receiving the same information from the physicians and the nurses, and the possibilities for parents to be actively involved in decision-making processes. Part VI discusses the overall results of the EMPATHIC studies. The measures, meanings, and memories of satisfaction are highlighted including the utilization of validated parental satisfaction questionnaires. Finally, future research directives are provided

Perceptions of parents, nurses, and physicians on neonatal intensive care practices

OBJECTIVE: To identify satisfaction with neonatal intensive care as viewed by parents and healthcare professionals and to explore similarities and differences between parents and healthcare professionals. STUDY DESIGN: A 3-round Delphi method to identify neonatal care issues (round 1) and to determine the importance of these issues (rounds 2 and 3) was conducted among nurses (n = 84) and physicians (n = 14), followed by an exploratory survey among parents (n = 259). Main outcome measures were 92 neonatal care-related items. RESULTS: Sixty-eight nurses and 13 physicians completed all 3 rounds. The first round yielded 419 neonatal care related statements, which were clustered into 92 items. The survey was completed by 148 (57%) parents. Parents rated 25 of 92 care items significantly higher than did the professionals (effect size of Cohen's d, 0.31 to 1.14, P <or= .02). Two items related to medication administration had the largest effect size. Professionals rated 7 items significantly higher than didparents (Cohen's d, -0.31 to -0.58, P <or= .04). One of these was assigning a physician and a nurse to the parents. Three were related to multicultural care. CONCLUSIONS: This study revealed disparities between parents and neonatal intensive care unit staff on a number of care issues reflecting incongruity in rec

Construction of a parent satisfaction instrument: Perceptions of pediatric intensive care nurses and physicians

Purpose: The aims of the study were (1) to identify parental satisfaction items through the opinions of pediatric intensive care unit (PICU) nurses and physicians, (2) to reach consensus on the identified items, and (3) to apply factor analysis to evaluate the items and domains toward a PICU parental satisfaction instrument. Materials and Methods: Pediatric intensive care unit nurses and physicians working in 8 university hospitals in the Netherlands participated. A 2-round Delphi method was completed. Confirmatory factor analysis was performed on the satisfaction items and domains. Results: Three hundred two nurses and 62 physicians participated in the Delphi study, and 269 (76%) completed 2 questionnaire rounds. In Delphi round 2, 14 of the 78 items had a mean of less than 8.0 (range, 1 [low importance] to 10 [high importance]). The interquartile range of all domains decreased by almost half, and only 10 satisfaction items had a heterogeneity of less than 70%. Structure determination revealed that 4 satisfaction items needed to be excluded. Out of 74 satisfaction items, 72 showed factor loadings greater than 0.50. The reliability estimates, Cronbach α, for the 6 domains varied from 0.74 to 0.92. Conclusions: Priorities in parental satisfaction measures are identified. The findings are fundamental in the development of a PICU parental satisfaction instrument

Dynamics of earthquake nucleation process represented by the Burridge-Knopoff model

Dynamics of earthquake nucleation process is studied on the basis of the one-dimensional Burridge-Knopoff (BK) model obeying the rate- and state-dependent friction (RSF) law. We investigate the properties of the model at each stage of the nucleation process, including the quasi-static initial phase, the unstable acceleration phase and the high-speed rupture phase or a mainshock. Two kinds of nucleation lengths L_sc and L_c are identified and investigated. The nucleation length L_sc and the initial phase exist only for a weak frictional instability regime, while the nucleation length L_c and the acceleration phase exist for both weak and strong instability regimes. Both L_sc and L_c are found to be determined by the model parameters, the frictional weakening parameter and the elastic stiffness parameter, hardly dependent on the size of an ensuing mainshock. The sliding velocity is extremely slow in the initial phase up to L_sc, of order the pulling speed of the plate, while it reaches a detectable level at a certain stage of the acceleration phase. The continuum limits of the results are discussed. The continuum limit of the BK model lies in the weak frictional instability regime so that a mature homogeneous fault under the RSF law always accompanies the quasi-static nucleation process. Duration times of each stage of the nucleation process are examined. The relation to the elastic continuum model and implications to real seismicity are discussed.Comment: Title changed. Changes mainly in abstract and in section 1. To appear in European Physical Journal

Exploring the role of curriculum materials in teacher professional development

Curriculum materials (schemes of work, lesson plans, etc.) play a complex and pivotal role in school and teacher practices. The adaptation and development of curriculum materials often constitute part of teacher professional development (PD) activities. However, compared with research examining the relationship between PD and teacher professional change, the role of curriculum materials in professional learning remains under-researched and under-theorised. We address this gap by applying a multi-perspectival approach to data from a PD programme in which teachers were supported to develop curriculum materials. We use an interconnected model to analyse the role of curriculum materials in catalysing change in individual teachers’ practice. Our use of Boundary Theory proposes that curriculum material adoption is mediated by the solidity of boundaries between school practice and research findings, and Actor-Network Theory perspectives examine the assemblage of networked relations within and beyond schools that are entangled in curriculum materials. We highlight how combining linear and non-linear perspectives may contribute to improved understanding of the complexity of supporting teachers’ learning and use our analyses to outline implications of using curriculum materials in teacher professional development

Advances in multispectral and hyperspectral imaging for archaeology and art conservation

Multispectral imaging has been applied to the field of art conservation and art history since the early 1990s. It is attractive as a noninvasive imaging technique because it is fast and hence capable of imaging large areas of an object giving both spatial and spectral information. This paper gives an overview of the different instrumental designs, image processing techniques and various applications of multispectral and hyperspectral imaging to art conservation, art history and archaeology. Recent advances in the development of remote and versatile multispectral and hyperspectral imaging as well as techniques in pigment identification will be presented. Future prospects including combination of spectral imaging with other noninvasive imaging and analytical techniques will be discussed

The German EMPATHIC-30 questionnaire showed reliability and convergent validity for use in an intermediary/general pediatric cardiology unit: a psychometric evaluation

Education and Child Studie