Creating a home with a critically ill child: a qualitative study exploring the experiences of parents of children admitted to paediatric critical care following treatment in neonatal care

Background Survival of children with complex medical conditions has increased over time. Around 5% of children admitted to a neonatal unit (NNU) later have an admission to a paediatric intensive care unit (PICU) in early life. No work to date has explored the needs of parents who have a child admitted to both of these healthcare settings. Objective The overall aim of this study was to understand parents' experiences as they navigate the transition between admissions to the neonatal unit and the paediatric intensive care unit. This paper reports on one of the themes (creating a home) identified inductively from the dataset. Methods We used a qualitative research design using semi-structured interviews with parents who had a child (or children) who had been admitted to neonatal care after birth and then subsequently were also admitted to a PICU. We recruited a national purposive sample of parents with experiences of having a child treated on NNU before being admitted to PICU. We undertook the interviews and transcribed them before taking a reflexive thematic analysis approach. Results A total of 15 mothers and three fathers, of 17 children, were interviewed between January and March 2022. ‘We identified ‘creating a home’ as a key inductive theme with three sub-themes: (1) developing parental roles; (2) creating a physical home and (3) creating core memories. Conclusions There is a growing cohort of children living with chronic health conditions. In this work, we have explored how their parents establish a home whilst often spending significant periods within the public arena of intensive care. Families across settings need support from healthcare professionals to help them develop their role as parents, build a home and to create memories together.</p

What validated instruments, that measure implementation outcomes, are suitable for use in the Paediatric Intensive Care Unit (PICU) setting? A systematic review of systematic reviews

Background/Aims The measurement of implementation outcomes can establish the success of implementingevidence into practice. However, implementation outcomes are seldom measured in acutehealthcare settings, such as Paediatric Intensive Care Units (PICU), and if they are used, arelikely to be non-validated, site or intervention-specific measures. To address this literaturegap, this systematic review of systematic reviews aims to identify validated instruments tomeasure implementation outcomes of new EBP interventions in a PICU setting. Methods A systematic review of systematic reviews was conducted in two phases. Phase One: Fiveelectronic databases were searched between 06/10/22 and 14/10/22. Systematic reviewswere selected using pre-determined eligibility criteria. Methodological quality was assessedusing the Critical Appraisal Skills Programme tool and a data extraction table was used toallow further synthesis. Phase Two: Secondary eligibility criteria were used to extract andreview instruments from the systematic reviews selected in Phase One. Instruments wereanalysed and mapped to the Consolidated Framework of Implementation Research (CFIR). Results  Phase One: Searches resulted in 3195 unique papers. Five systematic reviews were eligiblefor   inclusion.   All   examined   the   psychometric   properties   of   each   instrument,   utilisingdifferent methods to do so; three considered their pragmatic or usability properties; andone identified instruments that were transferrable to different settings. Each systematic review identified that most included instruments had limited evidence of their validity orreliability and had poor psychometric properties. Phase two: 93 instruments were screened,and nine were eligible for analysis. After analysis and CFIR mapping, two instruments wereidentified as potentially adaptable to the PICU setting. Conclusions The   methodological   quality   of   implementation   outcome   measurement   instruments   isinadequate, warranting further validation research. Two instruments were identified thatcover multiple CFIR domains and have scope to be adapted for use when implementingevidence-based practice into the PICU. Further work is needed to adapt and further validatean instrument for use in practice. Registration For transparency of procedures and methods, the protocol for this systematic review was registered with PROSPERO (registration number CRD42022361638L)</p

Understanding the co-construction of safety in the paediatric intensive care unit: a meta-ethnography of parents’ experiences

Background Children experiencing critical illness or injury may require admission to a paediatric intensive care unit (PICU) to receive life-sustaining or life-saving treatment. Studies have explored the experience of parents with a child in PICU but tend to focus on subgroups of children or specific healthcare systems. Therefore, we aimed to undertake a meta-ethnography to draw together the published research. Methods A systematic search strategy was developed to identify qualitative studies, which had explored the experiences of parents with a critically ill child treated in a PICU. A meta-ethnography was undertaken following the structured steps of identifying the topic; undertaking a systematic search; reading the research; determining how the studies relate and translate into each other; and synthesising and expressing the results. Results We identified 2989 articles from our search and after a systematic series of exclusions, 15 papers remaining for inclusion. We explored the original parent voices (first order) and the interpretation of the study authors (second order) to identify three third-order concepts (our interpretation of the findings), which related to technical, relational and temporal factors. These factors influenced parents' experiences, providing both barriers and facilitators to how parents and caregivers experienced the time their child was in the PICU. The dynamic and co-constructed nature of safety provided an analytical overarching frame of reference. Conclusion This synthesis demonstrates novel ways in which parents and caregivers can contribute to the vital role of ensuring a co-created safe healthcare environment for their child when receiving life-saving care within the PICU.</p

Physical, cognitive, emotional, and social health outcomes of parents in the first 6-months after childhood critical illness: A prospective single centre study

Childhood critical illness can have long-term effects on families, but the extent and trajectory of recovery for parents are unknown. Using prospective longitudinal design, we describe the health outcomes of parents and their trajectory six months after paediatric intensive care unit (PICU) discharge. Parents reported health outcomes at PICU discharge (baseline), and 1-, 3-, and 6-months post-discharge. We used the Pediatric Quality-of-Life Family Impact Module, Patient Health Questionnaire-4, and post-traumatic stress disorder (PTSD) Checklist for DSM-5. The group-based trajectory model was used to identify recovery patterns. We included 128 parents of children aged 1 month to 18 years, admitted to the PICU for ≥48 h. Three post-discharge composite health trajectory groups were classified: 54 mild (42%), 68 moderate (53%), and 6 severe (4%). Parents in the mild and moderate groups returned to baseline health within the first 3 months, but those in the severe group exhibited worse outcomes at 6-months. The mean (SD) PICU stay durations for mild, moderate, and severe groups were 9 (16), 7 (10), and 38 (61) days; days of mechanical ventilation were 4 (5), 4 (7), and 18 (25) days; and readmission rates were 12 (22%), 23 (34%), and 4 (66%), respectively. Identifying these trajectories enables novel, targeted interventions for at-risk parents, underscoring the significance of integrated PICU follow-up care.</p

EMpowerment of PArents in THe Intensive Care: A multi-centre validation study in Japan

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