Family-Centered Care in the Pediatric Intensive Care Unit.

Aim: To evaluate the application of the principles of Patient and Family-centered Care Methodology: A cross-sectional study was conducted in the Pediatric and Neonatal Intensive care unit of a tertiary care hospital in Punjab, Pakistan. IRB approval was granted, and the study spanned a period from January 2019 to June 2019. A questionnaire was created to survey the pediatric patient's parents. Data analysis was done using SPSS 25. Results: A total of 158 responses were recorded. The majority of the parents felt that patient and family-centered care was not being applied to the admitted patients' management plans in the pediatric and neonatal ICUs. Conclusion: The treatment of patients in the pediatric and neonatal ICUs was not following the principles of patient and family-centered care. Therefore, further studies are required to improve the ease of access, alongside limiting the barriers to the patient and family-centered care in Pakistan. This way, patients can benefit from improved outcomes associated with PFCC. Keywords: Neonatal intensive care unit (NICU), intensive care unit (ICU), pediatric intensive care unit (PICU), patient and family-centered care (PFCC).

Important Outcomes for Parents of Critically Ill Children.

To review extant research on family-centred care in a paediatric intensive care environment and identify gaps in the literature. Family-centred care is currently a core concept in paediatric nursing, focusing on the premise that families are central to a child's well-being, and as such, should be included as equal members of the child's healthcare team. Due to the nature of critical care, family-centred care may be challenging to implement and maintain. An integrative literature review. The review was conducted using the Cumulative Index to Nursing and Allied Health Literature, PubMed, OVID MEDLINE and Google Scholar databases, from 1990 to present. The search focused on the following terms: 'p(a)ediatric critical care', 'paediatric intensive care unit', 'family cent(e)red care', 'parental needs', 'family presence' and 'family/nurse roles'. Additionally, the search was limited to studies conducted in a developed country and published in English. Eighteen studies were included in the review. The results demonstrated that implementing family-centred care into a paediatric intensive care environment posed several challenges. The discrepancy between nurses' and parents' perception of their roles, the reluctance of medical staff to share potentially negative or rapidly changing information, restrictive family presence and poor understanding of family needs emerged as the key difficulties. No studies evaluated strategies to improve family-centred care practice. Family-centred care presents many challenges in a paediatric intensive care environment; however, nurses are uniquely positioned to foster relationships with families, encourage accurate and honest information sharing and advocate for families to be present when they choose. This review outlines the extant research to enhance awareness of the unique state of family-centred care in paediatric intensive care and makes recommendations for future research.

Family-centered Pediatric Perioperative Care

The philosophy of family-centred care is a familiar one among children's nurses and a subject that has been explored for over five decades. It constitutes direct involvement by parents and is an everyday and expected component of care (Coyne et al., 2010). Family-centred care is considered ‘a way of caring for children and their families within health services which ensures that care is planned around the whole family, not just the individual child/person, and in which all the family members are recognized as care recipients’ (Shields et al., 2007, p. 1318). However, there are several challenges for family-centred care in the paediatric intensive care unit (PICU). The physical setting, the ‘busyness’ and the use of advanced technological equipment may inhibit or limit full parental presence or involvement (Bagnasco et al., 2013; Feeg et al., 2015). Additionally, the PICU structure/layout, routines [often requiring long time periods waiting outside the PICU for parents (e.g. to avoid X-ray exposure)] and, worryingly, the existence of restrictive visiting practices in some PICUs are current barriers to full parental participation (Abuqamar et al., 2015; Bagnasco et al., 2013; Baird et al., 2015; Curtis et al., 2015). Additionally, within the wider context of children's nursing it is acknowledged that, even when there is professed family-centred care, children and their parents are not always allowed to become active participants when it comes to decision-making (Feeg et al., 2015; Lambert et al., 2011; Montgomery et al., 2016). This is particularly relevant in PICU where the level of care required is complex and parents may be deemed unable or unwilling to be involved. Overall there are discrepancies and variances in the way heath care professionals perceive and approach PICU family-centred care internationally (Abuqamar et al., 2015; Bagnasco et al., 2013; Baird et al., 2015; Coyne et al., 2016; Curtis et al., 2015; Feeg et al., 2015; Montgomery et al., 2016). It is not known if these discrepancies are because of underlying beliefs, culture variations, national values, national income levels, health care rights or government support (Feeg et al., 2015). First, in the context of modern society, health professionals have come to expect that a parent stays with an admitted child and gives what is described as ‘basic care’ and that parents may not be ‘good parents’ if they do not stay at the bedside (Shields, 2015). In many circumstances, total involvement in physical and psychological caring and tasks by parents and family is sometimes an expectation without careful exploration of child and family wishes or cultural preferences (Coyne et al., 2010). Some of this expectation may have arisen from ongoing nursing staff shortages because nurses may have become more dependent upon parents to be involved to assist them with some of the ‘comfort’ tasks (Shields, 2010; Shields et al., 2006). However, parents need to be able to negotiate with health professionals what their participation will involve, which means negotiating new roles for themselves in sharing care of their sick child (Feeg et al., 2015). In addition to this, while the need for 24 h access to children in PICU is advocated internationally, resources to support this, such as sleeping quarters and refreshment facility for parents, are infrequently or inconsistently provided. Discrepancies are manifested also when looking at open visiting policies in PICU, as both restrictive and open visiting coexist internationally (Bagnasco et al., 2013). As such there are differing conceptualizations of family-centred care, in so far as it can be deemed to be a philosophy, a way of caring, an approach or the professional support of the child and family, an intrusion or an assistance for the nursing staff (Calza et al., 2011). Overall there is an identified need for these conceptualizations to move forward in order to develop a theory of family-centred care that could adequately guide practice, because at the moment the concept is ‘only partially mature’ (Calza et al., 2011, p. 1). In conclusion, various cultures have different ways of conceptualizing family-centred care; therefore, a study to develop a shared vision based on examples of best practice in PICU could be very helpful in defining internationally agreed standards of family-centred care. What is needed both in countries where restrictive visiting applies and internationally where there are inconsistencies in both policies and approaches to relationships, is an innovative and agreed framework with clear practice guidelines for family-centred care in PICU. However, models of care implemented in one setting may not be transferable to another hospital due to contextual differences in setting, processes and management (Curtis et al., 2015). Therefore, research needs to underpin any such initiatives, and has much to offer in PICU in terms of exploring and exposing the subjective life world that exists in each unique PICU situation.

Family-centered care is a proposed way of supporting family involvement with a child's care and decreasing distress associated with a child's critical illness by improving communication, helping manage stress and coping, and decreasing conflicts. Nurses are critical to successful implementation of family-centered care. To describe nurses' perceptions of the benefits and challenges of providing family-centered care in pediatric intensive care units. Semistructured interviews of 10 bedside and charge nurses in pediatric, cardiac, and neonatal intensive care units. Questions were related to 4 domains: the intensive care unit environment and its relationship to the structure and delivery of critical care, stressors for nurses and families, communication challenges and strategies, and involvement of families in care and decision-making. The main thematic finding was the nurses' descriptions of a "balancing act" to provide quality family-centered care. The balancing act was characterized by the interaction between 2 types of changes: (1) intensive care unit policies related to visitation hours and family presence at the bedside and (2) physical transformations in the intensive care unit from shared open space to individual private rooms. All of the nurses viewed the transition to family-centered care as having benefits for families. They also described how changes had created new challenges for the delivery of nursing care in intensive care units, particularly regarding mentorship and the safety of patients and staff.

Family-Centered Critical Care: A Practical Approach to Making It Happen

Ethical Issues in the Care of Emerging Adults in Pediatric Intensive Care Units.

Despite difficult challenges during responses to the terrorist attacks of September 11, 2001, Hurricane Katrina, and the 2009 Pandemic Influenza A/H1N1 and severe acute respiratory syndrome outbreaks, no North American emergency to date has overwhelmed intensive care unit (ICU) services on a widespread basis since the modern development of the field of critical care. However, planners have recognized that in a future public health emergency we may not be so fortunate. To deal with very large emergencies involving many patients whose survival depends on immediate access to intensive care, an international Task Force for Mass Critical Care proposed recommendations in January 2007 to extend critical care resources for the adult population, referred to as the Emergency Mass Critical Care (EMCC) approach (1–5). The EMCC approach triples critical care capabilities for a period of up to 10 days in a very large public health emergency by focusing on immediately life-saving interventions, while delaying or forgoing less urgent care. Crisis standards of care in a large public health emergency would attempt to optimize population outcomes, rather than use unlimited efforts to maximize survival of each individual. Available resources would be substituted or adapted for equivalent or nearly equivalent unavailable resources. Resources would be conserved, reused, and reallocated to those patients most likely to benefit from them. Modest increases in stockpiles and major changes in the organization of care would be essential. While planners in the field acknowledge that mass critical care is a reasonable concept, we lack evidence that such an approach is feasible. However, failure to begin operational planning for mass critical care guarantees a failed response. As public health emergency planners begin to consider the EMCC framework, it is urgent that pediatric implications be detailed for integration into these developing plans. This supplement represents the discussions of a multidisciplinary panel convened by the Oak Ridge Institute for Science and Education (supported financially by the Centers for Disease Control and Prevention), and provides guidance for pediatric EMCC (PEMCC). Work of the PEMCC Task Force was directed by a 17-member Steering Committee selected on the basis of their expertise and experience, and included representatives from the Task Force for Mass Critical Care, World Federation of Pediatric Intensive and Critical Care Societies, American Academy of Pediatrics, American College of Critical Care Medicine, American College of Emergency Medicine, Royal College of Physicians (Canada), and National Commission on Children and Disasters, as well as several unaffiliated disaster preparedness experts. This Steering Committee led development of all manuscripts and selected individuals for the PEMCC Task Force. The full PEMCC Task Force comprised 44 experts from fields including bioethics, pediatric critical care, pediatric trauma and surgery, neonatology, obstetrics, general pediatrics, emergency medicine, pediatric emergency medicine, disaster preparedness and response, emergency medical services (EMS), infectious diseases, toxicology, military medicine, nursing (including critical care nursing), pharmacy, veterinary medicine, information sciences, public health law, maternal and child public health, and local, state, and federal government emergency planning and response agencies. Priority topics were organized on the basis of MEDLINE and Ovid database literature searches, bibliographies, state and federal government planning documents, after-action reports of recent medical responses to catastrophes, and through participation in local, state, and federal government working groups on hospital and disaster preparedness. Where evidence was available, it was utilized in formulating recommendations. Where evidence was lacking, recommendations represent expert opinion. Wherever possible, recommendations are consistent with and easily integrated into prior recommendations of the adult Task Force for Mass Critical Care. The Steering Committee produced draft outlines by synthesizing information obtained in the evidence-gathering process and convened October 6–7, 2009, to review and revise each outline. Eight draft manuscripts were subsequently developed from the revised outlines. The full PEMCC Task Force convened March 29–30, 2010, to present and discuss the draft manuscripts. Feedback on each manuscript was compiled and the Steering Committee modified the draft documents to reflect this input, in addition to updating the manuscripts based on the most current medical literature. The Steering Committee revised the manuscripts from March to October, 2010, working primarily via email and conference calls. New versions were electronically transmitted to all Task Force members to obtain concurrence with manuscript revisions. All authors and reviewers completed disclosure statements; there were no conflicts of interest. The authors were given complete autonomy by the Oak Ridge Institute for Science. The views expressed in these summaries are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention. Based on the recognition of the special needs of children during disasters and extensive discussion, the following recommendations are made by the PEMCC Task Force. These recommendations are described in detail in nine subsequent articles. Readers should refer to individual articles for all recommendations rather than those highlighted in this executive summary. Treatment and Triage Recommendations for PEMCC (p. S109) PEMCC in Pediatric Hospitals. These recommendations provide the basis for hospitals to prepare for PEMCC: Every hospital with a pediatric ICU or neonatal ICU should plan and prepare to provide PEMCC, and should do so in coordination with regional health planning efforts. Hospitals with ICUs should plan and prepare to provide PEMCC every day of the response for a total critically ill patient census at least double the pediatric ICU bed capacity and at least triple usual ICU capability. Hospitals should prepare to deliver PEMCC for 10 days without sufficient external assistance. Care should be coordinated with the emergency department for triage and transfer of patients to/from ICUs. All communities should develop a graded response plan for events across the spectrum from multiple casualties to catastrophic critical care events. To optimize medication availability and safe administration, the Task Force suggests that modified processes of care should be considered before an event, such as the following: rules for medication substitutions and restrictions; safe dose and frequency reduction; conversions from parenteral to oral/enteral administration; shelf-life extension; and use of length-based weight estimations. PEMCC for pediatric patients ideally should occur in hospitals or similarly designed and equipped structures with experience in providing critical care to pediatric patients. Principles for staffing models should include the following: strategies to achieve and maintain adequate staffing levels; patient care assignments for the unit should be managed by the most experienced clinician available; and assignments should be based on staff abilities and experience, with delegation of some duties and efforts to reduce care variability and complications. PEMCC in Nonpediatric Hospitals All hospitals must plan to care for children in their proportion to the population or for those affected by the mass casualty event. To facilitate such planning, nonpediatric hospitals should include a pediatrician or pediatric medical liaison in those committees responsible for disaster planning, appeals, and determining when crisis standards of care should be implemented. During a disaster, it may be more efficient to transfer skilled pediatric critical care teams to nonpediatric centers to support those facilities in providing care to critically ill pediatric patients. Nonpediatric hospitals may not have the pediatric equipment needed to sustain critically ill patients; therefore, these teams may need to take their own equipment. Establish referral network for pediatrics consultation or transfers to support hospitals that do not normally receive pediatric patients. Nonpediatric hospitals should preidentify hospital staff with experience in care of pediatric patients and create key positions in which these individuals would serve. The Task Force was unable to recommend a protocol for allocating scarce pediatric critical care resources (tertiary triage) during PEMCC. However, they suggest that: Resources should be allocated on the basis of need, benefit, the conservation of resources, and finally lottery or queuing. Younger children should not be discriminated against based on age alone. While a validated pediatric scoring system is being developed, tertiary triage should be based on expert opinion and conducted by triage teams, including experienced trauma surgeons and/or intensivists, using their best medical judgment as is the current standard of practice. The Task Force recommends that the American Academy of Pediatrics and the Institute of Medicine, bodies with subject-matter expertise and necessary positioning, develop a set of research priorities for disaster pediatric medicine such that the evidence base can be established to facilitate the development of necessary tools (i.e., decision matrices). Supplies and Equipment for PEMCC (p. S120) This chapter focuses on strategies and paradigms for purchasing and stockpiling equipment that will be necessary in PEMCC. This includes specific equipment (not including personal protective equipment, which is beyond the scope of this chapter) and supply lists necessary to triple pediatric ICU capacity for up to 10 days for a scenario in which the surge includes patients across all ages, and another scenario in which most patients are from a single age group. Recommendations include the deployment of mechanical ventilators including specifications (see p. 128 for further details), ventilation ancillary equipment (including equipment that could be disinfected or sterilized between patient uses in a pandemic situation), other options for assisted ventilation and nonconventional ventilation, suggestions for a ventilator inventory, equipment for hemodynamic management, and supplies for sedation, analgesic, antimicrobials, and nutrition. Additional equipment and supply recommendations necessary for various types of pediatric hospitals to prepare for disasters have been provided by the New York City Department of Health and Mental Hygiene's Pediatric Hospital Disaster Toolkit (http://www.nyc.gov/html/doh/html/bhpp/bhpp-focus-ped-toolkit.shtml); the toolkit has been positively viewed and is an additional resource that should be considered. Neonatal and Pediatric Regionalized Systems in PEMCC (p. S128) This chapter outlines the present system of care in the United States and Canada, and the systems likely to be available for providing mass critical care. Topics discussed in this manuscript include: gaps between anticipated needs and existing resources, changes in functioning of regional systems necessary for PEMCC, protocols for patient transfer, agreements with healthcare institutions that primarily provide adult care, just-in-time training of healthcare workers, transport systems for patients, and allocating staff to other healthcare facilities. Recommendations are provided for operational planning integrated across jurisdictions necessary to implement PEMCC. All preparations for mass critical care for the general population must include pediatric aspects. For this to occur, pediatric experts must be involved in all aspects of emergency and disaster planning. States and Regions. States and regions should: Facilitate PEMCC by providing legal protections for those involved in PEMCC. Reaffirm ethical norms in PEMCC. Ensure that all hospitals are prepared to provide care for children in a mass casualty scenario, including a level or scope of care beyond what they might ordinarily provide during normal operating conditions. Plan to share scarce resources with neighboring states and ensure effective public-private collaboration to meet the needs of a pediatric patient surge and optimize pediatric critical care capacity in a mass casualty event. Develop pediatric-specific performance criteria to hold regional systems accountable for PEMCC preparations and responses. Perform vulnerability analyses to estimate anticipated pediatric mass critical care needs, including especially vulnerable populations. Inventories of functional resources (space, equipment, supplies, and staff) for mass critical care must be performed at every hospital with an ICU. State information systems must be developed to track critical care needs and resources in real time during public health emergencies. Integrate operational plans for mass critical care and triage allocation (rationing) across all jurisdictional levels and all response agencies, and integrated with all aspects of emergency preparedness planning. Define regional mechanisms to direct the distribution of patients and resources in a public health emergency. Federal. Action at the federal level should include: Plans for federal involvement are consistent with state plans for mass critical care and triage allocation (rationing). Federal expertise and guidance to promote consistency in informing state laws and regulations regarding mass critical care and triage allocation (rationing) in public health emergencies. Federal incentives, specific readiness requirements, readiness, and performance measures germane to pediatric care capabilities and capacity to ensure that all states prepare sufficiently for mass critical care and triage allocation (rationing). Federal support for research on best practices ahead of time, as well as real-time surveillance, epidemiologic research, and clinical trials during a public health emergency, which will result in better evidence-based practices at the level of regional systems of care, and better clinical care. Education in a PEMCC setting (p. S135) Prospective and just-in-time training modules for pediatric critical care providers and the public are discussed within this article. Recommended topics for skilled clinicians, particularly those who do not typically treat pediatric patients, include: training in pediatric triage, administration of EMCC coordination and planning, and training in use of nonstandard equipment. As part of comprehensive emergency preparation, educational needs should be identified and addressed. Practitioners should work to maintain their basic pediatric care levels pertinent to their job, and contemplate whether additional training might benefit them in preparation for potential mass critical care events. If they are likely to be involved in a PEMCC response, they should seek out additional proactive training. Hospitals should: identify team leaders and pediatric care providers and encourage them to receive additional training and stay current in the management of critically ill children; identify just-in-time resources that could be used in times of need, and contemplate how they could best implement those resources, particularly if infrastructure, such as internet access, is compromised; and, if they do not have pediatric critical care capabilities, establish a relationship with a regional children's hospital to look for potential educational and training collaboration and offer these courses to their hospital staff. Regional pediatric critical care centers should: maintain an active educational role in both self-education in management of critically ill children and in regional education in their usual referral network; identify potential local hospitals that could help with surge capacity and ensure that those hospitals are receiving necessary training to manage potential surge patients; and work to develop just-in-time resources for remote assistance in training, such as telemedicine or telephone consultation. State/federal/professional societies should fund and develop additional training courses for pediatric mass critical care, both proactive courses and for development, evaluation, and distribution of just-in-time training modules. PEMCC: The role of community preparedness in conserving critical care resources (p. S141) This section of the supplement addresses the role of the wider community in preparing for disasters and PEMCC. Community preparedness reduces extraneous use of hospital resources and conserves scarce critical care resources by delivering population-based care in the community by utilizing the following: citizens, hotlines/healthlines, EMS/9-1-1, alternate care facilities, pediatric-specific agencies and organizations (i.e., schools, daycares, after-school programs), and integration with a health emergency operations center linked to community incident command systems. The Task Force recommends the following actions by pediatric leadership (those who represent, care for, and advocate for children): Actively promote programs to ensure, before and during a crisis, an informed citizenry and the education of children and families in the Centers for Disease Control and Prevention guidelines on community mitigation strategies. Advocate for a community level of preparedness that leads to empowered self-awareness, knowledge of the information that best prepares the public to provide basic lifesaving information and self-care, and builds physical and mental health resilience. Advocate for the establishment of permanent national- and state-level call systems and disease- and child-specific healthlines as crucial adjuncts during public health emergencies. Advocate for 9-1-1 telephone triage with pre-established criteria and protocols for the proper use and safety of EMS and EMS-sanctioned transportation during pandemics. Work with community planners to identify the logistic support necessary for establishing and operating alternate care facilities, and identify and create protocol-driven, patient management objectives based on assumptions about the types of patients that would be managed in such facilities. Advocate for creative operational concepts that provide guidance and protocols sensitive to the needs of the pediatric population. Legal Considerations during PEMCC events (p. S152) Liability is a significant concern for healthcare practitioners and facilities during PEMCC. While many of the legal issues associated with providing PEMCC are not unique within the context of disaster health care, the scope of parens patriae power of state, principles of informed consent, and security should be considered in PEMCC planning and response efforts since parents and legal guardians may be unavailable to participate in decision making during disasters. This article describes the legal considerations inherent in planning for and responding to catastrophic emergencies and makes recommendations for PEMCC legal preparedness. To address gaps in existing liability protections for public health and PEMCC emergency responses, the Task Force recommends strengthening several areas of legal preparedness. As outlined in the Institute of Medicine crisis standards of care guidance (6): Necessary legal protections must be provided for healthcare practitioners and institutions that implement crisis standards of care plans. Unless comprehensive, national liability protections are implemented, state governments must link existing health practitioner and entity liability protections to crisis standards of care. Courts and other adjudicators should consider whether adherence to the Institute of Medicine guidance provides evidence of meeting the standard of care and "the legal effect of changing standards of care during emergencies" in medical malpractice claims. In addition to the Institute of Medicine recommendations, the following suggestions should be considered for PEMCC preparedness: PEMCC disaster protocols should be properly vetted and accepted; when providing pediatric mass critical care, practitioners who follow such accepted and vetted protocols in good faith should be protected from civil liability (5–7). PEMCC protocols should be included in state disaster plans. Health facilities should ensure that their pediatric disaster plans are consistent with state plans and, to the extent possible, with neighboring health facilities. Facilities that care for pediatric patients should develop specific informed consent and security protocols to incorporate into their disaster plans. Facilities that do not normally care for pediatric patients or that do not routinely provide care for critically ill pediatric patients should also consider incorporating such planning or partnering with other facilities that provide such care in the event that pediatric patients arrive at their facilities during emergencies. PEMCC: Focus on family-centered care (p. S157) Family-centered care (FCC) is especially a concern and challenge in PEMCC. This article addresses the tension between offering FCC and effective disaster treatment/triage. It offers a list of practical suggestions for incorporating FCC principles into each of the following healthcare settings during a disaster, including a PEMCC event: EMS transport, emergency departments, pediatric ICUs, general pediatric wards, and alternative sites. Disaster and PEMCC responses must incorporate FCC principles to the extent possible in a variety of healthcare settings. Family-Centered Care in EMS Care of Children. Practical suggestions have been developed for EMS professionals planning for and responding to mass casualty/pandemic events that involve children. These include encouraging families, local pediatricians, and local groups (champions) to engage in every stage of planning and preparation for disasters. FCC in Emergency Departments and ICUs in a Mass Event. Overcrowding, panic, security concerns, staff stress, and separation of families during triage make practicing FCC an imperative and demanding task. The fundamental precepts of FCC, such as attention to the as a of and of the health of the critical to the of disaster The following are some recommendations for emergency department professionals as they plan and to the needs of children and their families in a mass event: possible, EMS and emergency should a to with the child during the triage and This may providing care for parents in addition to children. The local triage and tools should for a and should a of including at least date of and should be obtained as and as possible, and if necessary to the National for and Children an by the government to with families in a mass Mental health professionals in triage and emergency of children should be available on the In the pediatric and of a liaison such as a child or nursing to and general information of to families could reduce on the and skilled medical to the acute needs of critically or patients. FCC in should include a for children with families and proper for children. The Task Force also recommends planning for FCC during PEMCC at alternative and a medical strategies to establishing of when families are and and families, including those with and in PEMCC (p. The specific is ethical issues unique to children in disasters to their and It that children should be not in proportion to existing resources, to their proportion of the general population or those affected by the event. While the ethical principles of triage the for and the lack of a validated pediatric scoring system on expert opinion. The article the to individuals between and of capacity for children should be based on their proportion of the population, or in proportion to those or likely to be affected by the mass critical care event, rather than in proportion to existing standards are to be resources should be allocated on the basis of medical need, medical benefit, and the conservation of resources. the of a validated pediatric the recommends the use of expert opinion. lists are to the Resources should not be allocated based on the complete or on or to in this is essential. The of PEMCC in the developing (p. care in developing is as well as the that can be for offering mass critical care in developed during disasters. in scarce resource and routinely make difficult allocation This article and recommendations for providing the most good with resources through with existing healthcare and using available resources to The of pediatric critical care should include "the of the child with a or in without for the and including emergency, and intensive to disasters in developing have to take into the available resources and (i.e., to provide special needs care that as a of immediate lifesaving The response in these needs to be to the stage of development of the health services and resources. In the must be on care, and basic emergency care, in care should without care resources. in preparing for a pandemic in a developing from public health and and developing strategies for community and mitigation strategies. care strategies must on using the United Health guidelines and for of and of and assistance is provided to during through provided by the Health of 2007 and the Regional emergency response capabilities and their through the Regional with international such as for government (Canada), Department for and will the deployment of scarce resources. are many issues to PEMCC that are such as of triage and decision making and research priorities that need to be addressed. institutions need to make use of these recommendations as guidelines to their readiness and in preparation for PEMCC. The Pediatric Emergency Mass Critical Care Task Force the American Academy of Pediatrics and Disaster for their review and to this

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

The paediatric intensive care unit (PICU) diary is a shared tool, kept at the patient bedside, written by relatives and health care providers. There is little evidence about its feasibility and how it supports the families of children admitted to the PICU. Currently, there is no evidence about how the PICU diary is used and what we can learn from it. To explore the contents of narrative PICU diaries in an Italian PICU. Qualitative study of PICU diaries conducted with a narrative research approach. Children sedated and mechanically ventilated for >48 hours were enrolled in a six-bed Italian PICU of a tertiary care paediatric hospital. During the child's PICU admission, caregivers, relatives, friends, and health care providers were invited to report events, thoughts, and messages, and attach drawings/pictures for the child in the PICU diary. A thematic analysis of the PICU diary contents was performed. Thirteen PICU diaries were completed between August and December 2020, mainly by parents (n=95; 45%) and health care providers (n=52; 25%). Three main themes emerged: "Social and spiritual support," "Caregiver's emotions, feelings and distress," and "PICU life." Diaries offer insight into caregivers' emotions, social support, clinical activities, and interactions with health care providers, and on progression towards recovery. PICU diaries are valuable in facilitating family-centred care by providing a space for the written account of the child's admission by parents, other visitors, and health care providers. PICU diaries support the relationship and the communication between the family and the team; they provide an informal account of the emotions and needs of parents that has the potential to improve mutual understanding and family-centred care. Social support and spiritual support are key elements reported by parents for coping with their child's PICU admission.

Background and Objectives: The optimal implementation of family-centered care requires a better understanding of the attitudes and opinions of treatment personnel and families; therefore, the barriers between the two groups should be recognized. This study was conducted with the aim of investigating the barriers to implementing family-centered care in Pediatric and Infants Intensive Care Units from the perspectives of nurses. Materials and Methods: In this cross-sectional descriptive study, 62 nurses in the pediatric and neonatal intensive care units of Be'sat and Fatemiyeh hospitals in Hamedan were investigated using a census method. The data were collected by the questionnaire of Barriers to Implementing Family-Centered Care in Pediatric and Neonatal Intensive Care Units from the Nurses’ Point of View and analyzed by SPSS software version 23 with descriptive statistical tests. Results: The most important obstacles to the implementation of family-centered care included parents' fear of the patient's condition worsening, a better understanding of the patient's needs by the nurse compared to the parents, parents' lack of self-confidence, nurses making necessary decisions based on medical treatment, and the nurse being the decision-maker regarding the presence or absence of parents. On the other hand, the least important obstacles were found to be the lack of necessary training for nurses, hospital managers' lack of enthusiasm for family-centered care policies, absence of clear policies regarding parental involvement, fear of harm to infants/children due to improper care by parents and staff, and insufficient personnel for the implementation and supervision of family-centered care. Conclusion: The barriers identified in the implementation process of family-centered care from the nurses’ perspectives can be provided to the officials as a guide to formulate strategies for a more powerful implementation of family-centered care.

In paediatric intensive care units (PICUs), advanced medical care meets deeply emotional human experiences. This review examines grief and bereavement support in PICUs, emphasising its significance in extending palliative care beyond end-of-life scenarios. A comprehensive literature search of PubMed and Google Scholar from 2014 to 2023 yielded 50 relevant studies. The findings illustrate the unique challenges in PICUs, such as children’s limited communication abilities, parental distress and emotional burden on healthcare providers. Our review revealed the multifaceted nature of grief in PICUs, including anticipatory and complicated grief, and its profound impact on families and siblings of PICU patients. We identified diverse emotional, psychological, cultural and spiritual support needs that underscored the importance of continuous bereavement care and access to resources. Current support practices, including counselling, support groups, memorial services and interdisciplinary teamwork, are explored. Challenges such as resource limitations, healthcare providers’ emotional toll and communication barriers are discussed. The study also highlights emerging trends such as digital tools, innovative therapies and policy changes to enhance holistic, family-centred care in PICUs.

A critical ethnographic look at paediatric intensive care nurses and the determinants of nurses’ job satisfaction

What Are You Doing to My Child? A Novel Approach to Family Teaching in the Pediatric Intensive Care Unit.