Parental Presence Research Articles

The Impact of Parental Presence on Emergence Delirium in Pediatric Patients After General Anesthesia: A Systematic Review and Meta-analysis

PurposeThis study reviewed existing literature on parental presence in cases of pediatric patients after general anesthesia and explored its effect on emergence delirium (ED) in the postanesthesia care unit (PACU). DesignSystematic review and meta-analysis. MethodsAfter protocol registration, we searched the PubMed, EMBASE, CINHAL, Web of Science, SCOPUS, and CENTRAL databases. Two authors independently searched and selected the relevant studies, assessed their risk of bias, and abstracted the data. The primary outcome was ED, and the additional outcome was pain. We provided the narrative synthesis and meta-analysis results. FindingsOf the 296 articles retrieved, 6 were included in the narrative synthesis, and 5 were used for the meta-analysis. Four studies were randomized controlled trials, and two studies were nonrandomized controlled trials. There were 348 pediatric patients in the parental presence group and 314 pediatric patients in the usual care group. Parental presence effectively reduced the ED score (mean difference, −0.58; 95% confidence interval [CI], −0.84 to −0.31; P < .001). The ED incidence rate (log odds ratio, −0.58; 95% CI, −1.24 to 0.09; P = .090) and pain score (standardized mean difference, −0.24; 95% CI, −0.57 to 0.10; P = .163) were lower in the parental presence group than in the usual care group. However, the differences were not statistically significant. ConclusionsThe presence of parents in the PACU can reduce ED in pediatric patients. Therefore, parental presence may be a useful intervention in the PACU.

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

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. 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. 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. 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.

Severity of developmental delay and parenting behavior in toddlers with neurodevelopmental disabilities.

The presence of a neurodevelopmental disability (ND) represents an adverse condition for child's development and parent-child relationship, and it is reasonable to assume that the severity of delay may influence parenting behavior. Previous research, however, did not specifically address this issue. This cross-sectional study compared parental behaviors of mothers of toddlers with moderate/severe or mild/borderline developmental delay and mothers of toddlers with typical development, while considering maternal emotional states. A total of 88 dyads with children aged between 12 and 47 months participated in a 10-min video-recorded interaction then coded with the PICCOLO, a validated observation checklist that assesses four dimensions of parenting: affection, responsiveness, encouragement, and teaching. The mothers also fulfilled two standardized questionnaires assessing parental stress and presence of depressive symptoms. MANOVA and MANCOVA models were used to explore between-group differences in specific parenting dimensions, also considering parental stress. Mothers of toddlers with ND were less responsive than the comparison group, while the presence of a moderate/severe developmental delay specifically affected teaching behaviors. No differences emerged for affection and encouragement behaviors. Importantly, although mothers of toddlers with moderate/severe ND reported higher child-related dysfunctional interaction stress, this did not directly affect parenting behaviors. These findings highlight how the presence of a disability and the severity of developmental delay can affect specific dimensions of parenting (i.e., responsiveness, teaching) and might inform clinical practice and research on early parental interventions.

Family Structure Associated with Measles-Rubella and Varicella Vaccination in Children.

Delayed vaccination is a well-studied and critical public health issue. However, limited studies have explored whether familial factors influence vaccination delay. This study aimed to determine whether family structure and comorbidities affect the refusal or delayed receipt of measles-rubella and varicella vaccines. We gathered data on all children from birth to 13 months of age between 2006 and 2020 using vaccination records linked with the administrative healthcare claims data from a Japanese city. Multivariable logistic regression analyses were conducted to examine the association of refusal or delay in receiving the first-dose measles-rubella and varicella vaccines with the following factors: the child's sex; presence of parents, siblings, and grandparents; parental and grandparental comorbidities; chronic pediatric comorbidities in the child and siblings; and year of vaccination. We identified a total of 14,241 eligible children. Refusal or delayed receipt of the first-dose measles-rubella vaccine was associated with an adjusted odds ratio of 2.46 (95% confidence interval, 1.86-3.24) for maternal absence and 1.61 (1.44-1.80) for paternal absence. Similarly, the refusal or delay in receiving the first-dose varicella vaccine was associated with an adjusted odds ratio of 2.04 (95% confidence interval, 1.01-4.16) for maternal absence and 1.37 (1.12-1.69) for paternal absence. The presence of siblings and maternal comorbidities were significantly associated with vaccination delays. The absence of a parent, the presence of siblings, and maternal comorbidities were associated with the refusal or delay in receiving measles-rubella and varicella vaccines. Strategies for vaccine recommendation should therefore consider family structure and maternal comorbidities.

Bioética e Eras: um microcosmo relevante

Abstract The objective of this article is to present a reflection on the concepts and applications of bioethics, its relationship with the development of the moral competence of health professionals, as well as to suggest strategies to mitigate ethical dissonances and clash of paradigms, which can become facilitators of other protocols or institutions. This is an experience report on developing a local protocol to accelerate pediatric cardiac surgical recovery. During this process, the health personnel presented critical points of discussion and dissonance related to venous access, anesthetic induction, parental presence, and pain control. Several reasons were presented and interpreted according to the four main scientific philosophical currents. Considering and reviewing bioethical principles was necessary, especially the autonomy applied to minors and the interrelationship between the principles and their hierarchy of importance. This reinforces the importance of continuing education and the role of medical ethics committees.

The influence of infant sleep problems and sleep training on maternal subjective well-being.

Disturbed sleep during infancy and early childhood can have a detrimental effect on parental sleep and consequently parental well-being. However, there is a paucity of research on how perceived child sleep problems and behavioural sleep interventions as treatment influence maternal subjective well-being. This study aimed to explore the incidence of subjective well-being in mothers of children with sleep problems and whether implementing two behavioural sleep interventions changed their well-being. The research was conducted in a community setting, with parents voluntarily approaching a sleep consultancy based in South Africa. Using data from 119 mothers voluntarily approaching a sleep consultancy in South Africa, a pre-test-post-test design was employed to investigate changes in life satisfaction, affect, couple satisfaction, perceived stress and depression approximately 3 weeks after implementation of a sleep intervention. Results indicate that mothers of children with sleep problems experienced moderate to high life satisfaction and positive affect although the presence of moderate negative affect, couple satisfaction and stress and mild depression suggest possible decreased subjective well-being. Findings suggest implementation of graduated extinction and extinction with parental presence sleep interventions may improve life satisfaction, affect, stress and depression but not couple satisfaction in the short-term. This study contributes towards understanding the effect of sleep loss on the subjective well-being of mothers and provides preliminary evidence regarding the benefits of two sleep interventions for improving maternal subjective well-being.

Parental norms and perceptions regarding use of mobile devices by children under five years.

(1) Most parents are concerned about their children's time on mobile devices. (2) Unrestricted access is associated with increased use of mobile devices in children. (3) Parents are concerned about early exposure to mobile devices by children. (4) Parental presence influences children's mobile device usage time. (5) Need for education and collaboration.

The parental role in the hospital: view of a group of specialist pediatric nurses

Objective Know how Nurses Specialists in Child and Pediatric Health (NSCPH´s) see their care within the scope of the parental role in the hospital context. Methods This was a descriptive study of a qualitative nature that used a focus group, with an intentional sample of 11 specialists working in a university hospital center in the northern region of Portugal in 2022. The data was collected, organized, analyzed for content, and grouped into categories, serving as a basis for the construction of a clinical nursing path within the scope of the parental role. Results Four categories emerged from the data collected: the parental role in the hospital; conditions for a care partnership; the parental role and children’s needs, and training to care. The structure of diagnoses and interventions relating to these categories brought together a consensus among 100% of the nurses in the sample. Conclusion The presence of parents during hospitalization is important. An effective care partnership between parents and nurses is necessary, minimizing the negative impact of hospitalization on children and promoting parental autonomy in care. The systematization of information through a flowchart facilitates the care and standardization of nursing records.

Family Management Skills Reported by Parents of Preterm Infants in the NICU Using the Self- and Family Management Framework (SFMF).

Across the globe, family-integrated care (FICare) has become an evidence-based standard in which parents deliver the majority of infant care in the neonatal intensive care unit (NICU). Because of extensive barriers to parent presence, adaptations to FICare may be required for successful implementation. Family management theory may provide structure to the Parent Education of FICare and help nurses guide parents' skill development as equal care members. To identify family management skills employed by NICU parents using the Self- and Family Management Framework (SFMF). We conducted secondary analyses of qualitative interview data from NICU parents (n = 17) who shared their experiences of using family management skills to care for their infant. We categorized skills according to 3 main self- and family management processes: Focusing on Infant Illness Needs; Activating Resources; and Living With Infant Illness. Parents reported several family management skills currently identified in the SFMF, as well as new skills such as conflict management, power brokerage, and addressing resources related to social determinants of health. Parent activation of resources was critical to sustaining parent focus on the infant's illness needs. By teaching skills that parents reported as helping them manage infant care, neonatal nurses may better facilitate parent integration into the care team. Future researchers can incorporate the skills identified in this study into the design of family management interventions that facilitate FICare implementation in the United States.

Effect of Using Virtual Reality Headset on Children Perioperative Anxiety: A Randomized Clinical Trial

Background: Perioperative anxiety can affect up to 75% of children, which is more harmful than it is for adults. One of the appealing methods for diverting children's attention from difficult situations is virtual reality technology. The purpose of this study is to determine how well a virtual reality headset reduces preoperative anxiety and other undesirable postoperative behaviors in children. Materials And Methods: Eighty children aged five to twelve, who were scheduled for elective day surgery were randomly divided into two groups, each with 40 children. The virtual reality group (VRG) and the non-virtual reality control group, but with parental presence (NVRG). The Visual Facial Analogue Scale (VFAS) was used to measure preoperative anxiety in the holding area and in the operation room during anesthesia induction. Emergency delirium, unfavorable behavioral development, and the parents’ satisfaction were also evaluated postoperatively. Results: The demographic and social parameters of children in both groups were comparable. Most children in VRG showed lower rates of moderate anxiety than NVRG (8% vs. 44%) at the holding area (P˂0.05). At the time of anesthesia induction, the NVRG developed the highest level of anxiety than VRG (8% vs. 0%). However, there were no significant intergroup differences in postoperative emergency delirium or the onset of new negative behavior (P=0.32). Conclusion: Children's participation during the induction of general anesthesia can be improved by using virtual reality distraction technology as a simple, non-invasive, and enjoyable alternative to parental presence.

Effect of video distraction on preoperative anxiety scores in pediatric patients undergoing general anesthesia in ophthalmic daycare procedures: A randomized controlled trial.

Parental separation, fear, and exposure to the operating room environment lead to stress and anxiety in pediatric patients. This study aims to identify the research gaps in the effect of video distraction on pediatric patients of Indian origin. We hypothesized that video distraction along with parental presence would reduce preoperative anxiety in pediatric patients undergoing ophthalmic procedures under general anesthesia compared with parental presence alone. In this prospective randomized trial, 145 patients aged 2-8 years, ASA I-II, with at least one functional eye undergoing elective ophthalmic daycare procedures were enrolled. They were randomly allocated to two Groups: Group V had distraction by watching a video/playing a video game together with parental presence, whereas control Group C had parental presence alone without any video distraction. The primary objective of the study was to compare preoperative anxiety using the Modified Yale Preoperative Anxiety score (mYPAS) and heart rate (HR), whereas the secondary objective was to compare child fear, emergence delirium, and parental satisfaction between the two groups. The three time points for intergroup comparisons were the preoperative holding area 10 min before induction (T0), transport of the child to the operating room (T1), and face mask introduction (T2). There was a statistically significant difference between mYPAS score in groups V and C at all time points (P = 0.036, P = 0.0001, P = 0.0000), parental satisfaction score at all three time points (P = 0.0049, P = 0.0000, P = 0.0000), and Child Fear Score at T1 and T2 (P = 0.0001, P = 0.0001, respectively). However, there was no statistically significant difference in the emergence of delirium between the two groups. Video distraction together with parental presence has a promising role for implementation in hospitals with heavy workload settings where pharmacological intervention would not be feasible, to alleviate preoperative anxiety in children. However, preoperative anxiety may not translate into increased postoperative emergence delirium as was earlier believed.

The Impact of Physical and Environment Factors on Parental Presence for Oral Feeding in New Zealand Neonatal Intensive Care Units.

To identify physical environmental factors influencing family involvement in feeding in New Zealand neonatal units. Infant oral feeding development is critical for both short-term feeding skills and longer term neurodevelopmental outcomes. The neonatal environment is well-known as challenging for neuroprotection due to negative sensory exposure. The impact of environmental factors on oral feeding in New Zealand (NZ) neonatal units is currently unexplored, and knowledge of this could allow for evidence-based unit design. Focused ethnography at five neonatal units, a national survey of NZ neonatal professionals (n = 102), and five focus groups were carried out. Current oral feeding practice, and beliefs, experiences, and opinions of unit staff and family about these practices were explored. Data were analyzed using qualitative content analysis. Units were providing the best experience to families that they could with the resources they had available. Lack of physical space, lack of privacy, limited on-site accommodation for families, and lack of coordination between maternity and neonatal services were identified as impacting on family's comfort and sense of homeliness on the unit. Unit staff used furniture, screens, and external accommodation providers to support families where they could. The physical design of neonatal units in New Zealand provides barriers to family's spending time privately developing oral feeding. Solutions are proposed to increase the size of bedspaces, provide single-family rooms, create greater on-site family accommodation options, combine maternity and neonatal healthcare, and improve family comfort and therefore connection with their infant.

Parental presence during invasive pediatric procedures: what does it depend on?

family-centered care during invasive procedures has been endorsed by many professional health care organizations. The aim of this study was to evaluate the health professionals' attitudes towards parental presence during their child's invasive procedure. pediatric healthcare providers (divided in professional categories and range of ages) from one of the Spain's largest hospitals were asked to complete a questionnaire and write free-text comments. 227 responded the survey. Most (72%) participants, in their answers, reported that parents are sometimes present during interventions, although there were differences between professional categories in this respect. The procedures in which the parents were present were those considered "less invasive" (96% of cases), while only 4% were present in those considered "more invasive". The older the professional, the less necessary parental presence was considered. the attitudes towards parental presence during pediatric invasive procedure are influenced by the professional category, the age of the healthcare provider and the invasiveness of the procedure.

An investigation of the opinions of doctors and nurses and the bioethical dilemmas raised by the presence of parents during nursing and medical procedures in particularly serious medical conditions

An investigation of the opinions of doctors and nurses and the bioethical dilemmas raised by the presence of parents during nursing and medical procedures in particularly serious medical conditions

Parental presence during invasive pediatric procedures: what does it depend on?

Resumen Objetivo: la atención centrada en la familia durante procedimientos invasivos ha sido respaldada por muchas organizaciones profesionales dedicadas al cuidado de la salud. El objetivo de este estudio fue evaluar las actitudes de los profesionales de la salud con respecto a la presencia de los padres durante los procedimientos invasivos realizados en niños. Método: a los prestadores de atención médica en Pediatría (divididos en categorías profesionales y rangos de edad) de uno de los hospitales más importantes de España se les solicitó que respondieran un cuestionario y redactaran comentarios de texto libre. Resultados: un total de 227 profesionales respondieron la encuesta. En sus respuestas, la mayoría (72%) de los participantes informó que, en ocasiones, los padres están presentes durante las intervenciones, aunque se registraron diferencias entre las distintas categorías profesionales al respecto. Los procedimientos en los que los padres estuvieron presentes se consideraron como “menos invasivos” (96% de los casos), mientras que solamente el 4% estuvo presente en los considerados “más invasivos”. A mayor edad de los profesionales, menos necesaria se consideró la presencia de los padres. Conclusión: las actitudes con respecto a la presencia de los padres durante procedimientos pediátricos invasivos se vieron influenciadas por la categoría profesional, la edad del prestador de salud y la invasividad de los procedimientos.

Parental presence during invasive pediatric procedures: what does it depend on?

Resumo Objetivo: o atendimento centrado na família durante procedimentos invasivos tem sido endossado por muitas organizações profissionais de saúde. O objetivo deste estudo foi avaliar as atitudes dos profissionais de saúde em relação à presença dos pais durante o procedimento invasivo realizado em seus filhos. Método: os prestadores de serviços de saúde pediátricos (divididos em categorias profissionais e faixa etária) de um dos maiores hospitais da Espanha foram solicitados a preencher um questionário e escrever comentários de texto livre. Resultados: a pesquisa foi respondida por 227 pessoas. A maioria (72%) dos participantes, em suas respostas, relatou que os pais algumas vezes estão presentes durante as intervenções, embora houvesse diferenças entre as categorias profissionais a esse respeito. Os procedimentos em que os pais estavam presentes eram aqueles considerados “menos invasivos” (96% dos casos), enquanto apenas 4% estavam presentes naqueles considerados “mais invasivos”. Quanto mais velho o profissional, a presença dos pais foi considerada menos necessária. Conclusão: as atitudes em relação à presença dos pais durante o procedimento pediátrico invasivo são influenciadas pela categoria profissional, a idade do prestador de serviço de saúde e a invasividade do procedimento.

Parental presence, participation, and engagement in paediatric hospital care: A conceptual delineation.

To delineate between the concepts of parental presence, participation, and engagement in paediatric hospital care. The concepts' uses in the literature were analysed to determine attributes, influences, and relationships. Delineations of each concept are established and conceptual definitions are proposed following Morses' methods. MEDLINE (PubMed); CINAHL, PsycINFO, Sociology Source Ultimate (EBSCOhost); Embase, Scopus (Elsevier); Google Scholar. Search dates October 2021, February 2023. Multinational publications dated 1991-2023 revealed these concepts represent a range of parental behaviours, beliefs, and actions, which are not always perceptible to nurses, but which are important in family-integrated care delivery. Parental presence is the state of a parent being physically and/or emotionally with their child. Parental participation reflects parents' performing caregiving activities with or without nurses. Parental engagement is a parents' state of emotional involvement in their child's health and the ways they act on their child's behalf. These concepts' manifestations are important to parental role attainment but may be inadequately understood and considered by healthcare providers. Nurses have influence over parents' parental presence, participation, and engagement in their child's care but need support from healthcare institutions to ensure equitable family-integrated care delivery. Problem: Lack of clear definition among these concepts results in incomplete and at times inequitable family-integrated care delivery. Parental presence is an antecedent to parental participation, and parental presence and participation are elements of parental engagement. The concepts interact to influence one another. Hospitalized children, their families, nurses, and researchers will benefit through a better understanding of the concepts' attributes, interactions, and implications for enhanced family-integrated care delivery.

I saw myself as an important piece of a jigsaw puzzle: Parents experiences of their child's anaesthesia induction.

Anxiety in children, as well as their parents, is common in high-tech environments such as an operating room. This study aimed to describe parents' experiences of being present when their child is being anaesthetised. Twenty-four parents were interviewed and data were analysed using a descriptive phenomenological approach. Findings show that being present at a child's anaesthesia and surgery is a long, continuous process that begins at home. Parents struggle to face strong emotions in a special and frightening environment, focussing on their child's well-being while trying to remain control in this situation. Security and trust are vital, but it's challenging to relinquish control in an uncertain situation. Professional caregivers can promote trust and participation, but an awareness that something can go wrong affects parents on a deep level. In conclusion, parental presence at induction of anaesthesia is important but can be overwhelming and anxiety-inducing for some parents. Parents should be seen as a resource rather than a disturbance. Overall, the healthcare system should prioritise parents' involvement and seek to create an environment where they feel supported and included.

Infant pain vs. pain with parental suppression: Immediate and enduring impact on brain, pain and affect.

In the short term, parental presence while a human infant is in pain buffers the immediate pain responses, although emerging evidence suggests repeated social buffering of pain may have untoward long-term effects. To explore the short- and long-term impacts of social buffering of pain, we first measured the infant rat pup's [postnatal day (PN) 8, or 12] response to mild tail shock with the mother present compared to shock alone or no shock. Shock with the mother reduced pain-related behavioral activation and USVs of pups at both ages and reduced Fos expression in the periaqueductal gray, hypothalamic paraventricular nucleus, and the amygdala at PN12 only. At PN12, shock with the mother compared to shock alone differentially regulated expression of several hundred genes related to G-protein-coupled receptors (GPCRs) and neural development, whereas PN8 pups showed a less robust and less coherent expression pattern. In a second set of experiments, pups were exposed to daily repeated Shock-mother pairings (or controls) at PN5-9 or PN10-14 (during and after pain sensitive period, respectively) and long-term outcome assessed in adults. Shock+mother pairing at PN5-9 reduced adult carrageenan-induced thermal hyperalgesia and reduced Fos expression, but PN10-14 pairings had minimal impact. The effect of infant treatment on adult affective behavior showed a complex treatment by age dependent effect. Adult social behavior was decreased following Shock+mother pairings at both PN5-9 and PN10-14, whereas shock alone had no effect. Adult fear responses to a predator odor were decreased only by PN10-14 treatment and the infant Shock alone and Shock+mother did not differ. Overall, integrating these results into our understanding of long-term programming by repeated infant pain experiences, the data suggest that pain experienced within a social context impacts infant neurobehavioral responses and initiates an altered developmental trajectory of pain and affect processing that diverges from experiencing pain alone.

FAMILY CAUSES OF PSYCHOLOGICAL PROBLEMS OF JUNIOR MIDDLE SCHOOL STUDENTS FROM SINGLE-PARENT FAMILIES AND THEIR EFFECTS ON SCHOOL PERFORMANCE

Psychological problems of adolescents have become more common, and changes in the family structure of single-parent families have exacerbated psychological problems and daily behaviour. Different family factors will have different degrees of influence on single-parent families. This research will adopt a qualitative method, in which several junior middle school students from single-parent families are collected through interviewing to understand the students' self-evaluation of the current family and school performance. According to the results of the research, it can be seen that family factors greatly influence adolescents from single-parent families. They are often sensitive, have low self-esteem, and desire companionship and attention. The guardian’s education level and style directly affect adolescents' learning attitudes and behaviour. The lack of parental presence leads to increased psychological problems and poor school performance in adolescents from single-parent families, and adolescents raised by grandparents are less emotionally close to their parents. So, in a single-parent family, the parent's company is the most important. Besides, parents' education style will also significantly impact adolescents' psychology and thus affect their school performance.