Preventing treatment interference: nurses' and parents' intervention strategies

Treatment interference in children with acute and critical conditions is the conscious or unconscious, threatened or actual disrupting, dislodgment, or removal of the technological equipment/devices used for monitoring and/or treating such conditions. The purpose of this research was to explore the intervention strategies used by critical care nurses and parents as they attempted to maintain the technological interface and avoid treatment interference. Using an ethological approach, data were collected by observing and interviewing 18 children, ages 3 through 6 years, who were hospitalized in the pediatric intensive care unit (PICU) of a pediatric hospital located in the mid-Atlantic region, reviewing systematically their health care records, and interviewing their parents/legal guardians. Field notes were analyzed using a qualitative content analysis. Parents used psychosocial and physiologic strategies, as well as manual restraint, to avoid treatment interference. Nurses used psychosocial, physiologic, activities, and environmental strategies, in addition to physical restraint, to maintain the technological interface.