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Do You Know My Child? Continuity of Nursing Care in the Pediatric Intensive Care Unit
Jennifer Baird1, Roberta S Rehm, Pamela S Hinds
1Jennifer Baird, PhD, MSW, RN, is Research Fellow, Boston Children's Hospital, Massachusetts. Roberta S. Rehm, PhD, RN, FAAN, is Associate Professor, School of Nursing, University of California, San Francisco. Pamela S. Hinds, PhD, RN, FAAN, is Director, Nursing Research and Quality Outcomes, Children's National Medical Center, Washington, DC. Christina Baggott, PhD, RN, PNP-BC, is Clinical Research Nurse Practitioner, Pediatric Oncology, Stanford University, Palo Alto, California. Betty Davies, PhD, RN, FAAN, is Professor Emeritus, School of Nursing, University of Victoria, British Columbia, Canada.
Insights
Parents highly value continuity of nursing care for children with complex conditions in the pediatric intensive care unit (PICU). However, staffing and training challenges hinder nurses from consistently providing this continuity.
Area of Science:
- Pediatric Nursing
- Critical Care Medicine
- Family-Centered Care
Background:
- Parents of children with complex, chronic conditions desire continuity of care.
- Understanding nursing continuity in inpatient settings is limited.
Purpose of the Study:
- Explore the delivery of nursing continuity in the pediatric intensive care unit (PICU).
- Examine parent and nurse perspectives on nursing continuity in the PICU.
Main Methods:
- Qualitative grounded theory study using situational analysis.
- Included seven parents and 12 nurses from a single PICU.
- Data collected via interviews, observation, and organizational materials; analyzed using memoing and mapping.
Main Results:
- Parents desire consistent nurses who value their child and understand care complexities.
- Nurses face challenges like staffing fluctuations, training needs, and emotional entanglement.
- Barriers to optimal continuity of care exist in the critical care environment.
Conclusions:
- Continuity of nursing care is highly valued by parents in the PICU.
- Significant barriers impede optimal delivery of nursing continuity.
- Need for support mechanisms for nurses and alternative strategies for parents to ensure knowledgeable care.
Background:
Parents of children with complex, chronic conditions report a desire for continuity of care, but relatively little is known about the ways in which nursing continuity of care occurs and the extent to which it is delivered in the inpatient setting.
Objectives:
The objective of this analysis, which arose from a study on best practices in parent/nurse interactions in the pediatric intensive care unit (PICU), was to explore the delivery of continuity of nursing care in the PICU from the perspective of both parents and nurses.
Methods:
A qualitative, grounded theory study using situational analysis was conducted with seven parents and 12 nurse participants from a single PICU. Data sources included in-depth interviews, observation, and organizational written materials. Data were coded and analyzed using memoing and situational and positional maps to highlight emerging themes, context, and positions within the data.
Results:
Parents repeatedly endorsed a desire for continuity of nursing care, wanting to ensure that the bedside nurse valued their child as an individual and understood the complexities of the child's care regimen. Nurses understood this need but faced both contextual and personal challenges to achieving continuity, including fluctuations in staffing needs, training demands, fear of emotional entanglement, and concern for missed learning opportunities.
Discussion:
Continuity of nursing care is highly valued by parents of children with complex chronic condition in the PICU, but significant barriers to optimal delivery exist within the current critical care environment. Mechanisms for supporting nurses to deliver continuity of care are needed, as are alternative ways to help parents feel that all nurses caring for their child have the knowledge necessary to deliver safe and compassionate care.
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