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Transition and Aftercare Following a Child's Discharge From ICU to a General Ward: A Qualitative Meta-Synthesis of
Hanlin Yang1, Jianlin Ji2, Chengxi Zeng2
1Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China.
Insights
Parental experiences during pediatric intensive care unit (ICU) to general ward transitions are challenging. Understanding these experiences and involving healthcare providers is key to facilitating smoother transitions for critically ill children and their families.
Area of Science:
- Pediatric critical care medicine
- Qualitative research synthesis
- Healthcare transition management
Background:
- Pediatric intensive care unit (ICU) to general ward transitions significantly impair children and parents.
- Understanding parental experiences is crucial for improving transitional care.
- This meta-synthesis addresses the need for better insight into these transitions.
Purpose of the Study:
- To synthesize qualitative studies on parental experiences during pediatric ICU-to-ward transitions.
- To identify key themes and factors influencing these transitions from the parents' perspective.
Main Methods:
- Systematic review and qualitative meta-synthesis.
- Searched nine databases for English and Chinese studies published since 2005.
- Thematic synthesis framework (Thomas and Harden) applied to 18 included studies.
Main Results:
- Parental experiences were characterized as challenging yet met with proactive responses.
- Identified facilitators and barriers impacting the transition process.
- Four descriptive and two analytical themes emerged from the synthesis.
Conclusions:
- Parental experiences during pediatric ICU-to-ward transitions are complex.
- Healthcare providers are vital support systems.
- Collaborative, tailored support from healthcare teams is essential for a smooth transition.
Background:
Transitions from the intensive care unit (ICU) to the general ward cause great impairment of physical and psychosocial functioning in children and their parents. Better understanding of parental experiences during children's ICU-to-ward transitions is required to inform the development of ICU transitional care.
Aim:
To examine the parental experiences during their children's ICU-to-ward transitions through the synthesis of original qualitative studies.
Design:
This study follows the preferred reporting items for systematic reviews and meta-analyses (PRISMA) and the enhancing transparency in reporting the synthesis of qualitative research (ENTREQ) statements, uses Thomas and Harden's thematic synthesis framework rooted in a critical realist philosophy to present qualitative meta-synthesis.
Data Sources:
We conducted a systematic review in June 2024 and searched nine electronic databases including Pubmed, Embase, CINAHL, PsycINFO, Cochrane Library, Sinomed, CNKI, Wanfang and VIP. Eligible studies contained parents quotes about their children's ICU-to-ward transitions and published in either English or Chinese since 2005.
Methods:
Systematic searches yielded 2825 identified studies. Two reviewers screened titles, abstracts and full text and reached consensus through critical discussion with a third reviewer. Eighteen studies were finally agreed for inclusion. Data were extracted into a Microsoft Excel spreadsheet and synthesised through line-by-line coding of relevant quotes with the help of NVivo.
Results:
The qualitative synthesis resulted in four descriptive themes followed later by two analytical themes. Specifically, these were (1) the nature of the parental experience during ICU-to-ward transition (challenging but responded proactively) and (2) factors involved in the ICU-to-ward transition (both facilitators and barriers).
Conclusions:
This study indicates the nature of parental experiences and factors involved during the critically ill child's ICU-to-ward transition. Healthcare providers serve as the primary support network for parents and should collaborate closely with them to facilitate a smooth transition by providing tailored support.
No Patient Or Public Contribution:
This is a meta-synthesis of previously published qualitative studies.
Trial Registration:
We have registered in the PROSPERO and the number is CRD42023422055.
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