Protective and Unequal? Caregiver Presence During Pediatric Hospitalizations

Abstract

OBJECTIVES: Describe the association between caregiver presence on hospital day 1 and outcomes related to readmissions, pain, and adverse events (AE). METHODS: Caregiver presence during general pediatrics rounds on hospital day 1 was recorded, along with demographic data and clinical outcomes via chart review. AE data were obtained from the safety reporting system. χ2 tests compared demographic characteristics between present and absent caregivers. Background elimination determined significant predictors of caregiver presence and their association with outcomes. RESULTS: A total of 324 families were assessed (34.9% non-Hispanic white, 41.4% Black, 17% Hispanic or Latinx, 6.8% other race or ethnicity). Adolescents (aged ≥14 years) had increased odds of not having a caregiver present compared with 6- to 13-year-olds (36.2% vs 10%; adjusted odds ratio [aOR] 5.11 [95% confidence interval (CI) 1.88–13.87]). Publicly insured children were more likely to not have a caregiver present versus privately insured children (25.1% vs 12.4%; aOR 2.38 [95% CI 1.19–4.73]). Compared with having a caregiver present, children without caregivers were more likely to be readmitted at 7 days (aOR 3.6 [95% CI 1.0–12.2]), receive opiates for moderate/severe pain control (aOR 11.5 [95% CI 1.7–75.7]), and have an AE reported (aOR 4.0 [95% CI 1.0–15.1]). CONCLUSIONS: Adolescents and children with public insurance were less likely to have a caregiver present. Not having a caregiver present was associated with increased readmission, opiate prescription, and AE reporting. Further research is needed to delineate whether associations with clinical outcomes reflect differences in quality of care and decrease barriers to caregiver presence.

From theory to practice: the inclusion of hospitalized children’s families in painful procedures

“…Child hospitalization generates impacts on families. Parents, in particular, experience an emotional turmoil, facing the transfer of their child’s care to health professionals, with renunciation of the parental role of caregiver to the acquisition of a passive role, especially if professionals are not favorable to their inclusion ( 1 , 2 ) . Aiming to change this context, health institutions have included the philosophy of Family-Centered Care (FCC) in their practices.…”

“…Over the past twenty years, research and international bodies have demonstrated the benefits of including the family in invasive procedures and have taken a position in favor (1)(2)(3)6) . However, this advance did not guarantee a translation of knowledge to our clinical practice, noting a frequent family exclusion.…”

Da teoria à prática: a inclusão da família de crianças hospitalizadas nos procedimentos dolorosos

“…A hospitalização de crianças gera impactos às famílias. Os pais, em especial, vivenciam uma turbulência emocional, confrontando-se com a transferência do cuidado de seu filho aos profissionais de saúde, com renúncia do papel parental de cuidador à aquisição de um papel passivo, principalmente se os profissionais não forem favoráveis à sua inclusão (1,2) . Visando modificar esse contexto, as instituições de saúde incluíram a filosofia do Cuidado Centrado na Família (CCF) em suas práticas.…”

“…Nos últimos vinte anos, pesquisas e órgãos internacionais vêm demonstrando benefícios da inclusão da família nos procedimentos invasivos e se posicionando a favor (1)(2)(3)6) . Entretanto, esse avanço não garantiu uma tradução de conhecimento à nossa prática clínica, notando-se uma exclusão familiar frequente.…”