Working With Families of Suddenly and Critically Ill Children

Abstract

To describe physicians' experiences in attempting to provide optimal care for families of children who suffer from sudden, acute life-threatening conditions (SALTC).Design: To generate descriptive data in this exploratory study, we used qualitative methods including focus groups and in-depth interviews. Transcripts of focus groups and interviews were analyzed for content using standard phenomenologic analysis methods, which resulted in a participant-generated conceptual model of optimal care for families of children with SALTC.Setting: The intensive care unit of an urban pediatric teaching hospital.Participants: Twenty-two pediatric intensive care unit physicians, including residents, fellows, and attendings. Intervention: None.Main Outcome Measures: Each participating physi-cian provided qualitative descriptions of experiences caring for families of children with SALTC.Results: Physicians identified 4 components of optimal care for families: (1) providing timely, accurate information about their child; (2) maintaining privacy for confidential discussions and personal grieving; (3) giving adequate emotional support; and (4) granting family members the right to hold and comfort their dying child. Physicians also described barriers to, and facilitators of this optimal care.Conclusions: Descriptive information provided in this exploratory study offers a complex model of optimal family care. Issues that affect the quality of care to families include those related to the context of providing care in a large teaching hospital, as well as subtleties of communication between parents and staff. Physicians' beliefs about optimal care of families in the pediatric intensive care unit revealed implications for both practice and training in pediatrics.

Talking With Parents About End-of-Life Decisions for Their Children

“…Most of them also find it helpful to share in decisions to withhold or withdraw lifesustaining treatment (LST), decisions that often precede a child's death. 2,3,5,9,11,[16][17][18][19][20] Parents' perception of a shared approach may even lower their grief in the long term. 21 The extent to which parents want to share in the decision-making process differs from parent to parent.…”

Testing the Feasibility of Skype and FaceTime Updates With Parents in the Neonatal Intensive Care Unit

“…10,[16][17][18][19][20] Inconsistent caregivers, poor communication, and mistrust can contribute to conflict between providers and patients' families and to regret. 18,[21][22][23][24] However, provider continuity is unrealistic in intensive care settings because of the involvement of multiple professions and the 24/7 nature of the work. Good relationships between providers and patients' parents are essential during critical illness, when treatment decisions are complex, the environment is chaotic and unfamiliar, and outcomes are uncertain.…”

Uma "boa" morte em UTI pediátrica: é isso possível?

“…35 More often than not, this requires time, a longer time than the medical staff can offer, as well as a larger capacity than the ICU allows. 36 It is known that patients designated as DNR or WD/WHLS have a longer PICU length of stay. 30,37 DNRs were written on average 6.9 days after patients were included in our study.…”