Review of the delivery and applicability to UK practice of nurse led innovative strategies to improve patient and family wellbeing following an admission to a Paediatric Intensive Care Unit (PICU).

Background

Childhood critical illness affects around 250000 children in the UK and the US every year. Research shows admission of a child to PICU can have a significant negative impact on both the child and their family’s psychological and emotional wellbeing (Melynk et al, 2004), however there is limited information in the research on how to identify those most at risk. In the US and Canada, there have been recently published research on care initiatives developed to counteract these adverse effects.

The aims of the Scholarship were to:

  1. Investigate evaluated nurse-led support services in the US and Canada that were developed for families whilst their child is critically ill and look at their impact on long-term well being.
  2. Identify low cost, innovative approaches to supporting families that could be applied within a UK healthcare context.

I visited the following hospitals in the US and Canada who were identified from the research as undertaking work in the field:

  • Childrens Hospital at Montefiore, New York
  • Boston Children’s Hospital
  • Hospital for Sick Children, Toronto
  • Montreal Children’s Hospital
  • BC Children’s Hospital, Vancouver
  • Alberta Children’s Hospital, Calgary

I held informal interviews with the key staff in the units, observe practices and explore the nurse education taking place.

I also reflected on and analysed the information gained from these visits.

Findings

There is no ‘one size fits all’ solution and more research is needed. However provision of good quality patient and family centred care (PFCC) as standard and the capacity to tailor emotional and practical support to the family’s needs helps families stay engaged with their child’s care and feel more empowered on discharge. The provision of a follow up service can help identify families struggling at home.

Recommendations

  • To disseminate these findings and raise awareness of the impact a PICU admission can have on families and on the importance of good PFCC in UK PICU’s. I am currently preparing a presentation for a Children’s Hospital meeting to disseminate my work outside of the PICU unit and am joining a new collaboration with other PICU’s across the UK looking at PFCC where I will further share my findings.
  • Improve the education provided to nurses on providing PFCC, communication techniques and in understanding the importance of helping families feel more engaged and empowered in their child’s care. After discussion with the nurse educators on my unit I have been given some teaching time with the next group of newly qualified nurses starting on the unit. I will get the session evaluated so I can assess its impact.
  • Collaborate with the hospital play specialist team to improve the support we provide to siblings and to create a resource for families on engaging with their child during their admission, after discharge and to provide advice on how to support their other children through a PICU admission.
  • To form a Family Centred Care Committee to allow members of the MDT to work together identifying the priorities for PFCC on the unit, implement solutions and evaluate progress with use of a validated family satisfaction questionnaire. I am currently in talks with the senior nursing team to start a committee, potentially using a shared governance format.
  • Develop the role of a PICU family liaison nurse – the role would allow a nurse specialist to provide emotional and practical support to families during their PICU admission, then on transfer to the ward and after discharge as well as provide support and education to the staff. The senior nursing and medical team on my PICU are enthusiastic and supportive of this recommendation but as it requires a higher level of resources it cannot be guaranteed. I am therefore writing a business plan for this role.
  • Explore further the need on our unit for any intervention to identify and prevent moral distress amongst frontline staff and liaise with other PICU’s in the UK to see what work, if any, is being done elsewhere on this subject.

Conclusion

This travel scholarship has equipped me with the knowledge and resources to understand methods of helping families during a PICU admission and with the drive and motivation to collaborate with different teams to improve PFCC and implement positive change in to the care provided on PICU.

Share this: