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Participation in pediatric perioperative care: "what it means for parents"
Halmstad University, School of Health and Welfare, Centre of Research on Welfare, Health and Sport (CVHI). Region Halland, Halmstad, Sweden & Halmstad Hospital, Halmstad, Sweden.ORCID iD: 0000-0002-9877-7357
Halmstad University, School of Health and Welfare, Centre of Research on Welfare, Health and Sport (CVHI). (Barns hälsa och hållbara uppväxt)ORCID iD: 0000-0003-4438-6673
Halmstad University, School of Health and Welfare, Centre of Research on Welfare, Health and Sport (CVHI).ORCID iD: 0000-0002-3576-2393
Halmstad University, School of Health and Welfare, Centre of Research on Welfare, Health and Sport (CVHI). (Barns hälsa och hållbara uppväxt)ORCID iD: 0000-0001-8354-3382
2017 (English)In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 26, no 23-24, p. 4246-4254Article in journal (Refereed) Published
Abstract [en]

Aims and objectives: To explore what it means for parents to participate in their children's paediatric perioperative care.

Background: Allowing parents to participate in paediatric perioperative care can make a major difference for children in terms of their well-being, a decreased need for painkillers, fewer sleeping disorders and a more positive experience for both parties. The nurse anaesthetist should have a holistic view and develop a shared vision for the child, the parents and for themselves to perform successful paediatric perioperative care.

Design: Descriptive qualitative study.

Methods: The study was conducted in 2014. Data were collected in 20 narrative interviews with 15 mothers and five fathers who had experience of participating in their child's paediatric perioperative day surgery. The analysis was carried out with qualitative content analysis to describe the variations, differences and similarities in the experiences.

Results: The analysis revealed a main category that describes that parental participation in the context of paediatric perioperative care in day surgery meant 'having strength to participate despite an increased vulnerability'. Three generic categories with additional subcategories explained what was essential for the parents to be able to preserve this strength and participate in their child's care despite their increased vulnerability. The generic categories were named, 'gaining information about what will happen', 'being seen as a resource' and 'gaining access to the environment'.

Conclusion: Efforts should be made to improve parents' roles and opportunities to participate in paediatric perioperative care.

Relevance to clinical practice: Nurse anaesthetists have a crucial role in enabling parents' participation and need knowledge to develop strategies and nursing interventions that meet parents' needs. © 2017 John Wiley & Sons Ltd.

Place, publisher, year, edition, pages
Chichester: Wiley-Blackwell Publishing Inc., 2017. Vol. 26, no 23-24, p. 4246-4254
Keywords [en]
Advanced Nursing, Anxiety, Child, Decision-making, Family-Centred care, Nurse-Patient Relationships, Parent, Preoperative, Qualitative Approaches
National Category
Nursing
Identifiers
URN: urn:nbn:se:hh:diva-33585DOI: 10.1111/jocn.13747ISI: 000416319600038PubMedID: 28152208Scopus ID: 2-s2.0-85016469835OAI: oai:DiVA.org:hh-33585DiVA, id: diva2:1083293
Projects
Hälsa och hållbar uppväxt
Note

Funding: Partial funding for the study came from Region Halland in Sweden.

Available from: 2017-03-20 Created: 2017-03-20 Last updated: 2020-08-28Bibliographically approved
In thesis
1. Barncentrerat förhållningssätt i perioperativ vård
Open this publication in new window or tab >>Barncentrerat förhållningssätt i perioperativ vård
2020 (Swedish)Doctoral thesis, comprehensive summary (Other academic)
Abstract [sv]

Bakgrund: Barns möjligheter att involveras i den perioperativa vårdkontexten kan förbättras med ett barncentrerat förhållningssätt. För att uppnå detta behöver hänsyn både tas till att barn är beroende av sin familj och att de som enskilda individer ska involveras och vara medaktörer i sin vård. Barns involvering i den perioperativa vården har många fördelar. Det bidrar till minskad oro och rädsla och att barnet kan stärka sin kompetens och bli behandlad med respekt. Barn upplever dock att det är svårt för dem att vara delaktiga och att ha kontroll i den främmande och skrämmande perioperativa sjukhusmiljön. Barns möjligheter att vara delaktiga i den perioperativa vården är därför beroende av föräldrar och hälso-och sjukvårdspersonal liksom rutiner och fördelning av resurser i vården. Det är därför viktigt att de vuxna som ska stödja barnen har förståelse för att barn är unika och uppfattar saker ur sitt eget perspektiv baserat på sina erfarenheter.

Syfte: Det övergripande syftet med avhandlingen var att öka förståelsen för vad ett barncentrerat förhållningssätt innebär inom perioperativ vård - utifrån barn, föräldrars och ett organisatoriskt perspektiv. 

Metod: I delarbete I användes en deskriptiv kvalitativ design med intervjuer av 10 barn (8 till 11år). Delarbete II hade en explorativ kvalitativ design med intervjuer av 20 föräldrar. Delarbete I och II analyserades med kvalitativ innehållsanalys för att beskriva barn och föräldrars erfarenheter av delaktighet i pediatrisk perioperativ vård. I delarbete III användes en explorativ kvalitativ design med intervjuer av hälso-och sjukvårdpersonal. Analysen genomfördes med grundad teori för att utforska processen av ett organisatoriskt förbättringsarbete för barn som genomgick sedering för intratekal cytostatikabehandling. I delarbete IV användes en deduktiv kvantitativ design med registerdata och analys med deskriptiv statistik för att beskriva tidsintervall och använd Propofol-dos vid sedering för intratekal cytostatikabehandling i tre olika miljöer. 

Resultat: Delarbete I visar att barns upplevelse av delaktighet påverkats av hur de informerats inför och under det perioperativa vårdförloppet. Vidare har relationen till hälso-och sjukvårdspersonalen haft betydelse för barns möjligheter att involveras i beslutsfattande. Dessutom har sjukhusmiljön, väntetid och möjligheter att förströ sig haft inflytande på barns upplevelse av delaktighet. I delarbete II beskriver huvudkategorin att föräldrars delaktighet i pediatrisk perioperativa vård vid dagkirurgi betydde ”Having strength to participate despite an increased vulnerability ”. Tillsammans med underkategorierna; få information om vad som ska hända, att bli sedd som en resurs och att få tillgång till miljön. I delarbete III beskriver “The theory of a shielding place” hur hälso-och sjukvårdspersonalen med ett barncentrerat förhållningssätt utförde proceduren sedering för intratekal cytostatikabehandling på barnavdelningen. Resultatet i delarbete IV kontrollerar och kvantifierar objektivt delar av resultatet från delarbete III. Genom att visa att när proceduren utförs på barnavdelningen minskas väntetid och tidsåtgång för proceduren som helhet.  

Konklusion: För barn och föräldrar som genomgår dagkirurgi har information, samspelet med hälso-och sjukvårdspersonalen och miljön haft betydelse för upplevelsen av delaktighet. Ur ett organisatoriskt perspektiv påverkas ett barncentrerat förhållningssätt av de rutiner som har betydelse för hur barn och föräldrar förbereds. Resurser och rutiner påverkar också om sjukhusmiljöer är anpassade för barn, väntetid och tidsåtgång, liksom relationer mellan barn och hälso-och sjukvårdspersonal.

Abstract [en]

Background: Children's opportunities to be involved in the perioperative care context can be enhanced with a child-centered approach. To achieve this, consideration must be given both to the fact that children are dependent on their family and that they, as individuals, must be involved and be co-actors in their care. The involvement of children in perioperative care has many advantages. It contributes to reduced anxiety and fear and that the child can strengthen his or her skills and be treated with respect. However, children feel that it is difficult for them to be involved and to have control in the strange and frightening peri-operative hospital environment. Therefore, children's opportunities to participate in peri-operative care depend on parents and health care personnel, as well as routines and distribution of resources in the care. It is therefore important that the adults who support the children have an understanding that children are unique and perceive things from their own perspective based on their experiences.

Aim: The overall aim of this dissertation was to increase the understanding of what a child-centered approach means in perioperative care - from the perspective of children, parents and an organizational perspective.

Method: Study I was conducted with a descriptive qualitative design and interviews with 10 children (8 to 11 years). Study II had an explorative qualitative design with interviews of 20 parents. Study I and II were analyzed with qualitative content analysis to describe children and parents' experiences of participation in pediatric perioperative care. Study III used an explorative qualitative design with interviews with healthcare professionals. Analysis was conducted with grounded theory to explore the social processes of a quality improvement work for children undergoing sedation for intrathecal cytostatic therapy. Study IV had a deductive quantitative design with register data and analysis with descriptive statistics to describe time intervals and Propofol dose used during sedation for intrathecal cytostatic therapy for children in different environments. 

Results: Study I shows that children´s experience of participation was influenced by information before and during the perioperative care period. Furthermore, the relationship with the healthcare professionals was important for being involved in decision making. In addition, the hospital environment, waiting time and opportunities for distraction had an impact on children's experience of participation. The main category in study II describes that parental participation in the context of pediatric perioperative care in day surgery can be understood as "having strength to participate despite an increased vulnerability" and further described by the subcategories; gaining information about what will happen, being seen as a resource and gaining access to the environment. In study III, "The theory of creating a shielding place" described how healthcare professionals with a child centered approach performed sedation for intrathecal chemotherapy for pediatric leukaemia at the children´s ward. The result in study IV controlled and quantified objective tacit knowledge from study  III and confirmed that sedation for intrathecal chemotherapy at the pediatric ward reduced the waiting time and time for the procedure as a whole.

Conclusion: For children who undergo day surgery, and parents who participate in pediatric perioperative care, information, interaction with health care professionals and the environment had impact on their experience of participation. From an organizational perspective a child centered approach is influenced by routines that affect how children and parents are informed and prepared. Resources and routines also affect whether hospital environments are adapted for children´s needs, waiting time, expenditure of time, as well as relationships between children and the healthcare professionals.

Place, publisher, year, edition, pages
Halmstad: Halmstad University Press, 2020. p. 82
Series
Halmstad University Dissertations ; 71
Keywords
Childcentered care, Perioperative care, Anesthetic Nursing, Barncentrerad vård, Perioperativ vård, Anestesiologisk omvådnad
National Category
Nursing
Identifiers
urn:nbn:se:hh:diva-42955 (URN)978-91-88749-51-2 (ISBN)978-91-88749-50-5 (ISBN)
Public defence
2020-09-25, Baertlingsalen, Visionen (Hus J), Kristian IV:s väg 3, Halmstad, 09:00 (Swedish)
Opponent
Supervisors
Available from: 2020-09-01 Created: 2020-08-28 Last updated: 2020-09-04Bibliographically approved

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Sjöberg, CarinaSvedberg, PetraNygren, Jens M.Carlsson, Ing-Marie

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