Parental presence, participation, and engagement in paediatric hospital care: A conceptual delineation.

AIM: To delineate between the concepts of parental presence, participation, and engagement in paediatric hospital care. DESIGN: The concepts' uses in the literature were analysed to determine attributes, influences, and relationships. METHODS: Delineations of each concept are established and conceptual definitions are proposed following Morses' methods. DATA SOURCES: MEDLINE (PubMed); CINAHL, PsycINFO, Sociology Source Ultimate (EBSCOhost); Embase, Scopus (Elsevier); Google Scholar. Search dates October 2021, February 2023. RESULTS: Multinational publications dated 1991-2023 revealed these concepts represent a range of parental behaviours, beliefs, and actions, which are not always perceptible to nurses, but which are important in family-integrated care delivery. Parental presence is the state of a parent being physically and/or emotionally with their child. Parental participation reflects parents' performing caregiving activities with or without nurses. Parental engagement is a parents' state of emotional involvement in their child's health and the ways they act on their child's behalf. CONCLUSION: These concepts' manifestations are important to parental role attainment but may be inadequately understood and considered by healthcare providers. IMPLICATIONS: Nurses have influence over parents' parental presence, participation, and engagement in their child's care but need support from healthcare institutions to ensure equitable family-integrated care delivery. IMPACT: Problem: Lack of clear definition among these concepts results in incomplete and at times inequitable family-integrated care delivery. FINDINGS: Parental presence is an antecedent to parental participation, and parental presence and participation are elements of parental engagement. The concepts interact to influence one another. IMPACT: Hospitalized children, their families, nurses, and researchers will benefit through a better understanding of the concepts' attributes, interactions, and implications for enhanced family-integrated care delivery.

Shifting the Paradigm: A Quality Improvement Approach to Proactive Cardiac Arrest Reduction in the Pediatric Cardiac Intensive Care Unit.

INTRODUCTION: Children with cardiac conditions are at higher risk of in-hospital pediatric cardiopulmonary arrest (CA), resulting in significant morbidity and mortality. Despite the elevated risk, proactive cardiac arrest prevention programs in the cardiac intensive care unit (CICU) remain underdeveloped. Our team developed a multidisciplinary program centered on developing a quality improvement (QI) bundle for patients at high risk of CA. METHODS: This project occurred in a 26-bed pediatric CICU of a tertiary care children's hospital. Statistical process control methodology tracked changes in CA rates over time. The global aim was to reduce CICU mortality; the smart aim was to reduce the CA rate by 50% over 12 months. Interprofessional development and implementation of a QI bundle included visual cues to identify high-risk patients, risk mitigation strategies, a new rounding paradigm, and defined escalation algorithms. Additionally, weekly event and long-term data reviews, arrest debriefs, and weekly unit-wide dissemination of key findings supported a culture change. RESULTS: After bundle implementation, CA rates decreased by 68% compared to baseline and 45% from the historical baseline. Major complications decreased from 17.1% to 12.6% (P < 0.001) and mortality decreased from 5.7% to 5.0% (P = 0.048). These results were sustained for 30 months. CONCLUSIONS: Cardiac arrest is a modifiable, rather than inevitable, metric in the CICU. Reduction is achievable through the interprofessional implementation of bundled interventions targeting proactive CA prevention. Once incorporated into widespread efforts to engage multidisciplinary CICU stakeholders, these patient-focused interventions resulted in sustained improvement.

Going Beyond Position Statements: One Hospital's Successful Initiative to Implement Napping for Night Shift Nurses.

BACKGROUND: Sleepiness during the night shift is associated with errors, accidents, injuries, and drowsy driving. Despite scientific evidence that supports brief naps to reduce sleepiness, and guidance documents from policy organizations, napping has not been widely implemented. METHODS: An initiative to translate scientific evidence about napping was implemented in one hospital over one year. The initiative included garnering leadership support and resources, building a translation team, evaluating the evidence, responding to operational concerns, developing an implementation strategy, and then implementing and evaluating the results. Night shift nurses were surveyed pre and post nap implementation for drowsy driving, sleepiness, and work and coworker relationships. Qualitative data documented the nurses' perceptions about napping. FINDINGS: Three-fourths of the units that were eligible to nap successfully implemented and sustained napping. Most nurses felt refreshed by a brief nap and felt safer on the drive home, but one-fourth worried about or had sleep inertia symptoms. Drowsy driving remained unacceptably high. CONCLUSION: The initiative was successfully implemented on most nursing units. The mixed reaction to napping, and the unfavorable drowsy driving outcome point to the need for additional interventions to reduce sleepiness.