Prospective Evaluation of Physical Contact with Critically Ill Child on Caregiver Spiritual Wellbeing.

OBJECTIVES: To evaluate whether a pediatric intensive care unit initiative promoting physical contact between caregiver and patient improves caregiver spiritual wellbeing. The secondary objectives were to evaluate caregiver perceptions of care before and after the initiative and to follow unplanned extubation rate as a marker of safety of the initiative. We hypothesized that caregiver spiritual wellbeing and caregiver perceptions of care would improve with implementation of our physical contact initiative known as Project ROSE (Reach Out, Soothe, and Embrace). STUDY DESIGN: Project ROSE was a practice change initiative promoting physical contact between caregiver and hospitalized child in an academic quaternary care pediatric intensive care unit. Caregivers' spiritual wellbeing and perceptions of care were surveyed at days 1 and 4, then compared pre- and postimplementation of the unit-wide initiative. Wilcoxon rank sum tests compared groups (pre- and post-Project ROSE). A total of 331 caregivers returned surveys. RESULTS: We analyzed 331 surveys (pre, n = 174/post, n = 157). Caregiver spiritual wellbeing at enrollment (day 1) was no different between groups (P = .47). Caregiver spiritual wellbeing on day 4 was greater in the postintervention group (pre 40.0 [32.0, 44.0] vs post 42.0 [37.5, 45.0] P = .03). Caregiver perceptions of care improved postintervention. There was no change in the unplanned extubation rate between groups. CONCLUSION: Project ROSE improved caregiver spiritual wellbeing and perceptions of care, was implemented safely, addresses a need in family-centered care of critically ill pediatric patients, and merits consideration for integration into practice.

An evaluation of unit-based ethics conversations.

Unit-based ethics conversations (UBECs) provide nurses with an opportunity for meaningful conversation about the ethical issues they face in routine clinical practice. The goal of the program is to increase participants' abilities and confidence in dealing with ethically challenging situations. This article reviews results from a formal evaluation of UBECs at one organization. The results of this evaluation suggest the UBEC program provides a transformational ethics experience for nurses.

Facilitated ethics conversations: a novel program for managing moral distress in bedside nursing staff.

Moral distress is a prominent problem for bedside nurses, and workable solutions for managing the toll it takes are needed. We created a unit-based ethics conversations program in response to nurses' need to find ways to deal with their moral distress. We review our initial experiences in conducting more than 100 such facilitated conversations in a large hospital system.