The elements of end-of-life care provision in paediatric intensive care units: a systematic integrative review.

BACKGROUND: Deaths in paediatric intensive care units (PICUs) are not uncommon. End-of-life care in PICUs is generally considered more challenging than other settings since it is framed within a context where care is focused on curative or life-sustaining treatments for children who are seriously ill. This review aimed to identify and synthesise literature related to the essential elements in the provision of end-of-life care in the PICU from the perspectives of both healthcare professionals (HCPs) and families. METHODS: A systematic integrative review was conducted by searching EMBASE, CINAHL, MEDLINE, Nursing and Allied Health Database, PsycINFO, Scopus, Web of Science, and Google Scholar databases. Grey literature was searched via Electronic Theses Online Service (EthOS), OpenGrey, Grey literature report. Additionally, hand searches were performed by checking the reference lists of all included papers. Inclusion and exclusion criteria were used to screen retrieved papers by two reviewers independently. The findings were analysed using a constant comparative method. RESULTS: Twenty-one studies met the inclusion criteria. Three elements in end-of-life care provision for children in the PICUs were identified: 1) Assessment of entering the end-of-life stage; 2) Discussion with parents and decision making; 3) End of life care processes, including care provided during the dying phase, care provided at the time of death, and care provided after death. CONCLUSION: The focus of end-of-life care in PICUs varies depending on HCPs' and families' preferences, at different stages such as during the dying phase, at the time of death, and after the child died. Tailoring end-of-life care to families' beliefs and rituals was acknowledged as important by PICU HCPs. This review also emphasises the importance of HCPs collaborating to provide the optimum end-of-life care in the PICU and involving a palliative care team in end-of-life care.

The effect of breastfeeding support provided by video call on postpartum anxiety, breastfeeding self-efficacy, and newborn outcomes: A randomized controlled study.

AIM: To examine the effects of breastfeeding support given by video call on anxiety, breastfeeding self-efficacy, and newborn outcomes. METHODS: We conducted a randomized controlled experimental trial with 72 women and their babies. Participants were randomly assigned to the intervention (video call) group (VCG: standard care + video call) and control group (CG: standard care). The primary outcomes of this study were the mean postpartum maternal anxiety level and the mean breastfeeding self-efficacy level. The secondary outcome was neonatal outcomes. This study followed the CONSORT (Consolidated Standards of Reporting Trials) checklist. RESULTS: Women in VCG had lower anxiety levels than the CG at postpartum 2 weeks (mean difference [MD] 25.42, p = .000) and 1 month (MD 47.72, p = .000). The breastfeeding self-efficacy level of women in the VCG was higher than the CG at postpartum 2 weeks (MD 13.18, p = .007) and 1 month (MD 10.1, p = .001). The newborns in VCG had higher weight gain and daily breastfeeding frequency than the CG at the postpartum second week (MD 9.64, p = .001, MD 2.88, p = .000; respectively) and 1 month (MD 47.16, p = .000, MD 2.98, p = .000; respectively). There were lower rates of challenges of breastfeeding, hyperbilirubinemia, and feeding with formula in VCG than CG at the postpartum second week (p = .043, p = .043, p = .039; respectively). CONCLUSIONS: Breastfeeding support via video calling has positive effects on maternal anxiety, breastfeeding self-efficacy, and newborn health. Postpartum caregivers may benefit from video calling for breastfeeding support.