Promoting Partnerships Between Families and Pediatric and Neonatal Intensive Care Units

Abstract

The objective of the systematic review by Barnes et al1 was to examine the impact and experiences of collaborating with families in pediatric critical care.Families of patients in a pediatric or neonatal intensive care unit (NICU) often can experience high levels of stress, depression, and lack of control during this traumatic period. One strategy to improve these experiences is to partner with families and involve them in the care process.2 Patient- and family-centered care in pediatric care includes partnerships among patients, families, and the health care team. A successful partnership is rooted in mutual respect of values, cultures, and beliefs, along with flexibility and an individualized approach.3 Although there have been studies and systematic reviews related to partnering with families in pediatric critical care, the authors of this review did not find any that included both the pediatric ICU (PICU) and the NICU, hence the purpose of this review.The authors of this review included quantitative, qualitative, and mixed-methods studies conducted in the PICU or NICU. Mixed-methods studies strategically combine quantitative and qualitative research methods to leverage the strengths of each, often providing deeper insights into the issue and improving the applicability of the findings.4Barnes et al1 included 48 studies with 19 randomized controlled trials (RCTs), 23 quasi-experimental studies, and 6 qualitative studies. The systematic review examined family psychological and satisfaction outcomes, including anxiety, stress, attachment, depression, and family satisfaction. The interventions included family education, skin-to-skin techniques, massage, enhanced communication among the health care team, participation in clinical rounds, and increased visitation. The JBI methodology was used for conducting a mixed-methods systematic review, and each study was independently assessed for the risk of bias, including selection, performance, detection, attrition, reporting, and publication biases.5 Any disagreements were resolved by reviewing and discussing the data. The standard mean differences (SMDs) with CIs, along with sample size, were extracted from the quantitative data. The extracted qualitative data included context, culture, methods, and the phenomena of interest. Findings of quantitative studies were statistically combined via meta-analysis when possible and others were reported narratively. Qualitative studies were combined through meta-aggregation into synthesized findings.This systematic review highlighted the importance and impact of involving the family when they have a child in the PICU or NICU. The partnership interventions significantly decreased family anxiety and stress and increased satisfaction. One main limitation of this systematic review is the high heterogeneity across studies in the interventions used and in how outcomes were measured. This variability limits the ability to identify the most favorable interventions, and a combination of approaches is likely beneficial.The evidence from this systematic review can inform clinical care team decisions when creating treatment plans for patients in this population. Exploring ways to involve the family in their child’s care through a variety of interventions can significantly improve their overall well-being. These interventions include actively encouraging family participation and empowering families to be involved in the care. An important part of our role as nurses caring for critically ill patients is advocating for the best evidence-based interventions.We must always consider the best available evidence and under-stand the feasibility, appropriateness, meaningfulness, and effectiveness of any intervention to determine whether it is most appropriate to implement in our individual context.