I am a staff nurse, working for the past 3 years in the wonderful Paediatric Critical Care Unit in Nottingham Children Hospital. Since I’ve been a student I have been passionate about family centred care and have always strived to support and care for the whole family, not just the patient. For the best part of two years I have been working on this project, honing it and improving it until it has reached what it is today. It has taken a lot of perseverance (or sheer bloody mindedness depending who you talk to) and three failed scholarship attempts before the fantastic Florence Nightingale Foundation awarded me their Travel Scholarship which has led me to where I am now, sat in the Upper East Side with a view of the East River out my window and a little dog called Bitsy watching me type (the dog of my Airbnb host)!
Over the coming weeks I will be keeping this blog to share what I am learning from the different hospitals I am visiting as well as the occasional gratuitous touristy post. First, here is the outline of my project for those new to it.
Review of the delivery and applicability to UK practice of nurse led innovative strategies to improve patient and family wellbeing following an admission to a Paediatric Intensive Care Unit (PICU)
Childhood critical illness affects more than 250,000 children in the UK and US each year. Surviving critical illness can have significant residual negative impact on the child and their families. The aim is to:
1. Investigate evaluated nurse-led support services developed for families whilst children are critically ill and their impact on long-term wellbeing.
2. Identify low cost, innovative approaches to support that could be applied within a UK healthcare context.’
1. Observe how research-based recommendations have been integrated into practice in North American hospitals.
2. Explore how these innovative services involve families in their child’s care on the and how play can be used.
3. Interview nursing staff and (where appropriate) families about their views on these services.
4. Observe transitional care services, which have been successfully developed to help families adapt to leaving PICU for the ward/home.
5. Investigate what education and training has been developed to support the bedside nurses implementing these new services.
6. Report and champion these findings to encourage my own unit and other UK PICUs to develop similar services to improve care and wellbeing in this patient group
7. Identify opportunities for research in this key area of PICU care
Anticipated benefits of the study
The key benefit will be to promote and support the introduction in the UK of strategies developed and evaluated in North America to reduce the long-term psychological and emotional impacts of a PICU admission on the child and their family by:
1. Reporting back on services which could be integrated into UK practice, focusing on those with limited or no resource implications
2. Using the findings to encourage these practices to be embedded in the training and education of nursing staff in PICUs thereby empowering nurses to provide a high standard of family-centred care which leads to the long-term wellbeing of the families .
It is now well recognized that the admission of a child to a PICU is traumatic not just for that child but for the whole family who struggle with anxiety, feeling helpless, and the lack of control over their child’s care. The effects can continue long-term, leaving the child vulnerable to behavioural, emotional and psychological problems and poor academic progress. Both child and family are at risk of symptoms of post-traumatic stress disorder (PTSD) such as anxiety, flashbacks and nightmares.
Although recommendations to address this situation have been reported in the literature, many UK PICU units are currently not implementing them. In the US and Canada there has recently been published research around care initiatives that have been developed and implemented to counteract these adverse effects. These initiatives could be of potential benefit to UK patients admitted to PICUs
Proposals to disseminate the knowledge and experience acquired:
1. Whilst abroad, keep a blog detailing my activities, progress and discussing the knowledge I have gained.
2. Present findings to my colleagues, the senior PCCU nurse team and the senior Nottingham Childrens Hospital Team and discuss what aspects are viable for implementation.
3. Organise teaching sessions with the bedside nursing staff.
4. Prepare an article for publication in order to disseminate my findings to a wider audience and aim to present at a conference, for example at the European Academy of Paediatric Societies Congress.
5. As changes are implemented on the unit, perform service evaluations to assess how the changes are working, with both the staff and families.
6. Aim towards creating a research study to measure and evaluate the longer-term effects of changes implemented.
7. Throughout the whole process, maintain an active presence within the Paediatric Intensive Care Society (PICS) to communicate with the wider PICU community and encourage discussion and debate about my work
May 16th –20th: New York City – Children’s Hospital at Montefiore
May 23rd – June 2nd: Boston – Boston Children’s Hospital
June 4th – 8th: Toronto PICC World Congress
June 13th – 17th: Toronto – Hospital for Sick Children
June 20th – 24th: Montreal – Montreal Children’s Hospital
June 27th – 30th: Vancouver – BC Children’s Hospital
July 11th – 15th: TBC Hopefully Seattle Children’s Hospital