Development and evaluation guideline of family support on resuscitation in pediatric wards: A Sequential Exploratory Mixed method study

Abstract

ABSTRACT Introduction: Resuscitation of a child is one of the most critical times that parents need support, and parental support is fundamental to providing family-centered care in critical care settings. Objective: Development and evaluation guidelines of family support on resuscitation in pediatric wards Methods: The study is mixed-method research with an approach of Exploratory Sequential which is included: the qualitative phase (Conventional Content Analysis, Systematic Review, and Delphi); Connecting phase; quantitative phase; and interpretation phase (providing the final guidelines). This qualitative study utilized content analysis. Participants were 17 parents and 13 pediatric healthcare professionals who shared their experiences and perceptions about parental support for resuscitation of the child through semi-structured and in-depth interviews. The PRISMA model guided the systematic literature search of Google Scholar, PubMed, MEDLINE, CINAHL, Cochrane, and Scopus for studies published until the end of 2021. To consult with a group of experts, the Delphi method was used to design the guidelines. The guidelines were evaluated in the quantitative phase with a quasi-experimental study after using the instructions in critical care units of pediatric hospitals. Results: In this content analysis, participants shared their experiences and perceptions about parental support surrounding child resuscitation in five categories: 1) Information sharing (Awareness of resuscitation, Chaos in providing information, and Providing situational information); 2) parental supporter (Requirement for the presence of a parental supporter, Role of the parental supporter, and Characteristics of the parental supporter); 3) Duality of parents' presence in resuscitation (Not Presence of parents and Presence of parents); 4) Interpersonal supporting communication (Professional communication, Duality of parental surrounding communication, and spiritual and cultural support); and 5) Supportive barriers (Obstacles related to the personnel, Environmental support barriers, and Economic support barriers). Recommendations extracted from Content analysis, Systematic review, and Classic Delphi was combined and prepared as recommendations to support parents during resuscitation. Finally, five guidelines were developed to support parents in the surrounding resuscitation: guidelines for parental support before resuscitation, during resuscitation, after successful resuscitation, after unsuccessful resuscitation, and guideline for parent supporter roles and characteristics. The evaluation results of these guidelines in a quantitative phase showed that the use of these guidelines was effective in reducing acute stress of parents surrounding resuscitation and it was statistically significant (20.25±8.78, P< 0.015). The use of these guidelines also was effective in increasing the perception of staff of family-centered care (71.69 ± 9.95 vs 61.84 ± 10.03), cultural sensitivity of the staff (24.45 ± 4.22 vs 22.81 ± 4.51), and perception of staff of bereaved parent needs (299.24 ± 41.41 vs 287.08 ± 38.29), which were statistically significant (P< 0.001). Finally, according to the results of AGREE II, a score above 70% indicated that the guidelines are appropriate for parental support in the child resuscitation process. Conclusion: The results of this study provide guidelines on parental support in their child's resuscitation crisis. So that the healthcare professionals can provide support to parents Before resuscitation to readiness them for the crisis ahead; During resuscitation by a parental supporter; After successful resuscitation and the possibility of resuscitation again; After the unsuccessful resuscitation in order to say goodbye to their child and to support the bereaved parents. Finaly, the guidelines can be used to enhance family-centered care practices in pediatric critical care settings.