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Caring for the Acutely, Severely Ill Child-A Multifaceted Situation with Paradoxical Elements: Swedish Healthcare Professionals' Experiences
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Pediatrics.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH).
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Pediatrics.
2016 (English)In: Journal of Pediatric Nursing: Nursing Care of Children and Families, ISSN 0882-5963, E-ISSN 1532-8449, Vol. 31, no 5, p. E293-E300Article in journal (Refereed) Published
Abstract [en]

Purpose: The aim of this study was to describe healthcare professionals' experience of caring for acutely, severely ill children in hospital in Sweden.

Design and Methods: Five focus group interviews were conducted with nurses, nurse assistants and physicians comprising a total of 20 participants. Data were analyzed using qualitative content analysis.

Results: An overall theme emerged that describes healthcare professionals' experiences as: "being in a multifaceted area of tension with paradoxical elements". The theme is based on three categories: proficiency of the individuals and the team is the fundamental base; interactions are crucial in an area of tension; and wellbeing of the individual is a balance of contradictory emotions. With maintained focus on the ill child, proficiency is the fundamental base, interactions are crucial, and moreover contradictory emotions are described.

Conclusions: The interplay based on proficiency may influence the assessments and treatments of acutely, severely ill children.

Practice Implications: Recognizing the multifaceted area of tension with paradoxical elements, practical teamwork exercises, a structured approach, and assessment tools could be a possible way to develop interprofessional team collaboration to improve the care of acutely, severely ill children in order to increase patient safety.

Place, publisher, year, edition, pages
2016. Vol. 31, no 5, p. E293-E300
Keyword [en]
Content analysis, Interprofessional, Focus groups, Pediatric care, Healthcare professionals, Children
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:uu:diva-306761DOI: 10.1016/j.pedn.2016.05.001ISI: 000384134300001PubMedID: 27237793OAI: oai:DiVA.org:uu-306761DiVA: diva2:1045612
Available from: 2016-11-10 Created: 2016-11-03 Last updated: 2017-12-20Bibliographically approved
In thesis
1. Early Detection and Treatment for Children: Experiences and outcome of implementation at a pediatric hospital
Open this publication in new window or tab >>Early Detection and Treatment for Children: Experiences and outcome of implementation at a pediatric hospital
2018 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Early recognition of severely ill children is necessary to prevent serious adverse events and unexpected death. To promote patient safety the Early Detection and Treatment Program for Children (EDT-C) was developed at a University Children’s Hospital in Sweden. This program consists of validated tools for communication and teamwork combined with the Pediatric Early Warning Score (PEWS) and guidelines for recommended actions. Ward specific guidelines were developed and EDT-C instructors were trained. The aims were to describe healthcare professionals’ experience of caring for acutely, severely ill children (Study I) and to evaluate the implementation of EDT-C (Study II, III, IV). The Promoting Action on Research Implementation in Health Services (PARiHS) framework guided both implementation and the research study.

Before introducing the EDT-C, focus group interviews were performed to explore healthcare professionals’ experience of caring for acutely, severely ill children. A context assessment, using the Alberta Context Tool (ACT) was also conducted. After implementation, a retrospective review of the electronic patient records (EPR) to assess adherence to guidelines were carried out. Instructors’ and healthcare professionals’ experiences from the implementation of EDT-C were gathered through individual interviews. To evaluate the introduction of EDT-C in relation to admission and stay at intensive care a retrospective before-after study using EPR data was performed. Interviews were analyzed using qualitative content analysis and descriptive statistical methods were utilized for quantitative data.

The caring for acutely severely ill children was described as being in a multifaceted area of tension with paradoxical elements where contradictory emotions emerged. According to documentation, children at a very high risk of clinical deterioration according to PEWS were identified. Adherence to actions prescribed in guidelines varied.

 Healthcare professionals and instructors described EDT-C as suitable for clinical practice and that it created a more structured way of working. It was furthermore described that PEWS measurement had become routine practice at the hospital.

EDT-C can lead to increased knowledge about early detection of deterioration, strengthen the healthcare in their profession, optimize treatment and teamwork and thereby has potential to increase patient safety for children treated in hospitals.

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2018. p. 64
Series
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 1410
Keyword
PEWS, Pediatric, Clinical deterioration, inter-professionell, teamwork, ACT, PARiHS
National Category
Pediatrics
Research subject
Medical Science
Identifiers
urn:nbn:se:uu:diva-335920 (URN)978-91-513-0185-3 (ISBN)
Public defence
2018-02-09, Sal IV, Universitetshuset, Biskopsgatan 3, Uppsala, 09:15 (Swedish)
Opponent
Supervisors
Available from: 2018-01-15 Created: 2017-12-11 Last updated: 2018-01-15

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