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Uncovering pain and caring for children in the pediatric intensive care unit: nurses’ clinical approach and parent’s perspective
Department of Clinical Science and Education, Södersjukhuset; Karolinska Institutet, Stockholm.ORCID iD: 0000-0002-4091-3432
2013 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Background: The thesis has a standpoint in a synthesis of caring science and educationscience from a clinical perspective. Children in a Pediatric Intensive Care Unit (PICU) are in an exposed position, dependent on nurses to acknowledge their needs. The alleviation of children’s pain has been investigated from various perspectives, but undertreated pain remains a problem in the PICU. There is a preponderance of empirical evidence pointing toward the role of nurses in uncovering children’s pain and suffering. How nurses interpret the child’s expressions and judge the clinical situation influences their actions in the clinical care. In a PICU, the basis for nurses’ concerns and interpretation of what is meaningful in the nursing care situation are formed by professional concern, workplace culture, traditions, habits, and workplace structures. This influences how parents interpret the meaning of care as well. Patricia Benner’s theory on clinical judgment forms a reference framework for this thesis. The assumption is that children need to be approached from a holistic perspective in the caring situation in order to acknowledge their caring needs. A nurse’s clinical education and insights allow for the possibility to enhance the quality of care for children and parents in the PICU.

Aim: To uncover clinical concerns, from caring and learning perspectives, in caring for children in the Pediatric Intensive Care Unit (PICU) from nurses and parents perspective.

Methods: Qualitative methods were used in all studies to unfold and explore the phenomena in the nurses’ and parents’ everyday clinical life world. In Papers I and II, a phenomenographic method was adopted. In Papers III and IV, an interpretive phenomenological approach was adopted.

Findings: Nurses that have a holistic view of the child and approach the child from a multidimensional perspective, with a focus on the individual child and his/her caring needs, develop a clinical “connoisseurship” and meet the parents’ expectations of the meaning of care. The nurses express that it is only when they focus on the child that subtle signs of pain are revealed. The meaning of nursing care, in the ideal case, is a holistic care where all aspects are integrated and the child as a person has first priority.

Conclusion: The meaning of caring and children’s needs must become elucidated to improve the cultural influence of what can be seen as good nursing care within the PICU.

Place, publisher, year, edition, pages
Karolinska Institutet , 2013. , p. 49
Keywords [en]
Nursing care, clinical judgment, pain, non-verbal children, PICU, caring culture, parental perspectives
National Category
Nursing Anesthesiology and Intensive Care
Identifiers
URN: urn:nbn:se:rkh:diva-1012ISBN: 978-91-7457-977-2 (print)OAI: oai:DiVA.org:rkh-1012DiVA, id: diva2:745011
Public defence
2013-01-18, Ihre, Stockholm, 13:00 (English)
Opponent
Supervisors
Available from: 2014-09-09 Created: 2014-09-09 Last updated: 2014-12-11Bibliographically approved
List of papers
1. Uncovering pain in critically ill non-verbal children: Nurses' clinical experiences in the paediatric intensive care unit
Open this publication in new window or tab >>Uncovering pain in critically ill non-verbal children: Nurses' clinical experiences in the paediatric intensive care unit
2011 (English)In: Journal of Child Health Care, ISSN 1367-4935, E-ISSN 1741-2889, Vol. 15, no 3, p. 187-198Article in journal (Refereed) Published
Abstract [en]

Critically ill paediatric patients are frequently exposed to pain that is required to be assessed and treated effectively. The most reliable resource for assessing pain is the child itself, but children in the paediatric intensive care unit (PICU) are commonly unable to communicate their needs, requiring professional caregivers to uncover and interpret pain. However, nurses and paediatricians do not have sufficient knowledge of how critical illness affects childrens' signs of pain. The aim of this study was to illuminate clinical experiences of pain in the PICU; describing nurses' perceptions of expressions of pain in non-verbal, critically ill 2-6 year old children. The participants were 17 experienced PICU nurses. Data were analysed according to the phenomenographic method and three qualitatively different main categories, gained from clinical experience, emerged: changes in the measurable parameters; perceived muscular tension; and, altered behaviour. Furthermore, contrasting the categories revealed two diverse perspectives to focus pain: measure-oriented and patient-oriented. Subtle expressions of pain were recognised when focus was patient-oriented. These findings support the necessity of actively looking for pain deriving from various perspectives and considering diverse caring needs when doing so. Acknowledging pain makes pain visible.

Place, publisher, year, edition, pages
Sage Publications, 2011
Keywords
Experiential knowledge; Intensive care; Non-verbal; Nurse-child interaction; Paediatric; Pain; PICU; Qualitative approaches
National Category
Nursing Anesthesiology and Intensive Care
Identifiers
urn:nbn:se:rkh:diva-947 (URN)10.1177/1367493511406566 (DOI)21828165 (PubMedID)
Available from: 2012-08-03 Created: 2014-08-28 Last updated: 2017-12-05Bibliographically approved
2. Clinical Judgment of Pain in the Non-Verbal Child at the PICU: A Phenomenographic Study
Open this publication in new window or tab >>Clinical Judgment of Pain in the Non-Verbal Child at the PICU: A Phenomenographic Study
2011 (English)In: Journal of Palliative Care & Medicine, ISSN 2165-7386, Vol. 1, no 1, p. 102-Article in journal (Refereed) Published
National Category
Nursing Anesthesiology and Intensive Care
Identifiers
urn:nbn:se:rkh:diva-946 (URN)10.4172/2165-7386.1000102 (DOI)
Note

Open Access

Available from: 2013-03-15 Created: 2014-08-28 Last updated: 2014-12-11Bibliographically approved
3. Caring for children in pediatric intensive care units: An observation study focusing on nurses' concerns
Open this publication in new window or tab >>Caring for children in pediatric intensive care units: An observation study focusing on nurses' concerns
2013 (English)In: Nursing Ethics, ISSN 0969-7330, E-ISSN 1477-0989, Vol. 20, no 5, p. 528-538Article in journal (Refereed) Published
Abstract [en]

Children in the pediatric intensive care unit are indisputably in a vulnerable position, dependent on nurses to acknowledge their needs. It is assumed that children should be approached from a holistic perspective in the caring situation to meet their caring needs. The aim of the study was to unfold the meaning of nursing care through nurses’ concerns when caring for children in the pediatric intensive care unit. To investigate the qualitative aspects of practice embedded in the caring situation, the interpretive phenomenological approach was adopted for the study. The findings revealed three patterns: medically oriented nursing—here, the nurses attend to just the medical needs, and nursing care is at its minimum, leaving the children’s needs unmet; parent-oriented nursing care—here, the nursing care emphasizes the parents’ needs in the situation, and the children are viewed as a part of the parent and not as an individual child with specific caring needs; and smooth operating nursing care orientation—here, the nursing care is focused on the child as a whole human being, adding value to the nursing care. The conclusion drawn suggests that nursing care does not always respond to the needs of the child, jeopardizing the well-being of the child and leaving them at risk for experiencing pain and suffering. The concerns present in nursing care has been shown to be the divider of the meaning of nursing care and need to become elucidated in order to improve the cultural influence of what can be seen as good nursing care within the pediatric intensive care unit.

Place, publisher, year, edition, pages
Sage Publications, 2013
Keywords
Children, nursing care, phenomenology, pediatric intensive care unit
National Category
Nursing Anesthesiology and Intensive Care
Identifiers
urn:nbn:se:rkh:diva-945 (URN)10.1177/0969733012466000 (DOI)23329781 (PubMedID)
Note

In press in dissertation

Available from: 2013-03-15 Created: 2014-08-28 Last updated: 2017-12-05Bibliographically approved
4. Meaning of caring in pediatric intensive care unit from the perspective of parents: A qualitative study
Open this publication in new window or tab >>Meaning of caring in pediatric intensive care unit from the perspective of parents: A qualitative study
2014 (English)In: Journal of Child Health Care, ISSN 1367-4935, E-ISSN 1741-2889, Vol. 18, no 4, p. 336-345Article in journal (Refereed) Published
Abstract [en]

When children are critically ill, parents still strive to be present and participate in the care of their child. Pediatric intensive care differs from other realms of pediatric care as the nature of care is technically advanced and rather obstructing than encouraging parental involvement or closeness, either physically or emotionally, with the critically ill child. The aim of this study was to elucidate the meaning of caring in the pediatric intensive care unit from the perspective of parents. The design of this study followed Benner's interpretive phenomenological method. Eleven parents of seven children participated in observations and interviews. The following aspects of caring were illustrated in the themes arising from the findings: being a bridge to the child on the edge, building a sheltered atmosphere, meeting the child's needs, and adapting the environment for family life. The overall impression is that the phenomenon of caring is experienced exclusively when it is directed toward the exposed child. The conclusion drawn is that caring is present when providing expert physical care combined with fulfilling emotional needs and supporting continuing daily parental care for the child in an inviting environment.

Place, publisher, year, edition, pages
Sage Publications, 2014
National Category
Nursing Anesthesiology and Intensive Care
Identifiers
urn:nbn:se:rkh:diva-948 (URN)10.1177/1367493513496667 (DOI)23939721 (PubMedID)
Note

As manuscript in dissertation

Available from: 2013-12-09 Created: 2014-08-28 Last updated: 2017-12-05Bibliographically approved

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Mattsson, Janet

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