This study examines the impact of the physical setting in the care and healing process of hospitalized children, their families, and the caregivers in two selected pediatric intensive care units (PICUs) in the U.S. and Turkey. A holistic, cross-cultural, comparative, and naturalistic approach emphasized the importance of the total (i.e., physical, social, cultural, spiritual, organizational, political) environment and quality of life to health and healing. Information was gathered through qualitative methods such as participant observations, behavioral maps, in-depth interviews, and floor plan analysis. Despite some universal features of the PICU atmosphere, the value and place ascribed to pediatric critical care in Turkey and the U.S. present different worldviews. Field studies revealed social interaction as a universal healing function despite its cultural specificity stemming from socio-cultural, ethnic, economic, and religious differences between different groups. Crowding, parental absence, and over-stimulation, which stem from the lack of individual patient rooms, and organizational problems related with human resources and staffing shortage play against the critically ill child’s deep need to heal in the Turkish PICU. Despite spatial limitations, informal social interactions and cooperative relationships among caregivers, their devotion, and their ability to adapt to the existing physical and social environment enable care delivery. While staffing shortage continues to be a crucial problem in the U.S. model, specialization of labor and the systemic organization in general support care delivery, reducing the importance of informal social interactions and cooperation among caregivers. However, emphasizing the role of the family in the child’s care, social interaction is also identified as a healing function in this setting. Therefore, despite the significant role the physical setting may play in healing, social interaction is found to be more important for improving patient outcomes and the well-being of families and caregivers. The study focuses on six healing design interventions to increase the chances for positive social interaction and collaboration. These are programmatic (provisional, scale, locational), functional, ambient, symbolic, social and psychological interventions.

No description available.

The pediatric intensive care unit (PICU) has been described as a stressful place for parents of critically ill children. Research to date has examined parents’ needs and stressors with a child in PICU. There is a paucity of research examining the experience for parents of a child who is transferred from the PICU to the hospital ward. Open-ended interviews were conducted with 10 parents within 24-48 hours after transfer from a PICU to a hospital ward at a children’s hospital in Canada to understand this experience. Parents revealed that the experience involved a search for comfort through transitions as expressed through the themes of: ‘being a parent with a critically ill child is exhausting’, ‘being kept in the know’, ‘feeling supported by others’, and ‘being transferred’. The findings from this study can help nurses and other health professionals working with parents to support them through the transition from PICU. Recommendations are made for the inclusion of family-centered care practices to assist parents through transitions.

Grounded theory methodology has guided the grounded theory methods used to explore the acute care paediatric nurses' perspective of what they do when a child has had a severe accident. The research was initiated from the experience of nursing children in the context of a rehabilitation centre and wondering how acute care nurses promoted a child's recovery after a severe unintentional injury.Many avenues were used to search international and New Zealand literature but the scarcity of literature related to what acute care paediatric nurses do was evident. Therefore this research has the potential of informing the speciality practice of acute care pediatric nursing.Nursing children in the acute care ward after a severe accident is complex. It encompasses nursing the family when they are experiencing a crisis. It is critical that the acute care nurse monitors and ensures the child's physiological needs are met, and the nurse "works with" the child to maintain and advance medical stability. Nursing interactions are an important part of "working with", communication is the essence of nursing. This research has focussed on the nurses' social processes whilst caring for the physical needs of the child and interacting with the family and multidisciplinary team when appropriate.An effective working-relationship with a nurse and family is founded on trust. Trust is an accepted part of our day-to-day lives and how to develop a trusting working-relationship with the child and family has not been explored prior to this research. Grounded theory methods supported the process of exploring the social processes of "building trust" whilst "working with" families in a vulnerable position. Nurses rely on rapport to be invited into a family's space to "work with" and support the re-establishment of the parenting role. The "stepping in and out" of an effective working-relationship with a family is reliant on trust. Nurses build trust by spending time to "be with", using chat to get to know each other, involving and supporting the family to parent a "different" child and reassuring and giving realistic hope to help the child and parents cope with their changed future.A substantive theory of the concept of "building trust to work with" has been developed using grounded theory methods. The theory has been conceptualized using the perspective of seven registered nurses working in paediatric acute care wards that admit children who have had a severe traumatic accident.

Thesis (MHSc--Health Science) -- Auckland University of Technology, 2004. / Also held in print (156 leaves, ill., 30 cm.) in North Shore Theses Collection. (T 618.920028 HAL)

Thesis supervisor: Loreen A. Herwaldt. Includes bibliographic references (p. 151-162).

Thesis (M.A.)--Northern Kentucky University, 2009. / Made available through ProQuest. Publication number: AAT 1462222. ProQuest document ID: 1697854251. Includes bibliographical references (p. 56-60)

M.Cur. / The neonate has the right to quality nursing care and the Neonatal Intensive nursing care practitioner is personally and professionally-ethically liable for quality nursing care. The process of quality improvement is a structured, planned and purposeful action where standards are set and the nursing care is evaluated after which remedial steps are taken to improve quality nursing care. In this study the focus is on the first step in the quality improvement cycle; the setting of standards. The central theoretical statement is as follows: standards for Neonatal Intensive nursing care facilitate quality nursing care in the Neonatal Intensive Care unit. The purpose of the study is to describe and formulate standards for Neonatal Intensive nursing care which can be utilised as an accreditation instrument for institutional self evaluation to improve quality nursing care. The aim of the study is justified by means of a descriptive, explorative, contextual research design. Standards for Neonatal Intensive nursing care were developed and validated by utilising a threephase research method. In phase one subjects for standards were identified by a panel of six experts. They were chosen according to their academic qualifications and nursing experience. The identification was done by means of a critical debate, after which a preliminary conceptual framework was formulated. During the second phase a comprehensive literature control was undertaken to refine the preliminary conceptual framework. The final conceptual framework, that was formulated during phase two, served as a basis for the description and formulation of standards. The standards were divided as unit management standards and clinical nursing care standards. During the third phase a final validation of the standards occured by means of a consencus debate between the experts that were used in the first phase. An accreditation instrument was developed to be utilised for institusional self evaluation in order to facilitate quality nursing care. The standards comply with content validity within the context of a Neonatal Intensive Care unit in a private hospital in Gauteng. It is recommended that the standards are validated nationally in the Neonatal Intensive Care practice in order to be implemented after inservice training to the different role players. The following hypotheses is set for testing: standards for Neonatal Intensive nursing care improve quality nursing care in the Neonatal Intensive Care unit.

The pediatric intensive care unit (PICU) has been described as a stressful place for parents of critically ill children. Research to date has examined parents’ needs and stressors with a child in PICU. There is a paucity of research examining the experience for parents of a child who is transferred from the PICU to the hospital ward. Open-ended interviews were conducted with 10 parents within 24-48 hours after transfer from a PICU to a hospital ward at a children’s hospital in Canada to understand this experience. Parents revealed that the experience involved a search for comfort through transitions as expressed through the themes of: ‘being a parent with a critically ill child is exhausting’, ‘being kept in the know’, ‘feeling supported by others’, and ‘being transferred’. The findings from this study can help nurses and other health professionals working with parents to support them through the transition from PICU. Recommendations are made for the inclusion of family-centered care practices to assist parents through transitions.

Importance: Evidence from randomized controlled trials (RCTs) is required to guide treatment of critically ill children. Unfortunately such evidence is not always available. Objectives: To describe the RCT research enterprise in pediatric critical care — the evidence and the process of creating it, along with problems and some solutions. Methods: To meet these objectives I undertook a series of 5 related studies. First a scoping review to describe the output of the research enterprise. Second, a social network analysis of coauthorship patterns to describe the community of researchers who produce this evidence. Third, a survey to investigate the importance of RCTs in clinicians’ decision-making. Fourth, a survey of trialists to identify barriers and facilitators of high quality RCTs. Fifth, a qualitative interview study to identify acceptable, feasible and effective strategies to improve the evidence available from RCTs in pediatric critical care. Results and conclusions: The number of RCTs in pediatric critical care is increasing but there is a preponderance of small, single-centred RCTs focusing on laboratory or physiological outcomes that are often stopped early because of feasibility problems or futility. The research community is highly fragmented and highly clustered. Experienced trialists identified approaches to improve the pediatric critical care research enterprise, including building a sense of community and ensuring key training and relevant practical experiences for new investigators. Because of the barriers that researchers face and their ethical obligation to undertake trials that are feasible and make a meaningful contribution to advancing the care of critically ill children, individuals and groups must take an active role in building a healthy research community. Only by changing how we function as a research community can we train the next generation of investigators and undertake the type of trials needed to improve the care of critically ill children. / Thesis / Doctor of Philosophy (PhD) / Evidence from randomized controlled trials (RCTs) is required to guide treatment of critically ill children. Unfortunately such evidence is not always available. My objectives in this thesis are to describe the RCT research enterprise in pediatric critical care — the evidence and the process of creating it, along with problems and some solutions. To meet these objectives I undertook a series of 5 related studies: to identify and describe the RCTs, describe how researchers collaborate, understand how clinicians use RCTs, identify barriers and facilitators of conducting high quality RCTs, and understand how we can improve the evidence available from RCTs in pediatric critical care. We found that the number of RCTs is increasing but there are opportunities to improve the methods, outcome measures, and quality of reporting. We identified strategies that researchers can adopt to facilitate the rigorous RCTs that are needed to improve the care of critically ill children.