Emergency department (ED) nurses exposed to pediatric resuscitations are at a high risk of developing posttraumatic stress (Adriaenssens et al., 2012; Lavoie et al., 2016). This may be especially true in community hospital EDs where nurses have less exposure to, knowledge about, and resources for managing these events (Gangadharan et al., 2018; Gilleland et al., 2014; Goldman et al., 2018). Interventions to proactively prevent nurse trauma in these contexts remain uninvestigated. To inform such interventions, this study aimed to understand the largely unknown lived experiences of these nurses. In-depth, semi-structured interviews were conducted with four registered nurses who experienced at least one pediatric resuscitation while working in a community hospital ED in Ontario. Data analyzed using Smith et al.’s (2009) interpretive phenomenological analysis revealed three superordinate themes (i.e., “Conceptualizing Pediatric Resuscitations,” “Seeing What I See,” and “Making Sense of What I Saw”) and nine corresponding subthemes. This study provides insight into the infrequent but profound experiences of nurses resuscitating children in community hospital EDs. Participants, who conceptualized these events as unnatural, emotional, and chaotic, were comforted by those who understood their experiences and distressed by those who could not see what they saw. To reconcile what they saw, the nurses reflected and ruminated on the event, ultimately restructuring their experiences of themselves, others, and the world to make room for a new reality where the safety of childhood is not certain. The findings of this study have implications for nursing practice, education, leadership, and research that may enhance nurse coping following these events.

Background One of the most stressful and frightening healthcare experiences for a parent is a cardiorespiratory arrest of their child. Each year, almost 16,000 American children experience cardiorespiratory arrest and attempted resuscitation in hospitals. This experience is traumatic for parents and may lead to a post-traumatic stress response as they fear their child will die or be seriously harmed. Post-traumatic stress response can ultimately lead to deficits in family functioning. There is limited knowledge about the experience of parents during a child’s resuscitation. We do not know how parents respond to a child’s resuscitation or if family functioning is affected after the event. Parent stress and family functioning after a child’s resuscitation has not been studied. While the available research on parents’ experience at their child’s resuscitation in the Emergency Department and Pediatric Intensive Care Unit provides some information, there is a gap in the knowledge about the experience of parents in general pediatric care units and Labor and Delivery areas. In order to develop interventions that support parents’ experience during emergency resuscitation of their child in the hospital setting, it is important to know parents’ experience in all settings where resuscitation of a child happens. Objectives The purpose of this qualitative descriptive study was to elucidate the experiences of parents during their child’s resuscitation and the potential consequences this traumatic event has on parental stress and family functioning after the event. Specific Aim 1: Describe the experiences of parents during the resuscitation of their child in the Emergency Department, Pediatric Intensive Care Unit, General Pediatric Care Unit, Neonatal Intensive Care Unit or Labor and Delivery. Specific Aim 2: Explore parent and family outcomes after parents experience a child’s resuscitation in the Emergency Department, Pediatric Intensive Care Unit, General Pediatric Care Unit, Neonatal Intensive Care Unit or Labor and Delivery by exploring parents’ stress response and family functioning at least one month after the experience using Impact of Events Scale – Revised (IES-R) (post-traumatic stress) and Family Problem Solving and Communication Index (FPSC) (family functioning) and Family Distress Index (FDI) (family functioning). Methods The setting for this study was a 280 bed Midwestern children’s hospital Emergency department (ED), Pediatric Intensive Care Unit (PICU), Neonatal Intensive Care Unit (NICU), Labor and Delivery (L&D) and inpatient pediatric units. Participant inclusion criteria were parents or legal guardians, age 18 or older and English speaking whose children experienced resuscitation within the hospital in a variety of settings. Participants included both parents who were present in the room during the resuscitation and those who were not in the child’s room but nearby. For the purpose of this study, resuscitation was defined as any emergency intervention required providing respiratory or cardiovascular support, including positive pressure airway support, ventilation, cardiac compressions and / or emergency medication administration. Qualitative descriptive methodology, using semi-structured qualitative interviews to generate data was used to provide a deeper understanding of the experience of parents while present during their child’s resuscitation. A small collection of quantitative survey data provided additional information about stress reactions of parents and family functioning at least one month after the event. In this study, measures of stress (Impact of Events scale) and family functioning (Family Problem Solving and Communication Index) and Family Distress Index) were assessed at a time between one and twelve months after the resuscitation experience. Analysis was completed with thematic analysis of the qualitative data and descriptive statistics were described for the quantitative data. Results Parents describe a sense of overwhelming chaos during their child’s resuscitation. However, they have a need to be with their children during this traumatic event. Some parents enter into the experience with an alternate reality, with disbelief that things are as bad as they look. Other parents are thrust abruptly into the experience as they are a participant in the resuscitation that starts outside of the hospital setting. As the experience unfolds, despite the overwhelming, scary experience, parents have identified things that help them get through the experience. Mothers who experience their newborn infant’s resuscitation in the delivery room have a different experience; they feel as though they were physically present, but unable to be a part of the experience. These women describe their unmet expectations. After parents experience their child’s resuscitation, some identify the event as a turning point in their lives that changed them as parents and as a family; some report a new outlook on life or even changed relationships with their significant other. Some parents get to successful resolution of their feelings after the experience, yet others are left feeling anger and resentment. Some parents even wonder if they could have done something different to effect a different outcome. While the outcomes for some parents and families are positive and show that families are stronger after the experience, it is evident that parental post-traumatic stress after a child’s resuscitation, as well as family distress are potential consequences for parents and families after experiencing a child’s resuscitation. Conclusions A thematic analysis of qualitative data about parents’ experience during their child’s resuscitation resulted in three overarching themes including “Overwhelming chaos”, “Getting through it”, “Cognitive presence” and “Joy mixed with heartache”. Each overarching theme was supported with several subthemes. In addition, parent stress and family functioning outcomes were described in two major themes of “Turning point – It changes you” and “After the experience – Resolution vs non-resolution”. Analysis of the quantitative survey data from the IES-R, FPSC index and FDI combined with the qualitative thematic analysis indicate that parent post-traumatic stress and family distress is a potential consequence for families who experience their child’s resuscitation. This study provides foundational knowledge of parent stress and family functioning after a child’s resuscitation and demonstrates that this is an important phenomenon for further study. In addition, the parents’ experience reported in this study also lays a foundation for development, standardization and implementation of interventions to support parents during and after this experience.