Nurse’s Perspective in the Implementation of Family Centered Care in PICU NICU
Abstract
Implementation of Family Centered Care (FCC) in pediatric critical care has many obstacles and challenges, so the role of nurses as facilitators and enforcers of rules is difficult in implementing FCC. The purpose of this study was to determine the perspective of nurses in the application of FCC in the NICU PICU . The study was conducted in January-February 2022 in PICU NICU at Dr Kariadi Hospital Semarang with a quantitative descriptive design method and a consecutive sampling technique of 52 samples. The results showed that the nurse's perspective in the implementation of FCC in NICU PICU was 90.4% good. The element of sharing information with parents is 100% good, the element of hearing a parental voice is good 98%, the element of making decisions with parents is good 96%, the element of individual communication is good 94%, and the element of negotiating roles is good 63%. FCC in critical care children prioritizes partnerships between parents and health workers, where the role of parents can be negotiated in the implementation of FCC according to the clinical condition of the child and the characteristics of the parents. Nurses are expected to improve skills during resuscitation so that the implementation of FCC in the role negotiation elements can be carried out properly.
Abstrak: Implementasi Family Centered Care (FCC) dalam keperawatan kritis anak mempunyai banyak hambatan dan tantangan, sehingga peran perawat sebagai fasilitator dan penegak aturan kesulitan dalam pengimplementasian FCC. Tujuan dari penelitian ini adalah untuk mengetahui perspektif perawat dalam penerapan FCC di PICU NICU. Penelitian dilakukan pada bulan Januari-Februari 2022 di PICU NICU RSUP Dr Kariadi Semarang dengan metode kuantitatif, desain deskriptif dan teknik consecutive sampling sebanyak 52 sampel. Hasil penelitian menunjukkan bahwa perspektif perawat dalam penerapan FCC di PICU NICU adalah baik 90,4 %. Elemen berbagi informasi dengan orang tua baik 100%, elemen mendengar keluhan dan menjawab pertanyaan orang tua baik 98%, elemen membuat keputusan dengan orang tua baik 96%, elemen komunikasi individual baik 94%, dan elemen negosiasi peran baik 63%. Family Centered Care (FCC) dalam keperawatan anak kritis mengedepankan kemitraan antara orang tua dan petugas kesehatan, dimana peran orang tua dapat dinegosiasikan dalam pengimplementasian FCC sesuai dengan kondisi klinis anak dan karakteristik orang tua. Perawat diharapkan dapat meningkatkan keterampilan saat tindakan resusitasi sehingga pengimplementasian FCC pada elemen negosiasi peran dapat terlaksana dengan baik.
Keywords
References
Ames, K. E., Rennick, J. E., & Baillargeon, S. (2011). A qualitative interpretive study exploring parents’ perception of the parental role in the paediatric intensive care unit. Intensive Crit Care Nurs. https://doi.org/10.1016/j.iccn.2011.03.004
Apriyanti, E., & Adawiyah, R. (2018). Kebutuhan Keluarga saat Anak Dirawat dI Paediatric Intensive Care Unit ( PICU ): Sudut Pandang Orang Tua dan Perawat. Jurna Keperawatan Indonesia, 21(3), 159–168. https://doi.org/10.7454/jki.v21i3.777
Azwar, S. (2007). Metode Penelitian. Pustaka pelajar.
Baird, J., Davies, B., Hinds, P. S., Baggott, C., & Rehm, R. S. (2014). What impact do hospital and unit-based rules have upon patient and family-centered care in the pediatric intensive care unit? J Pediatr Nurs. https://doi.org/10.1016/j.pedn.2014.10.001
Carnevale, F. A. (1990). A description of stressors and coping strategies among parents of critically ill children—a preliminary study. Intensive Care Nursing, 6(1), 4–11. https://doi.org/10.1016/0266-612X(90)90003-P
Carnevale, Franco A, Benedetti, M., Bonaldi, A., Bravi, E., Trabucco, G., & Biban, P. (2011). Understanding the private worlds of physicians, nurses, and parents: a study of life-sustaining treatment decisions in Italian paediatric critical care. J Child Health Care. https://doi.org/10.1177/1367493511420183
Carnevale, Franco A, Canoui, P., Cremer, R., Farrell, C., Doussau, A., Seguin, M.-J., Hubert, P., Leclerc, F., & Lacroix, J. (2007). Parental involvement in treatment decisions regarding their critically ill child: a comparative study of France and Quebec. Pediatr Crit Care Med. https://doi.org/10.1097/01.PCC.0000269399.47060.6D Abstract
Carnevale, Franco A, Catherine Farrell, Robin Cremer, S. S., Canouï, P., Leclerc, F., Lacroix, J., & Hubert, P. (2016). Communication in pediatric critical care: A proposal for an evidence-informed framework. J Child Health Care. https://doi.org/10.1177/1367493514540817
Cleave, A. C. Van, Roosen-Runge, M. U., Miller, A. B., Milner, L. C., Karkazis, K. A., & Magnus, D. C. (2014). Quality of communication in interpreted versus noninterpreted PICU family meetings. Crit Care Med. https://doi.org/10.1097/CCM.0000000000000177
Coats, H., Bourget, E., Starks, H., Lindhorst, T., Saiki-Craighill, S., Curtis, J. R., Hays, R., & Doorenbos, A. (2018). Nurses’ reflections on benefits and challenges of implementing familycentered care in pediatric intensive care units. American Journal of Critical Care, 27(1), 52–58. https://doi.org/10.4037/ajcc2018353
DeLemos, D., Chen, M., Romer, A., Brydon, K., Kastner, K., Anthony, B., & Hoehn, K. S. (2010). Building trust through communication in the intensive care unit: HICCC. Pediatr Crit Care Med. https://doi.org/10.1097/PCC.0b013e3181b8088b
Elaine C Meyer, Ritholz, M. D., Burns, J. P., & Truog, R. D. (2005). Improving the quality of end-of-life care in the pediatric intensive care unit: parents’ priorities and recommendations. Pediatrics. https://doi.org/10.1542/peds.2005-0144
Graham, R. J., Pemstein, D. M., & Curley, M. A. Q. (2009). Experiencing the pediatric intensive care unit: perspective from parents of children with severe antecedent disabilities. Crit Care Med. https://doi.org/10.1097/CCM.0b013e3181a00578
Halal, G. M. C. A. El, Piva, J. P., Lago, P. M., Halal, M. G. S. El, Cabral, F. C., Nilson, C., & Garcia, edro C. R. (2013). Parents’ perspectives on the deaths of their children in two Brazilian paediatric intensive care units. Int J Palliat Nurs. https://doi.org/10.12968/ijpn.2013.19.10.495
Hendrawati, S., Fatimah, S., Fitri, S. Y. R., Mardhiyah, A., & Nurhidayah, I. (2018). Needs of Parents in Critically Ill Infants Care in the Neonatal Intensive Care Unit (NICU). Jurnal Keperawatan Universitas Muhammadiyah Malang, 9(1), 43–57.
Husna, S. A., & Sari, H. (2018). Stres Keluarga Dengan Anggota Keluarga Dirawat Di Ruang Intensive. Jurnal Ilmiah Mahasiswa Fakultas Keperawatan, 3(3), 119–124.
Jefferson, R., & Paterson, B. (2001). Efficient or family-centred? Practitioners’ goals in decisions regarding parental presence during invasive procedures.
Kahveci, R., Ayhan, D., Döner, P., Cihan, F. G., & Koç, E. M. (2014). Shared decision-making in pediatric intensive care units: a qualitative study with physicians, nurses and parents. Indian J Pediatr. https://doi.org/10.1007/s12098-014-1431-6
Kuo, D. Z., Houtrow, A. J., Arango, P., Kuhlthau, K. A., Simmons, J. M., & Neff, J. M. (2012). Family-centered care: current applications and future directions in pediatric health care. Matern Child Health J. https://doi.org/10.1007/s10995-011-0751-7
Lamiani, G., Giannii, A., Fossati, I., Prandi, E., & Vegni, E. (2013). Parental experience of end-of life care in the pediatric intensive care unit. Minerva Anestesiol.
Larocque, C., Peterson, W. E., Squires, J. E., Mason-Ward, M., Mayhew, K., & Harrison, D. (2021). Family-centred care in the Neonatal Intensive Care Unit: A concept analysis and literature review. Journal of Neonatal Nursing, 27(6), 402–411. https://doi.org/10.1016/J.JNN.2021.06.014
Latief, A., Pudjiadi, A. H., Kushartono, H., & Malisie, R. F. (2016). UKK ERIA. Buku panduan pelayanan emergensi, Rawat Intermediate dan Rawat Intensif Anak. Badan Penerbit Ikatan Dokter Anak Indonesia.
Latour, J. M., Goudoever, J. B. van, Schuurman, B. E., Albers, M. J. I. J., Dam, N. A. M. van, Dullaart, E., Heerde, M. van, Verlaat, C. W. M., Vught, E. M. van, & Hazelzet, J. A. (2010). A qualitative study exploring the experiences of parents of children admitted to seven Dutch pediatric intensive care units. Intensive Care Med. https://doi.org/10.1007/s00134-010-2074-3
Mary Ellen Macdonald, Liben, S., Carnevale, F. A., & Cohen, S. R. (2012). An office or a bedroom? Challenges for family-centered care in the pediatric intensive care unit. J Child Health Care. https://doi.org/10.1177/1367493511430678
Maxton, F. J. C. (2008). Parental presence during resuscitation in the PICU: the parents’ experience. Sharing and surviving the resuscitation: a phenomenological study. J Clin Nurs. https://doi.org/10.1111/j.1365-2702.2008.02525.x
McGraw, S. A., Truog, R. D., Solomon, M. Z., Cohen-Bearak, A., Sellers, D. E., & Meyer, E. C. (2012). “I was able to still be her mom”--parenting at end of life in the pediatric intensive care unit. Pediatr Crit Care Med. https://doi.org/10.1097/PCC.0b013e31825b5607
Michelson, K. N., Patel, R., Haber-Barker, N., Emanuel, L., & Frader, J. (2013). End-of-life care decisions in the PICU: roles professionals play. Pediatr Crit Care Med. https://doi.org/10.1097/PCC.0b013e31826e7408
Orioles, A., Miller, V. A., Kersun, L. S., Ingram, M., & Morrison, W. E. (2013). To be a phenomenal doctor you have to be the whole package": physicians’ interpersonal behaviors during difficult conversations in pediatrics. https://doi.org/10.1089/jpm.2013.0103
Putri, L., & Iskandar, S. (2021). Buku Ajar Keperawatan Anak. Insan Cendekia Mandiri.
Ramezani, T., Zahra, M. ;, Shirazi, H., Sarvestani, S., Moattari, M., & Sarvestani, R. S. (n.d.). Family-Centered Care in Neonatal Intensive Care Unit: A Concept Analysis.
Richards, C. A., Starks, H., & Doorenbos, A. Z. (2018). Elements of Family-Centered Care in the Pediatric Intensive Care Unit: An Integrative Review. Physiology & Behavior, 238–246. https://doi.org/10.1097/NJH.0000000000000335
Stickney, C. A., Ziniel, S. I., Brett, M. S., & Truog, R. D. (2014). Family participation during intensive care unit rounds: goals and expectations of parents and health care providers in a tertiary pediatric intensive care unit. J Pediatr. https://doi.org/10.1016/j.jpeds.2014.08.001
Tessie W October, Fisher, K. R., Feudtner, C., & Hinds, P. S. (2014). The parent perspective: “being a good parent” when making critical decisions in the PICU. Pediatr Crit Care Med . https://doi.org/10.1097/PCC.0000000000000076
Trajkovski, S., Schmied, V., Vickers, M. H., & Jackson, D. (2016). Experiences of neonatal nurses and parents working collaboratively to enhance family centred care: The destiny phase of an appreciative inquiry project. Collegian, 23(3), 265–273. https://doi.org/10.1016/J.COLEGN.2015.05.004
Vos, M. A. de, Bos, A. P., Plötz, F. B., Heerde, M. van, Graaff, B. M. de, Tates, K., Truog, R. D., & Willems, D. L. (2015). Talking with parents about end-of-life decisions for their children. Pediatrics. https://doi.org/10.1542/peds.2014-1903
Yulianawati, A., & Mariyam. (2019). Gambaran Reaksi Anak Usia Prasekolah terhadap Stressor Hospitalisasi. Prosiding Seminar Nasional Mahasiswa Unimus, 2, 217–223.
Ames, K. E., Rennick, J. E., & Baillargeon, S. (2011). A qualitative interpretive study exploring parents’ perception of the parental role in the paediatric intensive care unit. Intensive Crit Care Nurs. https://doi.org/10.1016/j.iccn.2011.03.004
Apriyanti, E., & Adawiyah, R. (2018). Kebutuhan Keluarga saat Anak Dirawat dI Paediatric Intensive Care Unit ( PICU ): Sudut Pandang Orang Tua dan Perawat. Jurna Keperawatan Indonesia, 21(3), 159–168. https://doi.org/10.7454/jki.v21i3.777
Azwar, S. (2007). Metode Penelitian. Pustaka pelajar.
Baird, J., Davies, B., Hinds, P. S., Baggott, C., & Rehm, R. S. (2014). What impact do hospital and unit-based rules have upon patient and family-centered care in the pediatric intensive care unit? J Pediatr Nurs. https://doi.org/10.1016/j.pedn.2014.10.001
Carnevale, F. A. (1990). A description of stressors and coping strategies among parents of critically ill children—a preliminary study. Intensive Care Nursing, 6(1), 4–11. https://doi.org/10.1016/0266-612X(90)90003-P
Carnevale, Franco A, Benedetti, M., Bonaldi, A., Bravi, E., Trabucco, G., & Biban, P. (2011). Understanding the private worlds of physicians, nurses, and parents: a study of life-sustaining treatment decisions in Italian paediatric critical care. J Child Health Care. https://doi.org/10.1177/1367493511420183
Carnevale, Franco A, Canoui, P., Cremer, R., Farrell, C., Doussau, A., Seguin, M.-J., Hubert, P., Leclerc, F., & Lacroix, J. (2007). Parental involvement in treatment decisions regarding their critically ill child: a comparative study of France and Quebec. Pediatr Crit Care Med. https://doi.org/10.1097/01.PCC.0000269399.47060.6D Abstract
Carnevale, Franco A, Catherine Farrell, Robin Cremer, S. S., Canouï, P., Leclerc, F., Lacroix, J., & Hubert, P. (2016). Communication in pediatric critical care: A proposal for an evidence-informed framework. J Child Health Care. https://doi.org/10.1177/1367493514540817
Cleave, A. C. Van, Roosen-Runge, M. U., Miller, A. B., Milner, L. C., Karkazis, K. A., & Magnus, D. C. (2014). Quality of communication in interpreted versus noninterpreted PICU family meetings. Crit Care Med. https://doi.org/10.1097/CCM.0000000000000177
Coats, H., Bourget, E., Starks, H., Lindhorst, T., Saiki-Craighill, S., Curtis, J. R., Hays, R., & Doorenbos, A. (2018). Nurses’ reflections on benefits and challenges of implementing familycentered care in pediatric intensive care units. American Journal of Critical Care, 27(1), 52–58. https://doi.org/10.4037/ajcc2018353
DeLemos, D., Chen, M., Romer, A., Brydon, K., Kastner, K., Anthony, B., & Hoehn, K. S. (2010). Building trust through communication in the intensive care unit: HICCC. Pediatr Crit Care Med. https://doi.org/10.1097/PCC.0b013e3181b8088b
Elaine C Meyer, Ritholz, M. D., Burns, J. P., & Truog, R. D. (2005). Improving the quality of end-of-life care in the pediatric intensive care unit: parents’ priorities and recommendations. Pediatrics. https://doi.org/10.1542/peds.2005-0144
Graham, R. J., Pemstein, D. M., & Curley, M. A. Q. (2009). Experiencing the pediatric intensive care unit: perspective from parents of children with severe antecedent disabilities. Crit Care Med. https://doi.org/10.1097/CCM.0b013e3181a00578
Halal, G. M. C. A. El, Piva, J. P., Lago, P. M., Halal, M. G. S. El, Cabral, F. C., Nilson, C., & Garcia, edro C. R. (2013). Parents’ perspectives on the deaths of their children in two Brazilian paediatric intensive care units. Int J Palliat Nurs. https://doi.org/10.12968/ijpn.2013.19.10.495
Hendrawati, S., Fatimah, S., Fitri, S. Y. R., Mardhiyah, A., & Nurhidayah, I. (2018). Needs of Parents in Critically Ill Infants Care in the Neonatal Intensive Care Unit (NICU). Jurnal Keperawatan Universitas Muhammadiyah Malang, 9(1), 43–57.
Husna, S. A., & Sari, H. (2018). Stres Keluarga Dengan Anggota Keluarga Dirawat Di Ruang Intensive. Jurnal Ilmiah Mahasiswa Fakultas Keperawatan, 3(3), 119–124.
Jefferson, R., & Paterson, B. (2001). Efficient or family-centred? Practitioners’ goals in decisions regarding parental presence during invasive procedures.
Kahveci, R., Ayhan, D., Döner, P., Cihan, F. G., & Koç, E. M. (2014). Shared decision-making in pediatric intensive care units: a qualitative study with physicians, nurses and parents. Indian J Pediatr. https://doi.org/10.1007/s12098-014-1431-6
Kuo, D. Z., Houtrow, A. J., Arango, P., Kuhlthau, K. A., Simmons, J. M., & Neff, J. M. (2012). Family-centered care: current applications and future directions in pediatric health care. Matern Child Health J. https://doi.org/10.1007/s10995-011-0751-7
Lamiani, G., Giannini, A., Fossati, I., Prandi, E., & Vegni, E. (2013). Parental experience of end-of life care in the pediatric intensive care unit. Minerva Anestesiol.
Larocque, C., Peterson, W. E., Squires, J. E., Mason-Ward, M., Mayhew, K., & Harrison, D. (2021). Family-centred care in the Neonatal Intensive Care Unit: A concept analysis and literature review. Journal of Neonatal Nursing, 27(6), 402–411. https://doi.org/10.1016/J.JNN.2021.06.014
Latief, A., Pudjiadi, A. H., Kushartono, H., & Malisie, R. F. (2016). UKK ERIA. Buku panduan pelayanan emergensi, Rawat Intermediate dan Rawat Intensif Anak. Badan Penerbit Ikatan Dokter Anak Indonesia.
Latour, J. M., Goudoever, J. B. van, Schuurman, B. E., Albers, M. J. I. J., Dam, N. A. M. van, Dullaart, E., Heerde, M. van, Verlaat, C. W. M., Vught, E. M. van, & Hazelzet, J. A. (2010). A qualitative study exploring the experiences of parents of children admitted to seven Dutch pediatric intensive care units. Intensive Care Med. https://doi.org/10.1007/s00134-010-2074-3
Mary Ellen Macdonald, Liben, S., Carnevale, F. A., & Cohen, S. R. (2012). An office or a bedroom? Challenges for family-centered care in the pediatric intensive care unit. J Child Health Care. https://doi.org/10.1177/1367493511430678
Maxton, F. J. C. (2008). Parental presence during resuscitation in the PICU: the parents’ experience. Sharing and surviving the resuscitation: a phenomenological study. J Clin Nurs. https://doi.org/10.1111/j.1365-2702.2008.02525.x
McGraw, S. A., Truog, R. D., Solomon, M. Z., Cohen-Bearak, A., Sellers, D. E., & Meyer, E. C. (2012). “I was able to still be her mom”--parenting at end of life in the pediatric intensive care unit. Pediatr Crit Care Med. https://doi.org/10.1097/PCC.0b013e31825b5607
Michelson, K. N., Patel, R., Haber-Barker, N., Emanuel, L., & Frader, J. (2013). End-of-life care decisions in the PICU: roles professionals play. Pediatr Crit Care Med. https://doi.org/10.1097/PCC.0b013e31826e7408
Orioles, A., Miller, V. A., Kersun, L. S., Ingram, M., & Morrison, W. E. (2013). To be a phenomenal doctor you have to be the whole package": physicians’ interpersonal behaviors during difficult conversations in pediatrics. https://doi.org/10.1089/jpm.2013.0103
Putri, L., & Iskandar, S. (2021). Buku Ajar Keperawatan Anak. Insan Cendekia Mandiri.
Ramezani, T., Zahra, M. ;, Shirazi, H., Sarvestani, S., Moattari, M., & Sarvestani, R. S. (n.d.). Family-Centered Care in Neonatal Intensive Care Unit: A Concept Analysis.
Richards, C. A., Starks, H., & Doorenbos, A. Z. (2018). Elements of Family-Centered Care in the Pediatric Intensive Care Unit: An Integrative Review. Physiology & Behavior, 238–246. https://doi.org/10.1097/NJH.0000000000000335
Stickney, C. A., Ziniel, S. I., Brett, M. S., & Truog, R. D. (2014). Family participation during intensive care unit rounds: goals and expectations of parents and health care providers in a tertiary pediatric intensive care unit. J Pediatr. https://doi.org/10.1016/j.jpeds.2014.08.001
Tessie W October, Fisher, K. R., Feudtner, C., & Hinds, P. S. (2014). The parent perspective: “being a good parent” when making critical decisions in the PICU. Pediatr Crit Care Med . https://doi.org/10.1097/PCC.0000000000000076
Trajkovski, S., Schmied, V., Vickers, M. H., & Jackson, D. (2016). Experiences of neonatal nurses and parents working collaboratively to enhance family centred care: The destiny phase of an appreciative inquiry project. Collegian, 23(3), 265–273. https://doi.org/10.1016/J.COLEGN.2015.05.004
Vos, M. A. de, Bos, A. P., Plötz, F. B., Heerde, M. van, Graaff, B. M. de, Tates, K., Truog, R. D., & Willems, D. L. (2015). Talking with parents about end-of-life decisions for their children. Pediatrics. https://doi.org/10.1542/peds.2014-1903
Yulianawati, A., & Mariyam. (2019). Gambaran Reaksi Anak Usia Prasekolah terhadap Stressor Hospitalisasi. Prosiding Seminar Nasional Mahasiswa Unimus, 2, 217–223.
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