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Factors influencing health care professionals’ decision-making regarding parental presence during invasive procedures in the PICU

University of British Columbia

Children admitted to pediatric intensive care units (PICUs) experience invasive and painful procedures as health care professionals intervene to assess, monitor and manage critical health problems. Most of these procedures elicit fear, anxiety and/or pain on the part of children, producing significant effects on them, their parents and health care professionals. Involving parents in the performance of procedures is a practice that has been researched in other care settings; research knowledge regarding the use of such a practice in the PICU is sparse. The purpose of this study was to identify factors influencing health care professionals' decision-making regarding parental presence during invasive procedures on a child in the PICU. Guided by the qualitative method of interpretive description, data was collected from fifteen PICU nurses and physicians interviewed regarding their decision-making. Data analysis was validated, clarified or revised by the study participants to reveal three possible decisions mediated by one of two goals identified by the health care professional for the procedure; in turn the goal and the decisions were influenced by many other mediating and contextual factors identified by participants. These findings contributed to the development of a schematic representation of decision-making that reflects the complexity of decision-making currently and could be used as a structure to further discuss the issue of parental presence during invasive procedures in the PICU. Participants identified that discussion regarding the decisions made and the factors that influenced them is important and that it currently does not occur. Participants identified some influences on their decision-making that are unique from those identified in literature regarding other care settings. Highlights from the findings include: the child's voice is rarely represented; health care professionals frequently circumvent parental involvement in decisions regarding invasive procedures on their child in the PICU in ways perceived as protection, or alternatively as control; and other family-centered care principles, such as forming collaborative partnerships, are not reflected currently in decision-making regarding parental presence during invasive procedures in the PICU. Implications for health care practice, education and research arising from the findings are identified.

Thesis/Dissertation

application/pdf

2009-05-19

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http://hdl.handle.net/2429/7922

Nursing

University of British Columbia

UBCV

DSpace