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RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES
BANGALORE,
KARNATAKA
ANNEXURE – 2
PROFOMA FOR REGISTRATION OF SUBJECT FOR DISSERTATION
NAME
1.
OF
CANDIDATE
THE Ms. ANITHA.S
AND
ADDRESS
M.Sc. NURSING , 2013 BATCH
ST.JOHNS COLLEGE OF NURSING,
BANGALORE-560034
NAME
2.
OF
THE ST.JOHNS COLLEGE OF NURSING,
INSTITUTION
ST.JOHNS NATIONAL ACADEMY OF HEALTH
SCIENCES,
BANGALORE-560034
COURSE OF STUDY MASTER OF SCIENCE IN NURSING
3.
AND SUBJECT
DATE
4.
CHILD HEALTH NURSING
OF
ADMISSION TO THE 02-05-2013
COURSE
TITLE
5.
TOPIC
OF
THE
EFFECTIVENESS OF GUIDED PARTICIPATORY
CARE ON PARENTALSATISFACTION AMONG
PARENTS OF CHILDREN ADMITTED IN PICU
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6. BRIEF RESUME OF INTENDED WORK
6.1 NEED FOR THE STUDY
In 2009, there were nearly 6.4 million hospital stays for children 17 years and
younger in the U.S comprising nearly 17 percent of all hospital stays. About three-quarters of
these pediatric hospital stays were for infants under the age of one year1. These children are
too young to express their own views, need to have parents, or other close relatives, to
interpret their needs. Although patient focused care has been part of nursing since years,
recognition of the important role that patient’s families play in providing support, assistance
and care for critically ill child, is much more recent2.
Now a days Hospital management, responsible for qualitative improvement, has
begun to recognize that patients and family members’ perception of quality of care, should be
part of the process of delivering a high quality care. Friedman et al assert that families are the
single greatest social institution that influences a person’s health3. During a critical illness,
patient’s families fulfill an additional essential role for patients who may be unconscious or
unable to communicate or make decisions. The families not only provide vital support to
patients but also become the “voice” of patients4.
The hospital is an unknown and unfamiliar place for both the child and parents. The
parents’ anxiety due to the fact that the child is ill, and the family is away from their home,
where privacy and control can be exercised, puts them in a vulnerable situation. The
expectation of the parents of hospitalized children has changed enormously, over the past
years. While parents were previously expected to remain separated from children, they are
now expected to stay with them, in the hospital and be involved in child’s care5.
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Health professionals have also come to value the role of patient’s family members in
providing nursing care. One of article published by the American academy of pediatrics focus
on the satisfaction measured from parental perspective. Through literature review, almost 11
dimensions of care were identified as important to parents whose infants received neonatal
intensive care. They are assurance, caring, communication, constant information, education,
and environment, follow up care, pain management, participation, proximity and support.
Parent involvement in care, particularly, in the decision making process over critical life
decisions were felt by 92% of the parents. Parents also have a need to be close to their infant
while the infant is hospitalized. This concept was identified using two parental surveys in
pediatric intensive care units.6
Parent involvement has been identified as a larger determining factor, for the parent
satisfaction of child medical care. It is a major challenge for health professionals such as
nurse and physician, to support the participation by the parents, in the care of their children in
Intensive care units, and it raises a central question of how parents are invited to participate in
this environment7.
Researcher also through her experience and observation in clinical area, has identified
that even though one of the parent is always allowed to be with the child inside pediatric
intensive care unit, parental involvement in the fundamental care of children is very less or
most of the time absent. Hence, parental participation in the care of hospitalized children is
an important concern , and there is a need to identify its influence on the satisfaction level
of care takers.
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6.2 REVIEW OF LITERATURE:
Patient satisfaction with adult health care services is not a new concept. There is an
extensive body of adult patient satisfaction literature with many validated surveys available
for measurement.
In the pediatric and particularly neonatal literature, there is scarce information that
identifies important aspect of health care services to parents with only a handful of validated
surveys available to measure parent satisfaction.
The review of literature related to the present study can be organized under the
heading.
LITERATURE RELATED TO PARENTAL INVOLVEMENT AND SATISFACTION
One of the first studies to recognize parents’ views of their child’s hospitalization was
performed in 1957 at Germany. They interviewed 100 parents both at the time of the child’s
admission to the hospital, and at discharge using a close ended questionnaire with likert type
response scale. At this time parents were not allowed, to stay with the child in the hospital.
Majority of the parents (90%) expressed the greatest anxiety, at separation from the child. In
a effort to determine how to reduce anxiety, parents expressed a desire to know why their
child was hospitalized, what the visiting hours were and whether the child could bring any of
the possession.8
A study on parental involvement, their presence and satisfaction conducted among
103 parents in Canada suggest that parents who involved in decision making as well had
good interaction with health care providers, were highly satisfied. A 4- item survey using
previous studies exploring parental satisfaction and after consulting with critical care experts
in PICU, was developed to collect data. The third item obtained parents ratings of
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involvement by asking “how involved were you with the treatment decisions” on a Visual
analog scale ranging from 0 to 100. The mean (SD) parental satisfaction rating was 87.6
( ±14.8) and involvement in decision making was 70.2( ±34.4). There was significant
association between parental involvement and parental satisfaction. Parents concerns were
largely revolving around issues, of assurance such as, obtaining accurate and timely
information and ensuring that the best care has been, provided to their child. The overall
satisfaction of parents of critically ill children were high (79%) but lower in parents of
children receiving more intensive therapies9.
In Swansea, care by the parent was introduced into a general pediatric ward without
any addition of finance or facilities. 32 resident parents were informed about the care by
parent scheme by the ward sister, if the child’s condition was suitable. Parents were
responsible for all daily routine care of their child, such as feeding, bathing, nappy changing,
and supervision of play. In addition, instruction was given by designated nurse , including
measuring and recording vital signs , collecting specimens, giving drugs, charting all
information and accompanying their child for special tests. Data related to the activities,
difficulties they encountered and their feeling about their role was collected, using structured
questionnaire. Results showed greater confidence of parents and their belief that child was
happier, ate and slept better than if they had not been present. They were grateful for the
privilege of being involved with their child’s care as part of the team, believing that the
experience would enable them cope better with their child’s future illness10.
By using family systems theory as the underlying framework, the amount of control
that parents of children with chronic illness wanted over their hospitalized care, and the
degree to which parents felt health care professional value their expertise was examined in a
sample of 121 parent caregivers in Madison. A retrospective, cross-sectional, descriptive
correlational design was used for this study. Self report measures on parent caregiver, child
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with chronic illness, and family demographic information; a modified parental control
preference scale (PCPS) and the valuing of parental expertise scale (VOPE) were used to
obtain the data. Descriptive statistics were computed on the demographic data, the PCPS
subscales, and the individual items of VOPE. Correlations between the demographic and
child’s illness data, PCPS, and VOPE were determined. The open – ended question was
analysed by using content analysis. Study results are as follows - Information sharing was the
area in which parents preferred the most control (M= 3.92, SD=.83). Preference for
participation in technical care (M=3.20, SD=1.87) and routine care (M=3.20, SD=5.66) were
rated next. Decision making was the area in which parents expressed the lowest desire for
control (M=3.09, SD=3.73). The child’s age (r= -.39, p= .01) and the length of illness r= -.45,
p= .01), were negatively correlated with participation in routine care.11
A multicenter prospective cohort study was conducted in Netherland , among 549
parents in seven multidisciplinary PICU’S to assess perception of parents who had
experienced a PICU admission of their children on parental satisfaction issues , and to
perform factor analysis to evaluate the satisfaction items with several domains. A self
administered questionnaire including 78 items of satisfaction with care in five domains.
Information, care and cure, organization, parental participation, and professional attitudes.
The item of “caregivers gives highest priority to the child’s health” was remarked as most
important. Parents felt an organizational issue to be least important. Seventeen satisfaction
items were rated with s mean scores of <8.0 with standard deviation > 1.65. The cronbach’s
∝ of the domains ranged between 0.87 and 0.9412.
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6.3 PROBLEM STATEMENT:
A study to assess the effectiveness of guided participatory care on parental
satisfaction among parents of children admitted in PICU, of a tertiary care hospital,
Bangalore.
6.4 OBJECTIVES:
1. To assess the parental satisfaction, among the control group.
2. To assess the parental satisfaction, among the experimental group.
3. To compare the parental satisfaction between experimental and control group.
4. To determine the association of parental satisfaction with selected baseline variables
among the experimental and control group.
6.5 OPERATIONAL DEFINITION:
6.5.1 EFFECTIVENESS
The degree to which something is successful in producing a desired result.
-Cambridge dictionary
In this study it refers to the extent to which the Guided participatory care is effective
on parental satisfaction, as evident by gain in post participation satisfaction level assessed by
semi structured parent participation and satisfaction questionnaire.
6.5.2 GUIDED PARTICIPATORY CARE
In this study , guided participatory care refer to the selected nursing care activities of
the child in which parents are allowed and encouraged to participate or assist during their stay
in PICU. These activities include,
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
Sponge bath

Eye care

Hair care

Mouth care

Face wash

Limb exercises

Feeding of the child

Position changing

Back massage
6.5.3 PARENT
Father/ mother/ who constantly stays during day time with the child in PICU, more
than two days, since most of the nursing care are done during day time.
6.5.4 SATISFACTION
The pleasant feeling one has when they get something that they wanted or do
something that they wanted to do.
- Cambridge dictionary
In this study satisfaction refers to contentment experienced by parents after
participating or involving in the nursing care of their children, as measured by semi
structured parent participation and satisfaction questionnaire.
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6.5.5 CHILDREN
In this study the children refers to the children between the age group of 1month – 18
years admitted in pediatric intensive care unit.
6.5.6BASELINE VARIABLES
In this study the baseline variables of parents refers to the age, sex, education,
occupation, socio economic status, and previous experience in pediatric intensive care unit.
Baseline variables of children include age, sex, and diagnosis, no of days in PICU and
ventilator status.
6.6 ASSUMPTION
In pediatric hospital care the role of parents has been closely examined although
different expressions are used such as participation, involvement, or family centered care.
The main assumption of this study is that “Parents may have improved satisfaction after
participating in the selected nursing care activities of children.”
6.7 DELIMITATION
The study is only limited to parents whose children are admitted in PICU, St.Johns
Hospital, Bangalore.
6.8 PROJECTED OUTCOME
Enhancing the participation of parents in the care of children will improve their
satisfaction. Thus it will ensure in providing a family centered care.
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6.9 HYPOTHESIS
H1: There will be a significant difference, in the parental satisfaction in the experimental
group and control group at 0.05 level of significance.
H2: There will be a significant association between parental satisfaction and selected baseline
variables at 0.05 level of significance.
7 MATERIALS AND METHODS
7.1 SOURCES OF DATA
7.1.1 RESEARCH APPROACH
For this study, experimental research approach will be used.
7.1.2 RESEARCH DESIGN
For this study, Research design used will be quasi experimental, post test only control
group design.
7.1.3 SETTING
The study will be conducted in the PICU of St. johns medical college
Hospital(SJMCH), Bangalore which is a tertiary care teaching hospital with comprehensive
critical care services. PICU holds the bed capacity of 13 beds. The number of children
admitted in this unit is almost 60 per month. Usually nursing care is provided by the staff
nurses working in PICU. Any one parent or care taker is allowed to stay with the child inside
PICU. Generally parents do not have an active involvement in providing care to the child.
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7.1.4 POPULATION
The study population comprises of parents with children, between the age group of
1month – 18 years, admitted in PICU, SJMCH.
7.2 METHOD OF DATA COLLECTION
7.2.1 SAMPLING TECHNIQUE
The sampling technique used in this study will be purposive sampling.
7.2.2 SAMPLE SIZE
Assuming 15% SD in the parental satisfaction score and a 10% difference between
the intervention and control groups, the sample size required is 35 per study group. The
power and type 1 error considered are 80% and 5% respectively.
7.2.3 INCLUSION CRITERIA FOR SAMPLING
1. Children after 48 hrs of admission in PICU.
2. Parent who stays with the child in PICU during day time for at least 8-10hours for more
than two days.
7.2.4 EXCLUSION CRITERIA FOR SAMPLING
1. Parents whose children are on high ventilator status (peep value >12)
2. Children on more than two ionotropic agents.
3. Children who received CPR in last 48 hours.
4. Parents who are not willing to participate in the study.
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7.2.5 INSTRUMENTS USED:
SECTION A:

A Structured interview schedule for collection of baseline variables of parents.

The questionnaire consists of age, sex, education, occupation, socioeconomic status ,
number of children and previous experience in PICU.

Baseline variables of children will be collected from hospital records which include
age, sex, Diagnosis, number of days in hospital and ventilator status.
SECTION B:

A semi structured questionnaire to collect responses towards parental satisfaction in
nursing care of child.

An observation check list to assess the participation of the parents in the care of
children.

Few open ended questions to identify the opinion of health personnels regarding
parental participation in care of children.
7.2.6 DATA COLLECTION METHODS:

After obtaining permission from the authorities and H.O.D of pediatric ICU, St.johns
medical college hospital Bangalore , the parents will be identified and selected
according to the inclusion criteria using purposive sampling technique.

Prior to the interview, purpose of the study will be explained to the parents and
written consent will be obtained.

On the first day, structured interview schedule will be used to collect the base line
variable of the parents and hospital records will be used to collect the baseline
variables of children.
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
The following days, in control group, the parents will be allowed to stay with the
child but will not be encouraged to participate in their care. On the day of discharge/
transfer out, semi- structured questionnaire on parent satisfaction will be administered
to collect the parent responses.

In experimental group, after collecting the baseline variables, parents will be
encouraged to participate or assist in the care of children, by carrying out the selected
interventions, during the stay in the hospital.

In experimental group, observation checklist will be used to assess the level of
participation of parents in child care.

On the day of discharge/transfer parent satisfaction will be assessed using a semi
structured questionnaire.

Health personnel working at the intervention site will be clearly instructed about the
study to ensure their role in supporting the parent by encouraging and guiding in
giving nursing care to the hospitalized child.

Few open ended questions will be administered to the health personnel to identify
their opinion regarding parental participation in care of children.
7.2.7 DATA ANALYSIS PLAN

Both descriptive and inferential statistics will be used for the data analysis.

Organize the data in a master sheet.

Frequency , percentage , mean, standard deviation, to assess the baseline variables.

Mean, mean difference, and standard deviation to assess the satisfaction scores of
control group and experimental group respectively.

Student- t test to compare the satisfaction level of experimental and control group.
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
Chi square test to assess the association between parental satisfactions with selected
baseline variables.
7.3 DOES THE STUDY REQUIRE ANY INVESTIGATION OR INTERVENTION TO
BE CONDUCTED ON PATIENTS OR ANY OTHER HUMAN BEINGS OR
ANIMALS? IF SO EXPLAIN BRIEFLY.
Yes, it requires an intervention that is, parents are participated in taking care of the child
using the selected interventions.
7.4 HAS THE ETHICAL CLEARANCE BEEN OBTAINED FROM YOUR
INSTITUTION?
Yes. Administrative and ethical clearance with regard to the study will be obtained from the
research committee.
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