No abstract

Literature reviews, parental consultation and multi-disciplinary input informed the development of a questionnaire to evaluate parental satisfaction with a regional paediatric intensive care service. The questionnaire was tested in a postal survey of 220 parents (response rate 50 percent) following their child's discharge from the unit in order to measure satisfaction levels, determine positive service attributes and identify strategies for future service development. There was a high level of parental satisfaction with many aspects of the service, particularly the standard of care, the perceived competency of staff and the level of support and involvement experienced. Satisfaction with facilities was more variable, although this was largely in relation to the hospital as a whole, rather than paediatric intensive care (PIC) facilities. Respondents provided suggestions for service development, particularly regarding information, communication and preparation for the transition from PIC to ward environments. Many of the strategies identified to optimise the service were not dependent upon extensive organisational change or excessive additional resources.

Development of a chylothorax in infants and children in the UK was not common. The primary association was with a cardiac surgical procedure. The child's hospital stay was lengthy and therefore the impact on the child, family and hospital resources were significant. Common management strategies existed but national guidance is required to optimise practice. This study allows for better information relating to this serious complication to be given to patients and families and provides the basis for future research and practice development.

When children are ill enough to require admission to paediatric intensive care, parents may become distressed about their child's medical condition and this distress may be compounded by the unfamiliar nature of the highly technological environment. Parents of children who are sick enough to warrant intubation are particularly likely to be exposed to a frightening array of technological equipment. Seventy-one parents of intubated and non-intubated children completed the Parental Stressor Scale: Paediatric Intensive Care Unit (PSS:PICU). Overall the findings suggest that parents were most distressed (a) by the painful procedures to which their children were subjected, (b) by the sights and sounds of the intensive care unit and (c) by their children's reactions to intensive care. The behaviour of staff towards parents and the way that staff communicated with them caused the least distress. When the levels of stress reported by parents of intubated children were compared with those reported by parents of non-intubated children, different patterns of stress were found. Painful procedures were a source of greater stress to parents of intubated children whereas the behaviour of staff and the children's reactions to the intensive care experience caused greater stress to the parents of the non-intubated children. In general the findings suggest that the needs of parents of non-intubated children are being overlooked, with staff focusing more of their attention on the parents of intubated children.

Implementing evidence based-practice and research findings into nursing care has been identified as a challenge to nursing staff. This article identifies key barriers to the use of research in the international literature, however, there are limited suggestions as to how to improve this in the clinical arena. This article aims to identify how nurses could optimize the implementation of evidence and research into their clinical care and reviews barriers to implementing and undertaking nursing research, suggesting a framework for improvement. It considers the widely varied levels of knowledge of research and equally varied critical appraisal skills present both at a pre and post-registration nursing level. The authors discuss an innovative, collaborative approach that considers the role of the nurse consultant, clinical academic and research facilitator posts. To ensure quality evidence-based practice is implemented into clinical nursing care a realistic and practical structure must be applied. With the appropriate framework, clinical structure and organizational support, promotion of evidence-based practice and research for patient benefit can be optimized. The implications for practice are also discussed. The implementation of a realistic research framework into clinical nursing practice has the potential to influence and develop a more active nursing research culture and promote evidence-based care within the workplace.