‘So why didn’t you think this baby was ill?’ Decision-making in acute paediatrics

Roland, Damian; Snelson, Edward

doi:10.1136/archdischild-2017-313199

Cited by 19 publications

(18 citation statements)

References 19 publications

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“…Positive experiences of care, across (n = 12) studies, were reported where parents were able to express their opinions’ on care given to their newborns and when there was good communication between providers and parents [ 22 , 26 , 33 , 34 ]. Positive interactions were evident when parents are taught basic nursing skills such as feeding, cleaning, clothing and monitoring their newborn,.…”

Section: Resultsmentioning

confidence: 99%

Experience of care of hospitalized newborns and young children and their parents: A scoping review

et al. 2022

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Introduction Several global initiatives put parent involvement at the forefront of enabling children’s well-being and development and to promote quality of care for newborns and hospitalized young children aged 0–24 months. Scanty evidence on mistreatment such as delays or neglect and poor pain management among newborns exists, with even less exploring the experience of their parents and their hospitalized young children. To address this gap, authors reviewed research on experience of care for hospitalized young children and their parents, and potential interventions that may promote positive experience of care. Methods A scoping review of English language articles, guidelines, and reports that addressed the experiences of care for newborns and sick young children 0–24 months in health facilities was conducted. Multiple databases: PubMed, PROSPERO, COCHRANE Library and Google Scholar were included and yielded 7,784 articles. Documents published between 2009 and November 2020, in English and with evidence on interventions that addressed family involvement and partnership in care for their sick children were included. Results The scoping review includes 68 documents across 31 countries after exclusion. Mistreatment of newborns comprises physical abuse, verbal abuse, stigma and discrimination, failure to meet professional standards, poor rapport between providers and patients, poor legal accountability, and poor bereavement and posthumous care. No literature was identified describing mistreatment of hospitalized children aged 60 days– 24 months. Key drivers of mistreatment include under-resourced health systems and poor provider attitudes. Positive experience of care was reported in contexts of good parent-provider communication. Three possible interventions on positive experience of care for hospitalized young children (0–24 months) emerged: 1) nurturing care; 2) family centered care and 3) provider and parental engagement. Communication and counseling, effective provider-parental engagement, and supportive work environments were associated with reduced anxiety and stress for parents and hospitalized young children. Few interventions focused on addressing providers’ underlying attitudes and biases that influence provider behaviors, and how they affect engaging with parents. Conclusion Limited evidence on manifestations of mistreatment, lack of respectful care, drivers of poor experience and interventions that may mitigate poor experience of care for hospitalized young children 0–24 months especially in low resource settings exists. Design and testing appropriate models that enhance socio-behavioral dimensions of care experience and promote provider-family engagement in hospitals are required.

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Section: Resultsmentioning

confidence: 99%

Experience of care of hospitalized newborns and young children and their parents: A scoping review

et al. 2022

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“…Conversely all participants of this study relied on guidelines for severely unwell children and those in cardiac arrest regardless of experience. Decision tools in paediatrics are seldom as sensitive and specific as we would desire (Roland and Snelson, 2019)…”

Section: Discussionmentioning

confidence: 99%

“…Conversely, all participants of this study relied on guidelines for severely unwell children and those in cardiac arrest regardless of experience. Decision tools in paediatrics are seldom as sensitive and specific as we would desire ( Roland & Snelson, 2019 ). Accuracy of gut feeling in clinical decision making is variable but shows potential for identifying sick children when compared with individual clinical features ( Van den Bruel et al, 2010 ).…”

Section: Discussionmentioning

confidence: 99%

What factors influence clinical decision making for paramedics when attending to paediatric emergencies in the community within one ambulance service trust?

Hetherington

Jones

2021

British Paramedic Journal

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Background: Children’s healthcare needs are complex and diverse. Paramedics are expected to respond to a range of emergency calls across the patient demographic spectrum and to make complex clinical decisions, whilst facing growing pressures to seek provisions of care for their patients within the community.Aim: This study looked to understand the lived experiences of paramedics when attending to paediatric patients, and what factors influenced decision making.Methods: A qualitative study employing semi-structured interviews, to collect and describe the lived experiences of participants. Participants were paramedics working for an ambulance service responding to calls in the community. Participants varied in experience and registrant level of education. Interview data were transcribed verbatim and analysed utilising inductive thematic analysis.Results: <list id="list1" list-type="bullet"> <list-item>Education provoked the most discussion, with a desire for more knowledge and training to improve confidence when attending to patients with low acuity complaints.</list-item> <list-item>Confidence was found to be intrinsically linked to experience, with clinicians who were more exposed to paediatrics in their professional or personal life displaying more confidence when attending to this patient group.</list-item> <list-item>Emotion of clinicians and/or families contributes to the clinical decision-making process; coupled with a reliance on clinical guidelines, there is a high probability of a paediatric consultation resulting in conveyance to an emergency department.</list-item> <list-item>Provision of care was variable geographically, with largely negative experiences observed with attempts for community referrals.</list-item> </list>Conclusions: Providing a focus of education more reflective of paramedics’ experiences will address some of the factors discussed by participants. Introducing innovative solutions such as developing guidelines for lower acuity conditions and the introduction of specialist roles could contribute to mitigating the barriers paramedics faced while improving the quality of care provided to paediatric patients. Barriers to confidence existing due to lack of exposure may well still exist, as would options to refer to community services.

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“…14 The current diagnostic approach for sepsis rely predominately on clinician-guided assessment or physiologybased tools, which pose numerous challenges due to the complex nature of paediatric physiology. 15 While the search for more precise biomarkers for sepsis continues, little is known in relation to using concern as a diagnostic tool to aid in earlier recognition. 16 In addition to parental concern, the gut feeling or intuition of healthcare professionals may contribute to the recognition of sepsis.…”

Section: Strengths and Limitations Of This Studymentioning

confidence: 99%

Parental and healthcare professional concern in the diagnosis of paediatric sepsis: a protocol for a prospective multicentre observational study

et al. 2021

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IntroductionPaediatric sepsis is a major contributor to morbidity and mortality worldwide. Assessing concern from parents and healthcare professionals to determine disease severity in a child evaluated for sepsis remains a field requiring further investigation. This study aims to determine the diagnostic accuracy of parental and healthcare professional concern in the diagnosis of children evaluated for sepsis.Methods and analysisThis prospective multicentre observational study will be conducted over a 24-month period in the paediatric emergency department (ED) at two tertiary Australian hospitals. A cross-sectional survey design will be used to assess the level of concern in parents, nurses and doctors for children presenting to ED and undergoing assessment for sepsis. The primary outcome is a diagnosis of sepsis, defined as suspected infection plus organ dysfunction at time of survey completion. Secondary outcomes include suspected or proven infection and development of organ dysfunction, defined as a Paediatric Sequential Organ Failure Assessment Score >0, within 48 hours of presentation, paediatric intensive care unit admission, confirmed or probable bacterial infection independent of organ dysfunction, and hospital length of stay.Ethics and disseminationEthics approval was obtained from Children’s Health Queensland’s Human Research Ethics Committee (HREC/17/QRCH/85). Findings will be shared with relevant stakeholders and disseminated via conferences and peer-reviewed journalsTrial registration numberWHO Universal Trial Number, U1111-1256-4537; ANZCTR number, ACTRN1262000134092.

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‘So why didn’t you think this baby was ill?’ Decision-making in acute paediatrics

Cited by 19 publications

References 19 publications

Experience of care of hospitalized newborns and young children and their parents: A scoping review

Experience of care of hospitalized newborns and young children and their parents: A scoping review

What factors influence clinical decision making for paramedics when attending to paediatric emergencies in the community within one ambulance service trust?

Parental and healthcare professional concern in the diagnosis of paediatric sepsis: a protocol for a prospective multicentre observational study

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