Objective: To explore similarities and differences in perceptions on pediatric intensive care practices between parents and staff by using data from two studies.
Design: A two-round Delphi method among nurses and physicians followed by an empiric survey among parents.
Settings: Pediatric intensive care units at eight university medical centers.
Subjects: Parents whose child has been admitted to a pediatric intensive care unit, nurses, and physicians.
Measurements and Main Results: Outcome measures were 74 satisfaction-with-care items divided into five domains: 1) information; 2) care and cure; 3) organization; 4) parental participation; and 5) professional attitude. The Delphi study was completed by 218 nurses and 46 physicians and the survey by 559 of 1042 (54%) parents. Parents rated 31 items more important than the professionals based on the standardized mean difference (Cohen's d, 0.21–1.18, p < .003). Ten of these were related to information provision. Information on the effects of medication had the largest effect size (Cohen's d 1.18, p = .001). Correct medication administration by professionals was also rated significantly more important by parents (Cohen's d 0.64, p = .001). The professionals rated 12 items more important than the parents (Cohen's d −0.23 to −0.73, p < .005), including three about multicultural care. Significant differences remained on two of the three multicultural care items when the Dutch (n = 483) and non-Dutch parents (n = 76) were separately compared with professionals. On the domain level, parents rated the domains information and parental participation more important than the professionals (Cohen's d 0.36 and 0.26, p = .001).
Conclusions: Compared with the parents' perceptions, nurses and physicians undervalued a substantial number of pediatric intensive care unit care items. This finding may reflect a gap in the understanding of parental experiences as well as incongruity in recognizing the needs of parents.
From the Department of Pediatrics (JML, JBvG, JAH), Erasmus Medical Centre–Sophia Children's Hospital, Rotterdam, The Netherlands; the Department of Medical Psychology and Psychotherapy (HJD), Netherlands Institute for Health Science, Erasmus University Medical Centre, Rotterdam, The Netherlands; the Pediatric Intensive Care Unit (MJIJA), Beatrix Children's Hospital, University Medical Center Groningen, Groningen, The Netherlands; the Pediatric Intensive Care Unit (NAMvD), Leiden University Medical Center, Leiden, The Netherlands; the Pediatric Intensive Care Unit (ED), Maastricht University Medical Center, Maastricht, The Netherlands; the Department of Pediatric Intensive Care (MvH), VU University Medical Center, Amsterdam, The Netherlands; the Department of Pediatrics (JBvG), VU University Medical Center, Amsterdam, The Netherlands; the Department of Pediatrics (JBvG) AMC-Emma Children's Hospital, Amsterdam, The Netherlands; the Pediatric Intensive Care Unit (MDN), AMC–Emma Children's Hospital, Amsterdam, The Netherlands; the Pediatric Intensive Care Unit (CWMV), University Medical Center St Radboud, Nijmegen, The Netherlands; and the Pediatric Intensive Care Unit (EMVV), University Medical Center Utrecht–Wilhelmina Children's Hospital, Utrecht, The Netherlands.
This study was partially supported by a grant, SNO-T-0501114, from the Nuts OHRA Foundation.
The authors have not disclosed any potential conflicts of interest.
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