13 “Don’t Want to Be in the Room? Never. Can’t Be in the Room? Yes”: A Mixed Methods Analysis of Barriers and Facilitators to Parental Presence at the Bedside in a Paediatric Intensive Care Unit
Bibliographic record
Abstract
Abstract Background Though a paediatric intensive care unit (PICU) admission is overwhelming for families, bedside parental presence improves child comfort, reduces parental anxiety, and enables family engagement. Previous research has focused on parental presence during events (rounds, resuscitation, and procedures), but little is known about factors influencing parental presence at their child’s bedside for routine PICU care. Objectives To identify factors that parents perceive as impacting their capability, opportunity, and motivation to be at the bedside in PICU, and explore parental perceptions about the quality and value of time spent at the bedside. Design/Methods This mixed methods study used semi-structured interviews based on the Theoretical Domains Framework (TDF). Participants were parents of children admitted to a Canadian PICU. Participants completed a demographics form and the Medical Term Recognition Test (METER) to assess health literacy. Interviews were coded independently by two researchers using a directed content approach based on the TDF. Once consensus was reached, themes and subthemes were identified inductively within each domain to generate barriers and enablers. Factors were examined for trends based on dichotomized demographics. Results Fourteen primary caregivers participated in 11 interviews. Participants were 8 mothers and 6 fathers, of children with both planned (n=4) and unplanned (n=7) admissions. METER scores ranged from 4 to 40, with a mean of 31. Seventy-six barriers and enablers were identified within 13 domains. Factors were most commonly in the ‘environmental context and resources’ domain (n=13) and included “comfortable and functional physical environment”, “medicalization of the child”, and “PICU technology”. Parents emphasized the importance of self-care which, although requiring parents to leave the bedside, allowed them to be fully engaged when they were present. A ubiquitous factor was “maintenance of the parent role”. Parents felt responsible to be present, but recognized alterations in the parental role while in PICU. Parents who were <25 years old, fathers, or those who had first and unplanned PICU admissions identified relatively fewer skills and capabilities supporting their presence. Multiple factors, particularly in the domains of social influence and environmental context, are potentially modifiable to better support parental presence and engagement at the bedside. Conclusion Parents perceive multiple factors influencing their capability, opportunity, and drive to be present with their critically ill child in PICU, some of which are amenable to direct intervention by healthcare professionals and hospital policy. Healthcare professionals may maximize parental engagement by attempting to optimize quality, rather than quantity, of time at the bedside.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.036 | 0.035 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.001 | 0.002 |
| Bibliometrics | 0.004 | 0.004 |
| Science and technology studies | 0.003 | 0.002 |
| Scholarly communication | 0.003 | 0.002 |
| Open science | 0.002 | 0.002 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.003 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".