Date of Award

1-1-2001

Document Type

Thesis

Publisher

Edith Cowan University

Degree Name

Master of Nursing

Faculty

Faculty of Communications, Health and Science

First Supervisor

Rhonda Marriott

Abstract

A child's admission to a paediatric intensive care unit (PICU) is stressful for the family. Parental presence and involvement with their child in hospital have been recognised as important in reducing their stress. Several studies have identified parental needs in the PICU. Nurses have reported that they felt inadequately prepared to meet those needs. Although principles to guide nursing strategies have been identified, contextual behaviours of PICU nurses to reduce parental stress have not A qualitative study, using an ethnographic approach, was designed to describe contextual behaviours of experienced PICU nurses. Participants self identified their level of clinical practice to be at The Competency Standards for Specialist Critical Care Nurses (CACCN Inc., 1996). Fifteen nurses from six Australian PJCUs (two each in Brisbane and Sydney, one each in Melbourne and Adelaide) were interviewed. Recalled critical incidents identifying nursing behaviours to reduce parental stress were audiotaped, transcribed, analysed and interpreted. NUD•IST (version 4.0) was used to facilitate the initial data analysis. King's conceptual framework for nursing (1981), was used to illustrate the interactions of the interpersonal relationships between staff and parents and the effect of the culture within the PlCU. King's conceptual framework consists of three interacting, open systems; individuals as personal systems, two or more individuals forming interpersonal systems, and larger groups with common interests forming social systems or cultures. The nurses described parental stressors and behaviours. Nursing behaviours were anticipatory or in response to parental cues. Demonstrating empathy, sensitivity, caring and encouraging the parental role enabled rapport to be developed. Keeping parents fully informed, listening and talking through problems were also important stress reducing behaviours. PICU cultural behaviours, such as restricting parents' presence with their child, resulted in increased stress. The nurses found their role more difficult when parents were non English speaking, were of a different culture, religion or social background, or had long stays in the PICU. The nurses' personal challenges included the death of a patient, the need to remain impartial, and the pressure to always perform. The PICU nurses' ability to quickly establish rapport during a stressful time in the parents' lives was crucial to be able to reduce their stress. Many contextual nursing behaviours to reduce parental stress were described. However, consideration must be given to modifying those behaviours that increased parental stress. From both the perspective of positive and negative nursing behaviour, this study will enable nurses to be aware of behaviours that reduce and exacerbate parental stress in order to improve their practice in supporting parents.

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