Family-Centered Care in the Pediatric Intensive Care Unit

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Key points

  • Patient-centered and family-centered care (PFCC) is care that is respectful and responsive to the preferences, needs, and values of patients and families.

  • Efforts to implement PFCC in pediatric intensive care units (PICUs) include open visitation, family-centered rounding, family presence during invasive procedures, and family conferences.

  • Research on PFCC programs in PICUs generally suggests benefits to patients, families, and staff.

  • Further development of PFCC programs requires continued input

Family visitation

Historically, PICUs have had restrictive visiting policies, allowing only brief visits by parents and disallowing visits by siblings or multiple family members (please see accompanying article elsewhere in this issue).4 Concerns underlying these restrictive policies included the potential for spread of infection; breach of privacy and confidentiality, emotional trauma to patients, parents and siblings; and lack of space and staff to accommodate family. However, research on the needs of families

Family-centered rounds

The ACCM and the AAP recommend that attending physician rounds, case presentations, and discussions take place at the bedside of critically ill children in the presence of parents.2, 3 During rounds, parents should be given the opportunity to ask questions, clarify information, and participate in decision making. Recent studies16, 17, 18, 19, 20, 21, 22, 23, 24 exploring parents’ and health professionals’ perceptions, attitudes, and preferences regarding parental presence on rounds, and the

Family presence during CPR and invasive procedures

In 2000, the American Heart Association became the first national organization to recommend the option of family presence during CPR and other invasive procedures.26 These guidelines prompted several studies exploring health professionals’ views on family presence during CPR and invasive procedures for adult and pediatric patients in emergency departments and intensive care units.27, 28, 29, 30, 31, 32, 33 Health professionals supporting family presence believe that witnessing CPR increases

Family conferences

Family conferences are planned meetings between family members and the interdisciplinary team of professionals caring for the patient.2, 44, 45 Family conferences are considered an essential forum for shared decision making in the intensive care setting. Many critically ill patients are unable to communicate with health professionals or participate in decisions about their own care because of severity of illness, use of sedation and endotracheal intubation, and in the case of children, young

Summary

PFCC as an approach to care is strongly endorsed by many professional organizations. Preliminary research on the implementation of programs related to PFCC in the PICU setting generally suggests benefits to patients, families, and staff. However, more research is needed using experimental designs to further define both the benefits and risks of these practices. The development of PFCC policies and their implementation in clinical practice should reflect the needs of specific patient populations

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