N494-M1

SCENARIO

A child having a routine pediatric appendectomy develops multiple complications, and instead of the usual 2 days spent in the hospital, the child is now in the second week of hospitalization. The surgeon is insisting that the mother go home and get a good night’s sleep as she has been staying with the child 24/7. Other staff members are commenting on how wonderful it is to have a parent remain overnight. As a nurse, you are concerned about both the patient and the mother. You wonder what is best for the mother and the child in regard to having the mother continue to stay overnight for the rest of the child’s hospitalization.

BACKGROUND INFORMATION

You think about background information you might need. You know your hospital has recently changed their visitation policy from limited hours with no overnight stays to that of open visitation to allow patients to have their family members and friends with them 24/7.

You e-mail the chair of the visitation committee to ask for the evidence they used to develop the policy. This was easy, as the committee used a citation manager, RefWorks. He shared his RefWorks records with you. As you look through the evidence they used, you quickly realize they focused on adult patients, not pediatric patients. While this evidence may be relevant, you wonder if there may be evidence that speaks specifically to pediatric visitation. This information helps you formulate the following PICOT question:

PICOT QUESTION

In parents of hospitalized children, how does remaining overnight with the child compared with limited day visits affect parental level of anxiety?

And transfer the concepts to a PICOT table:

You contact your healthcare librarian to discuss your PICOT question and search strategy. You both agree that the best search strategy approach begins with three different methods: (1) using keywords; (2) using subject headings; and (3) looking for specific keywords in the title if your search produces too many articles. The librarian asks if you would like her to do the search. You thank her politely but explain that you need to develop your searching skills; you first will try this search on your own. You reassure her that you will keep her posted on how the search goes and call her right away if you run into challenges.

Looking at your PICOT questions, you begin to develop your list of possible keywords. As you enter your keywords, you notice which MeSH terms are used for relevant studies and what subject headings are suggested in CINAHL. These methods help you find your subject terms before you start that part of the search. Your search results emerge.

LAYOUT OF RELEVANT TERMS

DATABASES TO SEARCH

You go on to search the following databases that you think might be the best match for answering your PICOT Question: CINAHL, MEDLINE®, Joanna Briggs Institute, PsycINFO, Trip, Google, Google Scholar

CINAHL SEARCH HISTORY

Three keepers using keywords for Population and Intervention:

Record: 1

Title:

Anxiety levels of rooming-in and non-rooming-in parents of young hospitalized children.

Authors:

Alexander D, Powell GM, Williams P, White M, Conlon M

Source:

Maternal-Child Nursing Journal ( Matern Child Nurs J), 1988 Summer; 17(2): 79–99. (44 ref)

You look at subject headings to build your next strategy

Major Subjects:

Rooming In Child, Hospitalized—Psychosocial Factors Parents—Psychosocial Factors Anxiety

Record: 2

Title:

Anxiety of non-rooming-in parents of hospitalized children.

Authors:

Alexander D, White M, Powell G

Source:

Children’s Health Care ( Child Health Care), 1986 Summer; 15(1): 14–20. (32 ref)

Major Subjects:

Anxiety Parents Child, Hospitalized—Psychosocial Factors

Record: 3

Title:

Practices and provisions for parents sleeping overnight with a hospitalized child.

Authors:

Stremler R, Wong L, Parshuram C

Source:

Journal of Pediatric Psychology ( J Pediatr Psychol), 2008 Apr; 33(3): 292–297.

Major Subjects:

Child, Hospitalized Hospitalization Hospitals Parent–Child Relations Parents

One keeper using subject headings for Population and Intervention:

Record: 1

Title:

Resident parents and shorter hospital stay.

Authors:

Taylor MRH, O’Connor P

Source:

Archives of Disease in Childhood ( Arch Dis Child), 1989 Feb; 64(2): 274–276. (5 ref)

Major Subjects:

Length of Stay—In Infancy and Childhood Parents—Psychosocial Factors Child, Hospitalized—Psychosocial Factors Rooming In

One last thing to try, using the subject headings for both the Outcome and the Population of your PICOT question.

Two more keepers using the subject heading for the Outcome and combining with articles having parent* in the title

Record: 1

Title:

Parental anxiety and stress during children’s hospitalisation: The StayClose study.

Authors:

Wray J, Lee K, Dearmun N, Franck L

Source:

Journal of Child Health Care ( J Child Health Care), 2011 Sep; 15(3): 163–174. (32 ref)

Record: 2

Title:

Relationship between visitation policy in a pediatric intensive unit and parental anxiety.

Author:

Lee Proctor D

Source:

Children’s Health Care ( Child Health Care), 1987 Summer; 16(1): 13.

Six articles were kept and need to be appraised. Obtain copies from your librarian, and look at the references to see if there are other articles that might be useful that you didn’t find.

Obtain copies from your librarian, and look at the references to see if there are other articles that might be useful that you didn’t find. After looking at the reference lists, you discover two additional studies you were unable to find while searching (ancestry method):

Title:

Vigilance: The experience of parents staying at the bedside of hospitalized children.

Authors:

Dudley SK, Carr JM

Source:

Journal of Pediatric Nursing ( J Pediatr Nurs), 2004 Aug; 19(4): 267–275. (18 ref)

Title:

Afraid in the hospital: Parental concern for errors during a child’s hospitalization.

Authors:

Tarini BA, Lozano P, Christakis DA

Source:

Journal of Hospital Medicine ( J Hosp Med), 2009 Nov; 4(9): 521–527.

Associations to Consider

You identify associations that might have grey literature (e.g., guideline, standard, protocol, position statement) that won’t come up in a database search.

American Academy of Pediatrics (nothing found)

National Association of Pediatric Nurse Practitioners (NAPNAP) (nothing found)

Association of Women’s Health, Obstetric & Neonatal Nurses (AWHONN) (nothing found)

Applying the Evidence to Your Practice

After appraising the evidence you found, you will be able to confidently talk with parents and other healthcare providers about the impact of remaining at their child’s bedside overnight on their level of anxiety.