Trends in Palliative Care Research 2022; Issue #07

Commentary by:

Julia St. Louis, RN, MN student, University of Calgary

Feature Articles:

Ghavi, A., Hassankhani, H., Powers, K., Arshadi-Bostanabad, M., Namdar-Areshtanab, H., & Heidarzadeh, M. (2022). Parental support needs during pediatric resuscitation: A systematic review. International Emergency Nursing, 63, 101173.

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On my very first day as a practicing NICU nurse, I observed the resuscitation of a little boy. He had been extubated that morning and quickly needed to be reintubated. A code blue was called, and my preceptor encouraged me to watch the team at work if I could find an unobtrusive place to stand. Doctors, nurses, and respiratory therapists quickly arrived and began their preparations to reintubate this child. Nurses prepared medications, physicians shouted out orders, and a respiratory therapist provided the child with bag-mask ventilation. I observed the team in action, my newness to the profession inspiring awe. I then watched my colleague, a registered nurse, make her way through the chaos to stand with the two people I had not yet noticed: the baby’s parents. She stood with them and gently explained what was happening to their child. When there was an appropriate moment, she invited his mother to hold her son’s hand for a minute and provide him with comfort. She demonstrated exemplary family-centred care.

I have been witnessed and participated in many resuscitations since that day. It has not always been the case that someone was able to stand with the parents and guide them through the experience. It is unacceptable that sometimes parents stand or sit alone in a corner of the room, with no one to support them. The systematic review published by Ghavi et al. (2022) identified the different support needs parents have when their child is resuscitated in hospital and expressed how critical it is to meet those needs.

Parental needs during resuscitation, as identified in this systematic review, include spiritual and cultural support, maintaining relationship with their child, professional empathy from staff, complete and honest information sharing from staff, to be present during resuscitation, trust in the healthcare team, and physical and psychological support during and after resuscitation (Ghavi et al., 2022). Parents benefited from having a spouse or other important person with them during their child’s resuscitation and expressed the importance of medical professionals effectively sharing bad news (Ghavi et al., 2022).

Parents also need support before and after their child is resuscitated. Outside of the emergency department, the healthcare team often has a sense of which children might imminently require resuscitation. Sharing concern that their child might require resuscitation honestly with parents promotes trust and provides emotional support (Ghavi et al., 2022). Understanding the severity of their child’s illness and what interventions might occur during resuscitation gives parents the opportunity to better understand and cope with the situation, as well as help them to better accept their child’s death in the case of an unsuccessful resuscitation. Parents also need support immediately after the resuscitation of their child. In the case of successful resuscitation, it was identified as important to avoid giving false hope about potential outcomes. In the case of a child’s death, parents identified using simple language to share regret, physical mementos, and respect for the sacredness of death (privacy, space to pray, time alone with their child) as important elements of family-centred resuscitation (Ghavi et al., 2022).

Future research might evaluate long-term parental needs after resuscitations. Parents might require different information or supports to process the experience of resuscitation, as well as help in explaining their surviving child’s experiences to them later. Resuscitations are traumatic experiences for both patients and their loved ones, and research identifying how best to support people before, during, and after resuscitation has a high potential for clinical impact.