Cardiovascular and Critical Care Programs, Boston Children’s Hospital, Boston, Massachusetts, USA.
Am J Respir Crit Care Med. 2012 Dec 1;186(11):1133-9. doi: 10.1164/rccm.201205-0915OC. Epub 2012 Sep 20.
Parent presence during invasive procedures and/or resuscitation is a relatively underdeveloped and controversial practice. Much of the concern stems from the apprehension of the medical community.
To evaluate whether implementation of formal practice guidelines and corresponding interprofessional education would improve clinicians' sense of preparation and comfort in providing parents with options during their children's procedures.
Multiphase pre-post survey of (1) clinician perceptions and (2) practice from the perspective of clinicians and parents experiencing the same procedure. Data were collected over 4 years from a cardiovascular and critical care program in one U.S. children's hospital.
More than 70% of clinicians participated in the perception surveys (n = 782) and 538 clinicians and 274 parents participated in the practice surveys. After the intervention, clinicians reported that parents were present during more invasive procedures and reported higher levels of comfort with the practice of providing options to parents during resuscitative events. Levels of comfort were higher in clinicians who had practiced skills in a simulated learning environment. During both phases, few clinicians reported that parent presence affected their technical performance (4%), therapeutic decision-making (5%), or ability to teach (9%). During the post phase, clinicians reported more active parent behaviors during procedures. Parents who reported receiving information to help them prepare for their children's procedures reported higher levels of procedural understanding and emotional support.
Implementation of practice guidelines and interprofessional education had a positive impact on clinicians' perceptions and practice when providing parents with options and support during their children's invasive procedures and/or resuscitation.
在有创性操作和/或复苏期间允许家长在场，这是一种相对未充分发展且有争议的做法。人们的担忧主要源于医疗界的担忧。
评估实施正式的实践指南和相应的跨专业教育是否会改善临床医生在为其子女的操作过程中为家长提供选择时的准备感和舒适度。
对（1）临床医生的看法和（2）从经历相同程序的临床医生和家长的角度进行的实践进行多阶段前后调查。数据来自美国一家儿童医院的心血管和重症监护计划，在 4 年内收集。
超过 70%的临床医生参加了感知调查（n=782），538 名临床医生和 274 名家长参加了实践调查。干预后，临床医生报告说，在更多有创性操作中，家长在场，在复苏事件中为家长提供选择时，他们的舒适度更高。在模拟学习环境中练习过技能的临床医生中，舒适度水平更高。在两个阶段中，很少有临床医生报告说家长的存在会影响他们的技术表现（4%）、治疗决策（5%）或教学能力（9%）。在后期阶段，临床医生报告说，在操作过程中，家长的行为更加积极。报告收到有助于他们为子女手术做准备的信息的家长报告说，他们对手术过程的理解和情感支持水平更高。
在为其子女的有创性操作和/或复苏期间为家长提供选择和支持时，实施实践指南和跨专业教育对临床医生的看法和实践产生了积极影响。
