Paediatric Intensive Care Unit, Bristol Royal Hospital for Children, Bristol, BS2 8HW, UK.
Centre for Outcomes and Experience Research in Children's Health, Illness and Disability, Great Ormond Street Hospital, WC1N 3JH, London, UK.
Eur J Pediatr. 2018 May;177(5):747-752. doi: 10.1007/s00431-018-3117-y. Epub 2018 Feb 21.
Critically ill adolescents are usually treated on intensive care units optimised for much older adults or younger children. The way they access and experience health services may be very different to most adolescent service users, and existing quality criteria may not apply to them. The objectives of this pilot study were, firstly, to determine whether adolescents and their families were able to articulate their experiences of their critical care admission and secondly, to identify the factors that are important to them during their intensive care unit (ICU) or high dependency unit (HDU) stay. Participants were 14-17 year olds who had previously had an emergency admission to an adult or paediatric ICU/HDU in one of four UK hospitals (two adult, two paediatric) and their parents. Semi-structured interviews were conducted with eight mother-adolescent dyads and one mother. Interviews were transcribed and analysed using framework analysis.
The main reported determinant of high-quality care was the quality of interaction with staff. The significance of these interactions and their environment depended on adolescents' awareness of their surroundings, which was often limited in ICU and changed significantly over the course of their illness. Qualitative interview methodology would be difficult to scale up for this group. What is known • Critically ill adolescents are usually treated on intensive care units optimised for older adults or younger children. • The way they access and experience health services may be different to most adolescent patients; existing quality criteria may not apply. What is new • Reported determinants of high-quality care were age-appropriateness of the environment, respectfulness and friendliness of staff, communication and inclusion in healthcare decisions. • The significance of these depended on adolescents' awareness of their surroundings, which was often limited and changed over the course of their illness.
危重病青少年通常在为年龄较大的成年人或年幼儿童优化的重症监护病房接受治疗。他们获取和体验医疗服务的方式可能与大多数青少年患者非常不同，并且现有的质量标准可能不适用于他们。本试点研究的目的首先是确定青少年及其家属是否能够表达他们在重症监护病房入院期间的经历，其次是确定在重症监护病房（ICU）或高依赖病房（HDU）住院期间对他们重要的因素。参与者为在英国四家医院（两家成人，两家儿科）之一的成人或儿科 ICU/HDU 进行过紧急入院的 14-17 岁青少年及其父母。对 8 对母亲-青少年和 1 位母亲进行了半结构化访谈。使用框架分析法对访谈进行转录和分析。
主要报告的高质量护理决定因素是与工作人员互动的质量。这些互动及其环境的重要性取决于青少年对周围环境的意识，这种意识在 ICU 中往往受到限制，并在疾病过程中发生显著变化。对于这个群体，定性访谈方法很难扩展。已知的：危重病青少年通常在为年龄较大的成年人或年幼儿童优化的重症监护病房接受治疗。他们获取和体验医疗服务的方式可能与大多数青少年患者不同；现有的质量标准可能不适用于他们。新的：高质量护理的报告决定因素是环境的年龄适宜性、工作人员的尊重和友好、沟通和参与医疗保健决策。这些因素的重要性取决于青少年对周围环境的意识，这种意识在疾病过程中往往受到限制并发生显著变化。
