The aim of this study was to conduct a preliminary investigation into parents'
experiences of physical therapy and early mobility (EM) for their children in a
pediatric critical care unit (PCCU).
METHODS:
We conducted a series of four qualitative case studies using in-depth semi-structured
face-to-face interviews. We recruited parents of children who had undergone surgery and
received at least one EM physical therapy intervention while intubated. We conducted a
thematic analysis of transcribed interviews to illuminate the factors that influenced EM
experiences.
RESULTS:
Four parents participated in the study. We developed an overview of Parental
Experiences with Physical Therapy and Early Mobility in a PCCU, which
includes four themes that parents believed influenced their experiences: (1)
environmental factors; (2) awareness of physical therapist and health care professional
(HCP) roles; (3) communication among parents and HCPs; and (4) parental participation in
their child's EM, within the overarching parental experiences in the PCCU.
CONCLUSION:
This study affords a preliminary understanding of parents' experiences with physical
therapy and EM in a PCCU setting. Results provide an important foundation for future
research on mobility in the context of pediatric critical care research and
practice.
StiffD, KumarA, KissoonN, FowlerR, JouvetP, SkippenP, et al. Potential pediatric intensive care unit demand/capacity
mismatch due to novel pH1N1 in Canada. Pediatric Critical Care
Medicine. 2011; 12(2):
e51-e7. doi: 10.1097/PCC.0b013e3181e2a4fe.
2.
KnoesterH, BronnerM, BosA. Surviving pediatric intensive care: physical outcome after 3
months. Intensive Care Medicine. 2008;
34(6): 1076-82. doi:
10.1007/s00134-008-1061-4.
PetersenB, SchneiderC, StrassburgHM, SchrodL. Critical illness neuropathy in pediatric intensive care
patients. Pediatric Neurology. 1999;
21(4): 749-53. Epub
1999/12/02.
5.
RoetsL, Rowe-RoweN, NelR. Family-centred care in the paediatric intensive care
unit. Journal of Nursing Management. 2012;
20(5): 624-30. Epub
2012/07/25. doi: 10.1111/j.1365-2834.2012.01365.
6.
SmeetsIA, TanEY, VossenHG, LeroyPL, LousbergRH, van OsJ, et al. Prolonged stay at the paediatric intensive care unit
associated with paediatric delirium. European Child &
Adolescent Psychiatry. 2010;
19(4): 389-93. Epub
2009/09/29. doi: 10.1007/s00787-009-0063-2.
7.
KooK, ChoongK, FanE. Prioritizing Rehabilitation Strategies in the Care of the
Critically Ill. Critical Care Rounds.
2011; 8(4):
1-7.
8.
MorrisPE, GoadA, ThompsonC, TaylorK, HarryB, PassmoreL, et al. Early intensive care unit mobility therapy in the treatment
of acute respiratory failure. Critical Care Medicine.
2008; 36(8):
2238-43. Epub 2008/07/04. doi:
10.1097/CCM.0b013e318180b90e.
9.
SweeneyJK, HerizaCB, BlanchardY. Neonatal Physical Therapy. Part I: Clinical Competencies and
Neonatal Intensive Care Unit Clinical Training Models. Pediatric
Physical Therapy. 2009; 21(4):
296-307. doi: 10.1097/PEP.0b013e3181bf75ee.
10.
SweeneyJK, HerizaCB, BlanchardY, DusingSC. Neonatal Physical Therapy. Part II: Practice Frameworks and
Evidence-Based Practice Guidelines. Pediatric Physical
Therapy. 2010; 22(1):
2-16. doi: 10.1097/PEP.0b013e3181cdba43.
11.
ChoongK, KooKK, ClarkH, ChuR, ThabaneL, BurnsKE, et al. Early mobilization in critically ill children: A survey of
Canadian practice. Critical Care Medicine.
2013; 41(7):
1745-53. Epub 2013/03/20. doi:
10.1097/CCM.0b013e318287f592.
12.
KnoesterH, BronnerMB, BosAP, GrootenhuisMA. Quality of life in children three and nine months after discharge
from a paediatric intensive care unit: A prospective cohort study.
Health and Quality of Life Outcomes. 2008;
6(21): 1-9. Epub
2008/03/12. doi: 10.1186/1477-7525-6-21.
13.
ChristyJB, SaleemN, TurnerPH, WilsonJ. Parent and Therapist Perceptions of an Intense Model of Physical
Therapy. Pediatric Physical Therapy. 2010;
22(2): 207-13. doi:
10.1097/ PEP.0b013e3181db8151.
14.
MaringJ, CroarkinE, MorganS, PlackM. Perceived effectiveness and barriers to physical therapy services
for families and children with Friedreich Ataxia. Pediatric
physical therapy: The official publication of the Section on Pediatrics of the American
Physical Therapy Association. 2013;
25(3): 305-13. doi:
10.1097/PEP.0b013e31828ed7cb.
15.
O'NeilME, PalisanoRJ, WestcottSL. Relationship of Therapists' Attitudes, Children's Motor Ability,
and Parenting Stress to Mothers' Perceptions of Therapists' Behaviors During Early
Intervention. Physical Therapy. 2001;
81(8): 1412-24.
16.
AmesK, RennickJ, BaillargeonS. A qualitative interpretive study exploring parents' perception of
the parental role in the paediatric intensive care unit.
Intensive & critical care nursing: The official journal of the British
Association of Critical Care Nurses. 2011;
27(3): 143-50. doi:
10.1016/j.iccn.2011.03.004.
17.
GravemD, LakesKD, TeranL, RichJ, CooperD, OlshanskyE. Maternal perceptions of infant exercise in the neonatal intensive
care unit. Journal of Obstetric, Gynecologic, & Neonatal
Nursing. 2009; 38(5):
527-33. Epub 2009/11/04. doi:
10.1111/j.1552-6909.2009.01055.x.
18.
NealA, FrostM, KuhnJ, GreenA, Gance-ClevelandB, KerstenR. Family centered care within an infant-toddler
unit. Pediatric Nursing Journal. 2007;
33(6): 481-5. Epub
2008/01/17.
19.
BraunV, ClarkeV. Using thematic analysis in psychology.
Qualitative Research in Psychology. 2006;
3(2): 77-101.
20.
CarnevaleFA. A description of stressors and coping strategies among parents of
critically ill children - a preliminary study. Intensive and
Critical Care Nursing. 1990; 6(1):
4-11. Epub 1990/03/01.
21.
HallEO. Danish parents' experiences when their new born or critically ill
small child is transferred to the PICU-a qualitative study.
Nursing in Critical Care. 2005;
10(2): 90-7. Epub
2005/04/21.
22.
JansenLMC, KetelaarM, VermeerA. Parental experience of participation in physical therapy for
children with physical disabilities. Developmental Medicine
& Child Neurology. 2003;
45(1): 58-69.
23.
MilesMS, MathesM. Preparation of parents for the ICU experience: what are we
missing?Child Health Care. 1991;
20(3): 132-7. Epub
1992/02/03.
24.
ShudyM, de AlmeidaML, LyS, LandonC, GroftS, JenkinsTL, et al. Impact of Pediatric Critical Illness and Injury on
Families: A Systematic Literature Review. Pediatrics.
2006; 118(Supplement 3):
S203-S18.
25.
LeeCM, FanE. ICU-acquired weakness: What is preventing its rehabilitation in
critically ill patients?BMC Medicine. 2012; 10(115):
1-4. Epub 2012/10/05. doi: 10.1186/1741-7015-10-115.
26.
DangSL. ABCDEs of ICU: Early mobility. Critical
Care Nursing Quarterly. 2013;
36(2): 163-8. Epub
2013/03/09. doi: 10.1097/CNQ.0b013e318283cf45.
27.
WinkelmanC, PeereboomK. Staff-Perceived Barriers and Facilitators.
Critical Care Nurse. 2010;
30(2): S13-S6.
doi:10.4037/ccn2010393.
28.
GroverG, BerkowitzCD, LewisRJ. Parental recall after a visit to the emergency
department. Clinical Pediatrics. 1994;
33(4): 194-201. Epub
1994/04/01.
29.
KesselsRP. Patients' memory for medical information.
Journal of the Royal Society of Medicine. 2003;
96(5): 219-22. Epub
2003/05/02.
30.
DalleyJ, SimJ. Nurses' perceptions of physiotherapists as rehabilitation team
members. Clinical Rehabilitation. 2001;
15(4): 380-9. Epub
2001/08/24.
31.
JonesAY-M. Intensive Care Physiotherapy - Medical Staff
Perceptions. Hong Kong Physiotherapy Journal.
2001; 19(1):
9-16.
32.
FiserDH, StanfordG, DormanDJ. Services for parental stress reduction in a pediatric
ICU. Critical Care Medicine. 1984;
12(6): 504-7. Epub
1984/06/01.
33.
LatourJM, HazelzetJA, DuivenvoordenHJ, van GoudoeverJB. Perceptions of parents, nurses, and physicians on neonatal
intensive care practices. Journal of Pediatrics.
2010; 157(2):
215-20 e3. Epub 2010/04/03. doi:
10.1016/j.jpeds.2010.02.009.
34.
WisseloTL, StuartC, MurisP. Providing parents with information before anaesthesia: What do
they really want to know?Pediatric Anesthesia. 2004;
14(4): 299-307. Epub
2004/04/14.
35.
GaleG, FranckLS, KoolsS, LynchM. Parents' perceptions of their infant's pain experience in the
NICU. International Journal of Nursing Studies.
2004; 41(1):
51-8. Epub 2003/12/13.
Cescutti-ButlerL, GalvinK. Parents' perceptions of staff competency in a neonatal intensive
care unit. Journal of Clinical Nursing.
2003; 12(5):
752-61. Epub 2003/08/16.
38.
FarrellMF, FrostC. The most important needs of parents of critically ill children:
Parents' perceptions. Intensive & critical care nursing: The
official journal of the British Association of Critical Care Nurses.
1992; 8(3):
130-9.
39.
GordonC, BartonE, MeertKL, EgglyS, PollacksM, ZimmermanJ, et al. Accounting for medical communication: Parents' perceptions
of communicative roles and responsibilities in the pediatric intensive care
unit. Communication & Medicine. 2009;
6(2): 177-88. Epub
2009/01/01.
40.
HallEO. Being in an alien world: Danish parents' lived experiences when a
newborn or small child is critically ill. Scandinavian Journal
of Caring Sciences. 2005; 19(3):
179-85. Epub 2005/08/17.
41.
WigertH, JohanssonR, BergM, HellstromAL. Mothers' experiences of having their newborn child in a neonatal
intensive care unit. Scandinavian Journal of Caring
Sciences. 2006; 20(1):
35-41. Epub 2006/02/24.
42.
CurleyMA, MeyerEC. Parental experience of highly technical therapy: survivors and
nonsurvivors of extracorporeal membrane oxygenation support.
Pediatric Critical Care Medicine. 2003;
4(2): 214-9. Epub
2003/05/17.
43.
ObeidatHM, BondEA, CallisterLC. The parental experience of having an infant in the newborn
intensive care unit. The Journal of Perinatal
Education. 2009; 18(3):
23-9. Epub 2010/06/02.
44.
PowerN, FranckL. Parent participation in the care of hospitalized children: A
systematic review. Journal of Advanced Nursing.
2008; 62(6):
622-41. Epub 2008/05/28. doi:
10.1111/j.1365-2648.2008.04643.x 45.
45.
RapportMJ, SweeneyJK, DannemillerL, HerizaCB. Student Experiences in the Neonatal Intensive Care Unit: Addendum
to Neonatal Physical Therapy Competencies and Clinical Training Models.
Pediatric physical therapy: The official publication of the Section on
Pediatrics of the American Physical Therapy Association. 2010;
22(4): 439-40. doi:
10.1097/PEP.0b013e3181fac33e.
