What barriers and enablers to family presence at the bedside of critically ill children admitted to a pediatric intensive care unit have been proposed and studied?
This review will consider literature describing family members of children (birth to 18 years of age) admitted to a pediatric intensive care (including trauma, cardiac, neurocritical, burn, medical, and surgical units), critical care, or step-up/step-down care unit. For the purpose of this review, family members will be considered parents, siblings, legal guardians, foster- and step-parents and siblings, aunts, uncles, cousins, and any individual who is identified in the study as family.
Family presence at the bedside is defined as a family member being physically present in the PICU with the critically ill child during routine care practices. Key to this definition is the family member-child dyad. Family presence may be considered passive, in which the family member is in the room with the child and not participating in hand-on care, or active, in which the family member is engaging with the child in either their family-based role or to assist with provision of comfort or care.
Studies will be included that discuss or examine variables as either correlated with or predictive of the amount of time that families spend at the bedside, or that discuss factors that make it easier or harder to be present with the child at the bedside. Factors may be intrinsic or extrinsic to the family members. Intrinsic factors may include (but are not limited to) psychological factors, capabilities, motivators, and physical status. Extrinsic factors may include (but are not limited to) hospital and intensive care unit location, design, culture, practices, initiatives, and policy, healthcare provider attitude, child and disease-related factors, and home-life.
Family presence at the bedside will be studied in the context of a pediatric critical care unit. This will include trauma, cardiac, neurocritical, burn, medical, and surgical units, and will include units known as pediatric critical care. We will consider intermediate (step-up/step-down) care units when the scope of services includes those often provided in PICUs (e.g. continuous salbutamol, non-invasive ventilation, invasive hemodynamic monitoring). If a pediatric population can be identified within a mixed adult-pediatric or mixed neonatal-pediatric critical unit, the study will be included. We plan to exclude studies in the context of neonatal intensive care (NICU) only, mixed NICU-PICU where PICU families cannot be identified, or mixed adult-pediatric ICU where children cannot be identified. Studies that describe FPB in NICUs for neonatal patients will not be included because there is a large volume of literature related to barriers and enablers to family presence in NICU and as the culture of an NICU is different than that of a PICU. The context of the PICU will not be limited by geography or by whether the hospital in which the PICU is located is stand-alone pediatric or a larger hospital serving all age groups.