الفهرس 
Pediatric Intensive Care UnitOnly 14 pages are availabe for public view
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Abstract
Satisfaction is feelings of pleasure or disappointment resulting from comparing products perceived performance in relation to expectation. If the performance falls short of expectation, the parents are dissatisfied. If the performance matches the expectation, the parents are satisfied. If the performance exceeds the expectation, the parents are highly satisfied, Child satisfaction is important and commonly used indication for measuring the quality in health care.
Child satisfactions affect clinical outcomes, and medical mal practice claims. It affects the timely, efficient, and patient-centered delivery of quality health care. Child satisfaction improves the quality of health care and improved health outcomes.
The most efficient method for this evaluation is to assess the children satisfaction with nursing care. In the case of child who cannot personally express their views, parents can help determine their satisfaction with the provided care. Satisfaction evaluation is an integral part of improving the quality of the healthcare provided in hospitals. . The quality of care can be assessed through determining children satisfaction based on their parents perception. Parents have a central role in the care of their sick child in the PICU. Parental satisfaction with their child’s care is a critical part of quality assessment and outcome measure in healthcare. It is important to conduct this study to assess satisfaction level of parents toward nursing care provided for their children at PICU. Caring for the family is an important component of caring for the child and helps to reduce both child and family anxiety. This can be achieved when family members are supported and involved in the care of the child. Understanding how families make sense of this experience and identifying what needs are important to them will support them during this difficult time and will facilitate the delivery of holistic and family-centred care to the child. The admission of a child to a PICU is seen as a crisis for parents. Regardless of the anticipated outcome, admission of a child to the PICU is a highly stressful event for families.
Finally, satisfaction with care is an area of concern that has to be addressed when nursing care is being monitored because caring has been recognized as being central to nursing practice, but perhaps it has never been more important ever before than today. Parent’s satisfaction with nursing care has been a long-standing concern of policy makers, administrators, teachers as well as researchers. Nonetheless, its utility as a predictor of outcomes of hospital nursing care has not been conclusive, although some evidence supports relationship between satisfaction with nursing care and health care outcome.
Nursing profession has often used children’s outcome as a measure to evaluate the health care services provided to children. In other words, parent’s satisfaction assists in the evaluation of the nursing care efficiency. Moreover, it also assists in bringing improvements in the established nursing practices. Above all parent satisfaction has become an outcome indicator of quality and efficiency of a composite health care system. Parents’ satisfaction measurement can also be seen as a therapeutic intervention, an important criterion for making and evaluating organizational and administrative decisions and a tool for children marketing or also as an ethical obligation which has the potential to humanize care.
Aim of the study:
This study aims to assess satisfaction level of parents toward nursing care provided for their children at pediatric intensive care unit
Research Questions:
1. What are the levels of parent’s satisfaction toward nursing care provided to their children at pediatric intensive care unit?
2. What are the levels of parent’s stress toward nursing care provided for their children at pediatric intensive care unit?
3. What are the patterns of parent’s coping related to hospitalized children?
The subject and methods of the current study will be discussed under the following four (4) designs:
● Technical Design
● Operational Design
● Administrative Design
● Statistical Design
Technical Design:
It included research, design, settings, subjects and tools of data collection.
Research Design:
A descriptive exploratory design was utilized for the current study.
Settings:
This study was conducted at Pediatric Intensive Care Unit in new Children’s Hospital affiliated to Ain Shams University Hospitals.
Research Subjects:
A purposive sample composed of 120 parents who have children at pediatric intensive care unit regardless their age, education, job and residence and their children according to sample size formula:
Inclusion criteria:
1. Children at PICU.
2. Age above 1 Years.
Exclusion criteria:
Children with Infectious diseases or congenital diseases.
Tools of data collection:
Data were collected through using the following tools:
1) Interview questionnaire form: (Appendix II):
It was designed by the researcher and written in simple Arabic language based on scientific literature review it included two parts to assess data about the following:
● Part I: It was concerned with the characteristics of the studied parents which included: Age, educational level and jobs.
● Part II: It was concerned with characteristics of the studied children which include: Age, gender, ranking and diagnosis.
2) Coping Health Inventory for Parents (CHIP): Appendix III:
It was adapted from Aguilar-Vafaie (2014), to assess coping pattern of parents having children in PICU. The scale consists of 45 items.
Scoring system:
According to the responses obtained from the parents, a scoring system was following to assess coping level of parents each question scored from 3-0 as the following, (3) extremely helpful, (2) moderately helpful, (1) minimally helpful and (zero) not helpful. The scores of the items was sum-up and the total was dividing by the number of the statements. These scores converted into a percent score and the total coping of parent has child in PICU classified as the following:
● Poor Coping = Zero – 67 (<50%)
● Average Coping = 68- 101 (50 % to75%)
● Good Coping = 102 – 135 (> 75%)
3) Parent’s Satisfaction Survey (PSS):(Appendix IV):
It was adapted from Johannes (2009), to assess parent’s satisfaction toward nursing care provided to their children at PICU. This tool was consisting of 78 items that comprise five subscales:
● Information (17 statements)
● Care and Cure (20 statements)
● Organization (17 statements)
● Parental Participation (10 statements)
● Professional Attitude (14 statements)
Scoring system
According to the responses obtained from the parents, a scoring system was followed to assess the parent’s satisfaction toward nursing care provided to their children at PICU each question scored from 4-0 as follows: (4) strongly agree, (3) agree, (2) neutral, (1) disagree and (zero) strongly disagree. The scores of the items was sum-up and the total was dividing by the number of the statements. These scores were converting into a percent score, and the total score of the parent’s satisfaction toward nursing care provided to their children at Pediatric Intensive Care Unit was classified as the following:
● Satisfactory ≥156 (≥50%).
● Unsatisfactory < 156 (<50%).
4) Parental Stress Scale: (Appendix V):
It was adapted from Cheetham and Turner-Cobb (2016), to assess stress level of parents. The scale consists of 36 items that comprise seven subscales:
● Child’s Appearance (3 items)
● Sights and Sounds (3 items)
● Procedures (6 items)
● Behaviors of The Professional Staff (4 items)
● Parental Roles (6 items)
● Communicate (4 items)
● Behaviors and Emotional Responses (10 items)
Scoring system:
According to the responses obtained from the parents, a scoring system was following to assess the stress level of parents each question scored from 4-0 as following: scored (4) extremely stressful, (3) very stressful, (2) moderately stressful (1) minimally stressful and (zero) not stressful. The scores of the items was sum-up and the total were divided by the number of the statements. These scores converted into a percent score and the total stress of parents classified as the following:
● Mild stress = Zero <72 (< 50%)
● Moderate stress = 72 – 108 (50 % to75%)
● Sever stress = 108 – 144 (> 100%)
Operation Design:
The operational design for this study consisted of three phases, namely preparatory phase, pilot study, and fieldwork.
Preparatory Phase:
This phase included reviewing of related literature by using books, articles, journals, and internet, this served to develop the study tools for data collection. During this phase, the researcher also visited the selected study setting to get acquainted with the personnel and the study settings. Development of the tools was under supervisors’ guidance and experts’ opinions were considered.
Content and Face Validity and Reliability:
Content validity was ascertained by a group (3) of the experts in field of pediatric nursing to test its content validity and applicability, Reliability was don used test-retest: parent’s satisfaction survey (0.81), coping health inventory for parents (0.86) and parental stress scale (0.80).
Pilot Study:
Pilot study was carried out on 10% (12 parents) who have children at pediatric intensive care unit in the previously mentioned setting to test the applicability, clarity and visibility of the constructed tools. The pilot has also served to estimate the time needed for each subject to fill in the questions. According to the results of the pilot, some modifications and omissions of items were performed as needed. The participants included in the pilot study were excluded from the main study sample.
Fieldwork:
The actual field work of this study was carried out started from the first of January 2019 up to June 2019 (6 months). The researcher was available in the study setting 3days/week (Monday, Tuesday and Wednesday) to collect data. from PICU in Children Hospital affiliated to Ain Shams University Hospitals from 9 a.m. to 2 p.m. the children and their caregivers were interviewed (for 45- 60 minutes). The researcher started the interview by introducing herself to both the child and parents, giving them clear and brief idea about the aim of the study and its expectation to each child before starting the interview questionnaire.
Administrative Design:
An approval obtained through an issued letter from the Dean of Faculty of Nursing, Ain Shams University to Directors of the previously mentioned setting. The researcher then met the hospital director and explained the purpose and the methods of the data collection.
Ethical Considerations:
Ethical approval was obtained from the scientific Ethical committee of Faculty of Nursing, Ain Shams University In addition, oral informed consent was obtained from children and their caregivers prior to data collection. They were assured that anonymity and confidently would be guaranteed and the right to withdraw from the study at any time, Ethics, values, culture and belief were respected.
Statistical Analysis:
The data obtained were organized, revised, scored, tabulated and analyzed, and presented in the form of tables and figures using the Statistical Package for Social Sciences version 24.0 (SPSS). Qualitative variables were presented in the form of frequencies and percentages, quantitative variables were presented in the form of mean and SD. Correlation coefficient (r) was used to assess the correlation between two quantitative variables. The confidence interval was set to 95% and the margin of error accepted was set to 5%. So, the p-value was considered significant as the following:
● P value <0.05 was considered statistically significant.
● P value <0.001 was considered as highly statistically significant.
● P value >0.05 was considered statistically insignificant.
Findings of the current study can be summarized as the following:
● 33.3 % of the studied parents were disagree from access to information, also, 33.3% of them were strongly disagree from Caregivers answer their questions adequately.. Meanwhile, 36.1% of parents reported neutral regarding their information about changes in the child’s condition as soon as possible.
● 13.9% of the studied parents reported strongly agree regarding nurses awareness of responsibilities towards child and parents. While, 37% of them had neutral opinion regarding nurses alertness to the child’s comfort and (29.6%) of them were strongly disagree regarding nurses awareness of the child’s medical history.
● 24.1% of the studied parents reported strongly agree regarding the child’s bed space is amply enough and 32.4% of parents reported neutral satisfaction regarding the waiting room fitting out comfortably. Meanwhile, 32.4 % of parents were disagree regarding the PICU is imbued with a sense of safety.
● 25.9% of parents reported agree regarding caregivers regularly informing after parental experiences during the course of admission. Meanwhile less than third (29.6%) of the studied parents disagree regarding parents show respect to the nurse.
● 37% of parents were very stressed from seeing the heart beats on the monitors and 8.3% of them were not stressful regarding sound of monitors and equipment.
● 28.1% of studied parents were average coping regarding maintaining social support, self- esteem and psychological stability. Meanwhile, 52.6% of them had poor coping regarding understanding the medical situation through communication with other parents and consultation with medical staff.
● There is no statistical significant differences between parents gender & level of education and their total that satisfactions Regarding PICU, Mean while there is statistical significance difference between parents age and their total that satisfactions.
● There were statistically significant differences between parents gender, age and their stress (P<0.05), while there was no statistically significant differences between level of education and parent’s stress (P>0.05).
● There is a negative correlation between satisfaction of the studied parents and their stressors with statistically significant difference (p value = 0.04). where high stress levels are associated with lower level of satisfaction, and there is a positive correlation between satisfaction of the studied parents and their coping regarding child hospitalization in pediatric intensive care unit with statistically significant difference (p value= 0.01). Whereas high satisfaction level is associated with higher coping levels.
Conclusion:
The current study showed that, more than two thirds of the studied parents are unsatisfied regarding PICU. More than half of the studied parents had average coping level with care provided to their children in the PICU. Meanwhile, more than half of the studied parents were severely stressed regarding PICU. There is statistical significance difference between parent’s age and their total that satisfaction. There were statistically significant differences between parent’s gender, age and their stress. There was a positive correlation between satisfaction of the studied parents and their coping toward child hospitalization in pediatric intensive care unit with statistically significant difference. There was a negative correlation between stress level of the studied parents and their coping level with statistically significant difference.
Recommendation:
In the light of findings of the present study, the followings recommendations are suggested
● Establishment of educational program to provide continuous education for nurses working in PICU to refresh their knowledge practice for communication and parents’ satisfaction.
● Provide orientation for the parents about PICU.
● Designing and distribution of booklets contain all tasks for pediatric nurses working in PICU.
● Providing Periodic courses for nurses regarding parental satisfaction, procedures and relieving stress relating to child’s appearance and behaviors of the professional staff.
● Further studies should be carried out among pediatric nurses to assess their role in parents’ satisfaction.