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704 S P E C I A LT Y P R A C T I C E I N C R I T I C A L C A R E

Case study, Continued
a gastric tube and receiving 1 L/min of O 2 via nasal prongs. Respira- post-injury. At her first review with rehabilitation specialists three
tory physiotherapy continued on the ward. Spinal precautions con- months post-injury she was moving independently, tremor no
tinued until clinical clearance was achieved on the ward, although longer apparent, could recall three of seven elements after 10
she continued to wear a collar for several weeks. Lisa was dis- minutes, was animated and social in her interactions. However,
charged from hospital after eight weeks. ongoing frontal lobe type behaviours of impulsiveness and poor
attention span were also noted. Ongoing formal assessment was
Posttraumatic amnesia lasted for almost eight weeks. Lisa’s neuro- planned semiannually, including review of her first two terms at
logical status improved sufficiently to allow her planned return to school. Returning home has allowed extended family members to
school half-time with a dedicated full-time teacher’s aide and assist the family’s recovery and rehabilitation. Lisa’s parents con-
ongoing speech and occupational therapy to occur at 3 2 months tinue to share parenting and care for both children.
1

Research vignette
Colville G, Darkins J, Hesketh J, Bennett V, Alcock J, Noyes J. The mixed-method study that aims to complement and deepen the
impact on parents of a child’s admission to intensive care: Integra- understanding of the quantitative results. Colville and colleagues
tion of qualitative findings from a cross-sectional study. Intensive justified the mixed-method approach as a strategy that would
and Critical Care Nursing 2009; 25(2): 72–9. best fulfil the objectives and test underlying hypotheses of the
larger study. They described how the qualitative data from inter-
Abstract views was analysed using a framework approach. To meet the
Objectives objective of the study, which was to complement and deepen
In this study, parents were asked which aspects of their experience understanding of the quantitative results, clarification and illustra-
of having a child in intensive care had caused them the most tion of the results from the quantitative data was achieved by
distress and how they continued to be affected by these linking with the descriptive qualitative themes. For instance, recall
experiences. of vivid memories was compared and paired with the high level
of stress associated with witnessing medical procedures. Rigorous
Research methodology
Semi-structured interviews held with 32 mothers and 18 fathers of interpretation of the results was demonstrated with the research-
children admitted to a paediatric intensive care unit 8 months ers’ articulation of the theoretical positioning and the chosen
earlier, were audiotaped, transcribed and subjected to a thematic methodology.
analysis. The findings were clearly stated with emerging themes combined
with the level of distress measured in the quantitative component
Setting of the study. The most striking finding was that the vivid memories
The setting was an eight-bed paediatric intensive care unit in an of parents 8 months post-PICU discharge of their child correlated
inner city teaching hospital.
with the high level of stress experienced at admission. Although
Results they expressed negative emotions, including fear, horror, disorien-
Significant themes included the vividness of parents’ memories of tation and impotence, parents also expressed a great amount of
admission; the intensity of distress associated with times of transi- gratitude and relief. The worst memories were during transition
tion and the lasting impact of their experience, in terms both of times, including retrieval to PICU and transfer to the ward. Mothers
the ongoing need to protect their child and in relation to their reported higher levels of distress than fathers, possibly because
priorities in life. Fathers reported different coping strategies, spent they spent more time at the bedside and were more involved in
less time on the unit and were less likely than mothers to report the care of their child, and also expressed more fear of their child’s
fearing that their child would die. possible death when compared to fathers. This emphasises the
importance and benefits of good communication and support
Conclusions given to parents by nurses and other health professionals, espe-
Parents report significant and persisting distress. Further research cially during transitions from and to PICU.
is needed on how best to support them acutely and in the longer
term. One limitation of this study is the retrospective nature of data col-
lection, as parents were asked to recall their feelings eight months
Critique after their child’s admission to PICU. However, the results of this
This study addresses an important gap highlighted in the litera- longitudinal study add to current knowledge in this area of research
ture, that is, the exploration of the long-term psychological impact and as such should not be discarded. This study’s findings further
of the child’s critical illness on parents, with the targeted inclusion highlight the need for the psychological wellbeing of parents to be
of fathers who are often excluded in studies. As stated by the routinely monitored during PICU stay and after discharge, for
authors, this paper reports the qualitative component of a larger instance in follow-up clinics.