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Explore the care escalation process initiated by parents concerned about their hospitalised child's deterioration and healthcare providers' response to parental concerns.
A qualitative study using Charmaz's constructivist grounded theory.
Participants included healthcare providers, cultural mediators and parents of children hospitalized for ≥ 3 days, who had experienced previous urgent intensive care admission or parental concern during hospitalization, in a tertiary pediatric hospital. Data were collected through focus groups, and analyzed using a grounded theory methodology with NVivo Software.
A total of 13 parents, 7 cultural mediators and 68 healthcare providers participated in 16 focus groups. Two main categories were identified: (1) Parents navigating the uncertainty of the escalation system to get a response; (2) Healthcare providers balancing parents' concerns, their own situation awareness, escalation processes and team relations. We developed a Grounded theory called ‘Parents Supporting Timely Escalation Processes’ (P-STEP). By monitoring their children, parents identify early signs of deterioration and advocate for escalation. Reasons for concern are their child's behaviour, communication failure and admission on an off-service ward. Parents escalate by contacting ward providers, their child's specialist or the most trusted staff and, only selected parents, the Rapid Response Team. Staff escalate parents' concern according to their own situation awareness, parent evaluation and ward escalation practices. Parent's emotions and trust are influenced by the timeliness and type of staff response.
While some parents effectively advocate for their child, others face obstacles due to unclear and lack of formal care escalation systems. Understanding how parents escalate care and healthcare providers respond is essential to identify facilitators, barriers, key stakeholders, and implement a formal system for parent-initiated escalation of care.
Integrating parents into processes of escalation and rapid response systems could optimise early recognition and improve responsiveness in paediatric deterioration.
The study adheres to the COnsolidated criteria for REporting Qualitative research (COREQ) guidelines.
Parents and HCPs participated as interview respondents.
To explore the phenomenon of nurse–patient's illness experience.
A multicentre phenomenological qualitative study was conducted in Italy.
A convenience sample of nurses with an acute illness experience, requiring at least one hospitalisation of ≥ 3 days, was enrolled. Semi-structured interviews were conducted. Data were transcribed verbatim and analysed according to Giorgi's descriptive method. Ethics committee approval was obtained for this study. The COnsolidated criteria for REporting Qualitative research checklist guided the study reporting.
Eleven interviews were conducted from August 2022 to July 2023. The essential structure ‘being on the other side of the fence’ and six common themes, ‘role reversal’, ‘expanded awareness’, ‘professional identity’, ‘emotional swing’, ‘having experienced it on their own skin’ and ‘reframing the healthcare context’, were identified. Nurses' awareness of the healthcare system and pathways related to their professional background at the onset of their illness experience turns into an expanded awareness of the illness experience in itself, having it ‘lived on their own skin’. When nurses return from the ‘other side of the fence’ to their professional role this new awareness triggers a more compassionate and cognizant relationship with patients and colleagues.
This study highlights the lived experience of nurses who became patients, showing characterising elements of ‘being on the other side of the fence’ and the potential of this experience for expanding nurses' awareness of other patients' experiences under their care.
Nurse–patients' illness experience may be instrumental to reinforce nurses' awareness, empathy and any positive attitude or practice devised to improve patient's illness experiences and patient centred care in hospitals.
Nurses participated as interview respondents.
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