Aplication of Family Centered Care on the Impact of hospitalization in Intensive Care Unit In Parents’ Perspective: literature Review
Corresponding author:
Mariyam Mariyam
mariyam@unimus.ac.id
South East Asia Nursing Research, Vol 4 No 1, March 2022
ISSN:2685-032X
DOI: https://doi.org/10.26714/seanr.4.1.2022.35-46
Review Article
Aplication of Family Centered Care on the Impact of hospitalization in
Intensive Care Unit In Parents’ Perspective: literature Review
Staningsih Herlambang Kurniawati1, Mariyam Mariyam1, , Dera Alfiyanti1, Amin
Samiasih1
1 Universitas Muhammadiyah Semarang, Indonesia
Article Info Abstract
Article History:
Submitted: Jan 12th 2021
Accepted: March 5th 2022
Published: March 29th 2022
Keywords:
Family Centered Care;
Pediatric Intensive Care;
Parents / Family
family-centred Care (FCC) is an effective intervention in reducing the impact
of hospitalization. The aim of this literature review was to identify published
research articles on the application of the FCC concept to the reduction of
the impact of hospitalization in pediatric intensive care wards from the
perspective of the parents. The literature review research took 14 journals
from various databases published in 2015-2021. Searching for titles was
obtained through identification and screening, entering inclusion criteria, so
that 13 international journals and 1 national journal were obtained. The
results of this study identified parental perspectives regarding the
application of the core concepts of the FCC in reducing the impact of
hospitalization, where each concept is accompanied by theme findings, for
respect and dignity: a) the physical and cultural environment of the PICU, b)
the expression of compassion and support from staff; sharing information:
a) using understandable language, b) medical cycles, and c) satisfaction with
communication; participation: a) parents as experts, b) how parents
participate, c) environmental / staff impact on participation, and d) medical
cycles; and Collaboration. This review reveals parents' reports that the
implementation of the FCC concept in reducing the impact of hospitalization
has not been fully fulfilled, as evidenced by the finding of positive and
negative implementations related to the FCC concept.
INTRODUCTION
Children are individuals who are in a range
of changes starting from infants to
teenagers who experience changes in
growth and development in a fast or slow
time1 Children can experience illness and
even critical illness. Critical illness is a
condition that is not expected and
endangers the patient's life. These
conditions can be in the form of acute
illness, trauma and chronic disease. Critical
illness in children causes high morbidity
and mortality rates.2 In critical condition,
children need intensive care.
The pediatric intensive care unit is a unit
dedicated to treating pediatric patients
aged over 28 days to 18 years who
experience illness, accident/trauma, which
is life threatening, requires intensive care,
comprehensive observation, and special
care3 his room includes most of the
sophisticated and complex equipment such
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South East Asia Nursing Research, Vol 4 No 1, March 2022/ page 35-46 36
Mariyam Mariyam / Aplication of Family Centered Care on the Impact of hospitalization in Intensive Care Unit In
Parents’ Perspective: literature Review
as intravenous lines, drugs, ventilators,
monitors, and alarm sounds that are
unusual for the patient's family4
Hospitalization in the intensive care unit is
a crisis for patients and families because of
the emotional intensity experienced and
the complexity of the care provided.5 The
main stressors of hospitalization in
children include separation, loss of control,
bodily injury, and pain. The child's reaction
to the stressor of hospitalization at
separation showed that the child restrained
the parent to stay (64.5%), the reaction to
the loss of control was obtained by the child
depending on the parent (64.1%) and the
reaction to injury and pain was obtained by
the child asking for action. ended (60.3%).6
Other studies have identified anxiety in
parents that can arise as a response to
being alienated from the hospital
environment, such as not knowing the
room and the people in it, not
understanding medical rules and
procedures, and feeling unable to control
themselves and not being able to put
themselves in a position to care for
themselves. determine what role he must
do while the child is in the hospital7
888888Families with children in intensive
care units may experience significant
psychological symptoms, including acute
stress, post-traumatic stress, anxiety, and
depression.9 Families with patients in
critical care rooms experience Post Trauma
Syndrome Disorder (PTSD) as much as
33%, 33% experience anxiety and 20%
experience depression.10
Families are an important part of child care
during illness. Creating a relationship
between parents and health professionals
is necessary, such as involving parents in
making decisions and facilitating parental
participation in child care11 Increasing the
role of parents in child care from an early
age can reduce the negative impacts of
hospitalization of children in intensive
care.5
Family-centered care (FCC) as a model of
care is a way of caring for children and their
families in health services.12 The Institute
for Patient Family Centered Care developed
four core concepts for implementing the
FCC, namely respect and dignity;
information sharing involves
communicating and providing clear and
unbiased information; participation
includes family involvement in decision-
making and child care; collaboration
consists of partnerships with families to
improve policies, programs and
infrastructure (https://www.ipfcc.org/).
The results of observations by researchers
in the PICU room at a Semarang hospital,
showed that parents with children who
were treated in the PICU room waited more
outside the room and experienced
limitations in participating in caring for
their children. The family feels anxious
about the condition of their child in the
intensive room without parental
supervision. The partnership between the
family and the health care team is very
important in pediatric nursing. Parents are
the constant voice, advocate and caregiver
for the child. In addition, it is the parents
who are most responsible for the care of the
child after being discharged. The policy of
family visits at the hospital makes parents
or families have limited time in visiting
hours, so they do not have 24-hour access
to participate in caring for children.
Families experience high levels of anxiety,
stress and depression continuously.13 The
purpose of this literature review is to
describe the perspective of parents in the
implementation of FCC in the pediatric
intensive care unit.
METHODS
This study can be classified as a literature
review. The data based searches
ScienceDirect, Springer Link, PubMed dan
Google Scholar. The keywords used in the
article search using ‘Family Centered Care,
Pediatric Intensive Care, Parents/family’.
The search results obtained 13
https://www.ipfcc.org/
South East Asia Nursing Research, Vol 4 No 1, March 2022/ page 35-46 37
Mariyam Mariyam / Aplication of Family Centered Care on the Impact of hospitalization in Intensive Care Unit In
Parents’ Perspective: literature Review
international journals and 1 national
journal with the year published between
2015-2021. The articles discussed in the
literature review were obtained in the form
of open access, relevant and free full text
with the theme of family centered care in
the child intensive care room from the
perspective of parents. The title search
results can be seen in Figure 1
Figure 1. flowchart of screening articles
RESULT
Based on this literature review, there are
four core FCC concepts, namely respect and
dignity, information sharing, participation
and collaboration. In this section, we will
discuss the findings of the theme based on
each of the FCC core concepts, about
whether the application of the FCC core
concepts has been applied in the PICU as a
form of implementation to reduce the
impact of child hospitalization in the eyes of
the parents, which is summarized in table 2.
Tabel 1
Data Synthesis
No
Title. Researcher,
year, journal
source
Research design Result Conclusion
1 Family-centered
care and
traumatic
symptoms in
parents of
Research design:
Cross-sectional study
Sample: 90 parents of
children treated in
support from nurses is high in both
parents and is associated with Acute
Stress Disorder. 1/3 of parents have
ASD. There were no significant
gender differences when symptoms
Parents' traumatic
experiences with child
care in the PICU were
associated with acute
stress, but not disease
S
cr
e
e
n
in
g
In
cl
u
d
e
d
Id
e
n
ti
fi
ca
ti
o
n
ScienceDirect (n= 319 articles)
Pubmed (n= 220 articles)
ResearchGate (n=31 articles)
Google Schoolar (n=180 articles)
articles that meet the inclusion criteria (n
articles are screened with inclusion criteria in the year of
publication (2015-2021) (n = 467)
Screening of the same title and
abstract that has been read (n=46)
Articles included in the analysis
(n-13)
Full text articles were excluded because
not related family centered care in
intensive care unit
Total number of articles (n=750)
Full-text articles included in literature review
(n=30)
South East Asia Nursing Research, Vol 4 No 1, March 2022/ page 35-46 38
Mariyam Mariyam / Aplication of Family Centered Care on the Impact of hospitalization in Intensive Care Unit In
Parents’ Perspective: literature Review
No
Title. Researcher,
year, journal
source
Research design Result Conclusion
children admitted
to PICU, 14
Scandinavian
Journal of Caring
Sciences
PICU in University
Hospital of Aarhus.
Method: Parents fill
out a self-report
questionnaire
package when their
child is discharged
from the hospital
were dimensionally measured. If
measured categorically, 17% of
mothers and 7% of fathers suffer
from ASD. Mothers with very young
children had higher levels of acute
stress; fathers whose children have
high disease severity scores exhibit
more acute stress
severity, or fear of losing
the child.
More research is needed
to understand the
dynamics of family-
centered care
2 Family presence
during pediatric
tracheal
intubations
(Sanders et al.,
2016).
Journal of JAMA
Pediatrics
Research design:
Prospective cohort
study
Sample: With or
without family
presence, all
intubations of
patients younger than
18 years in 22
international PICUs
from July 2010 -
March 2014 in the
multicenter TI
database (National
Emergency Airway
Registry for Children)
Method: Comparing
intubation actions on
patients with family
presence or without
family presence
A total of 4969 tracheal intubations,
81% of intubations were performed
with family present with a mean
patient age of 2 years, 19%
intubations were performed without
family presence with a mean patient
age of 1 year
Family presence was not
associated with the
success rate of tracheal
intubation attempts or
adverse events such as
oxygen desaturation
(<80%), or increased
stress on the medical
team.
Data suggest that family
presence during
intubation can be safely
applied as part of the FCC
model in the PICU
3 Parental
satisfaction with
the quality of care
in a South African
paediatric
intensive care unit
(Mol, Argent, &
Morrow, 2018).
Southern African
Journal of Critical
Care
Research design:
descriptive study
Sample: 100 parents
whose children were
cared for in the PICU
for 48 hours
Method: Participants
completed a
questionnaire at the
Children's Red Cross
Hospital, South Africa
(EMPATHIC-30),
which includes 30
closed questions
assessing satisfaction
in different domains
and four open
questions to
qualitatively describe
the PICU experience
Overall, parents reported positive
experiences during their child's care
in the PICU. However, the lowest
response scores were found to be
related to 'Information' and 'parental
participation', which are important
aspects of the FCC. active
involvement of parents in decision-
making about the care and treatment
of their child as well as properly
informing about the indications,
effects and possible side effects of
drugs, are highlighted areas for
improvement of FCC practice in the
PICU.
Although parents are
generally very satisfied
with the quality of care,
increasing family
involvement and
providing adequate
information in the PICU
can contribute to the
quality of the FCC.
4 Parental Sources
of Support and
Guidance When
Making Difficult
Decisions in the
Pediatric
Research design:
prospective cohort
study
Sample: 86 English-
speaking parents of
75 children in the
pediatric intensive
Most parents choose doctors, nurses,
friends and extended family as their
main source of support and guidance
when making difficult decisions
Parents rely heavily on
doctors, nurses, and
extended friends and
family when making
difficult decisions for their
critically ill child
South East Asia Nursing Research, Vol 4 No 1, March 2022/ page 35-46 39
Mariyam Mariyam / Aplication of Family Centered Care on the Impact of hospitalization in Intensive Care Unit In
Parents’ Perspective: literature Review
No
Title. Researcher,
year, journal
source
Research design Result Conclusion
Intensive Care
Unit.
17
The Journal of
Pediatrics,
care unit at Children's
Hospital of
Philadelphia who
were hospitalized
more than 72 hours.
Method: Each parent
completed the survey
instrument
independently, and
team members were
present to answer
any questions
5 A qualitative
study of parents'
experiences in the
pediatric intensive
care unit.
Alzawad, Lewis,
Kantrowitz-
Gordon, &
Howells,
(2020)
Journal of
Pediatric Nursing
Research design:
qualitative research
Sample: 15 parents of
children with
complex medical
conditions who were
admitted for 48 hours
or more in the PICU
Method: Semi-
structured face-to-
face interviews were
conducted in the PICU
at the bedside of the
sick child
Riding a Roller Coaster is a core
construct that describes the parental
experience. The analysis revealed
four domains: being in a new stressful
situation, thinking hard all the time,
going through emotional storms,
being in a safe place with great
people
Despite the exceptional
medical services, parents
are traumatized by seeing
their child in a life-
threatening situation and
being hit by a tidal wave of
emotions. Parents live in a
state of uncertainty,
helplessness and fear, not
knowing if their child will
survive or have a bad
outcome such as
permanent disability.
6 Implementasi
Perawatan
Berpusat Pada
Keluarga.
Andra Saferi
dkk.(2018)
Google scholar
Research design:
Qualitative
phenomenology
Sample: 12 people
consisting of nurses,
parents and doctors
by purposive
sampling
Generated 6 themes: meaning of
parents with children, perceptions of
parents and nurses, implementation,
benefits, challenges, expectations of
implementing family-centered care in
the PICU
Strict regulations at PICU
prevent families from
participating in caring for
their children in Picu
7 Parents' Perceived
Satisfaction of
Care,
Communication
and Environment
of the Pediatric
Intensive Care
Units at a Tertiary
Children's
Hospital.
(Abuqamar,
Arabiat, &
Holmes, 2016).
Journal of
Pediatric Nursing
Research design:
Cross-sectional,
descriptive-
correlational design
quantitative
approach
Sample: 123 parents
with children
hospitalized in
Amman
90% of parents believe that nurses
ignore their child's needs by not
listening to parents and responding
slowly to their child's needs. Stepwise
regression analysis showed that the
number of hospitalizations, health
insurance and disease severity were
the main predictors of parental
satisfaction
the availability of health
professionals, the support
and information they
provide to parents and
children, are all important
for parent satisfaction and
for a better quality of care.
8 Dominance of
paternalism in
family-centered
care in the
pediatric intensive
care unit (PICU):
An ethnographic
study
Research design:
Etnographic
research design
Method: data
collection,
participant
observation, field
work, and
There are five themes: "non-owned
environment", "separation of children
from their parents," non-interactive
communication", "restricted
participation", and "combination of
affection and sympathy".
he prevailing atmosphere
in care is paternalistic
because there is a large
gap between the
conceptually or
theoretically accepted
implementation of the FCC
in the PICU and the
South East Asia Nursing Research, Vol 4 No 1, March 2022/ page 35-46 40
Mariyam Mariyam / Aplication of Family Centered Care on the Impact of hospitalization in Intensive Care Unit In
Parents’ Perspective: literature Review
No
Title. Researcher,
year, journal
source
Research design Result Conclusion
19
Jurnal
ComprehensiveChi
ld and Adolescent
Nursing
interviews with the
main PICU actors,
namely supervisors,
nurses, and parents
applied FCC. Bridging the
gap between theory and
practice can help improve
the social and
organizational cultural
environment for children,
parents, and medical
teams and their
performance in PICU
services
9 What Impact Do
Hospital and Unit-
Based Rules Have
Upon Patient and
Family-Centered
Care in the
Pediatric
Intensive Care
Unit?
20
Research design:
Qualitative studies
Sample: 7 parents of
patients treated in
PICU
and 12 nurses
Observation and
interview
the existence of explicit and implicit
rules in the pediatric intensive care
unit, has a negative impact on the
ability of families to receive care that
is attentive to their needs
Agencies make rules and
norms, which apply to
nurses as service
providers and
families/patients as
service recipients.
However, there is a
difference between what
parents are looking for
and what is provided by
the staff as a result of the
FCC's suboptimal
implementation of
institutional rules and
norms. so a wider FCC
model is needed.
10 Parents'
experiences of
their child being
admitted to a
paediatric
intensive care
unit: a
qualitative
study–like being
in another world
21
Scandinavian
Journal of Caring
Sciences
Research design:
Qualitative studies
Method: Interviews
were conducted on
12 parents
whose child is being
treated in the PICU
Parents' experiences of PICU care
are summarized under the
overarching theme of 'it's like being
in another world. The analysis of the
study led to the identification of two
categories namely, 'engaged' and
'informed', with seven
subcategories, namely caring for
parents, security and trust, changing
parental roles, stress and fear,
importance of knowing interactions
in care, preparation of information
before action.
A parent's experience of
having their child
admitted to a pediatric
intensive care unit is
fraught with various
emotions and fears. Good
information, involvement
and positive experiences
of being transferred to
the pediatric ward
reduce stress and anxiety
related to care in the
PICU. The results of this
study can be used as a
basis for follow-up
services for children and
their families after
treatment in the PICU
11 Elements of
Family-Centered
Care in the
Pediatric
Intensive Care
Unit: An
Integrative
Review
22
Jurnal Physiology
& behavior
Research desain:
literature review
Five themes were identified: 1)
information sharing; 2) hear the voice
of parents; 3) make decisions for or
with parents; 4) negotiating role; and
5) individual communication
PICU puts health staff in
touch with families and
protects them from
distress. Asking parents
about their preferences for
participation across these
domains can improve
doctor-family
relationships
12 An Evaluation of
Family-Centered
Research desain:
cross sectional
family and staff agree that medical
team visits keep families informed
and report positive statements
family and staff agree that
medical team visits keep
families informed and
South East Asia Nursing Research, Vol 4 No 1, March 2022/ page 35-46 41
Mariyam Mariyam / Aplication of Family Centered Care on the Impact of hospitalization in Intensive Care Unit In
Parents’ Perspective: literature Review
No
Title. Researcher,
year, journal
source
Research design Result Conclusion
Rounds in the
PICU
23
Jurnal Pediatric
Critical Care
Medicine
regarding family presence at the time
of visite; However, PICU colleagues
disagreed that families provided
relevant information and nurses
reported that family presence limited
discussion about patients. The main
advice families offer providers to
improve the well-being of medical
team visits is to be more considerate
and courteous, including adjusting
family schedules, minimizing
distractions, and limiting computer
viewing.
report positive statements
about family presence
during visits; However,
PICU colleagues disagreed
that families provided
relevant information and
nurses reported that
family presence limited
discussion about patients.
The main advice given by
families to health workers
to improve the goodness
of medical team visits is to
be more attentive and
polite, including adjusting
family schedules,
minimizing distractions,
and limiting computer
viewing
13 The
conceptualization
of family care
during critical
illness in
KwaZulu-Natal,
South Africa.
24
Jurnal of Health
SA Gesondheid
Research desain:
qualitative
Sample: 31
participants (family
members, intensive
care nurses and
doctors) who
voluntarily
participated
Data collection
includes in-depth
interviews
family care is conceptualized as
togetherness, partnership, respect
and dignity
During critical illness, the
patient's family fulfills an
additional important role
for the patient who may be
unconscious or unable to
communicate or make
decisions. Families not
only provide vital support
to their loved ones, but
also become the “voice” of
the patient
14 Exploring the
experiences of
parent caregivers
of children with
chronic medical
complexity during
pediatric intensive
care unit
hospitalization :
an interpretive
descriptive study
25
BMC Pediatrics
Interpretive
descriptive study
Semi-structured
interviews were
conducted with 17
caregivers of 14
critically ill patients
Parents of patients with Chronic
medical complexity (CMC) are
expected to continue to provide care
but feel that their knowledge and
expertise is not always recognized by
staff. They stress the importance of
parent-staff partnerships. Four
themes were identified: (1) "We
know our child best;" (2) When skills
collide; (3) Negotiating parenting
boundaries; and (4) Importance is
known. Results support the need for a
PICU parenting approach for CMC
that recognizes parental expertise
Partnership between staff
and parents, good
communication with staff,
continuous attention in
the PICU are very
important, especially in
the case of CMC
Tabel 2
Summary of Journal Description (n = 14)
FCC concept theme parents' perception n % Reference
Respect and
dignity
Perception of the
physical
environment and
trigger culture
the bathroom in the unit and the
waiting room furniture are not
available. Noise level in the PICU,
small room size, comfortable chair
near the patient's bed, facilities for
5 35 18
- (Mol, Argent, &
Morrow, 2018),
South East Asia Nursing Research, Vol 4 No 1, March 2022/ page 35-46 42
Mariyam Mariyam / Aplication of Family Centered Care on the Impact of hospitalization in Intensive Care Unit In
Parents’ Perspective: literature Review
FCC concept theme parents' perception n % Reference
meeting parents' personal needs
(cleaning, nutrition, rest)
- (Alzawad, Lewis,
Kantrowitz-Gordon, &
Howells, 2020).
- 19
- (Baird, Davies, Hinds,
Baggott, & Rehm, 2015)
Expressions of
affection and
support from the
staff
Expressions of affection and
support from the staff
8 57 25
- Madrigal et al., 2016)
- (Mortensen et al.,
2015)
- (Alzawad et al., 2020);
- ( Dahav & Sjöström-
Strand, 2018)
- (Sanders et al., 2016).
- 19
- ( Levin, Fisher, Cato,
Zurca, & October,
2015a)
Sharing
information
Use a language
you can
understand
Difficult terms, absorption of
information, parent's choice of
language, misunderstood
3 21 -26
-(de Beer & Brysiewicz,
2017).
-(Alzawad et al., 2020;
Baird et al., 2015).
Visit the medical
team
Parents can receive information,
feel accepted, feel opinionated, can
ask questions, feel reassured,
transparency, cause stress,
discomfort and anxiety
3 21 - (Levin et al., 2015a)
-27
- (Levin et al., 2015a).
Satisfaction with
communication
Satisfied with feedback, easier to
get information, introduced to staff.
Dissatisfied when staff speak
coldly, ignore emotional and
spiritual needs, poor admissions,
disparate information, too many
staff
7 50 - (Richards, Starks,
O’Connor, &
Doorenbos, 2017)
- (Levin et al., 2015a;
- Rennick et al., 2019).
-16
- Abuqamar et al., 2016
- Vasli et al., 2015)
- Saferi Wijaya et al.,
2018)
Participation parents as
experts
Staff: treats parents as experts,
accepts advice, asks for
consideration, puts it into practice,
Parents: feel unheard, hesitate to
express opinions, worry about
disturbing
5 35 -25,28
18–20
How Parents
participate
Parents look after children, are
involved in care, entertain children,
as child advocates
5 35 -(Abuqamar et al.,
2016; 2015;
-Rennick et al., 2019
-(Baird et al., 2015)
17,28
Environmental/s
taff impact on
participation
Staff guiding parents
Parents have limited participation,
because of the PICU rules, the
trigger environment is not child-
friendly
4 28 -(Mortensen et al.,
2015).
-(Baird et al., 2015)
-18
19
Visit the medical
team
As an avenue for participating in
treatment decision making,
equate perceptions in participation
2 28 -(Richards et al., 2017)
-(Levin et al., 2015)
Kolaborasi -
South East Asia Nursing Research, Vol 4 No 1, March 2022/ page 35-46 43
Mariyam Mariyam / Aplication of Family Centered Care on the Impact of hospitalization in Intensive Care Unit In
Parents’ Perspective: literature Review
DISSCUSION
Based on a review of the identified
literature, it provides an overview of the
application of the FCC core concept as an
intervention to reduce the impact of
hospitalization on children in the PICU in
the view of parents.
The concept of respect and dignity with the
theme of the perception of the physical and
cultural environment of the PICU and
expressions of compassion and support
from staff. The physical condition of the
PICU environment is a factor that influences
parents in getting respect and dignity.
Parents' perception that a clean and
comfortable room, close to the waiting
room is an indicator of respect.18 The lack of
respect was communicated by the
unavailability of a bathroom for the family,
so that during a visit the parents had to
leave the PICU to find a bathroom, then
return to the unit which had to pass through
the security guard/door with an automatic
lock button.16,27 Parents, expressed other
indicators of a lack of respect due to noise
levels in the PICU, disrupting rest, small
room size, insufficient space to
accommodate personal items or providing a
comfortable chair near the patient's
bed.18,27 there are no facilities for parents to
meet their personal needs such as
cleanliness, nutrition, or a place to rest.19 In
the pediatric intensive care unit, parents
comment that the waiting room is generally
an uncomfortable social space where
stressed family members exhibit various
emotional behaviors and annoy other
patients' families.20 One report describes
waiting room furniture that is not conducive
to sitting or resting.16 Having an
environment where parents can be present,
make unlimited visits, perform basic
activities of daily living and fulfill their own
hygiene needs, and feel comfortable, safe,
and welcome is a basic form of respect and
dignity that every parent should give when
their child is in the PICU as a form of
implementation of the FCC concept in
reducing the impact of hospitalization.
Children's room environment is considered
by parents to affect their ability to
physically participate in child care, in order
for parents to be active in care, staff should
explain to parents about equipment
installed in children and how parents can
safely touch, hold, and participate in care.
Equipment placement can be modified so
that parents can physically reach the side of
the bed to care for the child.
The concept of sharing information, related
themes are using understandable language,
medical team visits, and satisfaction with
communication. Information sharing is
defined as health workers communicating
and sharing complete and unbiased
information with patients and families.
Patients and families receive timely,
complete, and accurate information to
participate effectively in care and decision
making. For parents, the most important
aspect of communication is that the doctor
uses language that the family can
understand26, shows that the speed with
which information is provided is important
for the patient's family in absorbing
information, considering the stress, fatigue,
and emotions caused by the information
itself 24 Several parents indicated that the
terms used by the health team led to a
misunderstanding of the severity of the
child's illness, or why certain procedures
were not performed.20,27 Parents
recommend that when communicating with
families where multiple languages are
spoken, staff should communicate in the
parent's preferred language as a sign of
respect and to maximize understanding.
Regarding the Medical Team Visit or better
known as the doctor's visit in the pediatric
intensive care unit, it is an opportunity for
parents to participate and be an active part
of exchanging information about their
child's care. Parents' experiences with
doctor visits relate to information sharing
South East Asia Nursing Research, Vol 4 No 1, March 2022/ page 35-46 44
Mariyam Mariyam / Aplication of Family Centered Care on the Impact of hospitalization in Intensive Care Unit In
Parents’ Perspective: literature Review
and participation. Based on the results of
previous studies, 74% of family members
reported having received information
about the medical round, 92% felt accepted,
97% felt that listening to child case
discussions by the provider team was very
helpful, 92% felt comfortable asking
questions, parents also reported that
participating in the medical round about
their child provides an opportunity to
receive and exchange information with the
team.26 Although parents are not happy to
be in the PICU and see their child being
monitored intensively, they believe this is
the kind of care their child needs, which
gives them "a little peace of mind". Parents
feel "reassured" when surrounded by the
medical team during a doctor's visit to
discuss the child's case and treatment
plan.27 Although parents reported that
listening to the various treatment options
discussed during the medical round was
stressful and uncomfortable participating
in these activities, 36% believed doctor
visits promoted transparency between
parents and the care team. Parents report
feeling anxious about the information they
hear.26
Regarding the theme of satisfaction in
communicating, parents expect and need
regular and frequent feedback about their
child's progress and condition.28 Parents
indicated that they know their child best,
part of the role of parents is to obtain
information about their child's care and
condition.25,26 Parents expressed
satisfaction and dissatisfaction about
communication with the service team in the
PICU. In the intensive care unit, parents
reported that it was easier to get
information such as doctor's visit schedule
than in other wards because the ratio of
nurses to patients was one to one. The
parents said “The doctor immediately
informed me about the procedure to be
performed”. "We can ask any questions and
they are willing to answer." “We were
introduced to the staff and got complete
information about our son's condition."16
Parents reported that they were introduced
to service staff. Doctors and nurses
communicated well, answered questions
thoroughly, staff immediately informed
parents about the procedure to be
performed.16,18
n contrast to those who expressed
satisfaction with communication, parents
were dissatisfied when staff spoke coldly
and ignored their emotional and
psychological needs.19 Other parents
reported that the staff did not do a good job
of preparing them for hospitalization in the
PICU.18 Para orang tua melaporkan
mendapatkan informasi yang tidak
konsisten dari berbagai staf layanan, yang
menyebabkan kebingungan dan frustrasi.
Parents reported getting inconsistent
information from various service staff,
leading to confusion and frustration.
Parents report receiving disparate
information or among service staff they
think there are too many staff involved in
care to know what others are doing.25,28,29
Although there are several reports of
examples of communication being
considered poor, the implementation of
good information sharing is mostly fulfilled
from the perspective of parents with
children who are being cared for in
intensive care.
Reducing the impact of hospitalization on
parents with children being treated in the
PICU, there is a need for continuous
communication of understandable
information to parents of children in the
PICU, validating that what the family
"hears" is what the provider wants to
convey, and for clarification of
misunderstandings . Repeating information
in multiple formats (oral, written, or visual
demonstration), and using simple, family-
understandable terms in the family's
language of choice, and then verifying that
parents understand the information
correctly, can help exhausted parents
absorb a lot of the information. complex
information they provide when stressed.
South East Asia Nursing Research, Vol 4 No 1, March 2022/ page 35-46 45
Mariyam Mariyam / Aplication of Family Centered Care on the Impact of hospitalization in Intensive Care Unit In
Parents’ Perspective: literature Review
The concept of participation, discusses the
theme of parents as experts, how parents
participate, the impact of the
environment/provider on participation,
and visits to the medical team as a forum for
participation. Some parents view
participation in medical team visits as a
means to exchange information with the
health care team. However, some parents
refuse to participate in medical team visits
due to confusion or anxiety, in which case
staff must find other ways to share
information with parents. Parental
participation in medical rounds should not
replace the individual's frequent exchange
of information with the family. Treating
parents with respect includes respecting
their decision whether to participate in the
medical round and determining what
alternative opportunities are available to
them to participate in care and exchange
information with staff. parents should be
encouraged and supported to participate in
care at the level of their choosing. The key
is a shared understanding between parents
and providers of how, when, and the
amount of participation each parent wants.
Develop a plan for parental participation
re-evaluate it from time to time to find out
what level of participation they desire. This
is expected to reduce the impact of stress
experienced by parents.
On the concept of collaboration as defined
by the IPFCC there are no data showing its
implementation in the summarized
literature review. There is no evidence that
parents reported having been involved in
efforts with health care institutions or
health care systems about policy and
program development, facility design, and
education.
CONCLUSION
The application of the FCC is a benchmark in
caring for pediatric patients and their
families. Parents of children who are
admitted to the PICU often relate to the
severity of their child's illness and how to
treat their child in the PICU environment
which results in different levels of anxiety or
stress. The findings from this literature
review reveal parental reports that the
application of FCC in reducing the impact of
hospitalization has not been fully realized.
There are still positive and negative
implementations related to the FCC concept.
The medical services team must be aware of
the FCC's core concepts and how their
actions can impact parents in both positive
and negative ways.
ACKNOWLEDGMENTS
The author would like to thank all those
who have helped and supported the
research process and writing this research
article.
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