SCENARIO

A child having a routine pediatric appendectomy develops multiple complications, and instead of the usual 2 days spent in the hospital, the child is now in the second week of hospitalization. The surgeon is insisting that the mother go home and get a good night’s sleep as she has been staying with the child 24/7. Other staff members are commenting on how wonderful it is to have a parent remain overnight. As a nurse, you are concerned about both the patient and the mother. You wonder what is best for the mother and the child in regard to having the mother continue to stay overnight for the rest of the child’s hospitalization.

BACKGROUND INFORMATION

You think about background information you might need. You know your hospital has recently changed their visitation policy from limited hours with no overnight stays to that of open visitation to allow patients to have their family members and friends with them 24/7.

            You e-mail the chair of the visitation committee to ask for the evidence they used to develop the policy. This was easy, as the committee used a citation manager, RefWorks. He shared his RefWorks records with you. As you look through the evidence they used, you quickly realize they focused on adult patients, not pediatric patients. While this evidence may be relevant, you wonder if there may be evidence that speaks specifically to pediatric visitation. This information helps you formulate the following PICOT question:

PICOT QUESTION

In parents of hospitalized children, how does remaining overnight with the child compared with limited day visits affect parental level of anxiety?

            And transfer the concepts to a PICOT table:

PopulationParents of hospitalized children
InterventionParent remains overnight
ComparisonLimited day visits
OutcomeAnxiety level
TimeDuring hospitalization

You contact your healthcare librarian to discuss your PICOT question and search strategy. You both agree that the best search strategy approach begins with three different methods: (1) using keywords; (2) using subject headings; and (3) looking for specific keywords in the title if your search produces too many articles. The librarian asks if you would like her to do the search. You thank her politely but explain that you need to develop your searching skills; you first will try this search on your own. You reassure her that you will keep her posted on how the search goes and call her right away if you run into challenges.

            Looking at your PICOT questions, you begin to develop your list of possible keywords. As you enter your keywords, you notice which MeSH terms are used for relevant studies and what subject headings are suggested in CINAHL. These methods help you find your subject terms before you start that part of the search. Your search results emerge.

LAYOUT OF RELEVANT TERMS

ConceptsKeywordsMeSH IdentifiedCINAHL Terms
Population Parents of hospitalized childrenParent(s) Mom; mother Dad; father  Parents Visitors to patientsVisitors to patients Parents Parent–child relations
Hospitalized childrenChild, children Kid(s)  Child, hospitalized Inpatients Hospitals, pediatricChild, hospitalized Inpatients Hospitals, pediatric
Intervention   Remaining overnightOvernight; sleep; sleepover Stay; staying, stays Remain, remaining, remains Room(s) Room in; rooming inPatients’ roomsRooming in Patients’ rooms
Comparison Limited day visitNo overnight stayNoneVisitors to patients
Outcome Anxiety level  Anxiety; anxious Stress; stressful; stressed    Anxiety Stress, psychological Adaptation, psychological  Anxiety Separation anxiety Stress, psychological Coping

DATABASES TO SEARCH

You go on to search the following databases that you think might be the best match for answering your PICOT Question: CINAHL, MEDLINE®, Joanna Briggs Institute, PsycINFO, Trip, Google, Google Scholar

CINAHL SEARCH HISTORY

Set #QueryLimiters/ Expanders*Use truncation to pick up parent, parents, parenting Results
S1 (Using keyword to represent Population)Parent*Boolean/phrase84,351
S2Hospitalized child*Boolean/phrase1,016
S3 (Combining sets to represent Population)S1 and S2Boolean/phrase267
S4 (Limiting to English language)S1 and S2Limiters—English language231
S5 (Using keyword to represent Intervention)Rooming inBoolean/phrase186
S6 (Using keyword to represent Intervention)OvernightBoolean/phrase1,837
S7 (Using keyword to represent Intervention)RoomBoolean/phrase15,044
S8 (Combining sets to represent all Intervention)S5 or S6 or S7Boolean/phraseLook at these articles 17,022
S9 (Combining the keyword sets representing Population and Intervention)S8 and S3Boolean/phrase7
S10 (Using subject heading to represent Population)MM “Parents” 11,817
S11 (Using subject headings to represent the hospitalized pediatric patient)MM “Child, Hospitalized”Boolean/phrase2,576
S12S10 and S11Boolean/phrase348
S13 (Using subject heading to represent Intervention)Rooming inBoolean/phrase102
S14 (Combining the subject heading sets representing Population and Intervention)S12 and S13Boolean/phraseLook at these articles 3
S15 (Using subject heading to represent Outcome)MM “Anxiety”Boolean/phrase8,120
S16 (Combining subject headings for Population and Intervention)S15 and S10Boolean/phrase148
S17 (Limiting to English language)S15 and S10Limiters—English language141
S18 (Limiting by pediatric age group)S15 and S10Limit to all child114
S19 (Finding parent* in the title of the article)TI parent*Boolean/phrase25,735
S20 (Using title search to maintain relevance for Population) while decreasing yieldS19 and S18Boolean/phraseLook at these articles 92


Three keepers using keywords for Population and Intervention:

Record: 1

Title:

Anxiety levels of rooming-in and non-rooming-in parents of young hospitalized children.

Authors:

Alexander D, Powell GM, Williams P, White M, Conlon M

Source:

You look at subject headings to build your next strategy

Maternal-Child Nursing Journal (Matern Child Nurs J), 1988 Summer; 17(2): 79–99. (44 ref)

Major Subjects:

Rooming In
Child, Hospitalized—Psychosocial Factors
Parents—Psychosocial Factors
Anxiety

Record: 2

Title:

Anxiety of non-rooming-in parents of hospitalized children.

Authors:

Alexander D, White M, Powell G

Source:

Children’s Health Care (Child Health Care), 1986 Summer; 15(1): 14–20. (32 ref)

Major Subjects:

Anxiety
Parents
Child, Hospitalized—Psychosocial Factors

Record: 3

Title:

Practices and provisions for parents sleeping overnight with a hospitalized child.

Authors:

Stremler R, Wong L, Parshuram C

Source:

Journal of Pediatric Psychology (J Pediatr Psychol), 2008 Apr; 33(3): 292–297.

Major Subjects:

Child, Hospitalized
Hospitalization
Hospitals
Parent–Child Relations
Parents

One keeper using subject headings for Population and Intervention:

Record: 1

Title:

Resident parents and shorter hospital stay.

Authors:

Taylor MRH, O’Connor P

Source:

Archives of Disease in Childhood (Arch Dis Child), 1989 Feb; 64(2): 274–276. (5 ref)

Major Subjects:

Length of Stay—In Infancy and Childhood
Parents—Psychosocial Factors
Child, Hospitalized—Psychosocial Factors
Rooming In

One last thing to try, using the subject headings for both the Outcome and the Population of your PICOT question.

Two more keepers using the subject heading for the Outcome and combining with articles having parent* in the title

Record: 1

Title:

Parental anxiety and stress during children’s hospitalisation: The StayClose study.

Authors:

Wray J, Lee K, Dearmun N, Franck L

Source:

Journal of Child Health Care (J Child Health Care), 2011 Sep; 15(3): 163–174. (32 ref)

Record: 2

Title:

Relationship between visitation policy in a pediatric intensive unit and parental anxiety.

Author:

Lee Proctor D

Source:

Children’s Health Care (Child Health Care), 1987 Summer; 16(1): 13.

Six articles were kept and need to be appraised. Obtain copies from your librarian, and look at the references to see if there are other articles that might be useful that you didn’t find.

Obtain copies from your librarian, and look at the references to see if there are other articles that might be useful that you didn’t find. After looking at the reference lists, you discover two additional studies you were unable to find while searching (ancestry method):

Title:

Vigilance: The experience of parents staying at the bedside of hospitalized children.

Authors:

Dudley SK, Carr JM

Source:

Journal of Pediatric Nursing (J Pediatr Nurs), 2004 Aug; 19(4): 267–275. (18 ref)

Title:

Afraid in the hospital: Parental concern for errors during a child’s hospitalization.

Authors:

Tarini BA, Lozano P, Christakis DA

Source:

Journal of Hospital Medicine (J Hosp Med), 2009 Nov; 4(9): 521–527.

Associations to Consider

You identify associations that might have grey literature (e.g., guideline, standard, protocol, position statement) that won’t come up in a database search.

American Academy of Pediatrics (nothing found)

National Association of Pediatric Nurse Practitioners (NAPNAP) (nothing found)

Association of Women’s Health, Obstetric & Neonatal Nurses (AWHONN) (nothing found)

Applying the Evidence to Your Practice

After appraising the evidence you found, you will be able to confidently talk with parents and other healthcare providers about the impact of remaining at their child’s bedside overnight on their level of anxiety.

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