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.
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:
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:
|Population||Parents of hospitalized children|
|Intervention||Parent remains overnight|
|Comparison||Limited day visits|
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
|Concepts||Keywords||MeSH Identified||CINAHL Terms|
|Population Parents of hospitalized children||Parent(s) Mom; mother Dad; father||Parents Visitors to patients||Visitors to patients Parents Parent–child relations|
|Hospitalized children||Child, children Kid(s)||Child, hospitalized Inpatients Hospitals, pediatric||Child, hospitalized Inpatients Hospitals, pediatric|
|Intervention Remaining overnight||Overnight; sleep; sleepover Stay; staying, stays Remain, remaining, remains Room(s) Room in; rooming in||Patients’ rooms||Rooming in Patients’ rooms|
|Comparison Limited day visit||No overnight stay||None||Visitors 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 #||Query||Limiters/ Expanders||*Use truncation to pick up parent, parents, parenting Results|
|S1 (Using keyword to represent Population)||Parent*||Boolean/phrase||84,351|
|S3 (Combining sets to represent Population)||S1 and S2||Boolean/phrase||267|
|S4 (Limiting to English language)||S1 and S2||Limiters—English language||231|
|S5 (Using keyword to represent Intervention)||Rooming in||Boolean/phrase||186|
|S6 (Using keyword to represent Intervention)||Overnight||Boolean/phrase||1,837|
|S7 (Using keyword to represent Intervention)||Room||Boolean/phrase||15,044|
|S8 (Combining sets to represent all Intervention)||S5 or S6 or S7||Boolean/phrase||Look at these articles 17,022|
|S9 (Combining the keyword sets representing Population and Intervention)||S8 and S3||Boolean/phrase||7|
|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/phrase||2,576|
|S12||S10 and S11||Boolean/phrase||348|
|S13 (Using subject heading to represent Intervention)||Rooming in||Boolean/phrase||102|
|S14 (Combining the subject heading sets representing Population and Intervention)||S12 and S13||Boolean/phrase||Look at these articles 3|
|S15 (Using subject heading to represent Outcome)||MM “Anxiety”||Boolean/phrase||8,120|
|S16 (Combining subject headings for Population and Intervention)||S15 and S10||Boolean/phrase||148|
|S17 (Limiting to English language)||S15 and S10||Limiters—English language||141|
|S18 (Limiting by pediatric age group)||S15 and S10||Limit to all child||114|
|S19 (Finding parent* in the title of the article)||TI parent*||Boolean/phrase||25,735|
|S20 (Using title search to maintain relevance for Population) while decreasing yield||S19 and S18||Boolean/phrase||Look at these articles 92|
Three keepers using keywords for Population and Intervention:
Anxiety levels of rooming-in and non-rooming-in parents of young hospitalized children.
Alexander D, Powell GM, Williams P, White M, Conlon M
|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)
Child, Hospitalized—Psychosocial Factors
Anxiety of non-rooming-in parents of hospitalized children.
Alexander D, White M, Powell G
Children’s Health Care (Child Health Care), 1986 Summer; 15(1): 14–20. (32 ref)
Child, Hospitalized—Psychosocial Factors
Practices and provisions for parents sleeping overnight with a hospitalized child.
Stremler R, Wong L, Parshuram C
Journal of Pediatric Psychology (J Pediatr Psychol), 2008 Apr; 33(3): 292–297.
One keeper using subject headings for Population and Intervention:
Resident parents and shorter hospital stay.
Taylor MRH, O’Connor P
Archives of Disease in Childhood (Arch Dis Child), 1989 Feb; 64(2): 274–276. (5 ref)
Length of Stay—In Infancy and Childhood
Child, Hospitalized—Psychosocial Factors
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
Parental anxiety and stress during children’s hospitalisation: The StayClose study.
Wray J, Lee K, Dearmun N, Franck L
Journal of Child Health Care (J Child Health Care), 2011 Sep; 15(3): 163–174. (32 ref)
Relationship between visitation policy in a pediatric intensive unit and parental anxiety.
Lee Proctor D
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):
Vigilance: The experience of parents staying at the bedside of hospitalized children.
Dudley SK, Carr JM
Journal of Pediatric Nursing (J Pediatr Nurs), 2004 Aug; 19(4): 267–275. (18 ref)
Afraid in the hospital: Parental concern for errors during a child’s hospitalization.
Tarini BA, Lozano P, Christakis DA
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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