Uncovering pain and caring for children in the pediatric intensive care unit : nurses’ clinical approach and parent’s perspective

摘要

Background: The thesis has a standpoint in a synthesis of caring science and educationscience from a clinical perspective. Children in a Pediatric Intensive Care Unit (PICU) are inan exposed position, dependent on nurses to acknowledge their needs. The alleviation ofchildren’s pain has been investigated from various perspectives, but undertreated pain remainsa problem in the PICU. There is a preponderance of empirical evidence pointing toward therole of nurses in uncovering children’s pain and suffering. How nurses interpret the child’sexpressions and judge the clinical situation influences their actions in the clinical care. In aPICU, the basis for nurses’ concerns and interpretation of what is meaningful in the nursingcare situation are formed by professional concern, workplace culture, traditions, habits, andworkplace structures. This influences how parents interpret the meaning of care as well.Patricia Benner’s theory on clinical judgment forms a reference framework for this thesis. Theassumption is that children need to be approached from a holistic perspective in the caringsituation in order to acknowledge their caring needs. A nurse’s clinical education and insightsallow for the possibility to enhance the quality of care for children and parents in the PICU.Aim: To uncover clinical concerns, from caring and learning perspectives, in caring forchildren in the Pediatric Intensive Care Unit (PICU) from nurses and parents perspective.Methods: Qualitative methods were used in all studies to unfold and explore the phenomenain the nurses’ and parents’ everyday clinical life world. In Papers I and II, aphenomenographic method was adopted. In Papers III and IV, an interpretivephenomenological approach was adopted.Findings: Nurses that have a holistic view of the child and approach the child from amultidimensional perspective, with a focus on the individual child and his/her caring needs,develop a clinical “connoisseurship” and meet the parents’ expectations of the meaning ofcare. The nurses express that it is only when they focus on the child that subtle signs of painare revealed. The meaning of nursing care, in the ideal case, is a holistic care where allaspects are integrated and the child as a person has first priority.Conclusion: The meaning of caring and children’s needs must become elucidated to improvethe cultural influence of what can be seen as good nursing care within the PICU.