Introduction
Healthcare providers’ actions and attitudes largely define the overall level of patient satisfaction. The manner in which practitioners behave is even more important when patients and their families are coping with the outcomes of severe conditions/events. The qualitative study by Brooten et al. (2013) is devoted to the investigation of the effects of various provider practices on the ability of parents who lost their children to cope with grief. The analysis of research methodology and utilized tools will allow evaluating the credibility of findings.
Purpose
It is natural for parents to feel a wide range of negative emotions when the child’s chronic condition progresses and after he/she dies but also the overall clinical setting environment may add to their anxiety and depression. Therefore, the primary purpose of the study was to explore the practices that healthcare providers performed or did not perform to help caregivers cope with the death of their children in neonatal intensive care units (NICUs) and pediatric intensive care units (PICUs). Notably, the researchers focused on the parents’ perceptions to understand subjective effects of those practices.
Additionally, Brooten et al. (2013) suggested that differences in multicultural backgrounds may create barriers to effective practitioner-caregiver communication and affect the overall response of a parent to the situation. Thus, the second aim of the qualitative study was to comprehend the differences in parents’ perceptions based on their multicultural characteristics (including gender and race), as well as the type of a setting where their experience took place.
Study Design Elements: Sampling, Data Collection, and Analysis
To explore the topic from multiple perspectives, the researchers utilized a longitudinal, mixed-method study design. They assessed the sample over a prolonged period (throughout thirteen months after the child’s death) and employed both qualitative and quantitative tools yet summarized only the qualitative findings in the given article. The sample was recruited from four hospitals in South Florida and the FDH Office of Vital Statistics death records.
Researchers sent letters describing the research project to the potential participants and after that called them to identify their eligibility for the study. The inclusion criteria were White non-Hispanic, Black non-Hispanic, and Hispanic/Latino racial backgrounds; ability to understand English or Spanish; singleton pregnancy, an infant living for over two hours in a NICU or a child (age 0-18) who lived at least two hours in a PICU.
The exclusion criteria were multiple gestation pregnancies, child abuse cases, simultaneous death of one of the parents during the illness/injury event. As a result, Brooten et al. (2013) managed to recruit 63 parents (mean age of 35.1). 62 participants provided information about practitioner practices that were helpful for them, and 51 caregivers discussed factors that did not help them to cope with the loss.
It is possible to describe the implemented sampling technique as purposeful sampling because the researchers intentionally targeted individuals with needed knowledge and experience of the studied phenomenon. Since participants could provide all the necessary information, the sample size was adequate because the degree of expertise can decrease the number of respondents required for the investigation. Overall, the sample of 63 individuals was sufficient to attain the saturation point within the established timeframe.
Evidence-based, semi-structured interviews were the primary qualitative data collection instruments in the study. The tools were not tested, but they were constructed and verified by multiple experts. Therefore, a sufficient level of instrument validity and understandability was achieved. The interviews were administered at seventh and thirteenth month after the child’s death and conducted at parents’ homes. The main purpose of meetings was to allow caregivers to reflect on their experience after passing a six-month milestone after the event. The discussed topics included helpful/non-helpful practices and factors: practitioner-parent communication, level of caregiver involvement in decision-making, staff sensitivity, and so forth.
The time for each interview ranged from 1.5 to 2 hours. After that, the audios and transcripts were analyzed and systematized by expert coders who implemented an inductive approach to identify major themes and subthemes. Along with this, the qualitative data analysis software, Atlas.ti, was utilized. It allows developing a system of interconnected meanings in a data set and, therefore, significantly facilitates interpretation.
Main Findings
The findings of the study revealed that factors and practices that helped parents of the deceased child to cope with grief included compassionate and sensitive staff, excellent communication and education on issues related to the child’s condition/death, and sufficient level of caregivers’ involvement in decision-making regarding the child’s care. Additionally, parents felt better when they were sure that practitioners did everything they could for their child.
Conversely, practitioner insensitivity, conflicts and communication problems, insufficient level of nurse competence and expertise contributed to greater stress and were not helpful. Moreover, when a parent did not understand the child’s condition, his or her distress increased. Notably, women found the latter factor and conflicts with practitioners as more significant than men who were more concerned with communication problems and competence issues. Also, participants of all races found staff sensitivity and compassion as most important.
Conclusion
The obtained results allowed Brooten et al. (2013) to build a comprehensive picture of the problem and establish meaningful links among the variables of practitioner practices, clinical setting factors, and parents’ coping with grief.
It is possible to say that the provided findings are credible and valid because the researchers utilized appropriate investigation tools and involved a lot of professionals and experts for the research process validation. Additionally, the methods were consistent with study purposes and helped answer the formulated questions directly. Lastly, the sample was sufficiently diversified and included individuals from various multicultural backgrounds. Therefore, the findings can be generalized to a broad patient population with similar adverse experiences.
Reference
Brooten, D., Youngblut, J. M., Seagrave, L., Caicedo, C., Hawthorne, D., Hidalgo, I., & Roche, R. (2013). Parent’s perceptions of health care providers actions around child ICU death: What helped, what did not. The American Journal of Hospice & Palliative Care, 30(1), 40-49.