Research and commentary

Parents’ and nurses’ experiences of caring for infants with severe bronchiolitis

The experience of parents and nurses of hospitalised infants requiring oxygen therapy for severe bronchiolitis:  a phenomenological study.

Peeler A, Fulbrook P, Kildea S (2015) The experience of parents and nurses of hospitalised infants requiring oxygen therapy for severe bronchiolitis: a phenomenological study. Journal of Child Health Care. 19, 2, 216-228.

Bronchiolitis
Baby with bronchiolitis on oxygen therapy. Picture: Alamy

Background

Bronchiolitis is common in children under two years and is most often caused by respiratory syncytial virus (Jhawar 2003). Symptoms are usually self-limiting although some children develop respiratory distress requiring hospitalisation (Scottish Intercollegiate Guidelines Network 2006). Supplemental oxygen, fluid support and ventilator assistance may also be necessary. In cases of moderately severe bronchiolitis, oxygen can be delivered through a head box. Some hospitals deliver high-flow oxygen therapy with nasal prongs to treat respiratory distress.    

Aim

The research aim was to describe parents’ and nurses’ experiences of caring for infants who had been hospitalised with severe bronchiolitis requiring oxygen therapy.

Method

The research was undertaken in a large, tertiary paediatric hospital in Australia. The researchers adopted a descriptive phenomenological approach in which a purposive sample of mothers (n =12) of infants admitted with severe bronchiolitis and needing oxygen therapy were recruited alongside the nurses (n=12) who cared for these infants.

The infants were aged between two and six months at diagnosis, and stayed in intensive care (n=6) or high dependency (n=18) units for <48 hours. Most nurse participants were female with between two and 25 years’ experience.

Following the infants’ discharge, the researchers conducted semi-structured interviews with the mothers and nurses. 

Findings

Data analysis revealed several themes and three domains: fear, parent-child interaction and technical caring. 

Fear

The child's admission was viewed as a critical and life-threatening event by mothers, who felt anxious and distressed. Their lack of knowledge and inability to comfort their children because of the use of head boxes added to their distress.

In contrast, nurses viewed each of the admissions as an everyday situation and were not as worried about the children’s prognoses as the parents. Nurses did not appear to recognise the emotional intensity of the situation for the mothers, who feared for their children’s lives.

Parent-child interaction

Mothers felt inadequate and isolated because the use of head boxes limited their involvement in their children’s care. Mothers wanted to participate, but realised the risks involved. All mothers of children having nasal-prong therapy could be involved in their care, and so felt pleased and relieved.

Technical caring

In comparing oxygen therapies nurses preferred high-flow, nasal-prong, oxygen therapy due to its efficacy and safety rather than for any emotional reasons. Nurses said that caring for a child in a head box is demanding because access for care delivery is necessary but risks disturbing oxygen levels and rapid deterioration. The obscured view of an infant in a head box is also problematic.

Conclusion

There was an evident disconnect between the nurses’ perception of events as normal and the mothers’ feelings of distress and anxiety.

Understanding the service-user’s perspective

The mothers’ distress and anxiety appeared to have been underestimated by the nurses, who were concerned mainly with technical and safety issues. Further support for, and provision of information to, parents may improve their care experiences. 

When considering ways to improve hospital experiences for children and families, nurses should consider the service-user perspective as well as the clinical perspective. In particular, nurses should understand the psychological effects on mothers of seeing their infants receive oxygen therapy for bronchiolitis.

In May, the chief nursing officer for England launched a framework for nursing, midwifery and care professionals entitled Leading Change, Adding Value (NHS England 2016). This framework builds on the previous strategy, Compassion in Practice, and links to the NHS strategy Five Year Forward View in its vision for improving care. Leading Change, Adding Value focuses on providing better outcomes, better experiences and better use of resources in care.

Children’s nurses can refer to the new framework in practice as they look for ways to provide children and families with better experiences of hospital care.

References

  • Jhawar S (2003) Severe bronchiolitis in children. Clinical Reviews in Allergy and Immunology. 25, 3, 249-257.
  • NHS England (2016) Leading Change, Adding Value: A Framework for Nursing, Midwifery and Care staff. NHS England, London.
  • Scottish Intercollegiate Guidelines Network (2006) Bronchiolitis in Children:  A National Clinical Guideline. SIGN, Edinburgh.

 


About the author

Christine English is principal lecturer at Northumbria University on behalf of the RCN's Research in Child Health community

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