Understanding the experiences of parents in paediatric emergency departments

Chapter One: Systematic Review Abstract Objective: Parents present with various psychological responses while visiting the ED with their child, which can have a detrimental impact on the parent and their child both in the short- and long-term, particularly when left unsupported. To date, there has been no systematic review exploring the psychological responses of parents, particularly anxiety, stress, depression, and distress in this setting. This review summarises the evidence base to explore and understand these responses and how they can be supported within EDs. Methods: Five electronic databases (PsychInfo, Medline, CINAHL, Web of Science, and Scopus) were searched in March 2024. The references of the eligible studies and google scholar were also hand-searched. Extracted data from the eligible studies were thematically synthesised and the quality of the studies were critically evaluated using the Critical Appraisal Skills Programme (CASP, 2018) qualitative studies checklist. Results: A total of 15 papers pertaining to parents’ psychological responses within the ED were identified. Three themes were developed: (1) Psychological responses; (2) Coping strategies, and (3) Future changes. Parents experienced anxiety, stress, and distress, and spoke about contributing factors such as lack of communication, uncertainty regarding their child’s health, and witnessing their child’s procedure. Parents reported existing coping strategies and discussed future changes they would like to see in the support provided to parents in EDs. Conclusion: Parents presented with various psychological responses from a range of stressful experiences within the ED. This review offers a deeper understanding of those parental psychological responses and coping strategies, and has implications for staff training, parental support and coping, as well as child recovery and return visits. Chapter Two: Empirical Abstract Objective: Whilst the evidence base exploring parental distress is increasing over time, studies are yet to focus on understanding parental distress from the perspectives of parents and staff in UK-based paediatric emergency departments (PEDs). This study aims to explore parent and PED staff experiences of parental distress and the support provided, with the further aim of providing recommendations for clinical practice and training within PEDs. Method: A qualitative approach was adopted. A total of 15 parents took part in online semi-structured interviews and six PED staff took part in an online focus group. All data were analysed using reflexive thematic analysis. Findings: Three main themes were developed, which were inclusive of both parent and staff perspectives. The first theme outlined the various presentations of parental distress. The second theme described how parental distress can be experienced, before, during, and after a visit to the PED, and included experiences that were found to contribute to parental distress, such as wait times, uncertainty, staff approaches and communication, the ED environment, and a lack of follow-up support. The final theme highlighted future changes that parents and staff would like to see in PEDs for parental distress to be better understood and supported. Conclusion: This study provided a deeper understanding of parental distress in PEDs including how and when distress can present and the contributary experiences. The findings and resulting recommendations have implications for clinical practice, specifically staff-parent communication and support provided in PEDs, as well as staff training and support.