Interaction between healthcare professionals and the pediatric patient in an adult intensive care unit: An observational study

Aims To describe healthcare professionals’ interactions with pediatric patients at an adult ICU. Methods This non-participant naturalistic observational study was conducted at two adult ICUs in Sweden. Inclusion criteria were children aged 0–15 years, where both the child and the parent could speak and understand Swedish or English. Children undergoing palliative care were excluded. The observations encompassed both day and night shifts, capturing interactions during various procedures. The total observation time was 38 h and 12 min. The observation field notes were transferred to a narrative text, which was analyzed using a reflexive thematic analysis. Findings The healthcare professional’s ability to interact with the child at the adult ICU was influenced by the child́s illness, environmental factors, and the healthcare professional’s mindset. Three themes summarize the healthcare professionals’ approaches: A variation in the sensitivity to the child’s expressions; Parent as a gateway to the child; Attempting to give the child room for action. Conclusions This study showed that healthcare professionals within the adult ICU had awareness that the child has special needs different from those of the adult patient. The interactions seemed to be more related to each individual situation rather than a working framework like the person and family-centered approach. This assumption, that the child’s perspective was not consistently considered, may increase the likelihood that care practices are based on an adult-oriented perspective rather than a child-centered perspective. Implications for clinical practice These findings emphasize the need to meet the child’s needs, improve the quality of care, and focus on family-centered care for children in adult high–tech healthcare settings, underscoring that incorporating a child’s perspective is not a choice but an essential requirement.