The impact of the social and physical environments on parent-healthcare provider relationships when a child dies in PICU: Findings from a grounded theory study.


School of Nursing and Midwifery, Monash University, Victoria, Australia; Adult and Paediatric Intensive Care Unit, Monash Health, Victoria, Australia. Electronic address: [Email]


OBJECTIVE : This study explores the influences of the paediatric intensive care environment on relationships between parents and healthcare providers when children are dying. It forms part of a larger study, investigating parental experiences of the death of their child in intensive care.
METHODS : Constructivist grounded theory.
METHODS : Four Australian paediatric intensive care units.
METHODS : Audio-recorded, semi-structured interviews were conducted with twenty-six bereaved parents. Data were analysed using the constant comparison and memoing techniques common to grounded theory.
RESULTS : The physical and social environment of the intensive care unit influenced the quality of the parent-healthcare provider relationship. When a welcoming, open environment existed, parents tended to feel respected as equal and included members of their child's care team. In contrast, environments that restricted parental presence or lacked resources for parental self-care could leave parents feeling like 'watchers', excluded from their child's care.
CONCLUSIONS : The paediatric intensive care unit environment either welcomes and includes parents of dying children into the care team, or demotes them to the status of 'watcher'. Such environments significantly influence the relationships parents form with healthcare staff, their ability to engage in elements of their parental role, and their experiences as a whole.


Child,Death,Environment,Grounded theory,Paediatric intensive care unit,Parent-healthcare provider relationship,

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