Transition and Aftercare Following a Child's Discharge From ICU to a General Ward: A Qualitative Meta-Synthesis of Parental Experiences

Background: Transitions from the intensive care unit (ICU) to the general ward cause great impairment of physical and psychosocial functioning in children and their parents. Better understanding of parental experiences during children's ICU-to-ward transitions is required to inform the development of ICU transitional care.

Aim: To examine the parental experiences during their children's ICU-to-ward transitions through the synthesis of original qualitative studies.

Design: This study follows the preferred reporting items for systematic reviews and meta-analyses (PRISMA) and the enhancing transparency in reporting the synthesis of qualitative research (ENTREQ) statements, uses Thomas and Harden's thematic synthesis framework rooted in a critical realist philosophy to present qualitative meta-synthesis.

Data sources: We conducted a systematic review in June 2024 and searched nine electronic databases including Pubmed, Embase, CINAHL, PsycINFO, Cochrane Library, Sinomed, CNKI, Wanfang and VIP. Eligible studies contained parents quotes about their children's ICU-to-ward transitions and published in either English or Chinese since 2005.

Methods: Systematic searches yielded 2825 identified studies. Two reviewers screened titles, abstracts and full text and reached consensus through critical discussion with a third reviewer. Eighteen studies were finally agreed for inclusion. Data were extracted into a Microsoft Excel spreadsheet and synthesised through line-by-line coding of relevant quotes with the help of NVivo.

Results: The qualitative synthesis resulted in four descriptive themes followed later by two analytical themes. Specifically, these were (1) the nature of the parental experience during ICU-to-ward transition (challenging but responded proactively) and (2) factors involved in the ICU-to-ward transition (both facilitators and barriers).

Conclusions: This study indicates the nature of parental experiences and factors involved during the critically ill child's ICU-to-ward transition. Healthcare providers serve as the primary support network for parents and should collaborate closely with them to facilitate a smooth transition by providing tailored support.

No patient or public contribution: This is a meta-synthesis of previously published qualitative studies.

Trial registration: We have registered in the PROSPERO and the number is CRD42023422055.