title: Family Experience and PICU Death: A Meta-Synthesis.
abstract: OBJECTIVE
  The PICU is the most common site for inpatient pediatric deaths worldwide. The impact of this clinical context on family experiences of their child's death is unclear. The objective of the study was to review and synthesize the best available evidence exploring the family experience of the death of their child in the PICU.
  
  
  METHODS
  Studies were retrieved from CINAHL Plus, OVID Medline, Scopus, PsycINFO, and Embase. Gray literature was retrieved from greylit.com, opengrey.edu, Trove, Worldcat, and Google scholar. Study selection was undertaken by 4 reviewers by using a multistep screening process, based on a previously developed protocol (International Prospective Register of Systematic Reviews 2015:CRD42015017463). Data was extracted as first-order constructs (direct quotes) or second-order constructs (author interpretations) onto a predeveloped extraction tool. Data were analyzed by thematic synthesis.
  
  
  RESULTS
  One main theme and 3 subthemes emerged. "Reclaiming parenthood" encompasses the ways in which the parental role is threatened when a child is dying in the PICU, with the subthemes "Being a parent in the PICU," "Being supported," and "Parenting after death" elucidating the ways parents work to reclaim this role. The review is limited by a language bias, and by the limitations of the primary studies.
  
  
  CONCLUSIONS
  When a child dies in a PICU, many aspects of the technology, environment, and staff actions present a threat to the parental role both during and after the child's death. Reclaiming this role requires support from health care providers and the wider community.
authors.affiliation: School of Nursing and Midwifery, Monash University, Victoria, Australia; and Adult and Paediatric ICU, Monash Health, Melbourne, Australia aebut2@student.monash.edu.
authors.forename: Ashleigh E
authors.initials: AE
authors.lastname: Butler
authors.affiliation: School of Nursing and Midwifery, Monash University, Victoria, Australia; and.
authors.forename: Helen
authors.initials: H
authors.lastname: Hall
authors.affiliation: School of Nursing and Midwifery, Monash University, Victoria, Australia; and.
authors.forename: Georgina
authors.initials: G
authors.lastname: Willetts
authors.affiliation: School of Nursing and Midwifery, Monash University, Victoria, Australia; and.
authors.forename: Beverley
authors.initials: B
authors.lastname: Copnell
mesh_terms: D001601:Bereavement; D002648:Child; D003643:Death; D005190:Family / Q000523:psychology*; D006801:Humans; D015278:Intensive Care Units, Pediatric; D016487:Parenting / Q000523:psychology; D011368:Professional-Family Relations