Running head: THE PSYCHLOGICAL EFFECTS OF AN INTENSIVE CARE UNIT ADMISSION ON

A PEDIATRIC CLIENT 1

The Psychological Effects of an Intensive Care Unit Admission on a Pediatric Client.

Debra A. Carter
NUR 4115 Nursing Care of Children and Families
Bon Secours Memorial College of Nursing
September 17, 2016

I have neither given nor received aid, other than acknowledged, on this assignment, nor have
I seen anyone else do so. ~ Debra A. Carter
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CLIENT 2

A major theme this semester has been atraumatic care to the pediatric population.

Atraumatic care refers to minimizing the trauma a child endures during medical treatment.

(Gardner, 2016) To understand this topic further, the researcher wanted to investigate the

lasting psychological effects of a Pediatric Intensive Care Unit (PICU) stay. There are many

traumatic things that happen during a hospitalization, how does it affect the sick child and

what can practitioners do to help during the hospital stay?

Several studies have discussed the effects of a stay in the PICU and how it is

significantly more traumatic than an admission to the general pediatric floor. Children in the

PICU are exposed to considerably more invasive procedures and they are typically sicker than

the children in the other pediatric wards. (Rennick et al., 2014) These children are at risk for

psychological and behavioral difficulties following discharge, with approximately 25% of

children demonstrating post-traumatic symptoms or acute stress disorder within one year of

discharge. (Rennick et al., 2014) (Stowman, Kearney, & Daphtary, 2015)

Some of the extreme stressors reported were highly invasive procedures, separation

from parents, multiple different caregivers, and higher noise and light levels. (Rennick et al.,

2014) Compound these stressors with substantial sleep loss and a nursing/physician team that

has to do exams every hour to two hours can heighten the trauma. One study was designed to

assess post-traumatic stress in children admitted to the PICU by discussing their lived

experience. The children in this study were asked to recall the worst thing they had gone

through. The answers were honest and enlightening. Waking up and not knowing where their

parents were, having hallucinations in the PICU, and choking on the ventilator tube were

some of their answers. 35% of children reported an event outside the PICU, but most of those
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events were either the accident or the medical deterioration that lead to their ICU stay.

(Colville & Pierce, 2012) Not surprisingly, 63% of children remember some negative aspect

of their PICU stay including medical procedures, endotracheal intubation, and pain. (Rennick

et al., 2014)

Through this research, it was determined that the stress is not limited to the patients,

the stress is felt throughout the family. Parents also need to be monitored because they are at a

higher risk for developing post-traumatic stress and acute stress disorders. (Stowman et al,

2015) In one study, parents reported the most difficult thing to see was their child attached to

machines for the first time and the hardest thing to hear was receiving a life-threatening

diagnosis and realizing they could lose their child. (Colville & Pierce, 2012) The same study

concluded that over 50% of families were still experiencing post-traumatic stress 12 months

after discharge. (Colville & Pierce, 2012)

At this stage of understanding, practitioners are in a tertiary level of prevention.

Tertiary prevention is defined as restoration to optimal function. (Ball, et al., 2015) The

research is relatively new in understanding that a problem exists, so there are seemingly few

resources. One article discussed the use of interventions designed to promote communication

between parents and children which would serve as an outlet to share feelings. (Colville &

Pierce, 2012) Other beneficial resources are counseling and support groups for families of

other PICU survivors. In support groups, families collectively share their experiences with

others who have been in the same situation. This type of therapy can be helpful as all parties

are able to discuss their event as a way to promote healing as they work through their anxiety.
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The goal would be a return to baseline without underlying stress related to their

hospitalization.

There needs to be a shift from tertiary prevention toward secondary prevention.

Secondary prevention works to lessen the severity of problem. Becoming more aware of the

lasting physiological effects of a PICU stay, nurses and physicians needs to adjust their care to

reduce the adverse effects. Being attuned to common stressors, communication with the

patient and family, silencing alarms, and allowing family to be at the bedside are a few ways

to be proactive to lessen some of the anxiety. Given the intense nature of the ICU, there is no

way to eliminate stress from the environment. More research is needed to determine the best

way to

In summary, ICU stays are hard on patients and their families. Research is being

conducted to understand the depth of the problem. The hope is to bring awareness to this issue

in order to be proactive in facing this problem. These patients did not ask to get sick or to get

into an accident which resulted in their ICU stay. The least we can do as practitioners is to be

aware of these risks and focus on ways to reduce the stress and anxiety for our patients and

families. Some strategies would be to prevent or minimize the patients separation from

family, promote a sense of control for the patient, and prevent or minimize pain. (Gardner,

2016) Awareness of this problem may cause practitioners to rethink some of their practices

that may be deemed as stress producing. The goal would be to provide excellent critical care

and lessen the risk of a long term psychological effect on this vulnerable population.
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References

Ball, J.W., Bindler, R.C. & Cowen, K. (2015). Pediatric nursing: caring for children (6 th ed.).

Pearson Education, Inc.

Colville, G. & Pierce, C. (2012). Patterns of post-traumatic stress symptoms in families after

paediatric intensive care. Intensive Care Med, 38(9), 1523 1531.

Gardner, Trina. (2016). Nursing care of the hospitalized child [PowerPoint slides]. Retrieved

from https://bsmcon.blackboard.com/webapps/blackboard/content/listContent.jsp?

course_id=_2611_1&content_id=_122190_1

Rennick, J., Dougheerty, G., Chambers, C., Stremler, R., Childerhose, J., Stack, D., Harrison,

D., Campbell Yeo, M., Dryden Palmer, K., Zhang, X., & Hutchison, J. (2014).

Childrens psychological and behavioral responses following pediatric intensive care

unit hospitalization: the caring intensively study.

Stowman, S., Kearney, C., & Daphtary, K. (2015). Mediators of initial acute and after

posttraumatic stress in youth in a PICU. Pediatric Critical Care Medicine, 16, e113-

e118.