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Global perspectives

Limiting the impact of ICU on the wellbeing of children and their families

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Admission to a paediatric intensive care unit is often a difficult experience for children and families. This article reports on a Florence Nightingale Foundation travel fellowship

Citation: Dodds E (2017) Limiting the impact of ICU on the wellbeing of children and their families. Nursing Times [online]; 113: 7, 52. 

Author: Elizabeth Dodds is staff nurse, paediatric critical care unit, Nottingham Children’s Hospital.

Introduction

Admission of a child to a paediatric intensive care unit (PICU) can have a significant negative impact on both the child and their family’s psychological and emotional wellbeing (Nelson and Gold, 2012), Research on care initiatives to counteract these adverse effects has been published in the US and Canada, although there is limited information on how to identify families most at risk.

Scholarship

I visited five hospitals in the US and Canada I had identified as working on this issue. I held informal interviews with key staff, observed practices and identified any nurse education. The study aimed to:

  • Investigate evaluated nurse-led support services for families with a critically ill child in the US and Canada, and look at their impact on long-term wellbeing;
  • Identify low-cost, innovative approaches to supporting families that could be applied in a UK context.

Study results and discussion

There is no ‘one-size-fits-all’ solution and more research is needed. However providing patient- and family-centred care (PFCC) and tailoring emotional and practical support to the family’s needs helps families stay engaged with their child’s care and feel more empowered on discharge. The provision of a follow-up service can help identify families struggling at home.

These findings are mainly based on practices I observed and the anecdotal experiences of staff and families with whom I spoke, but are supported by the literature.

Outcomes of the scholarship

I am working to disseminate these findings to raise awareness of the impact a PICU admission can have on families and the importance of PFCC. I am sharing my work with colleagues and presenting a poster at the European Society of Paediatric and Neonatal Intensive Care congress this summer.

One of my main aims was to improve nurse education on providing PFCC, communication techniques, and understanding the importance of helping families feel more engaged and empowered. I have held two teaching sessions with new starters and students on the unit, which have had positive evaluation from a questionnaire given out before and six weeks after the session.

I am collaborating with another staff nurse, the hospital play specialist team and a charity to improve the support provided to patients’ siblings. I am also working to set up a family-centred care committee, using a shared governance format so frontline staff can work together to identify the priorities for PFCC on the unit, implement solutions and evaluate progress using a validated family satisfaction questionnaire.

With support, I have also started organising and chairing Thrive meetings, in which members of the PICU multidisciplinary team meet to discuss how we can work together to improve patient outcomes.

I am compiling a business plan to develop the role of a PICU family liaison nurse – a nurse specialist to provide emotional and practical support to families during their PICU admission, on transfer to the ward and after discharge, and support and educate staff. The senior nursing and medical team on my PICU are supportive of this, but as it requires a high level of resources, it cannot be guaranteed.

This scholarship has equipped me with the knowledge and resources to understand ways of helping families during a PICU admission, as well as the motivation to collaborate with different teams to improve PFCC and implement positive change in to the care provided on PICU.

Implications for practice

  • The impact of critical illness can last long after discharge from the paediatric intensive care unit (PICU)
  • Providing good-quality, consistent patient- and family-centred care should be standard practice
  • Families need emotional and practical support during their child’s PICU admission to help them feel engaged in care, and empower and equip them for life after discharge
  • PICU nurses and frontline staff need support and education so they can offer the whole family the best care
  • It is the responsibility of the PICU multidisciplinary team to collaborate on improving survivor outcomes
  • This article reports on a travel scholarship provided by The Florence Nightingale Foundation. The scholarships give nurses and midwives an opportunity to study practice elsewhere in the UK and/or overseas. For more information click here
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