Children’s Psychological Responses After Critical Illness and Exposure to Invasive Technology

Abstract

Children hospitalized in pediatric intensive care units (PICUs) are subjected to highly invasive interventions necessary in overcoming the critical period of their illness, yet little is known about their subsequent psychological adjustment. The purposes of this study were to compare the psychological responses of children hospitalized in a PICU with those of children hospitalized on a general ward and to identify clinically relevant factors that might be associated with psychological outcome. A prospective cohort design was used to follow 120 children for 6 months after PICU and ward discharge. Groups were compared on the children's sense of control over their health, their medical fears, posttraumatic stress, and changes in behavior. Relationships between children's responses and their age, the invasive procedures to which they were exposed, severity of illness, and length of hospital stay were also examined. No significant group differences were found. However, children who were younger, more severely ill, and who endured more invasive procedures had significantly more medical fears, a lower sense of control over their health, and ongoing posttraumatic stress responses for 6 months postdischarge. Findings indicate that regardless of the hospital setting, invasiveness coupled with length of stay and severity of illness in young children may have adverse long-term effects.

A Validated Method for Identifying Unplanned Pediatric Readmission

“…(1)(2)(3)(4)(5) Furthermore, like all hospitalizations, readmissions place patients at risk of hospitalacquired conditions and other nosocomial harm. (6)(7)(8)(9) In the era of the Patient Protection and Affordable Care Act, the Centers for Medicare and Medicaid Services have targeted 30-day readmission for cost containment by reducing payments to those hospitals with excess adult readmissions for specific diseases.…”

Change in Preoperative Nervousness: A Randomized Controlled Trial in Gynecological Cancer Patients

“…This idea is supported in a study about children's healthcare. It is less the case that the patient suffers pain from the actual procedures conducted, but from the environment in which they take place [39]. The inherent waiting time at the operating ward before the anesthetist nurse showed up may have contributed to patients' perception of the situation.…”

Hearing the Child's Voice: Their Lived Experience in the Pediatric Intensive Care Unit

“…Age and illness severity influence these outcomes, but the number of invasive procedures (Rennick & Rashotte, 2009) is the strongest predictor of psychological distress for as long as 6 months following PICU admission (Rennick, Johnston, Dougherty, Platt, & Ritchie, 2002). Pain also has long-term negative effects in children (Cohen et al, 2001;Johnson, Bournaki, Gagnon, Pepler, & Bourgault, 2005;Klein, Gaspardo, Martinez, Grunau, & Linhares, 2009).…”

“…Children hospitalized in the PICU experience procedures such as insertion and removal of intravenous catheters (peripheral, arterial, central), urinary catheters, chest tubes, artificial airways, and intracranial monitors; suctioning; dressing changes; tape removal; spinal taps; rectal temperatures and probes, and multiple heel and/or finger sticks. Rennick et al (2002) found children experienced as many as 160 (M = 89) invasive procedures a day.…”

“…Although health care personnel perceive more minor procedures such as taking temperatures and removing intravenous (IV) catheters as noninvasive, children perceive them quite differently (Rennick et al, 2002) and display anticipatory distress to needles and other invasive procedures (Blount et al, 2009;Coyne, 2006;Taddio, Shah, GilbertMacLeod, & Katz, 2002). Pharmacological interventions are typically used for pain in the PICU; however, children still experience pain from invasive procedures in spite of analgesia.…”