State of the science on parental stress and family functioning in pediatric intensive care units

Critical illness of a child is stressful for parents and may affect family functioning. Most research on hospitalization in pediatric intensive care units has focused on the immediate responses of parents to the experience.

To critically review literature about pediatric intensive care units and to link those studies to a theoretical framework: McCubbin and McCubbin's resiliency model of family stress, adjustment, and adaptation. An updated synthesis of the literature is essential to prevent unnecessary duplication of research.

Guidelines presented by Ryan-Wenger were used to critique the scientific credibility and integrity of 38 research reports found by searching MEDLINE, the Cumulative Index to Nursing and Allied Health, and reference lists. The critique was organized according to the components of the research process, and then study results were reviewed according to the variables of the resiliency model.

Most publications focused on variables in the adjustment phase, including stressors, resources, perceptions of stressors, and outcomes for patients' families. Obvious gaps in knowledge were related to families' vulnerability, type, and problem-solving and coping strategies. Many of the studies were biased toward white persons and toward mothers.

Further research is warranted on (1) families of various ethnic backgrounds; (2) fathers and their low participation rates; (3) mother and father comparisons; (4) replication of interventional research with larger and more diverse samples; (5) exploratory and prospective, longitudinal research; and (6) research with children in pediatric intensive care units.