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The Challenges of Caring for Long-Stay Patients in the PICU
Sophie Geoghegan1, Kate Oulton, Catherine Bull
11Great Ormond Street Hospital NHS Foundation Trust, London, United Kingdom. 2Institute of Child Health, University College London, London, United Kingdom.
Insights
Caring for long-stay pediatric intensive care unit (PICU) patients presents unique challenges for staff, impacting their expectations, work, and well-being. Enhanced support systems are crucial for addressing these difficulties and promoting staff resilience.
Area of Science:
- Pediatric Intensive Care
- Healthcare Staff Well-being
- Qualitative Research
Background:
- Caring for long-stay patients in intensive care units (ICUs) presents a disproportionate burden on healthcare staff compared to shorter-stay patients.
- Understanding the specific impact on staff caring for children with prolonged stays in the pediatric intensive care unit (PICU) is essential for optimizing care and support.
Purpose of the Study:
- To explore and understand the impact on healthcare staff of caring for children with prolonged stays in the PICU.
- To identify the key challenges and positive aspects experienced by staff when caring for long-stay pediatric patients.
Main Methods:
- A qualitative study design was employed, utilizing semi-structured interviews with 17 staff members (psychosocial staff, nurses, consultants) from PICU, neonatal ICU, and cardiac ICU.
- Data were collected through tape-recorded interviews and analyzed using the Framework approach.
Main Results:
- Staff reported both positive and challenging aspects of caring for long-stay PICU patients.
- Five key challenge areas were identified: staff expectations, patient characteristics, impact on staff, impact on the unit, and support availability.
- Individual patient cases significantly influenced staff perceptions, highlighting a spectrum of experiences.
Conclusions:
- While benefits exist, caring for long-stay PICU patients presents significant challenges with potential implications for staff and the unit.
- Specific patient subgroups may elicit more negative impacts on staff.
- Timely, accessible support mechanisms are a priority to help staff process their experiences and reactions to caring for long-stay patients.
Objective:
Compared to shorter-stay patients, caring for long-stay patients in the ICU entails a disproportionate burden for staff. Our objective was to gain a deeper understanding of the impact on staff of caring for children who have a prolonged stay on the PICU.
Design:
Qualitative study based on semi-structured interviews. Data were analyzed using the Framework approach.
Setting:
Children's tertiary hospital.
Participants:
Seventeen members of staff (7 psychosocial staff, 7 nurses, 3 consultants) working in the PICU, neonatal ICU, or cardiac ICU (PICU will be used to encompass neonatal ICU, cardiac ICU, and PICU for the remainder of this article).
Interventions:
Semi-structured, tape-recorded interviews.
Measurements And Main Results:
Staff reported both positive and challenging aspects of caring for long-stay patients in the PICU. Five key areas relating to the challenges of caring for long-stay patients were identified: staff expectations about their work, characteristics of the patient group, the impact on staff, the impact on the wider unit, and the availability of support. Staff views were often compounded by individual cases they had been involved with or had heard about which fell at either end of the spectrum of "good" and "bad".
Conclusions:
Whilst there are reported benefits associated with caring for long-stay patients, there are a number of challenges reported that may have implications for staff and the wider unit. When caring for a particular sub-group of long-stay patients, staff may be more likely to experience negative impacts. A key priority for the PICU is to ensure that support mechanisms are timely, accessible, and allow staff to explore their own reactions to their work.
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