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Family Functioning and Parent Behavioural Changes Post-Admission to the Paediatric Intensive Care Unit: A
Karina R Charles1,2,3, Belinda Dow1, Jessica A Schults3,4,5
1School of Nursing, Centre for Healthcare Transformation, Queensland University of Technology, Brisbane, Queensland, Australia.
Insights
Most families maintain healthy functioning after paediatric intensive care unit (PICU) admission, but caregiver mental health and child distress can negatively impact family dynamics, necessitating targeted support.
Area of Science:
- Pediatric Intensive Care
- Family Systems Theory
- Psychosocial Outcomes
Background:
- Paediatric intensive care unit (PICU) admission significantly impacts family dynamics.
- Post-Intensive Care Syndrome in paediatrics (PICS-p) is recognized, but its effects on family functioning remain unclear.
Purpose of the Study:
- Characterize family functioning in PICU survivors' families post-discharge.
- Investigate the influence of PICS-p sequelae on family dynamics.
Main Methods:
- Cross-sectional survey of 204 caregivers of PICU survivors in Brisbane, Australia.
- Caregiver-reported data collected via mail survey (March-August 2018).
- Descriptive and bivariate analyses examined family functioning and associated factors.
Main Results:
- Most families (97%) showed healthy functioning post-PICU discharge (median 25 months follow-up).
- 26 families reported poor functioning, primarily enmeshment.
- Poorer family functioning correlated with caregiver post-traumatic stress, mental illness, and child distress in under-5s.
Conclusions:
- While most families adapt well, a significant subset experiences ongoing challenges.
- Caregiver mental health and child distress are key predictors of adverse family outcomes.
- Targeted psychosocial screening and psychoeducational resources are crucial for post-PICU family support.
Background:
Admission to a paediatric intensive care unit (PICU) is a significant event with potential long-term effects on family dynamics. Although Post-Intensive Care Syndrome in paediatrics (PICS-p) is well recognised, the effects of PICU admission on family functioning are not well understood.
Aims:
This study sought to characterise family functioning in a cohort from the PICU following discharge and to investigate the impact of PICS-p sequelae on family dynamics.
Study Design:
We conducted a caregiver-reported cross-sectional survey of a single-centre cohort in Brisbane, Australia. Caregivers of PICU survivors were invited to participate by mail from March to August 2018. Parents completed the survey and returned it in a pre-paid envelope. Descriptive and bivariate analyses examined family functioning and its associations with PICU-related factors, child-related outcomes and caregiver-related outcomes.
Results:
A total of 204 caregivers participated, with a median follow-up of 25 months post-PICU discharge. Most families demonstrated healthy functioning, with 97% scoring above the threshold for balance on the Circumplex Model. Poor family functioning was reported in 26 families, with enmeshment being the most common dysfunction. Weak to moderate associations were observed between family functioning and caregiver-related factors, particularly post-traumatic stress (rs = -0.32) and mental illness (rs = -0.43). Child distress in those under 5 years was also associated with poorer family functioning (rs = -0.44). Persistent behavioural changes in caregivers, particularly sleep disturbances and reduced energy levels, were reported up to 48 months post-discharge.
Conclusion:
Whilst most families maintained healthy functioning after PICU, a subset faced ongoing challenges. Caregiver mental health and child distress were significant predictors of poorer family outcomes.
Relevance To Clinical Practice:
These findings highlight the necessity for targeted interventions to support families after PICU, including regular psychosocial screening and customised psychoeducational resources to enhance resilience and promote family well-being.
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