Scott Grace, Dunn Leigh M, Dow Belinda, Kenardy Justin, De Young Alexandra C, Long Debbie A
School of Psychology, The University of Queensland, Brisbane, Queensland, Australia.
School of Nursing, Centre for Healthcare Transformation, Queensland University of Technology, Brisbane, Queensland, Australia.
Nurs Crit Care. 2025 May;30(3):e70057. doi: 10.1111/nicc.70057.
Admission to a Paediatric Intensive Care Unit (PICU) can be a traumatic experience for children and their families. Most children admitted to a PICU will survive; however, a significant proportion of children and their parents will experience serious psychosocial difficulties before, during and after PICU admission. There remains a knowledge gap concerning effective interventions for preventing or reducing adverse psychological outcomes for children and their caregivers.
This study aimed to identify and describe the types and characteristics of psychosocial interventions for the prevention, early detection and/or treatment of adverse psychological outcomes in children and/or their families before, during and after experiencing PICU admission and to identify gaps in the current literature.
A scoping review was conducted through PsycINFO, PubMed, CINAHL and Scopus. English-language peer-reviewed and grey literature were searched from the earliest available records to July 2024. Key search domains included interventions and efficacy, feasibility, measurement instruments and psychological outcome variables.
Of 3137 studies initially identified through database searching, 10 were included for full review. The findings from included articles describe nine universal interventions that include information provision and psychoeducational approaches, and one targeted psychotherapeutic intervention. There exists a significant paucity of targeted and clinical interventions for those patients and families at high risk of poor psychological outcomes. The Creating Opportunities for Parent Empowerment (COPE) programme emerged as a notable intervention, demonstrating reductions in parental stress, improved emotional coping and increased parental engagement in their child's care.
The existing literature examining the efficacy and effectiveness of psychosocial interventions to prevent or treat poor psychological outcomes before, during and after PICU admission is limited. Although a diverse range of interventions has been explored, notable discrepancies have emerged between these interventions and the actual needs and preferences of children and their families. Challenges related to standardisation and intervention type, setting, timing, scope and target must be carefully addressed in future research.
This review highlights the need for targeted and clinical evidence-based psychosocial interventions in PICUs to address psychosocial outcomes including posttraumatic stress symptoms (PTSS) and posttraumatic stress disorder (PTSD) in children and families. Critical care nurses are uniquely positioned to identify early signs of psychological distress and should advocate for and actively participate in the development and delivery of tailored interventions with families to improve outcomes and recovery.
入住儿科重症监护病房（PICU）对儿童及其家庭来说可能是一次痛苦的经历。大多数入住PICU的儿童能够存活；然而，相当一部分儿童及其父母在入住PICU之前、期间和之后会经历严重的心理社会困难。在预防或减少儿童及其照顾者不良心理结果的有效干预措施方面，仍然存在知识差距。
本研究旨在识别和描述在儿童及其家庭经历PICU入院之前、期间和之后，用于预防、早期发现和/或治疗不良心理结果的心理社会干预措施的类型和特征，并找出当前文献中的差距。
通过PsycINFO、PubMed、CINAHL和Scopus进行了一项范围综述。检索了从最早的可用记录到2024年7月的英文同行评审文献和灰色文献。关键检索领域包括干预措施和疗效、可行性、测量工具和心理结果变量。
通过数据库检索最初识别出3137项研究，其中10项被纳入全面综述。纳入文章的研究结果描述了九种通用干预措施，包括信息提供和心理教育方法，以及一种针对性的心理治疗干预措施。对于心理结果不佳风险较高的患者及其家庭，针对性和临床干预措施严重匮乏。增强家长权能创造机会（COPE）项目是一项值得注意的干预措施，显示出家长压力减轻、情绪应对能力提高以及家长对孩子护理的参与度增加。
现有研究PICU入院前、期间和之后预防或治疗不良心理结果的心理社会干预措施的疗效和有效性的文献有限。尽管已经探索了多种干预措施，但这些干预措施与儿童及其家庭的实际需求和偏好之间存在明显差异。未来的研究必须仔细解决与标准化以及干预类型、环境、时间、范围和目标相关的挑战。
本综述强调了在PICU中需要有针对性的、基于临床证据的心理社会干预措施，以解决儿童及其家庭的心理社会结果，包括创伤后应激症状（PTSS）和创伤后应激障碍（PTSD）。重症护理护士处于独特的位置，能够识别心理困扰的早期迹象，并且应该倡导并积极参与为家庭制定和提供量身定制的干预措施，以改善结果和促进康复。
