PARENT/FAMILY SUPPORT
Numerous unavoidable stresses are encountered in any intensive
care setting. In a PICU, the difficulty of dealing with the illness or death of
a child often tends to magnify this normal stress. To support the ICU staff, children,
and families adequately, these potential problems should be discussed and understood.
The population in an ICU includes a permanent nurse, physician, and technical staff;
a rotating group of residents; and an ever-changing cadre of patients and families.
Together, these people are exposed to extremes of frustration and success, and such
exposure has an emotional and psychological impact on everyone. Constantly available
support systems for patients, parents, and staff are a necessity.
Pediatric patients range from premature infants to adults, and
each patient must be approached in an age-appropriate manner. Diseases, procedures,
and treatments should be discussed with the patient; children should participate
in their own care to the degree that limits of age, sedation, and disability permit.
Parents of a child with a critical illness often progress through the stages of
grief reaction described by Kübler-Ross.[372]
Their interaction with the ICU staff and with their child is dramatically influenced
by the character of their grief reaction. In addition, the ICU may be very confusing.
The hectic pace and the numbers of physicians and nurses often leave parents feeling
a lack of control and direction. ICUs are also very intimidating and isolating.
They are usually geographically isolated with a separate dedicated staff, a level
of technology not seen in other parts of the hospital, and a terminology of numbers
and abbreviations that can render conversations uninterpretable. All these factors
make it difficult for a parent to maintain a parenting role. Too often, parents
assume the role of an absent or passive parent, an angry critical parent, or a parent
who wants to assume the role of physician. Some parents can never be directed into
a more productive
role, but frequently, careful explanations of ICU operational procedures and generous
use of social and clerical services can help parents retain their parenting roles.
Other members of the family, especially the patient's siblings, should also be considered.
Many parents need help and encouragement before they can involve their children
at home in the events taking place at the hospital. Visiting should be encouraged
and supported by the ICU staff.
There are numerous, potentially troublesome interfaces among various
members of the ICU staff. The permanent ICU staff members have developed a credibility
of their intensive care skills and knowledge. Often, residents in training have
never been exposed to intensive care medicine; these physicians may find the ICU
and ICU staff overwhelming and intimidating. For the permanent staff, it is frustrating
to have to retrain yet another group of residents. These constantly changing levels
of expertise may produce antagonism. It is important for supervisors to be aware
of these problems and to address them frequently.
Death is a frequent and complicated subject in the ICU. With
the explosive growth of technology, the ability to support life often exceeds the
ability to cure diseases. Basic definitions of death are being challenged in the
medical, legal, and political arenas. The concepts of irreversible disease, chronic
vegetative state, and meaningful versus meaningless life are under constant discussion
and consideration. This lack of definitive guidelines increases the stress and frustration
of families, as well as ICU staff members. By definition, intensive care is a fast-moving,
stressful situation. Psychosocial support is a necessity for patients and parents,
as well as staff members.
