Children who spend time in the intensive care unit of a hospital can be traumatized by the experience even months after returning home.
Dr. Janet Rennick from the Research Institute of The Montreal Children's Hospital of the McGill University Health Centre and her colleagues have developed the Children's Critical Illness Impact Scale to measure psychological distress in children following hospital discharge.
This is the first self-report scale ever created to measure the psychological impact of intensive care unit hospitalization on children. The Journal of Pediatric Critical Care Medicine recently published the study.
This 23-item questionnaire provides a tool that will allow health care professionals to pick up on and recognize those children who need psychological support as a result of their hospital stay. It is based on the results of 64 interviews conducted with children who had been hospitalized in an intensive care unit, their parents, and health care professionals. The study was conducted across three Canadian pediatric hospitals.
"We know some children suffer post traumatic stress symptoms after having spent time in the intensive care unit," explains Dr. Rennick, "Parents and children have described delusional memories of their hospital experience which continue to bother the child after they go home. In addition, parents have described behavioural changes and ongoing fears in their children, and children have told us they don't feel the same as they did before they were critically ill. This tells us something negative is going on with these children, but there was no way to capture the whole story since questionnaires had not been developed specifically for use with this population of children. As a result, we found that some kids were falling through the cracks and not getting the help needed to cope with the stress of hospitalization."
Dr. Rennick and her colleagues decided to develop a questionnaire specifically for children aged six to 12 years. It was a challenging exercise because they had to find a way of interviewing children that would encourage and allow them to share their feelings and fears.
The interviews were done in two ways, focus groups and individual interviews. For younger children, researchers used a storyboard with felt pieces and hospital play sets. The children were encouraged to use the felt pieces to tell a four part story about: being in the hospital, going home, going back to school, and returning to the hospital for a check up.
"This interviewing method worked well for younger children who created detailed stories of their experiences But we discovered that the storyboard method was less effective for children 10 years and older. While it helped them focus on their hospital experiences, they didn't interact with the storyboard in the same way the younger children did. They would handle the felt pieces, and simply tell their story as we changed the storyboards," says Dr. Rennick.
Dr. Rennick believes this child friendly, self-report questionnaire will allow health care workers to more effectively determine if children are bouncing back after an intensive care unit stay. "With this new scale we will be better able to pick-up and help the child whose life simply hasn't returned to normal."
Dr Janet E. Rennick is a Nurse Scientist in the Department of Nursing at the Montreal Children's Hospital, an investigator with the Research Institute of The Montreal Children's Hospital of the McGill University Health Centre, and an Assistant Professor in the School of Nursing at McGill University. She holds a New Investigator Award from Sick Kids Foundation/IHDCYH*-CIHR National Grants Program. *Institute of Human Development, Child and Youth Health (IHDCYH)
The study was funded by the Canadian Institutes of Health Research (CIHR).
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