Publications & Posters
All fellows felt that it is important and at least partially the medical team’s responsibility to manage parent distress in the PICU. They identified parent medical understanding and child medical factors as risk factors. Being present, explaining medical information, and utilizing external resources were important strategies for responding to distress. Most were very interested in receiving training to better support parents. Educational interventions targeting these areas should be developed and tested to overcome barriers of provider time, resource availability, and language.
Results suggest that when considering a hypothetical PICU admission, community parents over-estimate LOS and likelihood of death, regardless of previous PICU experience or medical field employment. Therefore, medical providers should provide education that corrects overly negative expectations at admission. Previous research suggests that higher levels of social support mitigate poor parental psychological outcomes, and the present study indicates that parents were frequently willing to provide emotional and practical support to a friend with a child in the PICU. Therefore, providers should encourage PICU parents to seek support from friends and family in managing stress related to their child’s well-being and in fulfilling practical needs external to hospitalization.
RESULTS: For both PICU providers and patients and families, participants described a negative overall impact of the pandemic, especially relating to increased stress and fear of contracting the disease. Disease precautions such as visitor restrictions and restricting movement were reported to be particularly stressful for families because they limited coping strategies (eg, in-person social support). Providers described changes to the work environment, patient care, and their personal lives.
CONCLUSIONS: Results elucidate the perceived impacts of COVID-19 and associated hospital precautions on the lives of PICU providers, patients, and families. Providers, patients, and families likely require additional psychosocial support during the pandemic. When possible, policies regarding disease management should maximize safety while minimizing additional stress. Further research is needed to explore patient and family perspectives regarding the impact of COVID-19 and to evaluate the continued impact of COVID-19 over time.
RESULTS: Interpreters described that encounter type, setting, presence of emotional content, interpreter role, feeling uncertain or unprepared, consecutive consults, and consults related to their own life contribute to distress. Resources used for coping with distress were organizational (e.g., training programs), interpersonal (e.g., manager support), and intrapersonal (e.g., focus on interpreting). Interpreters shared challenges to accessing supports (e.g., employment status, exclusion from medical team debriefings). Interpreters suggested resources such as support groups, team debriefs, and training to facilitate coping with distress.
CONCLUSIONS: Pediatric medical interpreters experience many diverse contributors to distress. Given their unique positions, interpreters are at an increased risk of negative psychological sequelae. Healthcare supervisors, clinicians, and institutions can promote interpreter coping and distress management by viewing interpreters as part of the medical team (e.g., including interpreters in team debriefings), providing coping trainings that are co-created with interpreters, and tailoring supports to interpreters’ specific position as language and culture brokers. As this study represented the experiences of Spanish-English interpreters from a single pediatric hospital, further research is warranted to understand more interpreters’ experience of distress and the supports and resources needed.
RESULTS: Factors were identified by both interpreters and medical providers that negatively affected communication, equity, and inclusion. These included systems-level factors (e.g., time constraints and language variety), interpersonal factors (e.g., difficulties with communication and mistrust),and intrapersonal factors (e.g., implicit biases and judgements). These results highlight multiple layers of potential inequities which adversely affect patients and families in pediatric IME.
CONCLUSIONS: One way to address language access inequities is simply getting interpreters in the room, yet this cannot address language access inequities in pediatric systems and among pediatric IME stakeholders. The authors argue that to disrupt discriminatory practices in IME, care team members should be trained to identify and acknowledge their own biases regarding language use and language access services. Increased allocation of resources to language access services on the systemic, interpersonal, and intrapersonal levels is imperative to improving language access equity.
Rothschild, C., Balistreri, K. A., Mulligan, K.; Lee, H., Privatt, M., Magner, K., Karst, J., Lee, K.J., Davies, W. H., Scanlon, M. 580: Acceptability and Feasibility of Text Message Interface to Assess Parents’ Real-Time PICU Experience. Critical Care Medicine 51(1):p 278, January 2023. | DOI: 10.1097/01.ccm.0000908048.88129.55
RESULTS: Of twenty enrolled participants, the first 5 were excluded due to technical issues. Of the 15 included, results demonstrated feasibility and acceptability. Most participants (86%) completed all surveys during the PICU stay and continued to complete surveys at a high rate: 79-94% 3 mo post-discharge. All participants agreed that the system was easy to use during and after PICU stay and were satisfied with the system at discharge, and 91% remained satisfied 3 mo post discharge. Subjectively, 76% reported the interface was comforting and 69% benefited from the system. From the interviews, participants lauded the system’s convenience and applicability of content, as well as the built-in reminders. Some proposed changes to improve the ergonomics. Many suggested this interface could help teams better support families.
CONCLUSIONS: A text-based interface for measuring experience in the PICU is feasible and acceptable to parents. Further research can explore how this could identify parents most at risk of adverse psychological sequelae and lead to earlier supportive interventions.
Rothschild, C. B., Balistreri, K. A., Mulligan, K., Lee, K. J., Karst, J., Privatt, M., Magner, K., Lee, H. J., Scanlon, M., Davies, W. H., & Pediatric Collaborative for Resilience and Emotional Wellness Science (Pediatric CREWS) (2023). Acceptability and Feasibility of Text Message Interface to Assess Parents' Real-time PICU Experiences. Journal of intensive care medicine, 8850666231195754. https://doi.org/10.1177/08850666231195754