Children With Severe Neurologic Impairment and Their Families in the PICU: A Secondary Qualitative Analysis to Assess Clinician-Family Collaboration and Mutuality.

Abstract

Objectives: In children with severe neurologic impairment (SNI) admitted to the PICU, a trauma-informed approach to care may mitigate the effect of traumatic events on both parents and the child. We aimed to characterize the themes that impacted the trauma-informed care principle of collaboration and mutuality in the PICU.

Design: This study is a post hoc secondary analysis of transcripts of interviews conducted for a prospective mixed methods cohort study examining the experiences of parents of children with SNI in the PICU and their clinicians in 2021-2023. Parents and clinicians had completed the semi-structured interviews peri-PICU discharge. Data were analyzed using a conventional content analysis approach. Two analysts coded all data independently, with differences resolved by consensus. Dedoose qualitative software was used to facilitate analysis, which followed Consolidated Criteria for Reporting Qualitative Research guidelines.

Setting: Quaternary academic center children's hospital.

Patients: The original study (2021-2023) recruited parents of children and young people (3 mo to 25 yr old) with SNI who were admitted to the PICU and their PICU clinicians.

Interventions: None.

Measurements and main results: There were 34 transcribed interviews: 15 from parents and 19 from PICU clinicians of multiple disciplines. We identified facilitators of and barriers to collaboration and mutuality. Facilitators included: 1) knowing a patient beyond the medical chart; 2) understanding values; and 3) clinician(s)-family collaboration. Barriers included: 1) constraints of the PICU environment; 2) challenges when engaging fully with patients with SNI; 3) intrinsic variability among clinicians and parents; 4) families being overwhelmed amid critical illness; and 5) emotional toll on clinicians.

Conclusions: Participants described the importance of and barriers to collaboration and mutuality in the PICU, which underscores the impact of valuing partnerships between clinicians and families.