Interventions to Support Psychological Health Outcomes for Children and Families Experiencing Paediatric Intensive Care Unit (PICU) Admission: A Scoping Review.

Background: 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.

Aim: 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.

Study design: 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.

Results: 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.

Conclusions: 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.

Relevance to clinical practice: 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.