Post–Intensive Care Syndrome

Educational Interventions for Parents of Hospitalized Children

Stephanie A. Esses, DNP, APRN, CPNP-PC/AC; Sara Small, MSW, LCSW; Ashley Rodemann, MSW, LCSW; Mary E. Hartman, MD, MPH


Am J Crit Care. 2019;28(1):19-27. 

In This Article

Abstract and Introduction


Background: Targeted education to help parents and caregivers recognize the signs and symptoms of post–intensive care syndrome may increase their awareness and willingness to seek support during their child's admission. The optimal strategy for this education has not been established.

Methods: A pilot study to test 3 educational strategies for caregivers of pediatric intensive care unit patients. The 3 strategies were compared using the Practical, Robust Implementation and Sustainability Model framework for effectiveness of the education, the effect of each educational intervention on the intensive care unit nursing environment, and costs. Nursing responses were scored on a 3-point Likert scale.

Results: A total of 62 caregivers randomly received 1 of 3 educational strategies: brochures (n = 22), scripted conversation (n = 20), or a 3-minute video (n = 20). All 3 strategies were associated with a notable improvement in understanding of post–intensive care syndrome, with no single strategy being superior. Nineteen bedside nurses completed a survey on how daily workflow was affected and education was perceived. The survey indicated that all 3 interventions minimally disrupted workflow and all were recognized as useful. Final analysis indicated that brochures have the greatest likelihood of successful and sustainable implementation in the study hospital.

Conclusion: Simple, low-cost education can improve caregivers' knowledge of post–intensive care syndrome and can be well supported by nursing staff. To ensure sustainable implementation, the characteristics of the unit should be considered when selecting an educational program.


In recent years, investigators in the United States and Europe have identified significant mental health complications in patients and their families during and after stays in an intensive care unit (ICU). Long-term follow-up assessments show that up to 80% of ICU survivors experience emotional trauma.[1–5] More than one-third of family members of ICU patients show signs and symptoms of depression, and about 70% experience signs and symptoms of anxiety.[6] In many cases, these symptoms meet Diagnostic and Statistical Manual of Mental Disorders (Fifth Edition) criteria for posttraumatic stress disorder (PTSD), anxiety, and depression.[7,8]

These symptoms have been conceptually organized under the umbrella term post–intensive care syndrome (PICS). PICS is generally described as new or worsening impairments in physical, cognitive, or mental health status arising after critical illness and persisting beyond acute care hospitalization.[9,10] PICS can be applied not only to the patient but also to his or her caregivers and family members to refer to the effects of the critical illness on their psychological health, a concept that has been coined post–intensive care syndrome– family (PICS-F). Symptoms experienced by family members can include sleep deprivation, anxiety, depression, complicated grief, and PTSD. Symptoms of PICS and PICS-F can persist for months or years after the initial ICU admission.[10–16]

"Few accounts of a standard approach to the identification and management of PICS in the PICU have been published."

In the past 2 years, the Society of Critical Care Medicine has led efforts to support adult ICU programs to educate families about PICS and PICS-F, provide structured psychological support for patients and their families during the ICU admission, and develop longitudinal ICU recovery programs that include psychological counseling. However, few accounts of a standard approach to the identification and management of PICS and PICS-F in the pediatric ICU (PICU) setting have been published. Therefore, we conducted a study to assess the efficacy of 3 PICS educational interventions and determine the feasibility and acceptability of each strategy among the staff and leadership of the PICU in our hospital.