Pediatrics Resident Cincinnati Children's Hospital Cincinnati, Ohio, United States
Abstract:
Introduction: Children and their caregivers often experience anxiety and traumatic stress after intensive care unit (ICU) admission and these symptoms can interfere with longer-term child and family psychosocial outcomes. While providing information on expectations after ICU discharge can reduce parental anxiety, there are limited data on the use of proactive educational interventions to prevent or reduce psychological distress during cardiac ICU (CICU) admission. This study aimed to evaluate the acceptability and feasibility of educational videos utilizing visual storytelling to provide information to caregivers on the CICU environment and their child’s post-operative cardiac care. The videos aim to encourage caregivers to engage in their child’s care and address common sources of distress including feeling helpless during admission, exposure to foreign or frightening environmental stimuli (e.g., medical equipment, alarms), and ongoing uncertainty.
Methods: Two educational videos with a total duration of 6 minutes and an online survey were sent to 29 families previously admitted to the CICU during April 2020 to March 2021. Caregivers’ views on the quality, quantity, format, and relevance of information included in the videos were assessed, as were caregivers’ emotional responses and views on whether the videos would assist parents in partnering in their child’s care, improve their CICU experience, and/or reduce emotional distress. Quantitative thresholds for safety and acceptability were set a priori and an inductive approach to content analysis was used to identify themes in qualitative data.
Results: Sixteen parents participated in this pilot (response rate: 55%) and 13 parents completed all survey items. All acceptability and safety thresholds were met; 92% of parents indicated the videos were helpful and 85% indicated they were “very” or “extremely likely” to recommend the videos to other families. Regarding safety, no parents reported significant distress after viewing the videos. Expressions of parental empowerment were common, with 92% indicating the videos made them feel like an important member of their child’s cardiac care team. In qualitative responses, parents perceived the videos as likely to be helpful in mitigating emotional distress if viewed prior to CICU admission. Parents reported a preference for the informative nature of the second video, specifically the milestones required for transfer out of the CICU. In terms of modifications, parents suggested inclusion of additional images of medical equipment in the CICU and commented on the importance of matching the emotional tone in the videos with the gravity of the topic.
Conclusions: Preliminary findings indicate that educational videos utilizing visual storytelling to orient families to the CICU environment and address common sources of stress are likely important complementary interventions to mitigate psychological distress and encourage parental partnership with their child’s care team during CICU admission. Future studies will include broader distribution of the intervention for evaluation and parental input, followed by testing the effects of implementation prior to CICU admission using a randomized controlled trial design.
