A Psychiatric Consultant's Survival Guide to the Pediatric Intensive Care Unit

Jellinek, Michael S.; Biederman, Joseph; DeMaso, David R.; Meyer, Elaine C.

doi:10.1097/00004583-199610000-00029

Cited by 10 publications

(3 citation statements)

References 18 publications

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“…As pediatric critical care has grown, the medical and nursing staff have increasingly recognized the urgency and breadth of the mental health needs of patients and family members affected by PICU treatment. Various factors related to the PICU environment itself and the subjective experience of critical illness and its treatment, such as high levels of patient acuity, uncertainty of prognoses, complex ethical dilemmas and decision-making, pain and discomfort associated with physical illness and its treatment, and limited communication abilities of patients all contribute to patient and family distress, which may in turn prompt mental health referrals (Colville, 2001; DeMaso & Meyer, 1996; Meert et al, 2008; Tunick & Meyer, 2010). Many mental health consultation requests in this setting present as unspecified “cries for help” to support patients and families during times of extreme crisis and traumatic stress (Meyer et al, 1996).…”

Section: Mental Health Concerns In Pediatric Critical Carementioning

confidence: 99%

Pediatric psychology critical care consultation: An emerging subspecialty.

Tunick

Gavin

DeMaso

et al. 2013

Clinical Practice in Pediatric Psychology

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As the field of pediatric psychology expands and evolves, pediatric critical care settings hold considerable promise for our profession. Although extensive mental health needs have been recognized in patients and families affected by care in the pediatric intensive care unit (PICU), specifics regarding the need for, utilization of, and nature of pediatric psychology services have not yet been systematically examined. The current study provides a descriptive analysis of all consecutive referrals to a pediatric psychology consultation service within the critical care setting of a large metropolitan pediatric medical center from January 2006 through December 2009. During the study period, 611 pediatric psychology referrals (4.6% of PICU admissions) were generated. Consultations were initiated by interdisciplinary staff and spanned a diverse and farreaching range of behavioral health needs for patients and family members. Numerous factors were associated with increased need for pediatric psychology consultation, including longer than average hospitalizations, unanticipated critical care admissions, and previously healthy children who had sustained accidental trauma and those with new onset acute critical illness. Of note, the mortality rate within referred patients was significantly higher compared with the general PICU population, suggesting high need for pediatric psychology services during end-of-life care. Findings are discussed with respect to viable consultation models and training of pediatric psychologists who can function capably and confidently in the critical care setting.

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Section: Mental Health Concerns In Pediatric Critical Carementioning

confidence: 99%

Pediatric psychology critical care consultation: An emerging subspecialty.

Tunick

Gavin

DeMaso

et al. 2013

Clinical Practice in Pediatric Psychology

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“…'The starkest of alternatives -life and death of children -are focused in sharp relief in the PICU' (p. 1411). 35 Among the demands of this environment are that not all children will be saved and that many will have debilitating sequelae to their treatment. 1,30,36 This reality is sharply reflected in the PICU ethics literature, which is almost entirely focused on LST end-of-life care and related issues, such as futility.…”

Section: Ethical Issues In the Picumentioning

confidence: 99%

An Overview of Moral Distress and the Paediatric Intensive Care Team

et al. 2009

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A summary of the existing literature related to moral distress (MD) and the paediatric intensive care unit (PICU) reveals a high-tech, high-pressure environment in which effective teamwork can be compromised by MD arising from different situations related to: consent for treatment, futile care, end-of-life decision making, formal decision-making structures, training and experience by discipline, individual values and attitudes, and power and authority issues. Attempts to resolve MD in PICUs have included the use of administrative tools such as shift worksheets, the implementation of continuing education, and encouragement to report. The literature does not yet show these approaches to be effective in the resolution of MD. The need to acknowledge MD among PICU teams is discussed and an argument made that, to facilitate understanding among team members, practice stories need to be shared.

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“…The use of staff members or local family members eliminates the need for behavioral health training and focuses the position more on triage and communication. 11 The primary role of the child psychiatrist within the pediatric primary care setting is to perform consultation-liaison functions. The child psychiatrist reviews the care manager's caseload with the care manager, consults with www.jaacap.com/content/connect the pediatric primary care clinician and care manager regarding patients not making clinical improvements, and directly evaluates treatment-resistant patients and those with more severe behavioral health issues.…”

Section: The Integrated Behavioral Health Teammentioning

confidence: 99%

Skills for the Child and Adolescent Psychiatrist Within the Pediatric Primary Care Setting

Jeffrey,

Martini

2016

JAACAP Connect

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Behavioral health symptoms are a common presenting complaint within the pediatric outpatient setting. In fact, behavioral health symptoms account for 15% of chief complaints1 and inform 50% of presentations within outpatient pediatric practices.2 Yet, despite the pervasiveness of behavioral health symptoms, only 20% of children with a behavioral health disorder in the United States receive treatment.3 In order to increase access to high-quality behavioral healthcare, pediatric settings are beginning to implement integrated behavioral healthcare programs.4 Within integrated behavioral health programs, child and adolescent psychiatrists collaborate with pediatric primary care clinicians and care managers and improve patient outcomes.5

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A Psychiatric Consultant's Survival Guide to the Pediatric Intensive Care Unit

Cited by 10 publications

References 18 publications

Pediatric psychology critical care consultation: An emerging subspecialty.

Pediatric psychology critical care consultation: An emerging subspecialty.

An Overview of Moral Distress and the Paediatric Intensive Care Team

Skills for the Child and Adolescent Psychiatrist Within the Pediatric Primary Care Setting

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