Navigator-Based Intervention to Support Communication in the Pediatric Intensive Care Unit: A Pilot Study

Abstract

<jats:sec> <jats:title>Background</jats:title> <jats:p>Communication in the pediatric intensive care unit (PICU) between families and the health care team affects the family experience, caregiver psychological morbidity, and patient outcomes.</jats:p> </jats:sec> <jats:sec> <jats:title>Objective</jats:title> <jats:p>To test the feasibility of studying and implementing a PICU communication intervention called PICU Supports, and to assess families’ and health care teams’ perceptions of the intervention.</jats:p> </jats:sec> <jats:sec> <jats:title>Methods</jats:title> <jats:p>This study involved patients requiring more than 24 hours of PICU care. An interventionist trained in PICU-focused health care navigation, a “navigator,” met with parents and the health care team to discuss communication, decision-making, emotional, informational, and discharge or end-of-life care needs; offered weekly family meetings; and checked in with parents after PICU discharge. The feasibility of implementing the intervention was assessed by tracking navigator activities. Health care team and family perceptions were assessed using surveys, interviews, and focus groups.</jats:p> </jats:sec> <jats:sec> <jats:title>Results</jats:title> <jats:p>Of 53 families approached about the study, 35 (66%) agreed to participate. The navigator met with parents on 71% and the health care team on 85% of possible weekdays, and completed 86% of the postdischarge check-ins. Family meetings were offered to 95% of eligible patients. The intervention was rated as helpful by 97% of parents, and comments during interviews were positive.</jats:p> </jats:sec> <jats:sec> <jats:title>Conclusions</jats:title> <jats:p>The PICU Supports intervention is feasible to implement and study and is viewed favorably by parents.</jats:p> </jats:sec>

Challenges of Families of Patients Hospitalized in the PICU: A Preplanned Secondary Analysis From the Navigate Dataset*

“…For this study, we analyzed written, navigatorprovided responses about parents randomized to the PICU Supports arm, developed to provide emotional, communication, decision-making, informational, and transition support. As described in previous publications (11,16), navigators met separately with the parents and healthcare team members (HTMs) each weekday (if parents were at the bedside); offered and coordinated family meetings with HTMs weekly for patients in the PICU greater than or equal to 1 week; prepared parents for patient transitions out of the PICU or provided bereavement support; and completed post-PICU discharge follow up with the parent(s) via telephone or in-person. The decision to offer family meetings…”

“…Data were collected through a prospective, randomized study comparing the impact of a navigator-based intervention, PICU Supports (16), with an informational brochure on decision-making for parents. Previous publications with this dataset outline study methodology in detail (11, 14). This analysis was also described; see Content 6.3 in Appendix (14).…”

“…The family has a need for resources to support well-being Although communication challenges are known as a significant source of distress for families in the PICU (4), the infrequency with which they were represented in the present study was unexpected. This may be explained, at least in part, by the role of the navigators (11,14,16). It could also reflect that communication was satisfactory, and/or that families experienced other difficulties that overshadowed communication challenges.…”

“…Of the factors associated with family distress during (4) PICU hospitalization, communication difficulties during hospitalization are particularly stressful for families (7). Communication issues, outlined previously (8–10), include “absence of clinician-initiated discussions, poor access to clinicians, insufficient information exchange between parents and providers, and inadequate care coordination among providers” (11). Family members who experience communication with PICU staff as a major stressor demonstrate higher psychologic distress postdischarge, suggesting the importance of improving communication to address families’ informational, cognitive, and emotional needs and to improve family well-being (4).…”

Family Challenges and Navigator Support: It is Time We Support Our Families Better*

“…PCCM staffing has evolved beyond the historical constructs of residents, fellows, and attendings. Advanced practice registered nurses (APRNs) have become an integral part of the PCCM care team due to the coalescence of duty hour limitations, a focus on outpatient medicine education, an increasing number of PICU beds, and a growing recognition of the APRNs contribution to continuity of care, quality, and safety (1)(2)(3).…”