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 Table of Contents  
Year : 2021  |  Volume : 8  |  Issue : 3  |  Page : 119-120

Decoding parental stress – Toward better healthcare

Department of Pediatric Critical Care, Kovai Medical Center and Hospital, Coimbatore, Tamil Nadu, India

Date of Submission21-Apr-2021
Date of Acceptance28-Apr-2021
Date of Web Publication21-May-2021

Correspondence Address:
Dr. A R Mullai Baalaaji
Kovai Medical Center and Hospital, Coimbatore, Tamil Nadu
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/jpcc.jpcc_34_21

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How to cite this article:
Baalaaji A R. Decoding parental stress – Toward better healthcare. J Pediatr Crit Care 2021;8:119-20

How to cite this URL:
Baalaaji A R. Decoding parental stress – Toward better healthcare. J Pediatr Crit Care [serial online] 2021 [cited 2023 Jun 2];8:119-20. Available from: http://www.jpcc.org.in/text.asp?2021/8/3/119/316600

Illness in any child causes immense psychological stress to parents and families. Added to that, admission into the Pediatric Intensive Care Unit (PICU) is a even more overwhelming experience for families because of the emotional intensity and complexity of the medical condition demanding PICU care. The nature of illness, disruption of normal lives, uncertainties in the course of PICU stay, fear of poor outcomes, separation, and financial demands all result in significant stress to the families of children. Additional causes of psychological distress include disruption of the normal parental roles and poor communication by the health-care team. It has been studied that the resultant post-traumatic stress disorder rates in parents following PICU admission range between 10% and 42%.[1] The psychological effects are also long lasting and are known to affect the long-term psychological well-being of the child as well.[2] All these underscore the need for preventive strategies to support the family in times of emotional distress.

The first step to plan preventive strategies for the parents is to understand the factors associated with parental stress at the time of PICU admission. Parental stressor scale: PICU (PSS: PICU) is a scale that has been developed more than 30 years ago and measures parent-reported stressors in the PICU. The conceptual framework is based on cognitive theories of stress which proposed that the stress response is a complex interaction between (a) personal/family factors, (b) child's medical condition/treatment-related factors, and (c) PICU environment-related factors. The reliability of the scale has been widely studied and the scale has been found to have acceptable levels of internal consistency across many settings.[3],[4],[5]

The scale contains a set of questions across seven domains involving child's appearance, monitors surrounding the child, procedures undergone, children's behavior and response to the PICU environment, communication and behavior of the staff members, and parental roles assumed. A total of 37 items' questionnaire is designed covering these dimensions to self-report the level of stress experienced by the parent on a Likert scale. While using this scale to Non English-speaking population, language and cultural differences present significant barriers to get the appropriate response from the parents. The domains that are stressful for parents would also vary with the complexity of the medical condition usually seen in that PICU setup, available medical and support team, and communication skills of the staff members apart from the unique cultural beliefs of the family.

In the current issue of Journal of Pediatric Critical Care, Sethuraman and Venkateswaran[6] have proposed a Malayalam version of the PSS: PICU scale and have validated the scale for use in the local PICU setting. This would facilitate capturing the responses accurately and validation helps to know if the conceptual dimensions of the original scale are retained in the translated version.

Understanding the unique needs of Indian families and interplay of the social and demographic factors in our society will be very much essential if we were to deliver “Family-centered PICU Care.”[7] Hence, this is a big first step toward recognizing the psychological problems that are relevant to our settings. Furthermore, further research into this field needs to explore potential interventions that could be employed to the families to enhance their coping strategies and promote mental well-being of the parents during this stressful period.[8] At the same time, we need to realize that such scales give a broader perspective of the overall psychological stressors, but an individualized approach to each family situation would be necessary if we were to provide a “more effective, efficient and empathic pediatric healthcare.” This would go a long way in improving the outcomes of our children, as we move toward improving the overall PICU experience and holistic care to the children and their families.

  References Top

Yagiela LM, Carlton EF, Meert KL, Odetola FO, Cousino MK. Parent medical traumatic stress and associated family outcomes after pediatric critical illness: A systematic review. Pediatr Crit Care Med 2019;20:759-68.  Back to cited text no. 1
Colville G. The psychologic impact on children of admission to intensive care. Pediatr Clin North Am 2008;55:605-16, x.  Back to cited text no. 2
Pooni PA, Singh D, Bains HS, Misra BP, Soni RK. Parental stress in a paediatric intensive care unit in Punjab, India. J Paediatr Child Health 2013;49:204-9.  Back to cited text no. 3
Aamir M, Mittal K, Kaushik JS, Kashyap H, Kaur G. Predictors of stress among parents in Pediatric Intensive Care Unit: A prospective observational study. Indian J Pediatr 2014;81:1167-70.  Back to cited text no. 4
Rodríguez-Rey R, Alonso-Tapia J. Development of a screening measure of stress for parents of children hospitalised in a paediatric intensive care unit. Aust Crit Care 2016;29:151-7.  Back to cited text no. 5
Sethuraman J, Venkateswaran C. Validation of the Malayalam version of the parental stressor scale: Pediatric Intensive Care Unit. J Pediatr Crit Care 2021;8:128-33.  Back to cited text no. 6
  [Full text]  
Richards CA, Starks H, O'Connor MR, Doorenbos AZ. Elements of family-centered care in the Pediatric Intensive Care Unit: An integrative review. J Hosp Palliat Nurs 2017;19:238-46.  Back to cited text no. 7
Rückholdt M, Tofler GH, Randall S, Buckley T. Coping by family members of critically ill hospitalised patients: An integrative review. Int J Nurs Stud 2019;97:40-54.  Back to cited text no. 8


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