Parental Perceptions of Miscommunication and Stress in the PICU: A Mixed Methods Study

Abstract

Parents of pediatric intensive care unit (PICU) children experience significant stress and miscommunication with health care providers. This sequential mixed methods study aimed to (a) describe miscommunication, stress, and trust; (b) describe parent experiences related to miscommunication; and (c) compare stress levels between parents who perceived miscommunication and those who did not. A total of 200 parents completed the survey, with 14 participating in interviews. Key findings indicated that higher miscommunication led to increased distress and decreased trust in health care providers. Parents attributed miscommunication causes to clinician workload, provider availability, and involvement of multiple medical teams. Interestingly, greater distress occurred when miscommunication stemmed from conflicting information rather than clinical acuity concerns. The study highlights the urgent need for psychosocial support in PICU settings, as parental insights offer potential clinical relevance for future research. Parents’ experiences underscore the importance of addressing miscommunication to enhance patient care outcomes and improve parental well-being.

Keywords

communication miscommunication family pediatrics stress

Get full access to this article

View all access options for this article.

References

Anderson

L. A.

Dedrick

R. F.

(1990). Development of the trust in physician scale: A measure to assess interpersonal trust in patient-physician relationships. Psychological Reports, 67(Suppl. 3), 1091–1100.

Bergkvist

(2015). Appropriate use of single-item measures is here to stay. Marketing Letters, 26(3), 245–255.

Bergkvist

Rossiter

J. R.

(2007). The predictive validity of multiple-item versus single-item measures of the same constructs. Journal of Marketing Research, 44(2), 175–184.

Carter

M. C.

Miles

M. S.

(1989). The parental stressor scale: Pediatric intensive care unit. Maternal-Child Nursing Journal, 18(3), 187–198.

Creswell

J. W.

Clark

V. L. P.

(2018). Designing and conducting mixed methods research. Sage.

Dees

M. L.

Carpenter

J. S.

Longtin

(2022). Communication between registered nurses and family members of intensive care unit patients. Critical Care Nurse, 42(6), 25–34.

Foster

Whitehead

Maybee

(2016). The parents,’ hospitalized child’s, and health care providers’ perceptions and experiences of family-centered care within a pediatric critical care setting: A synthesis of quantitative research. Journal of Family Nursing, 22(1), 6–73. https://doi.org/10.1177/1074840715618193

Grandjean

Rahmaty

Perez

M. H.

Ramelet

A. S.

(2024). Psychosocial outcomes in mothers and fathers of chronic critically ill children: A national prospective longitudinal study. Intensive Care Medicine–Paediatric and Neonatal, 2(1), 9. https://doi.org/10.1007/s44253-024-00027-4

Greenway

T. L.

Rosenthal

M. S.

Murtha

T. D.

Kandil

S. B.

Talento

D. L.

Couloures

K. G.

(2019). Barriers to communication in a PICU: A qualitative investigation of family and provider perceptions. Pediatric Critical Care Medicine, 20(9), e415–e422.

10.

Hsieh

H. F.

Shannon

S. E.

(2005). Three approaches to qualitative content analysis. Qualitative Health Research, 15(9), 1277–1288.

11.

Hynan

M. T.

Hall

S. L.

(2015). Psychosocial program standards for NICU parents. Journal of Perinatology, 35(Suppl. 1), S1.

12.

Jones

A. H.

Jacobs

M. B.

October

T. W.

(2020). Communication skills and practices vary by clinician type. Hospital Pediatrics, 10(4), 325–330.

13.

Kazak

A. E.

Scialla

Deatrick

J. A.

Barakat

L. P.

(2024). Pediatric psychosocial preventative health model: Achieving equitable psychosocial care for children and families. Families, Systems, & Health, 42, 76–89. https://doi.org/10.1037/fsh0000856

14.

Khan

Furtak

S. L.

Melvin

Rogers

J. E.

Schuster

M. A.

Landrigan

C. P.

(2017). Parent-provider miscommunications in hospitalized children. Hospital Pediatrics, 7(9), 505–515.

15.

Khan

Spector

N. D.

Baird

J. D.

Ashland

Starmer

A. J.

Rosenbluth

. . .Landrigan

C. P.

(2018). Patient safety after implementation of a coproduced family centered communication programme: Multicenter before and after intervention study. British Medical Journal, 363.

16.

M. S. M.

Lee

W. K.

Sultana

Murphy

Heng

K. Y. C.

Loh

S. W.

. . .Lee

J. H.

(2024). Psychological outcomes in families of PICU survivors: A meta-analysis. Pediatrics, 154, Article e2023064210.

17.

Lisanti

A. J.

Demianczyk

Vogiatzi

M. G.

Quinn

Chittams

Hoffman

Medoff-Cooper

(2022). The associations of psychologic and physiologic manifestations of parental stress in critical congenital heart disease. Biological Research for Nursing, 24(3), 316–326.

18.

Logan

G. E.

Sahrmann

J. M.

Hartman

M. E.

(2020). Parental mental health care after their child’s pediatric intensive care hospitalization. Pediatric Critical Care Medicine, 21(11), 941–948.

19.

Michelson

K. N.

Clayman

M. L.

Haber-Barker

Ryan

Rychlik

Emanuel

Frader

(2013). The use of family conferences in the pediatric intensive care unit. Journal of Palliative Medicine, 16(12), 1595–1601.

20.

Mills

Chapman

Sutherland

Gillam

Collins

(2024). Parental perspectives on the clinician’s approach to serious illness communication: A qualitative study. Palliative & Supportive Care, 22(2), 354–359.

21.

Pediatric Trauma and Critical Illness Branch. (2023, October 9). Pediatric trauma and critical illness branch (PTCIB). Eunice Kennedy Shriver National Institute of Child Health and Human Development. https://www.nichd.nih.gov/about/org/der/branches/ptcib

22.

Roscigno

C. I.

Savage

T. A.

Grant

Philipsen

(2013). How healthcare provider talk with parents of children following severe traumatic brain injury is perceived in early acute care. Social Science and Medicine, 90, 32–39. https://doi.org/10.1016/j.socscimed.2013.04.017

23.

Salley

C. G.

Bakula

D. M.

Driscoll

C. F. B.

Flanagan-Priore

Kapke

T. L.

Moore

R. M.

. . .Sharkey

C. M.

(2024). Call to action: Screening and addressing caregiver mental health needs within all pediatric medical subspecialty settings as standard of care. Clinical Practice in Pediatric Psychology, 12, 328–338.

24.

Stremler

Haddad

Pullenayegum

Parshuram

(2017). Psychological outcomes in parents of critically ill hospitalized children. Journal of Pediatric Nursing, 34, 36–43. https://doi.org/10.1016/j.pedn.2017.01.012

25.

Wool

J. R.

Chittams

Morrison

Meghani

S. H.

Deatrick

Ulrich

C. M.

(2024). Factors associated with parent perceived miscommunication in the pediatric intensive care unit. American Journal of Critical Care, 33, 402–409.

26.

Wool

J. R.

Chittams

Meghani

S. H.

Morrison

Deatrick

J. A.

Ulrich

C. M.

(2023). Development of the perceived miscommunication measure in the pediatric intensive care unit. Journal of Pediatric Nursing, 71, e135–e141.

27.

Wool

J. R.

Irving

S. Y.

Meghani

S. H.

Ulrich

C. M.

(2021). Parental decision-making in the pediatric intensive care unit: An integrative review. Journal of Family Nursing, 27(2), 154–167.

28.

Zhang

McMahon

Leblanc

Braksmajer

Crean

H. F.

Alcena-Stiner

(2020). Association of medical mistrust and poor communication with HIV-related health outcomes and psychosocial wellbeing among heterosexual men living with HIV. AIDS Patient Care and STDs, 34(1), 27–37.