(828) Trauma-Informed Care Among ICU Clinicians and Parents of Children With Severe Neurologic Impairment

Introduction: Children with severe neurologic impairment (SNI) are frequently admitted to the pediatric intensive care unit (PICU). Patients, and their families, often experience traumatic events in the PICU. Through this qualitative analysis of interviews with parents of children with SNI, and clinicians who care for them, we aimed to characterize themes that helped or hindered the trauma-informed care (TIC) principle of collaboration and mutuality in the ICU care of these children.

Methods: This study was a secondary analysis of a larger prospective mixed methods cohort study examining the experiences of parents of children with SNI in the PICU and their clinicians. Parents, and clinicians caring for their children, completed semi-structured interviews after PICU discharge. Data were analyzed using a conventional content analysis approach. Two analysts coded all data independently, with differences resolved in consensus. Dedoose qualitative software was used to facilitate analysis.

Results: Interviews were completed by 15 parents and 19 clinicians. Most clinicians (74%) had cared for greater than 10 patients with SNI in the past month. We identified 3 themes characterizing the experience of collaboration and mutuality in the PICU, including 1) Knowing a patient beyond the chart: taking time to understand the personal details of a child’s care, 2) Understanding values: using a family’s value system to positively impact care, 3) Clinician-family and clinician-clinician collaboration: facilitating effective partnership in patient care. Additionally, several barriers to collaboration and mutuality were identified, including emotional toll on clinicians, constraints of the PICU environment, challenges communicating with SNI patients, and families being overwhelmed amidst critical illness.

Conclusions: Parents and clinicians described the presence of and barriers to collaboration between parents and health care team members who care for children with SNI. These findings underscore the importance of valuing partnerships between clinicians and families in the PICU. Future studies should address how collaboration, mutuality, and other TIC principles can be effectively incorporated into the care of SNI patients and families and identify strategies to overcome barriers to implementing these principles.