Development and Evaluation of Psychoeducational Booklets for Children Visiting the Intensive Care Unit

Introduction: The visit of children in Intensive Care Units (ICUs) has become more frequent thanks to the introduction of open visiting policies and family-centered care. Studies found that allowing children to visit their relatives admitted to the ICUs provides several benefits. However, they should be prepared and accompanied to minimize the possible traumatic aspects of the visit. To facilitate children’s visit to the ICU, we developed 2 booklets. This contribution aims 1) to describe the implementation of the 2 booklets; 2) to evaluate the impact of the prepared visit on children's psychological well-being. Methods: An interdisciplinary group coordinated by a clinical psychologist designed the booklets and their structure. The work resulted in the publication of “The Cave in the Forest” for children aged 6 to 10 and “The Journey” for children aged 11 to 13. Both booklets consist of a narrative story and a psychoeducational section. The booklets were used in 4 ICUs (Northern Italy) with children willing to visit their family members, who were hospitalized in ICU with a mechanical ventilation length ≥ 48 hours. Before the visit and upon parental consensus, children completed two online questionnaires to measure post-traumatic stress disorder (PTSD) and separation anxiety. Parents received the age-appropriate booklet for their children to read at home. The ICU staff facilitated the visit of children. With 5 days from the visit, children completed the same questionnaires. Results: To date, 13 children (8 boys; mean age=11.3; SD=2.4) completed pre and post questionnaires. Of them, 4 had a parent hospitalized, 5 the grandfather/grandmother, and 1 a sibling. Wilcoxon signed-rank test showed a reduction in PTSD after the visit (Mean-pre=23.3; Mean-post=16.9; X2=5.5, p=.018) and a reduction in separation anxiety (Mean-pre=8.4; Mean-post=5.6; X2=4.5, p=.009). Furthermore, 92% of the children found the booklets useful and age-appropriate. All children reported that they were glad that they had visited. Discussion: Findings suggest that a prepared visit together with the booklets can decrease post-traumatic stress disorder and separation anxiety. Implementing practices to maintain the attachment bond with hospitalized family members can play a protective role on children’s mental health.