Identifying Parent Anxiety and Family Distress of Critically Ill Children in Response to Changes in Hospital Visitation Policies During the COVID-19 Pandemic

A child’s admission to a pediatric intensive care unit (PICU) is one of the most stressful and anxiety-provoking situations that parents, and families can endure (Jee et al., 2012). Parents describe the PICU environment as unfamiliar, loud, confusing, unpredictable, and emotional (Alzawad et al., 2020). Parent and family routines are dramatically disrupted during a child’s PICU hospitalization further contributing to parent stress (Kirschbaum, 1990). Parents of critically ill children report feeling stressed and uncomfortable about the inability to participate in their child’s care. This loss of control increases parent anxiety and stress as well as feelings of hopelessness and helplessness (Dahav & Sjostrom-Strand, 2018; Simeone et al., 2018). Additional parent stressors include limited access to medical information, uncertainty of the child’s prognosis, and leaving the hospitalized child (Kirschbaum, 1990). Parents report that unrestricted access to their critically ill child helps them better understand the treatment plan and options for care, feel more confident in healthcare staff, and alleviates stress and anxiety (Dahav & Sjostrom-Strand, 2018; Simeone et al., 2018; Sood et al., 2018).In 2020, healthcare institutions throughout the world scrambled to care for unprecedented numbers of patients afflicted with COVID-19. While most children were spared significant illness, pediatric hospitals around the world found themselves adapting to accommodate adult patients or shifting personnel to assist in overwhelmed adult units. The desire to protect vulnerable staff and patients by limiting spread of the virus spread prompted abrupt changes in visitor policies in both adult and pediatric hospitals (Hugelius et al., 2021). For patients ofnchildren admitted to the PICU, the already-stressful circumstances surrounding ICU admission were compounded by checkpoints and restricted parent presence.