Pediatric Cardiology

, Volume 31, Issue 7, pp 961–968 | Cite as

Parent Stress Levels During Children’s Hospital Recovery After Congenital Heart Surgery

  • Linda S. Franck
  • Annette Mcquillan
  • Jo Wray
  • Michael P. W. Grocott
  • Allan Goldman
Original Article

Abstract

The hospitalization of a child for cardiac surgery is known to be a stressful experience for parents. However, little is known about the time course or the relationships between parental stress and the child’s actual or perceived recovery. This research aimed to investigate pre- and postoperative parental stress and to examine some of the influencing factors during the postoperative period for children undergoing elective cardiac surgery. Parents of 211 children completed questionnaires and structured interviews preoperatively and on postoperative days 3, 5, 8, and 15. The stress of the parents remained moderate to high throughout their children’s hospitalization regardless of the severity of illness. Parents’ perceptions of their children’s level of illness correlated with an objective measure of postoperative morbidity. There were few differences between mothers’ and fathers’ stress or their perceptions of their children’s illness. Parents in more deprived communities and mothers born outside the UK had higher stress levels. These findings indicate the negative impact of children’s surgery and intensive care hospitalization on parents. Better identification of parents at risk for high stress and specific interventions to improve parental support and coping are needed.

Keywords

Parents Cardiac surgery Hospitalized child Postoperative Stress 

References

  1. 1.
    Board R (2004) Father stress during a child’s critical care hospitalization. J Pediatr Health Care 18:244–249PubMedGoogle Scholar
  2. 2.
    Board R, Ryan-Wenger N (2000) State of the science on parental stress and family functioning in pediatric intensive care units. Am J Crit Care 9:106–122PubMedGoogle Scholar
  3. 3.
    Board R, Ryan-Wenger N (2003) Stressors and stress symptoms of mothers with children in the PICU. J Pediatr Nurs 18:195–202CrossRefPubMedGoogle Scholar
  4. 4.
    Casey FA, Craig BG, Mulholland HC (1994) Quality of life in surgically palliated complex congenital heart disease. Arch Dis Child 70:382–386CrossRefPubMedGoogle Scholar
  5. 5.
    Connolly D, McClowry S, Hayman L, Mahony L, Artman M (2004) Posttraumatic stress disorder in children after cardiac surgery. J Pediatr 144:480–484CrossRefPubMedGoogle Scholar
  6. 6.
    Curley MA, Wallace J (1992) Effects of the nursing Mutual Participation Model of Care on parental stress in the pediatric intensive care unit: a replication. J Pediatr Nurs 7:377–385PubMedGoogle Scholar
  7. 7.
    Darke PR, Goldberg S (1994) Father–infant interaction and parent stress with healthy and medically compromised infants. Infant Behav Dev 7:3–14CrossRefGoogle Scholar
  8. 8.
    Davidson JE, Powers K, Hedayat KM, Tieszen M, Kon AA, Shepard E, Spuhler V, Todres ID, Levy M, Barr J, Ghandi R, Hirsch G, Armstrong D (2007) Clinical practice guidelines for support of the family in the patient-centered intensive care unit: American College of Critical Care Medicine Task Force 2004–2005. Crit Care Med 35:605–622CrossRefPubMedGoogle Scholar
  9. 9.
    Davis CC, Brown RT, Bakeman R, Campbell R (1998) Psychological adaptation and adjustment of mothers of children with congenital heart disease: stress, coping, and family functioning. J Pediatr Psychol 23:219–228CrossRefPubMedGoogle Scholar
  10. 10.
    DeMaso DR, Campis LK, Wypij D, Bertram S, Lipshitz M, Freed M (1991) The impact of maternal perceptions and medical severity on the adjustment of children with congenital heart disease. J Pediatr Psychol 16:137–149CrossRefPubMedGoogle Scholar
  11. 11.
    Goldberg S, Morris P, Simmons RJ, Fowler RS, Levison H (1990) Chronic illness in infancy and parenting stress: a comparison of three groups of parents. J Pediatr Psychol 15:347–358CrossRefPubMedGoogle Scholar
  12. 12.
    Grocott M, McQuillan A, Goldman A, Franck LS (2007) Development and preliminary validation of a paediatric morbidity survey for congenital heart surgery. Pediatr Crit Care Med 8:A277Google Scholar
  13. 13.
    Grocott MP, Browne JP, Van der Meulen J, Matejowsky C, Mutch M, Hamilton MA, Levett DZ, Emberton M, Haddad FS, Mythen MG (2007) The Postoperative Morbidity Survey was validated and used to describe morbidity after major surgery. J Clin Epidemiol 60:919–928Google Scholar
  14. 14.
    Haines C, Perger C, Nagy S (1995) A comparison of the stressors experienced by parents of intubated and nonintubated children. J Adv Nurs 21:350–355CrossRefPubMedGoogle Scholar
  15. 15.
    Helfricht S, Latal B, Fischer JE, Tomaske M, Landolt MA (2008) Surgery-related posttraumatic stress disorder in parents of children undergoing cardiopulmonary bypass surgery: a prospective cohort study. Pediatr Crit Care Med 9:217–223CrossRefPubMedGoogle Scholar
  16. 16.
  17. 17.
    Kaaresen PI, Ronning JA, Ulvund SE, Dahl LB (2006) A randomized, controlled trial of the effectiveness of an early-intervention program in reducing parenting stress after preterm birth. Pediatrics 118:e9–e19CrossRefPubMedGoogle Scholar
  18. 18.
    Kang N, Cole T, Tsang V, Elliott M, de Lavel MR (2004) Risk stratification in paediatric open-heart surgery. Eur J Cardiothorac Surg 26:3–11CrossRefPubMedGoogle Scholar
  19. 19.
    Kazak AE, Kassam-Adams N, Schneider S, Zelikovsky N, Alderfer MA, Rourke M (2006) An integrative model of pediatric medical traumatic stress. J Pediatr Psychol 31:343–355CrossRefPubMedGoogle Scholar
  20. 20.
    Knoderer HM (2009) Inclusion of parents in pediatric subspecialty team rounds: attitudes of the family and medical team. Acad Med 84:1576–1581CrossRefPubMedGoogle Scholar
  21. 21.
    LeRoy S, Elixson EM, O’Brien P, Tong E, Turpin S, Uzark K (2003) Recommendations for preparing children and adolescents for invasive cardiac procedures: a statement from the American Heart Association Pediatric Nursing Subcommittee of the Council on Cardiovascular Nursing in collaboration with the Council on Cardiovascular Diseases of the Young. Circulation 108:2550–2564CrossRefPubMedGoogle Scholar
  22. 22.
    Majnemer A, Limperopoulos C, Shevell M, Rohlicek C, Rosenblatt B, Tchervenkov C (2006) Health and well-being of children with congenital cardiac malformations, and their families, following open-heart surgery. Cardiol Young 16:157–164CrossRefPubMedGoogle Scholar
  23. 23.
    Melnyk BM, Alpert-Gillis L, Feinstein NF, Crean HF, Johnson J, Fairbanks E, Small L, Rubenstein J, Slota M, Corbo-Richert B (2004) Creating opportunities for parent empowerment: program effects on the mental health/coping outcomes of critically ill young children and their mothers. Pediatrics 113:e597–e607CrossRefPubMedGoogle Scholar
  24. 24.
    Melnyk BM, Feinstein NF, Alpert-Gillis L, Fairbanks E, Crean HF, Sinkin RA, Stone PW, Small L, Tu X, Gross SJ (2006) Reducing premature infants’ length of stay and improving parents’ mental health outcomes with the Creating Opportunities for Parent Empowerment (COPE) neonatal intensive care unit program: a randomized, controlled trial. Pediatrics 118:e1414–e1427CrossRefPubMedGoogle Scholar
  25. 25.
    Miles MS, Brunssen SH (2003) Psychometric properties of the parental stressor scale: infant hospitalization. Adv Neonatal Care 3:189–196CrossRefPubMedGoogle Scholar
  26. 26.
    Miles MS, Carter MC, Hennessey J, Eberly TW, Riddle I (1989) Testing a theoretical model: correlates of parental stress responses in the pediatric intensive care unit. Matern Child Nurs J 18:207–219PubMedGoogle Scholar
  27. 27.
    Paediatric Intensitve Care Audit Network (PICANet) (2009) Retrieved January 2010 at http://www.picanet.org.uk/
  28. 28.
    Riddle I, Hennessey J, Eberly TW, Carter MC, Miles MS (1989) Stressors in the pediatric intensive care unit as perceived by mothers and fathers. Matern Child Nurs J 18:221–234Google Scholar
  29. 29.
    Shudy M, de Almeida ML, Ly S, Landon C, Groft S, Jenkins TL, Nicholson CE (2006) Impact of pediatric critical illness and injury on families: a systematic literature review. Pediatrics 118(Suppl 3):S203–S218CrossRefPubMedGoogle Scholar
  30. 30.
    Slater A, Shann F, Pearson G (2003) PIM2: a revised version of the Paediatric Index of Mortality. Intensive Care Med 29:278–285PubMedGoogle Scholar
  31. 31.
    Thompson RJ Jr, Gustafson KE, Hamlett KW, Spock A (1992) Stress, coping, and family functioning in the psychological adjustment of mothers of children and adolescents with cystic fibrosis. J Pediatr Psychol 17:573–585CrossRefPubMedGoogle Scholar
  32. 32.
    Thompson RJ Jr, Gil KM, Gustafson KE, George LK, Keith BR, Spock A, Kinney TR (1994) Stability and change in the psychological adjustment of mothers of children and adolescents with cystic fibrosis and sickle cell disease. J Pediatr Psychol 19:171–188CrossRefPubMedGoogle Scholar
  33. 33.
    Utens EM, Versluis-Den Bieman HJ, Verhulst FC, Witsenburg M, Bogers AJ, Hess J (2000) Psychological distress and styles of coping in parents of children awaiting elective cardiac surgery. Cardiol Young 10:239–244CrossRefPubMedGoogle Scholar
  34. 34.
    Van Horn M, DeMaso DR, Gonzalez-Heydrich J, Erickson JD (2001) Illness-related concerns of mothers of children with congenital heart disease. J Am Acad Child Adolesc Psychiatry 40:847–854CrossRefPubMedGoogle Scholar
  35. 35.
    Wray J, Sensky T (2004) Psychological functioning in parents of children undergoing elective cardiac surgery. Cardiol Young 14:131–139CrossRefPubMedGoogle Scholar
  36. 36.
    Yoos HL, Kitzman H, McMullen A, Sidora K (2003) Symptom perception in childhood asthma: how accurate are children and their parents? J Asthma 40:27–39CrossRefPubMedGoogle Scholar
  37. 37.
    Young Seideman R, Watson MA, Corff KE, Odle P, Haase J, Bowerman JL (1997) Parent stress and coping in NICU and PICU. J Pediatr Nurs 12:169–177CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2010

Authors and Affiliations

  • Linda S. Franck
    • 1
    • 2
  • Annette Mcquillan
    • 2
  • Jo Wray
    • 1
    • 2
  • Michael P. W. Grocott
    • 1
    • 3
  • Allan Goldman
    • 1
    • 2
  1. 1.UCL Institute of Child HealthLondonUK
  2. 2.Patient Care Research and Innovation CentreGreat Ormond Street HospitalLondonUK
  3. 3.Surgical Outcomes Research CentreJoint UCLH/UCL Comprehensive Biomedical Research CentreLondonUK

Personalised recommendations