Diary Reduces Family Stress and Anxiety in PICU

Storybook diary helps families cope in the pediatric intensive care unit.

Keeping a family diary during a child’s stay in the pediatric intensive care unit (PICU) was associated with decreased family stress and anxiety, according to research presented at the National Association of Pediatric Nurse Practitioners (NAPNAP) National Conference on Pediatric Health Care held March 15 to 18, 2023, in Orlando, Florida.

Researchers wanted to compare whether the introduction of a PICU diary, which is left in the patient’s room for the duration of their stay, would improve communication between staff and families and reduce anxiety. “Few evidence-based coping strategies are available for families of children admitted to the PICU,” said Samantha Lee, DNP, ARNP, CPNP-AC, and colleagues from the College of Nursing at the University of Iowa. This relatively inexpensive, simple tool, may help decrease parental stress, which would benefit patients who rely on their caregivers for emotional support, basic needs, and decision-making, noted the authors.

Researchers recruited families of patients with congenital heart disease estimated to stay in the PICU for 7 or more days as well as staff. The researchers developed an evidence-based family diary intervention called Storybook. Family satisfaction with the diary was evaluated using a postimplementation satisfaction survey and staff perceptions were evaluated using pre- and postimplementation surveys. The researchers had 3 objectives for this intervention:

  1. Implement Storybook in 50% of families with children with complex congenital heart disease
  2. Decrease perceived family stress and anxiety
  3. Improve staff knowledge, behaviors, and attitudes on Storybook
When we developed our printed copy of the Storybook, it was made in English and Spanish. As we use this tool more, we hope staff and families will be more apt to use it.

Families Report Positive Effects of Diary in PICU

Of the 23 eligible patients identified, Storybook was implemented in 65% of cases (n=15). Families expressed positive effects from Storybook use. Half of families thought Storybook helped bridge gaps in memory, 50% agreed they better understood their child’s illness, and 60% agreed that perceived stress and anxiety were reduced with Storybook participation.

Barriers to participation were language barrier, hesitancy by families, and workload of staff, Dr Lee explained. “When we developed our printed copy of the Storybook, it was made in English and Spanish. As we use this tool more, we hope staff and families will be more apt to use it.”

Education of staff was successful at improving their knowledge, behaviors, and attitudes pre- and postimplementation (Figure). The majority of the staff (76%) felt that they had tools to educate parents about Storybook. In addition, staff awareness of Storybook increased by 32%, and staff perception that Storybook is beneficial to families increased by 45%.

Figure. Improvements in staff knowledge, behaviors, and attitudes about Storybook. Reprinted with permission from Lee, et al.

Limitations of this study included the small sample size, the lack of time for staff participation, and that only patients with congenital heart conditions were recruited.

Implementation of the evidence-based intervention Storybook was streamlined through staff and family education, Dr Lee and colleagues concluded. Most families of a PICU patient reported a reduction in perceived stress and anxiety after use of Storybook.

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This article originally appeared on Clinical Advisor


Lee S, Bloxham J, Stoll H, et al. Implementation of a diary to decrease family stress in a pediatric intensive care unit. Presented at: NAPNAP National Conference; March 15-18, 2023; Orlando, FL.