title: Long-term psychosocial impact reported by childhood critical illness survivors: a systematic review.
abstract: OBJECTIVE
  To undertake a qualitative systematic review that explores psychological and social impact, reported directly from children and adolescents at least 6 months after their critical illness.
  
  
  BACKGROUND
  Significant advances in critical care have reduced mortality from childhood critical illness, with the majority of patients being discharged alive. However, it is widely reported that surviving critical illness can be traumatic for both children and their family. Despite a growing body of literature in this field, the psychological and social impact of life threatening critical illness on child and adolescent survivors, more than 6 months post event, remains under-reported.
  
  
  METHODS
  Searches of six online databases were conducted up to February 2012.
  
  
  METHODS
  Predetermined criteria were used to select studies. Methodological quality was assessed using a standardized checklist. An adapted version of the thematic synthesis approach was applied to extract, code and synthesize data.
  
  
  RESULTS
  Three studies met the inclusion criteria, which were all of moderate methodological quality. Initial coding and synthesis of data resulted in five descriptive themes: confusion and uncertainty, other people's narratives, focus on former self and normality, social isolation and loss of identity, and transition and transformation. Further synthesis culminated in three analytical themes that conceptualize the childhood survivors' psychological and social journey following critical illness.
  
  
  CONCLUSIONS
  Critical illness in childhood can expose survivors to a complex trajectory of recovery, with enduring psychosocial adversity manifesting in the long term. Nurses and other health professionals must be aware and support the potential multifaceted psychosocial needs that may arise. Parents and families are identified as fundamental in shaping psychological and social well-being of survivors. Therefore intensive care nurses must take opportunities to raise parents' awareness of the journey of survival and provide appropriate support. Further empirical research is warranted to explore the deficits identified with the existing literature.
authors.affiliation: JC Manning, RN (Child), PGCert Paediatric Critical Care, MNursSci (Hons), Research Fellow, School of Health Sciences, Faculty of Medicine & Health Sciences, The University of Nottingham, Nottingham, UK.
authors.forename: Joseph C
authors.initials: JC
authors.lastname: Manning
authors.forename: Pippa
authors.initials: P
authors.lastname: Hemingway
authors.forename: Sarah A
authors.initials: SA
authors.lastname: Redsell
mesh_terms: D000293:Adolescent; D002648:Child; D064648:Critical Care Nursing; D016638:Critical Illness / Q000523:psychology*; D006801:Humans; D016294:Models, Nursing; D015404:Nursing Methodology Research; D036301:Qualitative Research; D017741:Survivors / Q000523:psychology*
keywords: ICU follow-up; Paediatric intensive/critical care; Psychological care; Psychological issues during and after discharge from intensive care; Qualitative research; Short- and long-term patient outcome from intensive care