Please select the eligibility criteria that correspond to the clinical trial below.
Title: A Nursing Intervention to Enhance Comfort and Promote Psychological Well-Being in Children During and Following PICU Hospitalization: A Pilot Study
Brief Summary: Children who become critically ill and require Pediatric Intensive Care Unit (PICU)hospitalization may develop negative psychological outcomes following discharge. This pilot study will test a nursing intervention that seeks to promote child comfort, sleep and psychological well-being during and following PICU hospitalization.

Study objectives are to:

1. test the feasibility and acceptability of a PICU comfort care intervention that can be administered by nursing staff
2. examine the feasibility and acceptability of data collection procedures
3. pilot test outcome measures
4. determine effect sizes to inform sample size calculation for a future multi-centred randomized controlled trial (RCT).

The intervention will take place in the PICU, and consists of a parental soothing activity followed by a quiet period in which earmuffs are placed over the child's ears to block noise. Children's sleep time and comfort level will be monitored in the PICU, and the investigators will follow them for 3 months post-discharge to examine the effects of the intervention on psychological well-being.


Options:
A: Inclusion Criteria:

* Child aged 6-17 admitted to the PICU of one Canadian, university teaching hospital
* Child in age-appropriate grade at school (+- 1 year)
* Child can read and speak English or French
* Parent or primary caregiver willing to participate in the intervention, who can read, speak and write English or French

Exclusion Criteria:

* Child diagnosed with a sleep disorder, seizure disorder, hearing disorder, or who has had neurological surgery that precludes sleep measurement
* Child expected to die during their PICU stay
B: Inclusion Criteria:

* PICU patient at Oishei Children's Hospital of Buffalo
* \>4 years of age, \<18 years of age
* Patients with RASS of +1

Exclusion Criteria:

* Documented underlying psychological disorders
* Diagnosed with sever developmental delay
* Prior narcotic dependence
* Underlying medical conditions affecting heart rate, blood pressure, or neuromuscular system
* Chemically paralyzed patients
* Anyone with an aneurysm
* Patients who are deaf in both ears
* Ear bone fractures or other middle/inner ear trauma or major ear avulsion as determined by physician
* Hemodynamically unstable patients
* Patients facing imminent death
C: Inclusion Criteria:

* ICU-patients \>18 yrs old
* expected duration of stay \> 24 hrs

Exclusion Criteria:

* life expectancy of \<48 hrs on ICU admission
* necessity of prolonged deep sedation
* blindness
* inability to speak or understand dutch
D: Inclusion Criteria:

* age ≥6 months to \<18 years
* intubated and mechanically ventilated
* patient requires pharmacologic sedation/analgesia to tolerate mechanical ventilation
* ≤72 hours of mechanical ventilation at time of enrollment with anticipated need of mechanical ventilation for at least ≥48 hours more (in order to be able to receive at least one acupuncture session)
* approval of treating physician

Exclusion Criteria:

* underlying neurologic condition that could impact sedation/analgesia needs
* coagulopathy (inr ≥ 1.8) or history of spontaneous bruising
* thrombocytopenia (platelets \<20,000 that has not been treated with a platelet transfusion)
* hemodynamic instability (on continuous infusion of vasopressor or inotrope)
* sepsis or bacteremia on antibiotic therapy \<24 hours
* severe generalized skin disorder (e.g., epidermolysis bullosa, Stevens-Johnson)
* ward of state
* being treated with therapeutic level of systemic anticoagulation (e.g., heparin with unfractionated heparin activity level ≥0.3, enoxaparin with low molecular weight heparin activity level ≥0.5, warfarin with inr ≥1.8)
* immunosuppressed (on chemotherapy {e.g., daunorubicin, vincristine}, immunosuppressive medications {e.g., sirolimus, tacrolimus, cyclosporine, mycophenolate mofetil, high dose steroids \>4mg/kg/day}, or immunosuppressive biologics {e.g., thymoglobulin, etanercept, infliximab, adalimumab, rituximab})

Answer: A