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Jading in the pediatric intensive care unit

Implications for healthcare providers of medically complex children*

Levi, Benjamin H. MD, PhD; Thomas, Neal J. MD; Green, Michael J. MD, MS; Rentmeester, Christy A. MA; Ceneviva, Gary D. MD

Pediatric Critical Care Medicine: May 2004 - Volume 5 - Issue 3 - p 275-277
doi: 10.1097/01.PCC.0000124022.65859.8E
PCCM Perspectives
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Objective: To discuss the phenomenon of jading within the context of the pediatric intensive care unit.

Design: Drawing from their experience, the authors describe and then discuss a clinical scenario readily recognizable by pediatric intensive care unit practitioners: a child whose care requires the expenditure of a large amount of energy and resources, provides seemingly little reward, and leads to jading of the PICU staff.

Conclusion: Jading describes a process of exhaustion whereby apathy, cynicism, and callousness replace the drive to be responsive, to make a difference, and to care. The issue of jading has become an increasing area of concern in the pediatric intensive care unit, due in part to recurring, prolonged admissions, combined with the perception, at times, that continued medical care is fruitless. With a better understanding of the phenomenon of jading, and by reconsidering their own responses, pediatric intensive care unit practitioners can avoid becoming jaded.

From the Departments of Pediatrics (Division of General Pediatrics) and Humanities, Penn State Children’s Hospital (BHL), the Department of Pediatrics, Division of Pediatric Critical Care Medicine, Penn State Children’s Hospital (NJT), the Department of Medicine (Division of General Internal Medicine) and Humanities (MJG), and the Department of Pediatrics, Division of Pediatric Critical Care Medicine, Penn State Children’s Hospital (GDC), Penn State University College of Medicine, Hershey, PA; and the Department of Philosophy (CAR), Michigan State University, East Lansing, MI.

*See also p. 299.

©2004The Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies