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pediatric ICU nursing

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https://www.readbyqxmd.com/read/29680212/impact-of-a-clinical-therapeutic-intervention-on-pain-assessment-management-and-nursing-practices-in-an-intensive-care-unit-a-before-and-after-study
#1
Vincenzo Damico, Flavio Cazzaniga, Liana Murano, Rita Ciceri, Giuseppe Nattino, Alberto Dal Molin
Accurate pain assessment and management constitute a major challenge for medical and nursing staff in intensive care units (ICUs). A distinct recollection of pain is reported by high proportions of ICU patients. A clinical therapeutic intervention directed at improving pain assessment and management in critically ill patients who are unable to communicate was implemented at an Italian ICU. In this before-and-after study, data were collected before (T0 ) and after (T1 ) the adoption of a protocol involving pain assessment with an ad hoc behavioral pain scale and the administration of analgesics, rather than sedatives, to patients with intermediate to high pain scores...
April 18, 2018: Pain Management Nursing: Official Journal of the American Society of Pain Management Nurses
https://www.readbyqxmd.com/read/29652752/practice-change-from-intermittent-medication-boluses-to-bolusing-from-a-continuous-infusion-in-pediatric-critical-care-a-quality-improvement-project
#2
Jessica L Hochstetler, A Jill Thompson, Natalie M Ball, Melissa C Evans, Shaun C Frame, A Lauren Haney, Amelia K Little, Jaime L O'Donnell, Bryna M Rickett, Elizabeth H Mack
OBJECTIVES: To determine whether implementing a guideline to bolus medications from continuous infusions in PICUs affects nursing satisfaction, patient safety, central line entries, medication utilization, or cost. DESIGN: This is a pre- and postimplementation quality improvement study. SETTING: An 11-bed ICU and 14-bed cardiac ICU in a university-affiliated children's hospital. PATIENTS: Patients less than 18 years old admitted to the PICU or pediatric cardiac ICU receiving a continuous infusion of dexmedetomidine, midazolam, fentanyl, morphine, vecuronium, or cisatracurium from May 2015 to May 2016, excluding November 2015 (washout period), were eligible for inclusion...
April 12, 2018: Pediatric Critical Care Medicine
https://www.readbyqxmd.com/read/29605703/variability-in-the-time-to-initiation-of-cpr-in-continuously-monitored-pediatric-icus
#3
M Olson, E Helfenbein, L Su, M Berg, L Knight, L Troy, L Sacks, D Sakai, F Su
AIM: To study the influence of patient characteristics and unit ergonomics and human factors on the time to initiation of CPR. METHODS: A single center study of children, 0 to 21 years old, admitted to an ICU who experienced cardiopulmonary arrest (CPA) requiring >1 minute of chest compressions. Time of CPA was determined by analysis of continuous ECG, plethysmography, arterial blood pressure, and end-tidal CO2 (EtCO2 ) waveforms. Initiation of CPR was identified by the onset of cyclic artifact in the ECG waveform...
March 29, 2018: Resuscitation
https://www.readbyqxmd.com/read/29552425/clinician-driven-design-of-vitalpad-an-intelligent-monitoring-and-communication-device-to-improve-patient-safety-in-the-intensive-care-unit
#4
Luisa Flohr, Shaylene Beaudry, K Taneille Johnson, Nicholas West, Catherine M Burns, J Mark Ansermino, Guy A Dumont, David Wensley, Peter Skippen, Matthias Gorges
The pediatric intensive care unit (ICU) is a complex environment, in which a multidisciplinary team of clinicians (registered nurses, respiratory therapists, and physicians) continually observe and evaluate patient information. Data are provided by multiple, and often physically separated sources, cognitive workload is high, and team communication can be challenging. Our aim is to combine information from multiple monitoring and therapeutic devices in a mobile application, the VitalPAD , to improve the efficiency of clinical decision-making, communication, and thereby patient safety...
2018: IEEE Journal of Translational Engineering in Health and Medicine
https://www.readbyqxmd.com/read/29511037/analysis-of-a-pediatric-home-mechanical-ventilator-population
#5
Rambod Amirnovin, Sara Aghamohammadi, Carley Riley, Marlyn S Woo, Sylvia Del Castillo
BACKGROUND: The population of children requiring home mechanical ventilation has evolved over the years and has grown to include a variety of diagnoses and needs that have led to changes in the care of this unique population. The purpose of this study was to provide a descriptive analysis of pediatric patients requiring home mechanical ventilation after hospitalization and how the evolution of this technology has impacted their care. METHODS: A retrospective, observational, longitudinal analysis of 164 children enrolled in a university-affiliated home mechanical ventilation program over 26 years was performed...
March 6, 2018: Respiratory Care
https://www.readbyqxmd.com/read/29394481/transitioning-patients-from-the-intensive-care-unit-to-the-general-pediatric-unit-a-piece-of-the-puzzle-in-family-centered-care
#6
Lisa Manente, Terri McCluskey, Rachel Shaw
Transitioning patients from one unit to another is a nursing function that occurs daily. When done effectively, it streamlines continuity of care, decreases anxiety, ensures patients and families maintain confidence in care providers, and avoids readmissions to the intensive care unit (ICU). This article describes a transition plan for transferring patients from the ICU to the general pediatric unit developed by an inpatient, non-critical care cardiology/neuro logical unit to facilitate a smooth and informational transition from the ICU to the non-critical unit...
March 2017: Pediatric Nursing
https://www.readbyqxmd.com/read/29315137/reducing-ischemic-injury-from-indwelling-peripheral-arterial-catheters-in-a-pediatric-cardiac-icu-a-quality-improvement-initiative
#7
Adam C Adler, Stephanie Helman, Cynthia Field, Judith J Stellar, Lauren A Brown, Nicole Omensetter, Andrew T Costarino, Mahsun Yuerek, Karen S Bender
OBJECTIVES: To reduce the number of ischemic arterial catheter injuries in children with congenital or acquired heart disease. DESIGN: This is a quality improvement study with pre- and postintervention groups. SETTING: University-affiliated pediatric cardiac center in a quaternary care freestanding children's hospital. PATIENTS: All patients with an indwelling peripheral arterial catheter placed in the Children's Hospital of Philadelphia Cardiac Center associated with an admission to the Cardiac Intensive Cardiac Unit from January 2015 to July 2017 are included...
March 2018: Pediatric Critical Care Medicine
https://www.readbyqxmd.com/read/29167089/predicting-unplanned-transfers-to-the-intensive-care-unit-a-machine-learning-approach-leveraging-diverse-clinical-elements
#8
Ben Wellner, Joan Grand, Elizabeth Canzone, Matt Coarr, Patrick W Brady, Jeffrey Simmons, Eric Kirkendall, Nathan Dean, Monica Kleinman, Peter Sylvester
BACKGROUND: Early warning scores aid in the detection of pediatric clinical deteriorations but include limited data inputs, rarely include data trends over time, and have limited validation. OBJECTIVE: Machine learning methods that make use of large numbers of predictor variables are now commonplace. This work examines how different types of predictor variables derived from the electronic health record affect the performance of predicting unplanned transfers to the intensive care unit (ICU) at three large children's hospitals...
November 22, 2017: JMIR Medical Informatics
https://www.readbyqxmd.com/read/29133291/watcher-initiative-associated-with-decrease-in-failure-to-rescue-events-in-pediatric-population
#9
Melanie McClain Smith, Maryanne Chumpia, Lindsey Wargo, Julie Nicol, Mark Bugnitz
BACKGROUND AND OBJECTIVES: Improved situation awareness may prevent unplanned ICU transfers. Transfers with serious safety issues may be classified as unrecognized situation awareness failure events (UNSAFE) and are associated with intubation, vasopressors, or >3 fluid boluses within 1 hour before or after ICU arrival. Our aim was to decrease the proportion of unplanned ICU transfers that met UNSAFE criteria by 50% in 1 year. METHODS: We adapted a previously described huddle-based intervention...
December 2017: Hospital Pediatrics
https://www.readbyqxmd.com/read/28945629/critical-care-resource-utilization-and-outcomes-of-children-with-moderate-traumatic-brain-injury
#10
Theerada Chandee, Vivian H Lyons, Monica S Vavilala, Vijay Krishnamoorthy, Nophanan Chaikittisilpa, Arraya Watanitanon, Abhijit V Lele
OBJECTIVES: To characterize admission patterns, critical care resource utilization, and outcomes in moderate pediatric traumatic brain injury. DESIGN: Retrospective cohort study. SETTING: National Trauma Data Bank. PATIENTS: Children under 18 years old with a diagnosis of moderate traumatic brain injury (admission Glasgow Coma Scale score of 9-13) in the National Trauma Data Bank between 2007 and 2014. MEASUREMENT AND MAIN RESULTS: We examined clinical characteristics, critical care resource utilization, and discharge outcomes...
December 2017: Pediatric Critical Care Medicine
https://www.readbyqxmd.com/read/28875617/clinical-considerations-when-applying-vital-signs-in-pediatric-korean-triage-and-acuity-scale
#11
Bongjin Lee, Do Kyun Kim, June Dong Park, Young Ho Kwak
Initial vital signs of children at the emergency department may be abnormal because of anxiety and irritability, resulting in unrealistic triage levels. This study aimed to evaluate the effectiveness of pediatric triage by clinical decision based on the patient's general condition. The Pediatric Korean Triage and Acuity Scale (PedKTAS) has been used nationwide for triage since 2016. The triage level, as assessed by an experienced triage nurse and based on the patient's clinical condition, was defined as the 'real practice (RP)-level,' while the re-calculated triage level, as assessed by the direct application of initial vital signs, was defined as the 'simulation (S)-level...
October 2017: Journal of Korean Medical Science
https://www.readbyqxmd.com/read/28674302/effect-of-ipe-on-medical-profession-education-and-expectations-of-pharmacists-from-the-perspective-of-nurses
#12
Ikuko Sakai
 On January 1, 2015, the Interprofessional Education Research Center (IPERC) was opened at the Graduate School of Nursing at Chiba University, while being positioned as one of the Inohana Campus High Functionality Initiatives by the university. As the result of the establishment of an education research center in the nursing graduate school, various changes are coming into view. In particular, the active participation of young instructors of the medical, nursing, and pharmacology departments and university hospital in interprofessional education (IPE) efforts deserve special mention...
2017: Yakugaku Zasshi: Journal of the Pharmaceutical Society of Japan
https://www.readbyqxmd.com/read/28658501/palliative-and-end-of-life-care-education-needs-of-nurses-across-inpatient-care-settings
#13
Deborah M Price, Linda Strodtman, Marcos Montagnini, Heather M Smith, Jillian Miller, Jennifer Zybert, Justin Oldfield, Tyler Policht, Bidisha Ghosh
BACKGROUND: Educating nurses about palliative and end-of-life (EOL) care is a high priority in health care settings. The purpose of this study was to assess nurses' perceived competency regarding the provision of palliative and EOL care to hospitalized patients. METHOD: This study surveyed nurses from 25 pediatric and adult acute and intensive care units (ICU; N = 583) Quantitative data analysis was descriptive and correlational. Qualitative data analysis identified themes of participant concerns...
July 1, 2017: Journal of Continuing Education in Nursing
https://www.readbyqxmd.com/read/28616369/management-of-an-obstructed-tracheostomy-in-a-limited-resource-setting
#14
Julie Chiaravalli, Norman Lufesi, Elwin Shawa, Vitumbiko Nkhoma, Elaine Sigalet, Adam Dubrowski
Obstruction of a tracheostomy tube is a common cause of respiratory compromise in adults and pediatric patients, which can lead to a life-threatening emergency if it is not properly managed. Compromised airway patency has many potential etiologies; however, the scenario described in this technical report focuses specifically on the management of tracheostomy obstruction through the presence of a mucus plug, blood clot, or highly viscous secretions. The simulation described in this technical report was written to be conducted as an in-situ simulation within the intensive care unit (ICU) at Mzuzu Central Hospital, Malawi...
May 13, 2017: Curēus
https://www.readbyqxmd.com/read/28612089/the-intensive-care-delirium-research-agenda-a-multinational-interprofessional-perspective
#15
REVIEW
Pratik P Pandharipande, E Wesley Ely, Rakesh C Arora, Michele C Balas, Malaz A Boustani, Gabriel Heras La Calle, Colm Cunningham, John W Devlin, Julius Elefante, Jin H Han, Alasdair M MacLullich, José R Maldonado, Alessandro Morandi, Dale M Needham, Valerie J Page, Louise Rose, Jorge I F Salluh, Tarek Sharshar, Yahya Shehabi, Yoanna Skrobik, Arjen J C Slooter, Heidi A B Smith
Delirium, a prevalent organ dysfunction in critically ill patients, is independently associated with increased morbidity. This last decade has witnessed an exponential growth in delirium research in hospitalized patients, including those critically ill, and this research has highlighted that delirium needs to be better understood mechanistically to help foster research that will ultimately lead to its prevention and treatment. In this invited, evidence-based paper, a multinational and interprofessional group of clinicians and researchers from within the fields of critical care medicine, psychiatry, pediatrics, anesthesiology, geriatrics, surgery, neurology, nursing, pharmacy, and the neurosciences sought to address five questions: (1) What is the current standard of care in managing ICU delirium? (2) What have been the major recent advances in delirium research and care? (3) What are the common delirium beliefs that have been challenged by recent trials? (4) What are the remaining areas of uncertainty in delirium research? (5) What are some of the top study areas/trials to be done in the next 10 years? Herein, we briefly review the epidemiology of delirium, the current best practices for management of critically ill patients at risk for delirium or experiencing delirium, identify recent advances in our understanding of delirium as well as gaps in knowledge, and discuss research opportunities and barriers to implementation, with the goal of promoting an integrated research agenda...
September 2017: Intensive Care Medicine
https://www.readbyqxmd.com/read/28598947/moral-distress-in-picu-and-neonatal-icu-practitioners-a-cross-sectional-evaluation
#16
Charles Philip Larson, Karen D Dryden-Palmer, Cathy Gibbons, Christopher S Parshuram
OBJECTIVES: To measure the level of moral distress in PICU and neonatal ICU health practitioners, and to describe the relationship of moral distress with demographic factors, burnout, and uncertainty. DESIGN: Cross-sectional survey. SETTING: A large pediatric tertiary care center. SUBJECTS: Neonatal ICU and PICU health practitioners with at least 3 months of ICU experience. INTERVENTIONS: A 41-item questionnaire examining moral distress, burnout, and uncertainty...
August 2017: Pediatric Critical Care Medicine
https://www.readbyqxmd.com/read/28460698/when-nursing-assertion-stops-a-qualitative-study-to-examine-the-cultural-barriers-involved-in-escalation-of-care-in-a-pediatric-hospital
#17
REVIEW
Jodi Thrasher, Heidi McNeely, Bonnie Adrian
Pediatric codes outside the ICU are associated with increased morbidity and mortality. This qualitative research highlights results from confidential interviews with 10 pediatric nurses with experience of caring for children who required rapid response, code response, or transfer to intensive care. Detailed examination of nurses' experiences revealed local factors that facilitate and inhibit timely transfer of critical patients. Nurses identified themes including the impact of nurse assertiveness, providers' lack of understanding of nursing, team communication, and other hospital cultural barriers...
June 2017: Critical Care Nursing Clinics of North America
https://www.readbyqxmd.com/read/28459762/coping-with-staff-burnout-and-work-related-posttraumatic-stress-in-intensive-care
#18
Gillian A Colville, Jared G Smith, Joe Brierley, Kim Citron, Noreen M Nguru, Priyanka D Shaunak, Olivia Tam, Linda Perkins-Porras
OBJECTIVES: To examine the associations with symptoms of 1) burnout and 2) work-related posttraumatic stress, in adult and pediatric intensive care staff, focusing on the particular contributions of resilience and coping strategies. DESIGN: Point prevalence cross-sectional study. SETTING: Three adult ICUs and four PICUs. SUBJECTS: Three hundred seventy-seven ICU staff. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Brief Resilience Scale, abbreviated Maslach Burnout Inventory, Trauma Screening Questionnaire, and Hospital Anxiety and Depression Scale...
July 2017: Pediatric Critical Care Medicine
https://www.readbyqxmd.com/read/28334560/development-and-preliminary-testing-of-the-coordination-process-error-reporting-tool-cpert-a-prospective-clinical-surveillance-mechanism-for-teamwork-errors-in-the-pediatric-cardiac-icu
#19
Katherine E Bates, Judy A Shea, Geoffrey L Bird, Cynthia Field, Deipanjan Nandi, Robert E Shaddy, Joshua P Metlay
BACKGROUND: Patient safety reporting systems (PSRSs) may not detect teamwork or coordination process errors that affect all dimensions of quality defined by the Institute of Medicine. This study aimed to develop and observe the performance of a novel tool, the Coordination Process Error Reporting Tool (CPERT), as a prospective clinical surveillance mechanism for teamwork errors in the pediatric cardiac ICU. METHODS: Providers and parents used the qualitative nominal group technique to identify coordination process error examples...
December 2016: Joint Commission Journal on Quality and Patient Safety
https://www.readbyqxmd.com/read/28299540/psychosocial-needs-of-patient-s-relatives-and-health-care-providers-in-a-pediatric-critical-care-unit
#20
Sasidaran Kandasamy, Niranjan Vijayakumar, Rupesh Kumar Natarajan, Thangavelu Sangaralingam, Nedunchelian Krishnamoorthi
OBJECTIVE: To describe the needs of relatives of children admitted to an Intensive Care Unit and compare their needs with the perspectives of doctors, nurses and administrators. METHODS: This is a descriptive comparative study done at a tertiary care PICU from South India. A modified Critical Care Family Needs Inventory (CCFNI) (internal consistency reliability =0.93) was used to assess the needs of 35 family members, 30 nurses, 30 doctors and 30 administrators...
August 2017: Indian Journal of Pediatrics
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