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pediatric ICU nursing

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https://www.readbyqxmd.com/read/29167089/predicting-unplanned-transfers-to-the-intensive-care-unit-a-machine-learning-approach-leveraging-diverse-clinical-elements
#1
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
#2
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...
November 13, 2017: Hospital Pediatrics
https://www.readbyqxmd.com/read/28945629/critical-care-resource-utilization-and-outcomes-of-children-with-moderate-traumatic-brain-injury
#3
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...
September 22, 2017: Pediatric Critical Care Medicine
https://www.readbyqxmd.com/read/28875617/clinical-considerations-when-applying-vital-signs-in-pediatric-korean-triage-and-acuity-scale
#4
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
#5
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
#6
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
#7
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
#8
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...
June 13, 2017: Intensive Care Medicine
https://www.readbyqxmd.com/read/28598947/moral-distress-in-picu-and-neonatal-icu-practitioners-a-cross-sectional-evaluation
#9
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
#10
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
#11
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
#12
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
#13
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
https://www.readbyqxmd.com/read/28157808/improved-clinical-performance-and-teamwork-of-pediatric-interprofessional-resuscitation-teams-with-a-simulation-based-educational-intervention
#14
MULTICENTER STUDY
Elaine Gilfoyle, Deanna A Koot, John C Annear, Farhan Bhanji, Adam Cheng, Jonathan P Duff, Vincent J Grant, Cecilia E St George-Hyslop, Nicole J Delaloye, Afrothite Kotsakis, Carolyn D McCoy, Christa E Ramsay, Matthew J Weiss, Ronald D Gottesman
OBJECTIVES: To measure the effect of a 1-day team training course for pediatric interprofessional resuscitation team members on adherence to Pediatric Advanced Life Support guidelines, team efficiency, and teamwork in a simulated clinical environment. DESIGN: Multicenter prospective interventional study. SETTING: Four tertiary-care children's hospitals in Canada from June 2011 to January 2015. SUBJECTS: Interprofessional pediatric resuscitation teams including resident physicians, ICU nurse practitioners, registered nurses, and registered respiratory therapists (n = 300; 51 teams)...
February 2017: Pediatric Critical Care Medicine
https://www.readbyqxmd.com/read/28079605/delirium-in-critically-ill-children-an-international-point-prevalence-study
#15
MULTICENTER STUDY
Chani Traube, Gabrielle Silver, Ron W Reeder, Hannah Doyle, Emily Hegel, Heather A Wolfe, Christopher Schneller, Melissa G Chung, Leslie A Dervan, Jane L DiGennaro, Sandra D W Buttram, Sapna R Kudchadkar, Kate Madden, Mary E Hartman, Mary L deAlmeida, Karen Walson, Erwin Ista, Manuel A Baarslag, Rosanne Salonia, John Beca, Debbie Long, Yu Kawai, Ira M Cheifetz, Javier Gelvez, Edward J Truemper, Rebecca L Smith, Megan E Peters, A M Iqbal O'Meara, Sarah Murphy, Abdulmohsen Bokhary, Bruce M Greenwald, Michael J Bell
OBJECTIVES: To determine prevalence of delirium in critically ill children and explore associated risk factors. DESIGN: Multi-institutional point prevalence study. SETTING: Twenty-five pediatric critical care units in the United States, the Netherlands, New Zealand, Australia, and Saudi Arabia. PATIENTS: All children admitted to the pediatric critical care units on designated study days (n = 994). INTERVENTION: Children were screened for delirium using the Cornell Assessment of Pediatric Delirium by the bedside nurse...
April 2017: Critical Care Medicine
https://www.readbyqxmd.com/read/28057565/development-and-validation-of-a-continuously-age-adjusted-measure-of-patient-condition-for-hospitalized-children-using-the-electronic-medical-record
#16
Michael J Rothman, Joseph J Tepas, Andrew J Nowalk, James E Levin, Joan M Rimar, Albert Marchetti, Allen L Hsiao
Awareness of a patient's clinical status during hospitalization is a primary responsibility for hospital providers. One tool to assess status is the Rothman Index (RI), a validated measure of patient condition for adults, based on empirically derived relationships between 1-year post-discharge mortality and each of 26 clinical measurements available in the electronic medical record. However, such an approach cannot be used for pediatrics, where the relationships between risk and clinical variables are distinct functions of patient age, and sufficient 1-year mortality data for each age group simply does not exist...
January 2, 2017: Journal of Biomedical Informatics
https://www.readbyqxmd.com/read/28042054/design-and-rationale-of-heart-and-lung-failure-pediatric-insulin-titration-trial-half-pint-a-randomized-clinical-trial-of-tight-glycemic-control-in-hyperglycemic-critically-ill-children
#17
Michael Sd Agus, Ellie Hirshberg, Vijay Srinivasan, Edward Vincent Faustino, Peter M Luckett, Martha Aq Curley, Jamin Alexander, Lisa A Asaro, Kerry Coughlin-Wells, Donna Duva, Jaclyn French, Natalie Hasbani, Martha T Sisko, Carmen L Soto-Rivera, Garry Steil, David Wypij, Vinay M Nadkarni
OBJECTIVES: Test whether hyperglycemic critically ill children with cardiovascular and/or respiratory failure experience more ICU-free days when assigned to tight glycemic control with a normoglycemic versus hyperglycemic blood glucose target range. DESIGN: Multi-center randomized clinical trial. SETTING: Pediatric ICUs at 35 academic hospitals. PATIENTS: Children aged 2weeks to 17years receiving inotropic support and/or acute mechanical ventilation, excluding cardiac surgical patients...
February 2017: Contemporary Clinical Trials
https://www.readbyqxmd.com/read/27851704/developing-a-patient-classification-system-for-a-neonatal-icu
#18
Nancy M Daraiseh, William P Vidonish, Pam Kiessling, Li Lin
OBJECTIVE: The purpose of this study was to develop a valid and reliable patient classification system (PCS) for a neonatal ICU (NICU). BACKGROUND: PCSs have been widely used to determine required care hours, budgeting, and staffing. There is a lack of and a vital need for a valid and reliable pediatric PCS because of differences in needs and treatment from adults. METHODS: Data were collected in a NICU using work sampling, chart reviews, and expert opinion...
December 2016: Journal of Nursing Administration
https://www.readbyqxmd.com/read/27846827/nurses-perceptions-acceptance-and-use-of-a-novel-in-room-pediatric-icu-technology-testing-an-expanded-technology-acceptance-model
#19
Richard J Holden, Onur Asan, Erica M Wozniak, Kathryn E Flynn, Matthew C Scanlon
BACKGROUND: The value of health information technology (IT) ultimately depends on end users accepting and appropriately using it for patient care. This study examined pediatric intensive care unit nurses' perceptions, acceptance, and use of a novel health IT, the Large Customizable Interactive Monitor. METHODS: An expanded technology acceptance model was tested by applying stepwise linear regression to data from a standardized survey of 167 nurses. RESULTS: Nurses reported low-moderate ratings of the novel IT's ease of use and low to very low ratings of usefulness, social influence, and training...
November 15, 2016: BMC Medical Informatics and Decision Making
https://www.readbyqxmd.com/read/27815753/pediatric-ethics-and-communication-excellence-peace-rounds-decreasing-moral-distress-and-patient-length-of-stay-in-the-picu
#20
Lucia Wocial, Veda Ackerman, Brian Leland, Brian Benneyworth, Vinit Patel, Yan Tong, Mara Nitu
This paper describes a practice innovation: the addition of formal weekly discussions of patients with prolonged PICU stay to reduce healthcare providers' moral distress and decrease length of stay for patients with life-threatening illnesses. We evaluated the innovation using a pre/post intervention design measuring provider moral distress and comparing patient outcomes using retrospective historical controls. Physicians and nurses on staff in our pediatric intensive care unit in a quaternary care children's hospital participated in the evaluation...
March 2017: HEC Forum: An Interdisciplinary Journal on Hospitals' Ethical and Legal Issues
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