Development of a pediatric intensive care unit nurse practitioner program

The use of acute care nurse practitioners in the adult critical care environment is well established. In the last several years, nurse practitioners are being used in the pediatric intensive care unit as well. Consequently, an increasing number of pediatric nurse practitioners have moved from primary care to the acute care environment. The recent development of the national acute care pediatric nurse practitioner certification examination provides validation of the education and standards of care provided by this subset of advanced practice nurses. The authors describe the highly successful pediatric critical care nurse practitioner program and its outcomes in a pediatric intensive care unit.     

Outcome of cardiopulmonary resuscitation in a pediatric cardiac intensive care unit

OBJECTIVE: To determine the eventual outcome of children with heart disease who had cardiopulmonary resuscitation (CPR) in a specialized pediatric cardiac intensive care unit (CICU), and to define the influence of any prearrest variables on the outcome. DESIGN: A retrospective review of patients' medical records. SETTING: A pediatric CICU of a tertiary pediatric teaching hospital. PATIENTS AND METHODS: Patients were all children who presented with cardiopulmonary arrest and who were administered CPR in the pediatric CICU between June 1995 and June 1997. Prearrest variables such as age, diagnosis, prior cardiac surgery, and inotropic support with epinephrine, as well as cause of arrest, were evaluated. MEASUREMENTS AND MAIN RESULTS: Thirty-two patients, ranging in age from 1 day to 21 yrs (median, 1 month), satisfied criteria for inclusion in the study group. These 32 patients had a total of 38 episodes of cardiopulmonary arrest. Twenty-five of these patients (78%) had cardiac surgery before arrest. Inotropic support with continuous infusion of epinephrine was being administered at the time of arrest in 18 of 38 (47%) arrests. These prearrest variables did not influence outcome of CPR. Of the 38 episodes of CPR, 24 episodes (63%) were successful, with 20 episodes resulting in return of spontaneous circulation and four patients being successfully placed on mechanical cardiopulmonary support. Fourteen children, including all four patients who were rescued with mechanical cardiopulmonary support, survived to discharge. At 6-month follow-up, 11 patients were still alive, with three having neurologic impairment. CONCLUSIONS: After cardiopulmonary resuscitation in this pediatric CICU, the rate of success was 63% and the rate of survival was 42%. Prior cardiac surgery and use of epinephrine before arrest did not influence the outcome of CPR. The availability of effective mechanical cardiopulmonary support can improve the outcome of CPR.     

Implementation of a simulation-based education for mothers in managing respiratory emergencies in the neonatal intensive care unit

Neonatal Intensive Care Unit (NICU) discharge often causes concern for mothers since they are solely responsible for the care and safety of their infants. This study assesses the feasibility of simulation-based education on managing respiratory emergencies for mothers and investigates changes in mothers' confidence. It used a pilot one-group pre- and post-test design in an NICU. The general estimation equation was used to analyze the effects of simulation-based education and factors affecting mothers' confidence. The simulation-based education increased mothers' confidence in managing respiratory emergencies, and these effects continuedeven after discharge. Mothers with multiple pregnancies and mothers of infants with low birth weight, long gestation, and NICU stays showed increased confidence compared to their counterparts. Teaching using a simulation approach is feasible and significantly improves mothers' confidence in infants’ respiratory emergency management. The findings demonstrate the feasibility of simulation-based education in terms of clinical education for improving infant health outcomes.     

哈尔滨市ICU护士护理软技能现状的调查

目的调查哈尔滨市重症监护室（ICU）护士护理软技能现状及其影响因素。方法2011年4—7月采用整群随机抽样方法,在哈尔滨市抽取3家三甲医院ICU的护士为调查对象,采用护理软技能测评量表对300名ICU护士进行调查,评价其护理软技能情况并分析影响因素。结果共发放问卷300份,回收275份,有效问卷245份,有效回收率为89．09％。哈尔滨市ICU护士护理软技能的总均分为（145．40±15．43）分,低于全国常模。得分最高的项目为自我管理技能（43．76±4．32）分,最低得分为职业情操（26．17±2．54）分。对影响ICU护士护理软技能得分的因素进行单因素分析,发现不同年龄、性别、学历、婚姻状态、聘用形式及职称的护士软技能得分不同,差异具有统计学意义（F／t分别为13．28,6．14,4．22,6．85,2．34,5．24;P〈0．05）。以护理软技能总分为因变量,以年龄、性别、婚姻状况、学历、聘用形式、职称为自变量,进行多元线性回归分析,结果表明,护士护理软技能水平受学历、年龄、婚姻状况的影响（R。=0．202）。结论哈尔滨市ICU护士护理软技能还需进一步提高,需要对低学历、已婚及护龄长的护士进行重点干预和培训,从而改善护患关系,提高护理质量。     

Mortality in a cardiac intensive care unit

Objective  

There are no reliable data on mortality and morbidity of adult patients in modern university-based cardiac intensive care units. Therefore, the present study was aimed to provide complete data in respect to mortality and morbidity of all patients admitted between 1 January 2008 and 31 December 2009 to the newly opened cardiac intensive care unit of the Heart Centre of the Cologne University Hospital.     

儿童加强监护病房患儿营养状况的调查

目的 了解危重患儿的营养状况,探讨营养状况与病情严重程度及预后的相关性,为临床对危重患儿进行合理的营养支持提供一定理论依据.方法 采集2010.11-2011.01期间入住北京儿童医院儿童加强监护病房(pediatric intensive care unit,PICU)的所有患儿作为研究对象.采用前瞻性研究方法,对入组患儿的身长、体质量等人体参数进行测量及营养评估.收集基础疾病、危重病例评分、住院时间、机械通气时间等临床资料.结果 196例患儿中,营养不良共43例,营养不良现患率为21.9％.营养不良组的儿童死亡危险评分大于营养正常组(P＜0.05);机械通气使用率高于营养正常组(P＜0.05);营养正常组患儿28 d存活率高于营养不良组(P＜0.05).结论 PICU入院患儿中营养不良的患病率为21.9％.营养不良组患儿儿童死亡危险评分、机械通气使用率高于营养正常组,28 d存活率低于与营养正常组,提示营养不良与疾病严重程度和预后相关.     

Nosocomial infections in a pediatric intensive care unit

In a prospective 30-month study of nosocomial infections in a pediatric ICU (PICU), the incidence, sites, and causes of infection were determined. Factors associated with increased risk of infection were investigated. In 1,388 patients who remained in the PICU for a minimum of 72 h, 116 infections occurred (6.1 infections/100 admissions). Primary bacteremias comprised 38% of PICU infections and lower respiratory infections comprised 15%. The remaining infections were divided equally among GI, skin, eye, upper respiratory, postoperative wounds, and other sites. Coagulase-negative staphylococci, Pseudomonas aeruginosa, and Staphylococcus aureus were the most prevalent pathogens. Surgical patients had similar rates of infection to medical patients. Patients in the first 2 yr of life, particularly those between 7 and 30 days of age, had the highest rate of infection. Onset of infection was more common after the first week in the PICU with 11% of patients staying 14 to 20 days, 27% of patients staying 21 to 27 days, 48% of patients staying 28 to 34 days, and 52% of patients staying more than 35 days before the onset of infection. The risk of nosocomial infection increases with arterial and central line use, prolonged intubation, ventilation, intracranial pressure monitoring, and paralysis.     

A sampling study of bedside nursing activity in a cardiac surgical intensive care unit

For a selected group of 17 patients following cardiac surgery, 33 discrete elements of nursing workload have been defined. It was possible to identify 3 broad types of activity undertaken by the bedside nurse; technical nursing care (Type 1), intermittent nursing care (Type 2), and learning activities (Type 3). The latter is the balance of the nurses time which is largely concerned with observation and liaison with other staff. The 17 patients comprised 4 groups of pathologies, 2 each representative of the adult and paediatric workload. The primary bedside nurse performs virtually all of the Type 1 activities, recruiting the assistance of a secondary nurse principally to change the patients' posture (a Type 2 activity). The only practically significant period of time spent by the secondary nurse is in clinical discussion with the bedside nurse, largely at change of shift. Statistically significant differences in bedside nursing activities between age groups can be explained by the relative physical size of the patients and equipment. However the nurse maintains a higher level of awareness with shorter periods of inattention when nursing children. A greater number of significant differences between pathologies were found within the paediatric group of patients; this may indicate that a broader spectrum of such differences is to be found in this age group. An estimate was made of the impact of computer technology on the nurse's bedside workload.     

Depression in a pediatric intensive care unit nursing staff

This study compared the depressive symptoms of 36 ICU nurses to 23 non-ICU nurses. The study was conducted in a pediatric setting where critically ill children may present unique demands. The ICU nursing staff had a significantly higher frequency (28%) of symptoms consistent with a depressive disorder than either the age group norm (12%) or the non-ICU nurses (13%). This finding suggests a continued need for investigation into the stresses associated with the delivery of critical care.     

Incidence and outcome from adult cardiac arrest occurring in the intensive care unit: A systematic review of the literature

Background

Significant amount of data on the incidence and outcome of out-of-hospital and in-hospital cardiac arrest have been published. Cardiac arrest occurring in the intensive care unit has received less attention.

Aims

To evaluate and summarize current knowledge of intensive care unit cardiac arrest including quality of data, and results focusing on incidence and patient outcome.

Sources and methods

We conducted a literature search of the PubMed, CINAHL and Cochrane databases with the following search terms (medical subheadings): heart arrest AND intensive care unit OR critical care OR critical care nursing OR monitored bed OR monitored ward OR monitored patient. We included articles published from the 1st of January 1990 till 31st of December 2012. After exclusion of all duplicates and irrelevant articles we evaluated quality of studies using a predefined quality assessment score and summarized outcome data.

Results

The initial search yielded 794 articles of which 780 were excluded. Three papers were added after a manual search of the eligible studies’ references. One paper was identified manually from the literature published after our initial search was completed, thus the final sample consisted of 18 papers. Of the studies included thirteen were retrospective, two based on prospective registries and three were focused prospective studies. All except two studies were from a single institution. Six studies reported the incidence of intensive care unit cardiac arrest, which varied from 5.6 to 78.1 cardiac arrests per 1000 intensive care unit admissions. The most frequently reported initial cardiac arrest rhythms were non-shockable. Patient outcome was variable with survival to hospital discharge being in the range of 0–79% and long-term survival ranging from 1 to 69%. Nine studies reported neurological status of survivors, which was mostly favorable, either no neurological sequelae or cerebral performance score mostly of 1–2. Studies focusing on post cardiac surgery patients reported the best long-term survival rates of 45–69%.

Conclusions

At present data on intensive care unit cardiac arrest is quite limited and originates mostly from retrospective single center studies. The quality of data overall seems to be poor and thus focused prospective multi-center studies are needed.     

Impact of a pediatric clinical pharmacist in the pediatric intensive care unit

OBJECTIVE: To study the impact of a clinical pharmacist in a pediatric intensive care unit. The goals of the study were to determine the type and quantity of patient care interventions recommended by a clinical pharmacist and to specifically examine cost savings (or loss) that resulted from clinical pharmacist recommendations. DESIGN: A prospective case series. SETTING: Ten-bed pediatric intensive care unit in a university-affiliated children's hospital. PATIENTS: All patients admitted to the pediatric intensive care unit during the study period. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: During the 24-wk study period, the pediatric clinical pharmacist documented all interventions that occurred during her shift. She rounded with the pediatric intensive care unit team approximately two times a week and reviewed medication lists daily. Drug acquisition costs were used to calculate drug cost savings. Demographic information was collected on all the patients in the pediatric intensive care unit during the study period. There were 35 recommendations per 100 patient days. The most common interventions were dosage changes (28%), drug information (26%), and miscellaneous information (22%). The average time spent per day by the clinical pharmacist in the pediatric intensive care unit was 0.73 hrs or 0.02 full-time equivalent. The total cost direct savings for the study period was $1,977. Extrapolated to direct cost savings per year, the total amount saved was $9,135/year or 0.15 full-time equivalent. Indirect savings from educational activities, avoidance of medication errors, and optimization of medical therapies represent an additional nonquantifiable amount. CONCLUSION: We conclude that a clinical pharmacist is an important and cost-effective member of the pediatric intensive care unit team.     

Urinary catheter care in the intensive care unit

Urinary catheters are associated with a number of complications, and nurses are ideally suited to minimize the associated risks by utilizing the available research in their practice. Urine tract infections caused by urine catheters are associated with increased mortality; however, urine catheter care is a nursing procedure, the importance of which is sometimes overlooked. This study reviews recommended guidelines on urine catheter care and current published literature on the subject. The aim of the study was to identify recommended practice and compare it with the current research and literature to conclude best practice. Conclusions made from this study are that existing guidelines correspond to the recommendations and findings in recent research and literature. However, more detailed guidelines and further research on how to prevent catheter-associated urine tract infections and other complications may be of benefit.     

Tasks and organization of a pediatric intensive care unit

Paediatric intensive care medicine mainly involves infants during the neonatal period and, in particular, premature babies. 70% of the children on assisted ventilation at the paediatric hospital of Graz University in 1985 and 1986 were neonates. Older children needing mechanical ventilation comprised only 1.6% of the total number of patients at our paediatric hospital. Paediatric intensive care units are therefore almost exclusively neonatal care units. Otherwise when serving the needs of children beyond the neonatal period these units are mostly required by paediatric subspecialities (i.e. cardiology, burns unit etc.). In view of the small number of patients in this group a high-standard paediatric intensive care unit should be multidisciplinary and preferentially attached to a university hospital rather than a regional hospital so as to maximise experience in the management of these children and ensure optimal care.     

An educational program for a comprehensive pulmonary care unit

The opening of a pulmonary cluster unit designed to provide care for patients from the critical phase of their illness through their recovery created a need for an educational program to develop the expertise of the nursing staff. The author describes how to develop a program to increase the expertise of staff nurses in caring for pulmonary patients through all phases of their illness.