Nurses' Perspectives on Caring for Critically Ill Children During a Measles Outbreak: A Case Report.

BackgroundDecent work perception significantly influences an individual’s professional decisions and choices. This survey aimed to evaluate the current status and influencing factors of decent work perception among pediatric intensive care unit (PICU) nurses, to provide insights for clinical nurse management and care.MethodsThe PICU nurses in a university hospital at Nanjing, China were surveyed during May 1st to May 31st, 2024. Nurse Decent Work Perception Scale with good validity and reliability was used to survey the level of decent work perception among PICU nurses. The SPSS 23.0 software package was used for data analysis.ResultsA total of 176 PICU nurses were included. The decent work perception score of included PICU nurses was 51.46 ± 8.22, indicating that the PICU nurses have a relatively low perception of decent work. Age(r = 0.506), professional title(r = 0.464) and average monthly income(r = 0.539) were positively correlated with the decent work perception score of PICU nurses, educational level(r=-0.526) and have been personally assaulted(r=-0.512) were negatively correlated with the decent work perception score of PICU nurses (all P < 0.05). Multiple linear regression analysis indicated that age, educational level, professional title, average monthly income and have been personally assaulted were the independently influencing factors of the decent work perception score of PICU nurses (all p < 0.05).ConclusionsThe decent work perception among PICU nurses is relatively low, highlighting the need to prioritize the improvement of their salary, educational levels, and career development opportunities. Besides, hospitals should provide organizational support to ensure a secure working environment.

Work engagement, a multifaceted concept encompassing dedication, vigour and absorption, is critical for paediatric intensive care unit (PICU) nurses who are providing critical care to ensure optimal patient care and maintain their well-being. This study examines the effect of a brief mindfulness-based intervention (MBI) on different dimensions of work engagement among PICU nurses. Using a quasi-experimental design with pretests and posttests across two groups, we evaluated the impact of a brief MBI on work engagement. Two hospitals were randomly selected to implement the intervention, and the other two served as controls. A total of 204 nurses participated, with 101 in the intervention group and 103 in the control group. Post-intervention, the intervention group exhibited significantly higher levels of vigour (M = 3.88, SD = 0.56), dedication (M = 4.67, SD = 0.64) and absorption (M = 4.18, SD = 0.56) compared with the control group (p < .001 with 95% CI of -2.02, -1.62 for vigour; -2.23, -1.78 for dedication; and -1.89, -1.50 for absorption). The multivariate analysis of variance results indicated a significant effect of the intervention on the linear combination of dependent variables (V = .30, F[3, 200] = 29.22, p < .001), with a substantial effect size (partial η2 = .30). The current study highlights the efficacy of a brief MBI in enhancing work engagement among paediatric ICU nurses. Thus, MBIs could be a practical solution to issues encountered in a demanding work environment. The brief MBI significantly enhanced the work engagement dimensions of vigour, dedication and absorption among PICU nurses. These improvements suggest that mindfulness practices effectively boost nurses' energy levels, sense of purpose and deep concentration, which are essential for high-quality patient care. The findings highlight the potential of integrating mindfulness interventions into health care settings to promote caregiver well-being and better patient outcomes.

Pediatric Nurses’ Perceptions of Obstacles and Supportive Behaviors in End-of-Life Care

Providing appropriate education for nurses working in the pediatric intensive care unit (PICU) to develop and update the skill sets and knowledge required to care for infants and children with congenital heart disease (CHD) is a challenge. We provide care to children with a variety of congenital heart defects that require medical care and surgical corrections. In the extreme circumstance, we provide extracorporeal membrane oxygenation to those children who require extracardiac support postoperatively. Our program deals with a mean of about 150 cases annually that require surgical correction, in addition to the medically managed patients with CHD.The hospital-based simulation center opened in 2010. It provides high-fidelity simulation to enhance current medical and nursing education. Patient scenarios are created on the basis of real patient cases, maintaining the realistic details of the disease and injury processes essential to provide the pertinent learning points of each case. Shortly after the simulation center opened, the PICU educator inquired about the process to provide PICU nurses an opportunity to learn about pediatric open heart surgery patients at the simulation center. The inherent challenge within our PICU is that we have 32 nurses with various skills sets and experiences who must be able to provide care for all patients within our unit, including children with CHD.At that time, 7 PICU nurses were ready to learn how to provide nursing care to children who have undergone open heart surgery. This state of readiness is detailed later. A classroom format was used to present the material, which addressed identification of defects, along with medical and nursing management. This classroom training was followed by a 4-hour simulation session, wherein these nurses participated in 2 patient scenarios. Clinical objectives (Table 1) were reviewed and reinforced to define what needed to be learned and to ensure that learning occurred. Following this simulation training, each nurse was assigned to admit a pediatric open heart patient with an experienced nurse present to reinforce the prior learning.Few publications have addressed the process of training PICU nurses on how to care for pediatric open heart surgery patients in a simulation laboratory. Donoghue and colleagues1 used a high-fidelity simulation laboratory for Pediatric Advanced Life Support training of pediatric residents. Anesthesiologists have been using simulation laboratories to train their residents for a number of years, and published reports2 validate the positive learning outcomes within that environment. Kane and colleagues3 explained the process of preparing and implementing an educational activity addressing pediatric codes for the pediatric cardiac ICU staff that included the simulation laboratory. The PICU staff's levels of knowledge, skill, and comfort with resuscitation improved significantly after the simulation education was completed. Certainly, learning does occur within the simulation environment. Those participants surveyed agreed that the experience did provide an opportunity to learn.1,2,4–6 Both medical and nursing arenas have begun to integrate this option into training in an effort to better mimic real-life clinical experiences.In a different arena, review of rapid response data led to concern about the deterioration of patients' respiratory status among staff and managers on step-down cardiac units. Need for nurse education was identified by Disher and colleagues,7 which led to an evaluation of the process and identification of the need for specific nurse education. They provided a unit-based educational pilot study to address this issue. Knowledge deficits were identified, education through simulation was provided, and follow-up was evaluated. Nurses' knowledge and self-confidence improved significantly from before to after simulation education. The study by Disher et al is another example of observing the participants' own perceived self-evaluations. In our project, our initial evaluations relied on anecdotal clinical reports after the simulation experience. Over the course of 3 years, we were also observing participants for their perceived knowledge and self-confidence before and after the simulations.The educational process within our PICU is representative of our unique population and staffing. Our 10-bed PICU resides within our 32-bed special care unit. Because our pediatric population is so varied in terms of diagnoses and census, when there are empty pediatric beds, we admit adults as well. Therefore, our PICU nurses provide critical care nursing to all populations. Although each nurse who is new to our unit arrives with variable knowledge and skill sets, the general expectation of competency is that each nurse learn to care for the adult patients first. Once that competency is established, then the nurse is oriented to the pediatric population, starting with the 10- to 18-year-olds, then the infants through 9-year-olds. Generally, within 6 to 12 months, new nurses are oriented to the CHD patients, as described here. All new nurses are evaluated for their previous clinical skills and given appropriate patient assignments. Those nurses with pediatric skills who are not familiar with the adult population will be trained to provide care for adults, so that they can meet our expectation that we all provide care to all populations within our unit.8Education within our PICU is individualized for each new nurse, with the ultimate intention that we provide care for all patient populations. Our 10-bed PICU has a staff of 32 nurses. Given this, the CHD educational program is taught annually, with a varying attendance of 3 to 7 nurses. Although our focus is to educate the PICU nurses to manage these patients, nurses from the neonatal ICU and pediatric care areas also are invited to these classes. The neonatal ICU sometimes provides preoperative nursing care of critically ill patients, and the pediatric care area manages children with CHD once they are transferred from the PICU. Therefore, a cohesive transition is the goal, as the nursing care for children recovering from open heart surgery is sometimes managed on different nursing units.To meet the educational needs of our staff, a classroom format was used to teach CHD embryology, medical and surgical interventions, and appropriate postoperative nursing care. Appropriate assessments and treatments of potential complications were included. Once the classroom training was completed, the participants were scheduled to attend the simulation component.The PICU educator and 3 PICU nurses each with more than 20 years of PICU experience met to develop clinical scenarios. These scenarios were based on typical postoperative cardiac patients. The first 2 scenarios we developed met the initial clinical expectations of this group: the ability to admit a postoperative cardiothoracic patient from the operating room, and the ability to identify noncoagulopathic bleeding postoperatively that requires return to the operating room (Table 1). Simulation training of these experienced PICU nurses was provided by the simulation nurse educator to facilitate the development of the case scenarios.The simulation experience is described in Table 2. Participants were preselected for each scenario, depending on the composition of the scenario and the individual strengths and learning needs of each PICU nurse. The learning needs assessment was an informal evaluation based on each learner nurse's previous clinical experiences and current clinical competence at the bedside. As the simulation day unfolded, participants were escorted from the classroom to the simulation ICU room and back, in an effort to maintain a mindset of the scenario and learning process as it evolved and to avoid distractions.The simulation staff used a Gaumard newborn simulator for these 2 scenarios. Whenever possible, exact equipment that is used in the PICU was used on the mannequin, such as the same blood pressure cuffs, intravenous equipment, ventilators, and the like. The mannequin's chest was prepared with similar surgical equipment to replicate the postoperative dressing placed by the surgeon, including mediastinal chest tubes.After a number of the PICU nursing staff were invited to the simulation laboratory to experience these 2 scenarios, we created more complex scenarios for our more experienced PICU nursing staff. In the past 3 years, most nurses on our staff have attended the 6 scenarios that we have created thus far.Two simulation scenarios are described in Table 1. Identified objectives to be met are based on the American Association of Critical-Care Nurses practice standards9 for the pediatric open heart population. Once the stated objectives had been reached, the scenario was ended. Everyone (participants and nurses providing the simulation experience) attended the debriefing immediately after each scenario. The debriefing is an opportunity to learn by reflecting on the scenario. A review of the participants' perceptions of the scenario, any discrepancies from the actual scenario, and the learning objectives are discussed. The intention is for sharing of knowledge, learning, and clarification of questions. Simulation literature consistently reiterates how important it is that this process provide a safe environment to learn, seek clarification, and practice in a nonjudgmental arena.10 The intention is that participant learners will always feel welcome within this learning environment without feeling judged. Given the novelty of this learning experience for many staff, the wish is that learning be positive, not punitive. The evaluation tool included in Table 1 was used to determine whether or not the stated objectives were met. We found this approach to be clear and concise for everyone.The simulation allowed the PICU nurses an opportunity to discuss any concerns or fears they had. As the scenarios evolved, each participant was able to ask any question. Reinforcement was provided as indicated for each action taken by the nurses. As well, it allowed them to begin developing some "muscle memory" required to build a skill set foundation. The skill sets needed to react in critical and stressful situations correctly are developed through practiced experiences such as those described in this article. The nurse's experiences were positive, and they stated that they would return to the simulation center for more case scenarios. They appreciated the safe environment in which to learn and practice. Collectively this group of nurses stated that they now have a real sense of what to expect and what is expected of them. Months later, some of the nurse participants expressed appreciation for this simulation experience. They explained that the simulation cases reinforced what they had learned in the classes. One nurse stated, "I knew what to do when I admitted my first open heart patient." Another nurse stated "I was not frightened when I had to call the cardiac surgeon with my patient's labs and vital signs." We used the simulation laboratory to facilitate an opportunity to practice with a new syringe pump that had been recently purchased and that the nursing staff had received in-service training to use. An experienced nurse had participated in a complex scenario where the patient needed prostaglandins to be initiated. The learning process of doing this on a new intravenous syringe pump during a simulation scenario proved very beneficial. A few weeks later, this same experienced nurse stated that she had admitted an infant with a very similar clinical course as the simulation case in which she had participated and that she was able to start the prostaglandins very efficiently as a direct result of her learning experience during the simulation scenario.Creating the scenarios was both exciting and challenging. In general, we used lived experiences in the PICU and adapted them for the simulation laboratory, while keeping the nuances of the scenario as realistic as possible. The PICU educator and 3 very experienced PICU staff nurses created these scenarios, learned the process of simulation, and provided this experience to the nurses who were learning to care for pediatric open heart surgery patients. The learners expressed great apprehension in anticipation of the simulation experience. The simulation laboratory was very new to the hospital. In fact, we were the first group of nurses to use this avenue to provide education to staff nurses. After the experience, all 7 nurse participants stated that this was the most realistic way to learn patient care and that they most definitely believed that they could more readily admit a pediatric open heart patient to the PICU and that they could identify a bleeding pediatric open heart patient and confidently provide care, including returning the patient to the operating room. Because our PICU is small, this education is provided only annually. As well, our patient volume is low, with a mean of 150 surgical cases annually. Because these factors truly limit our ability to conduct a quantitative study, we elected for this initial exploratory and descriptive study. Anecdotal accounts have provided feedback on the value of this new learning experience.This venture has led to the creation of more complicated case scenarios. In an effort to provide time-efficient learning, the 3 classes have been converted into voice-over PowerPoint learning modules, to be reviewed independently. Following this, we provide a 3-hour review class, which entails review of the material, and case reviews. We have developed a number of other pediatric open heart scenarios for our PICU nurses. As our PICU nursing staff continues to change, our educational process to facilitate learning about this complex population of patients will continue to evolve. Recently the institutional review board granted approval so that we can use a survey questionnaire for simulation participants to identify their level of perceived skill, knowledge, and comfort when caring for a variety of patient populations. This survey will be used with future nurse learners.The simulation center has provided another dimension to the ever-challenging process of educating nursing staff about such a diverse PICU population. This pediatric open heart simulation education program has provided a cornerstone for the development of future simulation-based nursing education at this tertiary care facility.The author thanks Callie Chase, rn, Theresa McKay, rn, bsn, and Anne Boehm, rn, bsn, for their collaboration in creating and implementing these simulation scenarios. Ms Campbell also thanks Kristiina Hyrkas, rn, mnsc, licnsc, phd, and Lynda Macken, rn, phd, for their guidance and expertise with this article.

Background: Pediatric intensive care unit (PICU) nurses are regularly exposed to high-stress situations, particularly when dealing with patient death and postmortem care. While much attention has been paid to the physical demands of their role, the emotional and psychological impacts of these experiences are often overlooked. Understanding how nurses regulate their emotions in such high-pressure environments is essential for improving their well-being and providing better care. Objective: This study aims to explore the emotional burdens faced by PICU nurses, particularly in the context of patient death and postmortem care. It examines how nurses regulate their emotions in response to these experiences and how these emotional responses affect their professional roles and personal lives. Methods: The study was conducted at Zhejiang Children's Hospital. A total of 15 PICU nurses, with at least two years of experience, participated in semi-structured, in-depth interviews. The data were analyzed using reflexive thematic analysis, allowing for a detailed exploration of emotional experiences, coping strategies, and the emotional impact of postmortem care. Results: The analysis revealed four major themes: (1) emotional and physical strain of patient loss; (2) fear and unease in postmortem care; (3) navigating professionalism amid emotional turmoil; and (4) impact on parenting and career choices. Conclusions: PICU nurses face significant emotional challenges when dealing with patient death and postmortem care. These emotional burdens affect not only their professional roles but also their personal lives. Developing effective emotional support systems and training for nurses can enhance their emotional regulation and improve both their well-being and the quality of care they provide.

To examine the relationships among safety culture perception, organizational support, and safety behavior in nurses working in the intensive care unit (ICU) of a pediatric hospital, as well as the underlying mechanisms. We surveyed 133 ICU nurses using the Nurse Safety Behavior Scale, Nurse Culture Perception Questionnaire, and Organizational Support Questionnaire. Nurses completed questionnaires during designated breaks in their shifts. We analyzed responses using SPSS 22.0, calculated descriptive statistics, ran correlation analyses, and performed mediation analysis with bootstrapping. We set significance at P≤ 0.05. The mean scores for safety behavior, safety culture perception, and organizational support were 56.26 ± 4.61, 103.92 ± 12.80, and 50.11 ± 11.32, respectively. Safety behavior was positively correlated with both safety culture perception (r = 0.367, P ≤ 0.01) and organizational support (r = 0.360, P ≤ 0.01). Mediation analysis revealed that safety culture perception partially mediated the effect of organizational support on safety behavior, explaining 30.47% of the total effect. Safety culture perception acts as a mediator between organizational support and safety behavior in pediatric ICU nurses. Hospital administrators can foster a culture of safety, enhance organizational support, and promote safety practices among nurses to better ensure patient safety in pediatric critical care settings. These findings have important implications for developing targeted interventions to improve safety behaviors among pediatric ICU nurses.

Introduction: PICU is a relatively new medical specialty that has shown a marked growing up around the world over the last three decades. The study was conducted for the first time in tertiary care hospital in Karachi, Pakistan on PICU curriculum for residents on basic principles of critical care. However, there is no data and study is available for PICU nurses who are the primary care takers. PICU is one of the specialties which require skilled nurses for early recognition and treatment for critically ill children especially in developing countries to curb pediatric mortality (children under 5 years). Aim: To develop core pediatric competency based module for PICU Nurses and enable them to function competently. Method: To develop the core pediatric competency based module for PICU nurses, I primarily used the data from currently working PICU nurses on the need of clinical teaching and learning. The comprehensive literatures were reviewed, covering the period of 2005 to 2010, using the data bases pubmeds, science direct and journals of pediatrics and medical associations. Result: The practical aspects of this educational project are implemented on PICU nurses including educational sessions, clinical teachings and demonstration especially pediatric respiratory system initially. In post evaluation test 57% nurses scored >80% marks, 29% scored 70-80% and only 14% staff scored between 60-70%. Conclusion: The need of the competent nurse in pediatric critical care specialty with critical thinking skills has to be enhanced that will enable complete patient centered care.

Severity and prevalence of burnout syndrome in paediatric intensive care nurses: A systematic review

BackgroundMechanical ventilation (MV) carries potential risks to mortality and morbidity; therefore, weaning should not be delayed. To safely reduce ventilator support, practice has transitioned from individual preference to a structured...

Background:Acute kidney injury (AKI) in critically ill children is associated with increased risk for short- and long-term adverse outcomes. Currently, there is no systematic follow-up for children who develop AKI in intensive care unit (ICU).Objective:This study aimed to assess variation regarding management, perceived importance, and follow-up of AKI in the ICU setting within and between healthcare professional (HCP) groups.Design:Anonymous, cross-sectional, web-based surveys were administered nationally to Canadian pediatric nephrologists, pediatric intensive care unit (PICU) physicians, and PICU nurses, via professional listservs.Setting:All Canadian pediatric nephrologists, PICU physicians, and nurses treating children in the ICU were eligible for the survey.Patients:N/A.Measurements:Surveys included multiple choice and Likert scale questions on current practice related to AKI management and long-term follow-up, including institutional and personal practice approaches, and perceived importance of AKI severity with different outcomes.Methods:Descriptive statistics were performed. Categorical responses were compared using Chi-square or Fisher’s exact tests; Likert scale results were compared using Mann-Whitney and Kruskal-Wallis tests.Results:Surveys were completed by 34/64 (53%) pediatric nephrologists, 46/113 (41%) PICU physicians, and 82 PICU nurses (response rate unknown). Over 65% of providers reported hemodialysis to be prescribed by nephrology; a mix of nephrology, ICU, or a shared nephrology-ICU model was reported responsible for peritoneal dialysis and continuous renal replacement therapy (CRRT). Severe hyperkalemia was the most important renal replacement therapy (RRT) indication for both nephrologists and PICU physicians (Likert scale from 0 [not important] to 10 [most important]; median = 10, 10, respectively). Nephrologists reported a lower threshold of AKI for increased mortality risk; 38% believed stage 2 AKI was the minimum compared to 17% of PICU physicians and 14% of nurses. Nephrologists were more likely than PICU physicians and nurses to recommend long-term follow-up for patients who develop any AKI during ICU stay (Likert scale from 0 [none] to 10 [all patients]; mean=6.0, 3.8, 3.7, respectively) (P < .05).Limitations:Responses from all eligible HCPs in the country could not obtained. There may be differences in opinions between HCPs that completed the survey compared to those that did not. Additionally, the cross-sectional design of our study may not adequately reflect changes in guidelines and knowledge since survey completion, although no specific guidelines have been released in Canada since survey dissemination.Conclusions:Canadian HCP groups have variable perspectives on pediatric AKI management and follow-up. Understanding practice patterns and perspectives will help optimize pediatric AKI follow-up guideline implementation.

This study evaluated the sensitivity of nonconvulsive seizure detection by non-neurophysiologist physicians and nurses using a panel of quantitative EEG (QEEG) trends in the setting of a pediatric intensive care unit. Forty-five 1-hour QEEG epochs were obtained retrospectively from 10 patients admitted to the McMaster Children's Hospital pediatric intensive care unit, which included 184 electrographic seizures. Each epoch constituted 4 QEEG trends, a seizure probability marker, automated seizure detector, rhythmicity spectrograms, and amplitude-integrated EEG. Six pediatric residents and 5 pediatric intensive care unit nurses analyzed the epochs for possible seizures after a 15-minute power point presentation. This was compared with the gold standard of a board-certified epileptologist interpreting the conventional EEG data for seizures. Sensitivity of seizure detection for pediatric residents and intensive care unit nurses were 0.90. The specificity was 0.87 and 0.89, respectively. The interrater agreement among the pediatric residents was moderate with a kappa (κ) value of 0.45 (confidence interval: 0.41-0.49), and among the nurses were moderate with a κ value of 0.59 (confidence interval: 0.54-0.63). A post hoc analysis involving 2 neurophysiologists demonstrated a sensitivity of 0.90 and a specificity of 0.93 (confidence interval: 0.90-0.96) for seizure detection and a substantial interrater agreement of κ = 0.76 (confidence interval: 0.61-0.91). A panel of QEEG trends can be used by non-neurophysiologists in a pediatric critical care setting to detect nonconvulsive seizures with a reasonable accuracy, which may expedite subclinical seizure identification and timely intervention.

Discussion Guide for the Lebet Article.

This study aimed to examine the relationship between work stress and depression; and investigate the mediating effect of occupational burnout among nurses in paediatric intensive care units. The relationships among work stress, occupational burnout and depression level have been explored, neither regarding occupational burnout as the mediating role that causes work stress to induce depression nor considering the paediatric intensive care unit context. A cross-sectional correlational design was conducted. One hundred and forty-four female paediatric intensive care unit nurses from seven teaching hospitals in southern Taiwan were recruited as the participants. Data were collected by structured questionnaires including individual demographics, the Nurse Stress Checklist, the Occupational Burnout Inventory and the Taiwan Depression Questionnaire. The results indicated that after controlling for individual demographic variables, the correlations of work stress with occupational burnout, as well as work stress and occupational burnout with depression level were all positive. Furthermore, occupational burnout may exert a partial mediating effect on the relationship between work stress and depression level. This study provides information about work stress, occupational burnout and depression level, and their correlations, as well as the mediating role of occupational burnout among paediatric intensive care unit nurses. It suggests government departments and hospital administrators when formulating interventions to prevent work stress and occupational burnout. These interventions can subsequently prevent episodes of depression in paediatric intensive care unit nurses, thereby providing patients with a safe and high-quality nursing environment.

Family-centred care is the dominant model for providing nursing care in paediatrics. Unit layout has been shown to impact nurses' ability to provide family-centred care. Little is known about the meanings and experiences of paediatric intensive care unit nurses concerning the care they provide to families within their unique physical setting. This study examined paediatric intensive care unit nurses' lived experience of caring for families following a major hospital transformation project, which included the construction of a new unit and quality improvement changes. A hermeneutic-phenomenological design was selected to study a paediatric intensive care unit in a large Canadian paediatric teaching hospital. Data were collected over a 6-month period through individual interviews, photographs, participant observation, and document review. The sample consisted of 15 paediatric intensive care unit nurses who experienced the unit both pre- and post-transformation. Data were analysed in an ongoing fashion using the method described by Benner to identify common and divergent meanings. Despite pride in offering a family-friendly environment, nurses' practice prejudiced a family focus in favour of patient-centred care. Nurses in this study negotiated physical and practice spaces with families by interpreting that nurses do not belong in the home-like patient room and exhibiting gatekeeping comportments. Although similar nurse comportments have been identified in prior works, no previous studies have identified these as forming a pattern of negotiating spaces with families. This study provides insights into the lived experience of paediatric intensive care unit nurses in relation to family care, which can stimulate reflections at an organizational level about creating environments where nurses and families can both feel at home.

Purpose: To assess the prevalence of relationship distress among Pediatric Intensive Care Unit (PICU) nurses in the United States. Method: In 2016, an online survey of PICU nurses throughout North America was conducted. Approximately 254 PICU nurses responded to the survey. The survey gathered demographic data, practice and personal characteristics, Revised Dynamic Adjustment Scale (RDAS), and revised Maslach Burnout Inventory (MBI). RDAS is a validated measure of relationship …