Pediatric Intensive Care Nurses Research Articles

Sedation Experiences of Pediatric Intensive Care Nurses: Exploring PICU Nurse Perspectives on Sedative Management and Communication.

Objective: This study's purpose is to better understand pediatric intensive care nursing perspectives on sedative management as a precursor to improving aspects of sedation assessment, titration, and communication. Methods/Design: We queried nurses in the pediatric intensive care unit at a 40+ bed quaternary care using an electronic survey about their experiences with sedation management. Data was collected using REDCap and statistical analyses were performed to assess for differences between experience levels in areas. Results: Seventy nurses responded with 42% response rate. More than 95% were comfortable calculating sedation and delirium scores. Those with less than 5 years' experience were significantly more likely to consider sedation scores helpful (P = .04) and also significant more likely to agree that delirium scores are used effectively (P = .01). Eighty-eight percent of respondents were comfortable raising concerns about sedation to the multidisciplinary team, but those with less than 5 years' experience were significantly less likely to express concerns to attending (P = .001). Conclusion: Newer nurses are more inclined to support use of standardized scoring systems for sedation and delirium, but less comfortable approaching attending clinicians with their concerns. Intensive care teams should pay careful attention to team dynamics, particularly as they apply to sedative management and work to improve communication, collaboration, and educational interventions to improve patient care. Further work understanding nursing perspectives and further attempts to improve interprofessional communication seems a wise investment and could obviate barriers that may exist.

Knowledge, attitudes, and practices (KAP) regarding intra-abdominal pressure monitoring among pediatric intensive care nurses: A cross-sectional study

Objectives: This study aimed to assess the knowledge, attitudes, and practices (KAP) and the training requirements of pediatric intensive care nurses regarding intra-abdominal pressure (IAP) monitoring, in order to provide a reference for the development of relevant training programs and operational procedures in clinical practice. MethodsThis descriptive and cross-sectional survey was conducted from April 2023 to June 2023. A convenience sample was created by recruiting 212 pediatric intensive care nurses in eight hospitals in Zhejiang Province. A self-developed IAP monitoring KAP assessment was used for evaluation, which included knowledge (14 items), attitude (6 items), and practice (8 items), three dimensions, 28 items. ResultsThe overall KAP score was 60.73 ± 8.35; the knowledge score was 7.84 ± 2.35, with a scoring rate of 56.0%; the attitude score was 25.16 ± 3.23, with a scoring rate of 83.9%; and the practice score was 28.44±6.46, with a scoring rate of 69.3%. Nurses who have received IAP monitoring training have higher KAP score, knowledge score and practice score than those who have not received it (P < 0.05). Nurses aged ≤ 30 showed better knowledge of IAP monitoring than those aged >30 (P < 0.05). 55.7% of the nurses believed the current knowledge was insufficient to perform IAP measurement effectively. Difficulty in identifying the high-risk population of intra-abdominal hypertension (IAH) (64.6%), unfamiliarity with the operation process of IAP measurement (55.6%), and unreasonable nurse-patient ratio allocation (52.8%) were the main obstacles for nurses to monitor IAP. ConclusionsPediatric intensive care nurses have a positive attitude towards IAP monitoring, but the knowledge level and practical behavior still need to be strengthened. In particular, the knowledge of published consensus definitions, measurement techniques, and frequency for IAP monitoring is inadequate. It is necessary to implement tailored IAP monitoring training based on their training needs and potential obstacles to promote the standardization and scientificity of IAP monitoring.

Paediatric Organ and Tissue Donation: Developing a Comprehensive Protocol for Effective Donation Procedures in the Netherlands

The waiting list for children needing organ and tissue transplantation increases yearly; some die while waiting for a suitable transplant. Most of them need small organs or tissues from paediatric donors. Paediatric donation is a unique and extremely sensitive process that requires specific knowledge and competencies. Because paediatric donation is relatively rare and complex, gaining knowledge and experience in this field is difficult. This article describes essential facts about donation and transplantation concerning children in the Netherlands and summarises studies reporting on the various factors influencing paediatric donation. The methodology used combines various research methods, including literature review, online survey, face-to-face interviews, and retrospective study, to evaluate the organ and tissue donation protocols for the paediatric population in Dutch Paediatric Intensive Care Units and Neonatal Intensive Care Units. The studies provide insights into the current process and limitations of paediatric donation and offer recommendations for the development of a paediatric donation protocol. Recurrent themes that emphasise the importance of a robust paediatric donation process were identified and later used to form the groundwork for a paediatric donation protocol. Healthcare professionals lack knowledge and experience with donation procedures. Work experience at the Paediatric Intensive Care Unit or Neonatal Intensive Care Unit is not related to the gained experience in the organ or tissue donation procedure. Paediatric Intensive Care nurses had significantly less experience than Paediatric Intensivists. The survey respondents confirmed needing more guidance on the paediatric donation process. They further agreed there was a need for an easily accessible and clear guidelines document for paediatrics known as “the children's protocol” to cover all types of paediatric donation procedures (Donation after Brain Death, Donation after Circulatory Death and tissue donation). Neonatal Intensive Care Unit donation potential is limited. A new donation protocol for paediatrics was designed using the results of all the above studies. The comprehensive protocol for paediatric organ donation in the Netherlands aims to assist healthcare professionals in identifying potential donors and referring them to an Organ Procurement Organization in a timely manner. Additionally, the protocol will support healthcare professionals in conducting sensitive yet necessary discussions with the family regarding the possibility of organ and tissue donation. Finally, while using the protocol, healthcare professionals provide the appropriate state-of-the-art support to the parents during a challenging and emotional time.

Investigation of grief and posttraumatic growth related to patient loss in pediatric intensive care nurses: a cross-sectional study

Background and aimPediatric Intensive Care Units (PICUs) are clinical settings where patient loss is frequently experienced. A sense of professional grief and posttraumatic growth in nurses who have experienced patient loss has a significant impact on psychological and physical health, work satisfaction, turnover rates, as well as on personal and professional relations, and employee loyalty. The aim of this study was to investigate grief and posttraumatic growth in PICU nurses and to examine related factors.MethodsThe study is of cross-sectional design and was conducted with 200 nurses who were working in 87 PICU’s around Turkey during the period March 30 - June 30, 2021. Data were collected with a Descriptive Information Form, the Texas Revised Inventory of Grief (TRIG), the Posttraumatic Growth Inventory (PTGI), and an open-ended question asking for suggestions as to how nurses can cope with loss. Online questionnaires were used in the data collection. Descriptive statistics, the student t-test, one-way analysis of variance, and post-hoc tests were employed in the analysis of the data.ResultsThe nurses’ mean scores were 49.425 ± 10.868 on TRIG and 61.450 ± 24.934 on PTGI. A negative weak correlation was found between the intensity of the nurses’ grief and their posttraumatic growth (r = 0.144, p = 0.041). Receiving training on dealing with a patient’s terminal stage (t=-2.688, p = 0.001), feeling comfortable about providing the patient’s care (t = 2.624, p = 0.009) and providing the family with emotional support during patient care (t = 1.979, p = 0.049), and the presence of supporting health professionals reduced levels of grief (t = 2.797, p = 0.000). Being a woman (t = 3.299, p = 0.001), willingness to work in the unit (t=-3.219, p = 0.002), and being given enough time to accept the loss (t = 3.986, p = 0.000) were correlated with higher levels of posttraumatic growth. The nurses most commonly wanted more time allotted to recuperate after a loss (n = 35) and professional support (n = 22).ConclusionsNurses experience a moderate sense of grief after a patient’s loss. As levels of grief decrease, posttraumatic growth increases. Healthcare administrators and future researchers can benefit from these findings when planning supportive interventions to help nurses cope with their feelings of grief and achieve posttraumatic growth.Strengths and limitationsA limitation of the study is that it was conducted only with nurses who were Association members.

Competency Assessment of Pediatric Intensive Care Nurses

One of the biggest challenges that clinical nurse educators at the unit level face today is measuring the ongoing competency of nursing staff members to ensure provision of high-quality, evidence-based care. Pediatric nursing leaders at an urban, level I trauma teaching institution in the southwestern United States used a shared governance approach to create a standardized competency assessment tool for pediatric intensive care unit nurses. Donna Wright's competency assessment model was used as a framework to guide the tool's development. The adoption of the standardized competency assessment tool was aligned with the organization's institutional goals and enabled clinical nurse educators to comprehensively evaluate staff members on a regular basis. This standardized competency assessment system for pediatric intensive care nurses is more effective than use of a practice-based, task-oriented assessment method and has improved nursing leaders' ability to staff the pediatric intensive care unit safely.

Trauma-Informed Care: Pediatric Intensive Care Nurses at the Root of Children's Safety and Trust.

Any experience that a child perceives as threatening or detrimental and has long-term consequences for the child's holistic health and welfare qualifies as trauma. Whether an experience is traumatic depends on the 3 E's of trauma: the event, the experience of the event, and the effects. Traumatic events can affect an infant's or child's development and have lifelong repercussions. Because of the prevalence of pediatric trauma, trauma-informed care has become the standard of care. Nurses are perfectly positioned to lead trauma-informed care in the pediatric intensive care unit. This article explores the components of trauma-informed care and the application of this standard of care to children in the pediatric intensive care unit. The nurse providing trauma-informed care understands the impact of trauma on the child, the family, and the staff and responds by integrating knowledge about trauma into care, both individually and systemwide, seeking to actively avoid retraumatization. This article presents the 6 principles of trauma-informed care and 3 case examples illustrating the application of these principles in the pediatric intensive care unit. Additional resources are provided to equip critical care nurses to fully implement this standard of care for critically ill children.

The relationship between moral distress levels and ethical climate perceptions of PICU nurses.

The organizational climate in paediatric intensive care units is specific to the conditions of the patient, and there may be a relationship between the ethical climate perception and moral distress levels of the nurses working in this unit. The research aim was to examine the relationship between the moral distress levels and their perceptions of hospital ethical climate of paediatric intensive care unit nurses. This research was aimed a descriptive, cross-sectional and correlational type with 239 paediatric intensive care unit nurses of public, university and training and research hospitals in Turkey. Research data were evaluated with mean, Pearson correlation and multiple linear regression analysis. The total score of moral distress scale was 106.36 ± 53.63, and of the hospital ethical climate scale was 100.60 ± 14.41. A moderate negative relationship was found between nurses' moral distress levels and ethical climate perceptions, ethical climate perception explained moral distress levels with a 12% variance and this significance came from the physicians sub-dimension. The moral distress levels of paediatric intensive care nurses were below the average, and their ethical climate perceptions were above the average. It was seen that the physicians sub-dimension was an important explanatory on the total moral distress. In order to eliminate the moral distress arising from the hospital ethical climate, practices should be developed to increase the cooperation between nursing and physicians.

The Effect on the Care Behaviors of Nurses Working in Intensive Care Clinics of Moral Distress Experienced During End of Life Patient Care.

This research was conducted as a descriptive study in order to examine the effects of the moral problems experienced by nurses working in intensive care clinics on their end of life care behaviors. The data were collected using the Moral Distress Scale and Caring Behaviors Inventory. It was found that 74.5% of the nurses were women and their mean age was 32.60 ± 6.6years. The frequency of moral distress in the nurses was 44.27 ± 16.25 and total score was 111.02 ± 63.85. There were significant differences in the scores of the concept the use of futile treatment by nurses, the decision not to begin life-support treatment being made only by physicians, and moral distress and discomfort felt by pediatric intensive care nurses (p < .05). A statistically significant relationship was found between total scores of discomfort on moral distress and assurance, knowledge and skills, connectedness, and being respectful on the end of life care behaviors (p < .05).

Building Inpatient Pediatric Readiness for the Clinically Deteriorating Child.

Building Inpatient Pediatric Readiness for the Clinically Deteriorating Child.

The Impact of Volunteering at a Family Camp for Children and Adolescents With Cancer: The Experience of Pediatric Intensive Care Nurses.

This study explored the experience of pediatric ICU (PICU) nurses who volunteered at a camp for families of children and adolescents with cancer. PICU nurses are at risk of developing symptoms of posttraumatic stress disorder, compassion fatigue, depression, and burnout due to exposure(s) to traumatic events. Spending time with patients, families, and nurse colleagues at camp may reduce the effects of this exposure. A qualitative descriptive study was conducted using content analysis. Fifteen nurse participants completed a precamp questionnaire and semistructured focus groups immediately following camp. Individual interviews were conducted 6 months after camp. Three categories emerged: 1) personal factors, changes in the nurses themselves; 2) patient and family factors, changes in how nurses perceived patients and families; and 3) work-related factors, relationships with colleagues. Supporting PICU nurses to participate with patients, families, and colleagues outside of the hospital may reduce burnout and support nurses' well-being.

Beyond technology, drips, and machines: Moral distress in PICU nurses caring for end-of-life patients.

Moral distress is an experience of profound moral compromise with deeply impactful and potentially long-term consequences to the individual. Critical care areas are fraught with ethical issues, and end-of-life care has been associated with numerous incidences of moral distress among nurses. One such area where the dichotomy of life and death seems to be at its sharpest is in the pediatric intensive care unit. The purpose of this study was to understand the moral distress experiences of pediatric intensive care nurses when caring for pediatric patients at the end of life. A secondary analysis was undertaken of seven transcripts from registered nurses across six Canadian pediatric intensive care units and produced three themes: under prioritization of child patient dignity, burden of insider knowledge, and environmental constraints on nursing roles and responsibilities. When caring for patients at the end of life, nurses experienced moral distress when a dignified death was not realized. Furthermore, despite interprofessional collaboration efforts in Canada, the concept of silo mentality persists and contributes to moral distress. Organizational involvement is needed to address moral distress in pediatric intensive care nurses both to achieve a dignified death for child patients and in addressing silo mentality.

The impact of interprofessional perspective-taking on moral distress in the pediatric intensive care unit

ABSTRACT Moral distress arises when constraints outside of healthcare professionals’ control prohibit them from acting according to the ethically sound course of action. It can be triggered by poor communication and different perspectives between professionals. We examined whether and how taking the perspective of the other profession reduces moral distress among pediatric intensive care nurses and physicians. Using elements of a previously published scale, we created a Vignette-based Moral Distress Rating Scale (V-MDRS). Study participants from three sites included 105 nurses and 34 physicians who read a patient vignette with their own profession’s perspective, completed the V-MDRS, then received the other profession’s perspective and completed the V-MDRS again. We conducted semi-structured interviews with nine nurses and nine physicians who completed the V-MDRS to explore how interprofessional perspective-taking impacts moral distress. Nurses experienced higher baseline moral distress than physicians (mean ± standard deviation 31.1 ± 6.9 vs 26.4 ± 5, P < .001), and at two study sites nurses’ moral distress declined after reading the physician’s perspective. Findings from interviews suggest that physicians were already sensitized to nurses’ perspective and that perspective-taking may be particularly beneficial to cohesive teams with strong relationships. Thus, encouraging interprofessional perspective-taking may mitigate moral distress in healthcare professionals.

Relationship Distress at Home and Burnout Among 254 Pediatric Intensive Care Nurses.

To assess the prevalence of relationship distress and burnout among PICU nurses. Cross-sectional, web-based survey. Pediatric intensive care nursing practices in the United States. Pediatric intensive care nurses. None. A total of 254 pediatric intensive care nurses in the United States completed the survey consisting of demographic data, practice, and personal characteristics, Revised Dyadic Adjustment Scale, and modified Maslach Burnout Inventory. Relationship distress in consensus was noted in 45.6% of participants, and 26.3% reported distress in relationship satisfaction. Moderate to high burnout was reported by 65% nurses in the emotional exhaustion domain, 43% in depersonalization, and 27% of nurses reported low personal accomplishment. A significant difference in relationship satisfaction was found among nurses identified in different domains of burnout, showing that nurses who scored higher in depersonalization also reported higher distress in relationship satisfaction (p = 0.045). Interestingly, nurses who reported high personal accomplishment (thereby less burnout) reported higher distress in relationship consensus (p = 0.015). The difference in the satisfaction subscale between different age groups was significant, suggesting distress in satisfaction among nurses over the age of 40 (p = 0.004). Comparison of nurses actively involved in marriage counseling with those not actively involved in marriage counseling demonstrated a significant difference in relationship consensus (p = 0.046; odds ratio = 2.46; 95% CI, 0.99-6.06) and satisfaction (p = 0.004; odds ratio = 3.26; 95% CI, 1.42-7.47), suggesting an association between higher relationship distress and counseling. This study reflects the prevalence of relationship distress and its association with burnout and other practice and personal factors among PICU nurses. Nurses with high depersonalization experienced significantly higher distress in relationship satisfaction, and nurses who reported high personal satisfaction had significantly higher distress in relationship consensus.

Building Moral Resiliency Through the Nurse Education and Support Team Initiative.

Findings from 3 nurse-led research studies conducted in a large pediatric institution resulted in a call to action to support intensive and progressive care nurses experiencing moral and ethical challenges. To evaluate the feasibility of and satisfaction with implementation of a Nurse Education and Support Team (NEST) coach role. An interdisciplinary work group identified solutions for just-in-time support, including a new NEST coach role. This role was implemented in January 2017 to provide peer-to-peer support for nurses. The NEST coaches provide coverage 5 days per week in 4 intensive care units and 1 progressive care unit. Feasibility of the role was evaluated by assessing the number, type, length, and outcome of NEST coach consultations. Staff satisfaction was evaluated 6 months and 1.5 years after implementation. A total of 6262 NEST coach consultations occurred across the units from January 2017 through November 2019. At both evaluation periods, more than 85% of respondents indicated that they were satisfied with their interactions with the NEST coach and nearly 80% indicated that they would seek consultation again. Pediatric intensive and progressive care nurses experience many challenges in their practice environments. The innovative NEST coach role enabled access to just-in-time support and guidance through morally and ethically challenging situations. As evidenced by the number of consultations and the positive staff response, intensive and progressive care nurses have embraced and integrated the NEST coach role into their culture and practice.

The SARS-CoV-2 epidemic, a step towards recognizing the speciality of critical care nursing in France.

The SARS-CoV-2 epidemic, a step towards recognizing the speciality of critical care nursing in France.

A modified Delphi to define drug dosing errors in pediatric critical care

BackgroundThere is no globally accepted definition for dosing error in adult or pediatric practice. The definition of pediatric dosing error varies greatly in the literature. The objective of this study was to develop a framework, informed by a set of principles, for a clinician-based definition of drug dosing errors in critically ill children, and to identify the range that practitioners agree is a dosing error for different drug classes and clinical scenarios.MethodsWe conducted a nationwide three staged modified Delphi from May to December 2019. Expert clinicians included Canadian pediatric intensive care unit (PICU) physicians, pharmacists and nurses, with a least 5 years’ experience. Outcomes were underlying principles of drug dosing, and error thresholds, as defined by proportion above and below reference range, for common PICU medications and clinical scenarios.ResultsForty-four participants met eligibility, and response rates were 95, 86 and 84% for all three rounds respectively. Consensus was achieved for 13 of 15 principles, and 23 of 30 error thresholds. An over-dosed drug that is intercepted, an under-dose of a possibly life-saving medication, dosing 50% above or below target range and not adjusting for a drug interaction were agreed principles of dosing error. Altough there remained much uncertainty in defining dosing error, expert clinicians agreed that, for most medication categories and clinical scenarios, dosing over or below 10% of reference range was considered an error threshold.ConclusionDosing principles and threshold are complex in pediatric critical care, and expert clinicians were uncertain about whether many scenarios were considered in error. For most intermittent medications, dosing over 10% below or above reference range was considered a dosing error, although this was largely influenced by clinical context and drug properties. This consensus driven error threshold will help guide routine clinical dosing practice, standardized reporting and drug quality improvement in pediatric critical care.

Not Just Big Kids: Paediatric Intensive Care Nurses' Experience of Working in Adult Intensive Care during the COVID-19 Pandemic in A UK Hospital

Twenty-five of the nurses who received the survey responded (81%). The themes motivation, provision of care, teamwork, and wellbeing were identified. Eighteen of the nurses who re-deployed would volunteer to work in adult intensive care again if there were a need.

95. Effect of a pediatric mock code on resuscitation skills and team performance: an in situ simulation experience over three years.

Introduction: Early initiation of high-quality cardiopulmonary resuscitation (CPR) significantly improves the outcome of cardiopulmonary arrest in the hospital. Mock code simulation significantly reduces the time between the cardiac arrest event and the initiation of CPR. This type of simulation training facilitates the acquisition of critical CPR skills and improves team performance, which significantly improves cardiopulmonary arrest survival rates and leads to better clinical outcomes. In situ mock codes allow interprofessional teams to learn how to work together and how to improve the skills that are necessary to provide optimal CPR in a realistic environment in which patient safety is not threatened. Methods and procedures: Simulation program design and Participants: The mock code simulation program at King Abdullah Specialized Children’s Hospital - King Abdulaziz Medical City in Riyadh, Saudi Arabia, uses an in situ mock code simulation, and it is held 2-3 times per month on random wards in any unoccupied patient room at an unexpected time. The pediatric residents in our hospital serve as leaders of the pediatric cardiac arrest team. The code team is composed of pediatric ward nurses, in addition to pediatric intensive care nurses, respiratory therapists, pharmacists. The time it took to initiate CPR, the first epinephrine dose, and defibrillation were evaluated for team improvement using an evaluation form. The evaluation form included also team dynamics evaluation as nontechnical evaluation, and it included an assessment of effective leadership and closed-loop communication. Study design: This was a retrospective descriptive study conducted at King Abdullah Specialized Children’s Hospital. All records of the mock code simulation sessions conducted from July 2016 to June 2019 in the pediatric wards were included. Data were usually recoded and archived for each session in simulation program files, and they included a crisis resource management (CRM) score for the team leader. Other data related to team members’ performance was also documented, including the CPR initiation time and the overall team performance assessment. Outcomes: The purpose of this research project was to explore the impact of simulation-based training on resuscitation skills. The primary outcome was to assess the impact of the mock code simulation on the team’s performance by assessing CPR initiation time. Results: A total of 82 sessions met the inclusion criteria. CPR initiation time: With each attempt of a mock simulation for each pediatric ward of the nine pediatric wards where mock code was conducted, there was a significant decrease in the CPR initiation time by 6 seconds (p=0.0002) (Table 1).Non-Technical Team performance assessment (total global rating score): The results showed significant improvements in team performance as represented by the total global rating score for each pediatric ward team over a series of mock code simulation sessions, and the score increased by 3.4 times (=0.0001) Discussion: The results of this study showed improvements in the time it took to initiate CPR over a series of mock code simulation sessions that were conducted for each pediatric ward’s team. Initiation of CPR was related mainly to first responders and was the responsibility of the ward nursing staff in our study, and by repeating the mock code sessions, the ward nursing staff showed significant improvements in initiating CPR by accomplishing a faster CPR initiation time. This improvement also reflects that the recognition of a patient in cardiac arrest is better as well as the sequence to respond to a collapsed child. The team performance was assessed using the global rating score by conducting a series of mock code simulations in pediatric wards with intervals of three months. The results showed improvements in team performance overall and in team dynamics and communication specifically. This finding was also represented by improvements in the time to administer the first epinephrine dose, which reflects the harmony of efficient teamwork. Conclusion: In situ mock code simulation is a helpful way to enhance team dynamics and improve the quality of cardiac resuscitation. It can also help with skill retention for team leaders and team performance. Critical skills and CPR initiation time were greatly improved by continuous mock code simulation training for the code team. These results suggest advantages for considering this type of educational strategy for pediatric residents, code teams, and nursing staff, and they also support the continued use of ongoing mock code simulation training to further improve team performance, maintain team leader confidence, and assure quality patient care.

Impact of Exposure to Patient Death or Near Death on Compassion Fatigue in Pediatric Intensive Care Nurses.

Compassion fatigue affects up to 40% of health care professionals who work in intensive care settings. Frequent exposure to the death of patients, particularly children, may put nurses at risk for compassion fatigue, but the relation between these is unclear among those working in pediatric intensive care units. To examine the relationship between exposure to the death or near death of a pediatric patient and compassion fatigue, specifically the outcomes of compassion satisfaction, burnout, and secondary traumatic stress. Pediatric and neonatal intensive care nurses were surveyed about their exposure to patient death and near-death experiences. They were asked to respond to the Professional Quality of Life Scale, which has 3 subscales that measure compassion satisfaction, burnout, and secondary traumatic stress. Bivariate and multivariate linear regression modeling was used to identify correlates of these outcomes. Of the 65 respondents, 94% were female, 41% were aged 31 to 45 years, and 71% had a bachelor's degree. No significant relationship was found between nurses' experiences of patient death or near death and their compassion satisfaction, burnout, or secondary traumatic stress. Significant correlates of compassion satisfaction and burnout included educational level and an age-experience interaction. No relationship seems to exist between nurses' experiences of patient death or near death and their compassion satisfaction, burnout, or secondary traumatic stress. Further research is needed to evaluate the impact of educational attainment on nurse outcomes and determine how best to support nurses who are at risk for compassion fatigue.

Relationship Distress Among Pediatric Intensive Care Nurses in the United States

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 …