Pediatric Critical Care Nurses Research Articles

Attitude of Pediatric and Adult Critical Care Nurses about Technology Uses in Nursing Care and Caring Attributes

Attitude of Pediatric and Adult Critical Care Nurses about Technology Uses in Nursing Care and Caring Attributes

Training needs assessment for practicing pediatric critical care nurses in Malawi to inform the development of a specialized master\u2019s education pathway: a cohort study

BackgroundSignificant improvements in under-five mortality in Malawi have been demonstrated over the past thirty years; however, Malawian healthcare remains with gaps in availability and access to quality pediatric critical care nursing training and education. To improve expertise of pediatric critical care nurses in Malawi, Kamuzu University of Health Sciences (KUHeS), Queen Elizabeth Central Hospital (QECH), and Mercy James Center (MJC) entered a partnership with Seed Global Health, a US non-governmental organization. A needs assessment was conducted to understand the training needs of nurses currently working in pediatric critical care and in preparation for the development of a specialized Master’s in Child Health pathway in Pediatric Critical Care (PCC) Nursing at KUHeS.MethodsThe needs assessment was completed using a survey questionnaire formatted using an ABCDE (Airway, Breathing, Circulation, Disability, and Exposure) framework. The questionnaire had Likert scale and yes/no questions. Data was manually entered into excel and was analyzed using descriptive statistics.ResultsOne hundred and fifty-three nurses at QECH and MJC responded to the survey. Most nurses were between the ages of 25 and 35 years (N = 98, 64%), female (N = 105, 69%), and held either a Bachelors (N = 72, 47%) or diploma (N = 70, 46%) in nursing. Nurses had high rates of confidence in certain skills: airway management (N = 120, 99%), breathing assessment & management (N = 153, 100%). However, nurses demonstrated little to no confidence in areas such as: mechanical ventilation (N = 68, 44%), ECG evaluation (N = 74, 48%), and arterial blood gas collection & interpretation (N = 49, 32%).ConclusionIt is important to identify priority areas for training and skills development to address in the PCC master’s within the child health pathway at KUHeS. Ideally this partnership will produce practice-ready PCC nurses and will establish a recognized PCC nursing workforce in Malawi.

Pediatric Critical Care Nurses' Practices Related to Sedation and Analgesia.

Pediatric intensive care unit (PICU) nurses may consider additional factors beyond validated tools when managing pain and sedation of children. However, these other factors and related beliefs, practices, and decision-making for analgesia and sedation have not been well described. This study describes nurses' beliefs, practices, and decision-making related to sedation and analgesia for mechanically ventilated children on a PICU and a pediatric cardiovascular ICU at a tertiary academic children's medical center in the United States. A 35-item web-based survey tool was developed to more fully identify nurses' pain, sedation, comfort, and analgesia beliefs, decisions, planning, and procedures for children who were mechanically ventilated in the ICU. It was distributed to 102 nurses in the PICU, pediatric cardiovascular ICU, and pediatric critical care float pool. Twenty-six nurses (25%) responded; a majority worked the night shift and had 5 years or less of ICU experience. While participants believed intubated pediatric patients required moderate to deep sedation, approximately only half reported patients were adequately sedated. They reported that they were more likely to manage pain and sedation using specific behaviors and changes in vital signs than scores on a standardized scale. Nurses also reported routinely incorporating nonpharmacologic comfort measures. Premedication was more common for invasive procedures than for routine nursing care. Pediatric ICU nurses in this study considered factors beyond standardized scales when evaluating and managing pain and sedation of ventilated children. Nurses prioritized children's specific behaviors, vital signs, and their own nursing judgment above standardized scales. Research is needed to describe nurses' practices beyond this small study and to define and validate additional assessment parameters to incorporate into decision-making to improve management and care outcomes.

926: Ultrasound Assessment of Peripheral Intravenous Catheters by Pediatric Critical Care Nurses

Good, Ryan1; Diaz-Misuraca, Elizabeth2; Thomas, Robin3; Wathen, Beth4; Carpenter, Todd5 Author Information

530: Education on End-of-Life Care for Pediatric Critical Care Nurses: A Needs Assessment

530: Education on End-of-Life Care for Pediatric Critical Care Nurses: A Needs Assessment

Paediatric nursing management of renal replacement therapy: Intensive care nursing or dialysis nursing?

Children who develop Acute Kidney Injury may start renal replacement therapy (RRT) in Paediatric or Neonatal Intensive Care Units (hereafter PICU or NICU); RRT can be delivered either by paediatric dialysis nurses or by critical care nurses. In both case, nurses devoted to this task must have a high level of competence in providing care to children receiving haemodialytic treatment in a specific technological environment. The objective of this research was to investigate which models have been adopted to organize nursing care in RRT management in different Italian PICU and NICU, and to explore the training of ICU nurses on the management of RRT. A multi-centre survey was conducted through an online questionnaire directed to the Italian PICU and NICU nurse coordinators. A total of 15 Intensive Care Units (12 PICU and 3 NICU) in 12 hospitals were involved. The mean nurse/patient ratio in these units is 1:3. In 72.7% of critical care units, dialysis treatment is delivered by critical care nurses belonging to the unit itself, while in 27.3% of units paediatric dialysis nurses are in charge of dialysis treatment in collaboration with critical care nurses. In 25% of surveyed units there is some structured form of collaboration between Paediatric Dialysis nurses and critical care nurses. However, 75% of units did not respond to this specific question. The different units adopt various forms of RRT training for nursing staff. The scenario resulting from this analysis showed how in our sample of Italian hospitals there is no standard practice for RRT nursing management. In addition, although various forms of training for nursing staff exist, a proper educational programme and/or a standardized specific training about RRT management for nursing staff is not in place in the surveyed hospitals. The lack of standardized protocols or guidelines for RRT delivery to critically ill children can compromise their safety. The structuring of these protocols and the production of best clinical practice guidelines would allow standardization of the nursing management of the RRT and of the corresponding training. This may help to provide the proper care and to guarantee the patients' safety.

Discomfort of the critically ill paediatric patient and correlated variables

IntroductionThe care of critically ill children is usually invasive and aggressive, requiring numerous traumatic procedures that may cause fear, pain, and discomfort. ObjectivesThe aim of this study was to analyse the level of discomfort of patients admitted to the paediatric intensive care unit of a specialist children's hospital and to determine the sociodemographic and clinical variables that influence the degree of discomfort experienced by critically ill paediatric patients. MethodsWe performed a descriptive observational cross-sectional study that included a total of 311 children with a median age of 5.07 y (interquartile range = 0.9–11.7). A team of 10 paediatric critical care nurses assessed the degree of discomfort once for each shift (morning, afternoon, and night) on 2 successive days using the COMFORT Behavior Scale—Spanish version. ResultsIn total, 49.8% (n = 155) of the patients were free of discomfort (score ≤10 points) vs. 50.2% (n = 156) who experienced discomfort. There was a significant negative correlation between discomfort and the length of stay in days (Rho = 0.16; p = 0.02), that is, the longer the stay, the less discomfort the patient felt. The correlation between age and degree of discomfort was found to be both positive and significant (Rho = 0.230, p < 0.001); the greater the age, the greater the discomfort. In comparison of all children who received analgosedation (n = 205), with discomfort levels of 10.77 ± 2.94, with those who did not receive analgosedation (n = 106), with discomfort levels of 11.96 ± 2.80, we did find a statistically significant difference (χ2 = −4.05; p < 0.001). ConclusionsHalf of the patients admitted to the paediatric intensive care unit experienced discomfort. Age and analgosedation were the two most important variables involved with a high degree of discomfort. Clinical care practices must consider these factors and try to plan activities designed to relieve discomfort in all critically ill paediatric patients.

Self-care Strategies to Combat Burnout Among Pediatric Critical Care Nurses and Physicians.

Professional burnout is a widespread phenomenon in health care. The health of patients and organizations begins with the well-being of health care professionals. Identifying and understanding self-care strategies that professionals perceive to be helpful is crucial to combat burnout. To determine perceptions of self-care strategies to combat professional burnout among nurses and physicians in pediatric critical care settings. This was a qualitative descriptive study with a phenomenological overtone. The study was conducted in a 20-bed pediatric intensive care unit and an 8-bed intermediate care unit of a children's hospital in the United States. Information flyers and emails were used to introduce the study. A combination of convenience and purposive sampling methods was used to recruit participants who were full-time nurses and physicians in the 2 units. Information saturation was used to regulate sample sizes, resulting in 20 participants. Data were collected through a onetime face-to-face interview with each participant. A qualitative descriptive approach was used to analyze the data. The first author was the primary coder and discussed the codes with the coauthors throughout the coding process. Six major self-care strategies were identified: finding meaning in work, connecting with an energy source, nurturing interpersonal connections, developing an attitude of positivity, performing emotional hygiene, and recognizing one's uniqueness and contributions at work. Developing effective self-care strategies helps promote health care professionals' physical and psychological well-being and reduce burnout. It is vital for health care professionals to care for themselves so that they can best care for others.

Moral Distress: Defined and Described by Neonatal and Pediatric Critical Care Nurses in a Quaternary Care Free-Standing Pediatric Hospital.

Despite a growing population of chronically and acute critically ill neonatal and pediatric patients, there were few published articles related to moral distress as experienced by nurses caring for these patients. The aim of this study was to define moral distress based on the perceptions and experiences of neonatal and pediatric critical care nurses. A qualitative descriptive study using focus group methodology was undertaken. All nurses with 2 or more years of experience from the 4 neonatal and pediatric intensive care units in a large 404-bed urban pediatric hospital located in the northeast were invited to attend 1 of 15 audio-recorded focus groups lasting 60 to 90 minutes. Once data were transcribed, conventional content analysis was used to develop the definition and categories of moral distress. Nurse participants defined moral distress as "patient care situations where there is a mismatch or incongruity between expected behaviors of the nurse and his/her personal values/beliefs in the neonatal/pediatric critical care setting." The 2 overarching categories that emerged from the data were patient-focused factors and nurse-focused factors. Understanding how neonatal and pediatric critical care nurses define moral distress and what contributes to its development is foundational to developing targeted strategies for nursing support and education, with the goal of creating a culture of moral resiliency.

Effect of Audiovisual Cardiopulmonary Resuscitation Feedback Device on Improving Chest Compression Quality

The one month survival rate after out-of-hospital cardiac arrest (OHCA) in the paediatric population remains low. Improving survival in paediatric OHCA by enhancing the quality of cardiopulmonary resuscitation (CPR) is important. In this study, we aimed to analyse the factors associated with CPR quality by using a real-time feedback device. Participants were prospectively divided into 4 groups: paediatric research fellows, paediatric residents, medical students (clerks), and paediatric critical care nurses. Then, the participants were asked to perform 5 cycles of CPR on a paediatric simulation manikin without prompts from feedback devices, and to repeat another 5 cycles of CPR after education with the 2015 paediatric advanced life support guidelines. A total of 75 participants were evaluated. In the overall analysis, an improvement in the percentage of participants meeting the target compression rate was observed (from 49.82% to 71.23%, P < 0.001). The percentage of participants achieving the target compression depth improved from 73.77% to 85.63% (P = 0.005). Among the 4 groups, the residents showed the most significant improvement in both compression rate (from 48.41% to 86.57%, P < 0.001) and compression depth (from 63.50% to 95.57%, P < 0.001). Inappropriate rate was a more important factor resulting in inadequate CPR performance than inappropriate depth. An excessive compression rate was also a common problem. In conclusions, the real-time CPR feedback device may help clinical physicians and nurses in improving the quality of chest compression. Excessive CPR compression rate may be a major cause of inadequate CPR performance.

Stripping or Milking of Chest Tubes.

Stripping or Milking of Chest Tubes.

High Occurrence of Potential Contamination Risks Observed for Pediatric Patients Receiving Rapid Fluid Boluses with Single-use Syringes

BACKGROUND The disconnect-reconnect technique (DRT) and push-pull technique (PPT) are commonly used to deliver fluid boluses to pediatric patients with septic and hypovolemic shock. Maintaining aseptic technique can be challenging as both methods include many steps during which syringes and tubing can become contaminated. However, there is a paucity of research regarding the contamination risks or CLABSI (central line associated blood stream infections) rate secondary to PPT or DRT methods. This study examines the rate of aseptic violations in a simulated environment. METHODS Ten pediatric critical care nurses were asked to deliver 500mL of saline to a simulated 25kg patient through a 22G (gauge) catheter using PPT and DRT techniques. Nurses were instructed to follow aseptic technique and administer the fluid boluses rapidly. Aseptic violations were recorded by an independent observer. RESULTS An average of 32.9 (SD+/-20.9) and 17.7 (SD+/-8.4) aseptic violations per each 500mL bolus were observed using DRT and PPT, respectively. With PPT, 97% of violations occurred due to hand contact with the sterile portion of the plunger. With DRT, hand contact with both the plunger (60%) and the syringe tip (14%) were observed. With all nurses, the needleless hub was cleaned only prior to the initial syringe connection, not in between subsequent connections. CONCLUSIONS The simulation had a high rate of contamination events when using both DRT and PPT. Previous research suggests that repeated contact of the syringe plunger increases the risk of potential pathogens infused into the patient. Reducing the number of patient connections and reducing aseptic plunger violations may decrease the risks of hospital acquired infections associated with fluid resuscitation. Greater awareness of these risks, and the use of a rapid infusion device which eliminates these two risks, should be considered. The disconnect-reconnect technique (DRT) and push-pull technique (PPT) are commonly used to deliver fluid boluses to pediatric patients with septic and hypovolemic shock. Maintaining aseptic technique can be challenging as both methods include many steps during which syringes and tubing can become contaminated. However, there is a paucity of research regarding the contamination risks or CLABSI (central line associated blood stream infections) rate secondary to PPT or DRT methods. This study examines the rate of aseptic violations in a simulated environment. Ten pediatric critical care nurses were asked to deliver 500mL of saline to a simulated 25kg patient through a 22G (gauge) catheter using PPT and DRT techniques. Nurses were instructed to follow aseptic technique and administer the fluid boluses rapidly. Aseptic violations were recorded by an independent observer. An average of 32.9 (SD+/-20.9) and 17.7 (SD+/-8.4) aseptic violations per each 500mL bolus were observed using DRT and PPT, respectively. With PPT, 97% of violations occurred due to hand contact with the sterile portion of the plunger. With DRT, hand contact with both the plunger (60%) and the syringe tip (14%) were observed. With all nurses, the needleless hub was cleaned only prior to the initial syringe connection, not in between subsequent connections. The simulation had a high rate of contamination events when using both DRT and PPT. Previous research suggests that repeated contact of the syringe plunger increases the risk of potential pathogens infused into the patient. Reducing the number of patient connections and reducing aseptic plunger violations may decrease the risks of hospital acquired infections associated with fluid resuscitation. Greater awareness of these risks, and the use of a rapid infusion device which eliminates these two risks, should be considered.

Validation of the Complexity Assessment and Monitoring to Ensure Optimal Outcomes (CAMEO II) Acuity Tool for Pediatric Critical Care Nursing.

The Complexity Assessment and Monitoring to Ensure Optimal Outcomes (CAMEO II) acuity tool was developed to quantify patient acuity in terms of nursing cognitive workload complexity in a large, freestanding children's hospital in the United States. To describe the acuity and complexity of pediatric critical care nursing at a large children's hospital and correlate the CAMEO II with pediatric physiologic measures. Construct validation was conducted correlating the CAMEO II to a pediatric classification system and 2 physiologic acuity tools. Descriptive statistics summarized patient characteristics. Construct validity across tools was evaluated using the Spearman correlation coefficient. CAMEO II was described both continuously and as ordinal complexity levels (I-V). Among 235 patients who completed CAMEO II across 4 intensive care units (ICUs), the mean total score was 99.06 (median, 97; range, 59-204). The CAMEO II complexity classification for 235 patients was as follows: I: 22 (9.4%), II: 53 (22.6%), III: 56 (23.8%), IV: 66 (28.1%), and V: 38 (16.2%). Findings from the 235 patients across the 4 ICUs revealed a significant correlation between the CAMEO II and the Therapeutic Intervention Scoring System-Children (ρ = 0.567, P < .001), CAMEO II and Pediatric Risk of Mortality III (ρ = 0.446, P < .001), and the CAMEO II and Score for Neonatal Acute Physiology Perinatal Extension II (ρ = 0.359, P = .013). Utilization of CAMEO II across ICUs provides an opportunity to validate the current complexity of pediatric critical care nursing in a large children's hospital.

Scaling the Measurement of Pediatric Acuity Using the Complexity Assessment and Monitoring to Ensure Optimal Outcomes (CAMEO II) Tool.

The Complexity Assessment and Monitoring to Ensure Optimal Outcomes (CAMEO) acuity tool was developed to quantify patient acuity in terms of nursing cognitive workload complexity. An expert panel including representatives from 4 intensive care units (ICUs) convened to scale and implement the CAMEO II across the ICUs in a large, freestanding children's hospital in the United States. The aims of this study were to scale and implement a standardized acuity measure of pediatric critical care nursing. This study used a modified Delphi technique. Through a series of 3 Delphi rounds, the expert panel identified care items not characterized in the original CAMEO and assigned each of these items a cognitive workload scale of 1 to 5. The expert panel identified 4 additional Domains of Care while confirming the original 14 Domains of Care in the first CAMEO version. The panel agreed that a number of care items could be classified as "Standard of Care," reducing items in the CAMEO and generating a baseline score. The panel, serving as ambassadors and unit-based experts, then implemented the refined CAMEO II in each of the 4 ICUs. Utilization of the CAMEO II across ICUs provides a standardized measure to describe and quantify the acuity of pediatric critical care nursing. Use of this acuity measure informs projection of staffing models and benchmarking across pediatric ICUs. Further research is needed to validate the CAMEO II for multisite use.

AACN Core Curriculum for Pediatric High Acuity, Progressive, and Critical Care Nursing, Third Edition

The purpose of the AACN Core Curriculum books is to highlight the essential knowledge and competency requirements of nurses caring for specific patient populations. Ongoing pharmacologic and technologic advances for management of pediatric patients require nurses with the same level of knowledge, skills, and abilities as their counterparts working with adults. The need for resources to support the lifelong learning of nurses caring for pediatric patients continues to grow. The long awaited third edition of AACN Core Curriculum for Pediatric High Acuity, Progressive and Critical Care Nursing has finally arrived to help meet this need. Margaret Slota has been the editor of this resource since the first edition in the 1990s; she has provided direction and continuity through the second and this third edition. This updated Core Curriculum also has an updated title, which demonstrates the understanding that pediatric critical care extends beyond the typical intensive care unit. Pediatric critical care patients may be found anywhere in the hospital, from the emergency department to diagnostic areas to progressive care units to intensive care units. Chronically critically ill children may also be cared for outside the walls of an acute care hospital. Progressive care units have multiple names and levels of acuity in facilities across the country. In these areas, patients are just as likely to “step up” from lower acuity care as they are to “step down,” which is how we have traditionally understood this level of care.This AACN Core Curriculum is divided into 1 chapter introducing the care requirements of critically ill children and their families, 8 clinical system chapters, and 1 final chapter addressing professional issues, including quality, safety, work environment, and wellness. The chapter discussing multisystem issues is divided into subsections addressing multiple trauma, toxicology, sepsis and septic shock, burns, disaster preparedness and response, and initial stabilization and transport.In this book, the continuum of patient needs and nurse competencies identified in the AACN Synergy Model for Patient Care describes patient care. In addition, an outline format presents the content and figures and tables help explain the concepts of the content throughout the book. Historically, pediatric care has been loosely based on research and evidence developed in the adult care world. However, research and evidence specific to pediatric patients continues to grow and, where available, supports the content presented in this AACN Core Curriculum.Although this resource is a heavy tome at 968 pages, any nurse wanting to pursue a strong baseline knowledge of pediatric high-acuity, progressive, and critical care should purchase this book for their foundational library. In addition, nurses considering certification may find this book helpful. Purchase of the book includes access to the Springer Publishing CONNECT platform, which provides online access and the ability to search for specific content.

Automated Audiovisual Feedback in Cardiopulmonary Resuscitation Training: Improving Skills in Pediatric Intensive Care Nurses

High-quality cardiopulmonary resuscitation is associated with improved survival and neurological outcomes after cardiac arrest. Unfortunately, health care professionals frequently do not perform resuscitation within guidelines after life-support training. To determine if brief intermittent training in cardiopulmonary resuscitation could improve nurses' skills to perform high-quality resuscitation 70% or more of the time during 2 minutes of cardiopulmonary resuscitation after 3 training sessions. In a prospective single-center quality improvement program, pediatric critical care nurses had monthly training in cardiopulmonary resuscitation. A portable manikin/defibrillator with a chest compression sensor was used to provide corrective audiovisual feedback to optimize resuscitation skills. Resuscitation was practiced on an adult manikin. Target goals were compression depth 2 in or greater at a compression rate of 100/min to 120/minute. Percentage of time in the target range and mean compression depth and rate were recorded. Data were collected every other month. The percentage of time both compression rate and depth were in the target range was compared among nurses with different total numbers of training sessions. Of the 62 nurses who participated in the training, 48 had data collected. The median percentage of time in the target range improved from 29% with no training to 46% after 1 session, 54% after 2 sessions, 68% after 3 sessions, and 74% after 4 sessions (P = .001). Compression depth increased with the number of training sessions (P = .002). This training program in cardiopulmonary resuscitation yielded significant skill improvement and retention.

Feasibility of Online Mental Wellness Self-assessment and Feedback for Pediatric and Neonatal Critical Care Nurses

PurposeThe primary goal of this study was to test the feasibility of an educational online self-assessment of burnout, resilience, trauma, depression, anxiety, and common workplace stressors among nurses working in a pediatric intensive care unit or neonatal intensive care unit setting. The secondary, exploratory objectives were to estimate the prevalence of psychiatric symptoms in this sample and to identify those variables that most strongly predict burnout. Design and MethodsData from optional and anonymous online measures were analyzed for 115 nurses (67.9% aged 25–44; 61.7% Caucasian) working in an urban children's hospital pediatric or neonatal ICU. Multiple linear regressions identified demographic variables and workplace stressors that significantly predicted each of three components of burnout. ResultsMost respondents found the educational assessment and feedback to be helpful. Choosing nursing as a second career was associated with better resilience. Having worked in ICU settings longer and being older were both linked to lower levels of anxiety. Predictors of burnout varied across the three burnout subscales. ConclusionsImplementation of an online self-assessment with immediate educational feedback is feasible in critical care settings. The variability of predictors across the three burnout subscales indicates the need for tailored interventions for those at risk. Future research may include follow-up of nurses to examine changes in scores over time and expansion of the tool for other medical personnel. Practice ImplicationsAn educational online self-assessment can be a helpful tool for pediatric critical care nurses experiencing varying degrees of burnout and distress.

Expressive writing as an intervention to decrease distress in pediatric critical care nurses

Experiencing distress is a common phenomenon among pediatric critical care nurses. Expressive writing provides a cost-effective and easily implemented intervention nurses can utilize to address distress as a consequence of providing care for critically ill patients. This intervention may decrease the array of consequences of distress and improve nursing staff satisfaction and retention.

Excellence by Design: The Patricia A. Hickey Award for Excellence in Cardiovascular Nursing.

This award reflects the high-impact contributions of pediatric critical care nurses that have helped to shape the field. Lessons from an ongoing career in nursing leadership are shared by Dr Patricia Hickey. Four themes are highlighted which include (1) our role models/mentors, (2) our profession and its impact, (3) our teams and environments of excellence, and (4) our bright future. Program and practice excellence does not just happen. It requires strategic thinking, deliberative processes, risk-taking and guts to create and sustain. A bright future is forecasted with stellar contributions of professional nurses and interprofessional cardiac critical care teams.

Learning Needs Assessment of Pediatric Nurses Regarding Delirium and Its Barriers of Screening at Intensive Care Units

Pediatric delirium is a significant issue among critically ill children; Professional and highly qualified nurses are usually the first who identify delirium in ICU patients, with a need for close monitoring, recognition, and prevention. Aim of the study was to assess learning needs of critical care nurses regarding pediatric delirium and its barrier of screening at ICUs. Method: A descriptive design was conducted on a purposive sample of 91 pediatric critical care nurses working at Mansoura University Children's hospital and New Mansoura General hospital who fulfills the criteria of selection using pediatric nurses learning needs structured questionnaire that includes questions about characteristics of studied nurses, nurse's knowledge, attitude and practice about pediatric delirium and barriers of delirium screening among pediatric critical care nurses. Results: the level of nurses' knowledge was poor in 94.5%, fair in 5.5% and there was any one with good knowledge, the negative attitude toward delirium was reported in 54.9% of nurses, while only 3.3% of nurses has positive attitude and the level of practice was unsatisfactory in 81.3% of nurses. The most common barriers for delirium screening as reported by the studied nurses is absent of tool to evaluate delirium (86.8%), difficult to determine delirium in children on ventilator (78.0%) and inefficient of symptoms registering in children taking sedation (70.3%). Conclusions: the majority of studied nurses have poor knowledge about pediatric delirium particularly for its definition, causes and its management. Also, more than half of them has negative attitude regarding delirium and majority of them has unsatisfactory practice. The commonest barriers for delirium screening were absent of tool and difficulties of delirium screening for children on ventilator at ICUs. Recommendation: pediatric critical care nurses learning needs should be assessed constantly and progressively through implementing educational training program to increase competences of Pediatric ICUs staff focused on practical guidelines for hospitalized children with delirium.