Pediatric Intensive Care Unit Nurses Research Articles

Attitudes, knowledge and practices concerning delirium among paediatric intensive care unit nurses: a multisite cross-sectional study in Sichuan, China.

Delirium is an acute mental state associated with poor outcomes. The incidence of delirium is high, especially in the paediatric intensive care unit (PICU). It is important for staff, particularly nurses, to understand delirium and implement interventions to prevent it. We performed a survey with the aim of evaluating and analysing the factors influencing the knowledge, attitudes and behaviour of PICU nurses towards delirium. This cross-sectional descriptive study included 215 PICU nurses in 6 PICUs from five teaching hospitals in Sichuan Province, China. An online survey about the knowledge, attitudes and practices related to delirium care was conducted among PICU nurses used a self-made and validated questionnaire. The data were analysed using descriptive statistics; differences between groups were compared using t tests, ANOVA and rank-sum tests. Variables with a significance level of 0.05 in the univariate analysis were entered into the multivariable regression analysis to identify predictors. Only 14.4% of the nurses had a good understanding of delirium, and 40.9% had received relevant training. The mean knowledge score was 9.01 ± 3.86, and the overall passing rate of knowledge was 49.8%. The mean attitude and behaviour scores were 40.95 ± 5.62 and 40.33 ± 8.01, respectively. Among the hospitals, different delirium assessments for children and specific training were performed, explaining approximately 10% of the variability in knowledge scores (F = 6.152), approximately 10% of the variability in attitude/belief scores (F = 5.908), and approximately 17% of the variability in practice scores (F = 10.767). PICU nurses have poor knowledge of delirium, particularly regarding its clinical manifestations, influencing factors and medications used, and they have adequate attitudes and confidence and good behaviour regarding delirium in children. To better prevent delirium, we suggest that PICU departments routinely assess delirium and conduct delirium training for nurses. Not applicable.

“At Least I Can Push this Morphine”: PICU Nurses’ Approaches to Suffering Among Dying Children

ContextParents of children who die in the pediatric intensive care unit (PICU) carry memories of their child's suffering throughout a lifelong grieving experience. Given their prolonged time at the bedside, PICU nurses are poised to attend to dying children's suffering. ObjectivesWe aimed to explore how PICU nurses identify, assess, and attend to EOL suffering. MethodsInterpretive descriptive qualitative study with thematic analysis of virtual focus groups from a geographically diverse sample of PICU nurses. ResultsNurses participated in five focus groups (N = 19). Most identified as White (89%) females (95%) with a range of 1-24 years of PICU experience and involvement in >10 EOL care cases (89%). Nurses described approaches to suffering within five themes: 1) Identifying and easing perceptible elements; 2) Recognizing and responding to subtleties moment-to-moment; 3) Acclimating to family interdependence; 4) Synchronizing nurse in-the-room insight with systemic complexity; and 5) Accounting for ambiguity. Nurses detailed elements of suffering they could “fix” with straightforward, external interventions (e.g., pain medication). More complex tasks like optimizing care within familial and interprofessional team relationships while navigating psychosocial responses from children and families challenged nurses. Nurses attempted to minimize EOL suffering amidst ambiguity and complexity using internal processes including managing the environment and titrating moment-to-moment care. ConclusionsWhile physical suffering may be remedied with direct nursing care, holistically attending to EOL suffering in the PICU requires both bolstering external processes and strengthening PICU nurses’ internal resources. Improving psychosocial training and optimizing interprofessional care systems could better support dying children and their families.

Attitudes toward Thanatophobia: comparative analysis between pediatric intensive care units (PICUs) nurses, nurse interns and student nurses

Background: Thanatophobia refers to the anxiety related to fear of death. Nurses who care for critically ill children and their families may encounter death and dying recurrently, which can be emotionally challenging and distressing. Thanatophobia reported to significantly influence the emotional well-being and quality of life of healthcare professionals, especially those working in PICUs. Methods: A comparative study aimed to investigate and compare the attitudes toward death and dying patients among 176 participants included pediatric intensive care units (PICUs) nurses, nurse interns, and student nurses and to explore the relationship between various factors such as work experience, palliative care training, and personal experience with dying patients utilizing a quantitative descriptive correlation cross sectional research design and convenience sampling technique. Data was collected using a two part online self-reported questionnaire survey with the first section included sociodemographic data and second section was the thanatophobia scale by Merrill, Lorimor, Thornby and Woods (1998). Data was analyzed using the Statistical Software (JMP).

Evaluating the knowledge and attitudes towards radiation protection in portable radiological examinations among nurses in pediatric intensive care units

This study aims to assess the knowledge and attitudes towards radiation protection among nurses in pediatric intensive care units (PICUs), where portable radiological examinations are frequently conducted. In this study, we employed a descriptive cross-sectional research design using a 17-item self-administered questionnaire. The study comprised 160 nurses, mostly female (91%), with an even split in educational background between diploma and bachelor’s degree holders. The majority had 1–5 years (39%) and 6–10 years (33%) of experience, while only a small fraction (6.2%) had undergone training in radiation protection. The overall scores of knowledge and attitudes were 2.9 ± 1.4 out of 7 and 3.1 ± 0.9 out of 4, respectively. A statistically significant variation in knowledge scores was noted between those with a Bachelor’s degree (3.2 ± 1.4) and a Diploma (2.7 ± 1.3) (p = 0.044). A positive correlation between knowledge and attitude scores was statistically validated (Spearman’s rho = 0.19, p = 0.014), and training in radiation protection was identified as a significant factor affecting these scores (estimate = –1.38, p = 0.025). The study reveals a poor level of knowledge and a good attitude towards radiation protection among PICU nurses in the Jizan Region. This emphasizes the need for targeted educational interventions and training programs in radiation safety to enhance the quality of care in pediatric radiological procedures.

Pain assessment & management decision-making in pediatric critical care

PurposeThe aim of this study was to explore how nurses in the Pediatric Intensive Care Unit (PICU) reach their pain management decisions in children who are mechanically ventilated and chemically paralyzed. Design and methodsA qualitative descriptive design was used following a quantitative phase of a multi-method study. Eighteen PICU nurses participated in semi-structured interviews aiming at understanding how they assess pain and make management decisions. Content analysis was used to guide coding and generate themes. ResultsThree major themes were identified: 1) Assessment or cues that nurses use to trigger a pain assessment; 2) Mental models or patterns that nurses create to interpret cues to guide decision-making; 3) External factors that inhibit or facilitate decision-making. Overall, nurses rely on physiological cues to assess pain. From there, a large amount of variation exists on how nurses interpret those cues to make their pain management decision. External factors such as unit culture, perceived barriers and facilitators, and the nurse's experiences impacted how decisions are made. ConclusionsVariation exists in the mental models' nurses create to make their pain management decision in this population. Nurses reported confusion on pain and sedation scale selection and various documentation practices for pain assessment. “Assume pain present” was identified as a concept and documentation practice that may guide decisions; further research is needed. Practice implicationsDevelopment of clinician decision support tools that not only aid their understanding of reliable pain cues but also help create clear documentation practices may help nurses make pain management decisions.

Pain Assessment and Management for a Chemically Paralyzed Child Receiving Mechanical Ventilation.

Pain assessment in the pediatric intensive care unit (PICU) is complex, specifically for children receiving mechanical ventilation who require neuromuscular blockade (NMB). No valid pain assessment method exists for this population. Guidelines are limited to using physiologic variables; it remains unknown how nurses are assessing and managing pain for this population in practice. To describe how PICU nurses are assessing and managing pain for children who require NMB. A cross-sectional quantitative design was used with an electronic survey. Nurses were asked to respond to 4 written vignettes depicting a child who required NMB and had a painful procedure, physiologic cues, both, or neither. A total of 107 PICU nurses answered the survey. Nurses primarily used behavioral assessment scales (61.0%) to assess the child's pain. All nurses reported that physiologic variables are either moderately or extremely important, and 27.3% of nurses used the phrase "assume pain present" formally at their organization. When physiologic cues were present, the odds of a nurse intervening with a pain intervention were 23.3 times (95% CI, 11.39-53.92; P < .001) higher than when such cues were absent. These results demonstrate variation in how nurses assess pain for a child who requires NMB. The focus remains on behavioral assessment scales, which are not valid for this population. When intervening with a pain intervention, nurses relied on physiologic variables. Decision support tools to aid nurses in conducting an effective pain assessment and subsequent management need to be created.

Overcoming patient safety concerns and integrating early mobility into pediatric intensive care unit nursing practice

PurposeEarly Mobilization (EM) in Pediatric Intensive Care Units (PICU) is safe, feasible and improves outcomes for PICU patients, yet patient safety concerns persist among nurses which limits EM adoption. The purpose of this study was to explore how nurses incorporate EM into practice and balance their concerns for patient safety with the benefits of EM. Design & methodsThis focused ethnographic study included 15 in-depth interviews with 10 PICU nurses. Data were analyzed using thematic analysis. ResultsTwo major categories were found which describe the clinical judgement and decision-making of PICU nurses regarding EM. The nurses' concerns for patient safety was the first major category. This included patient-level factors: hemodynamic stability, devices attached, patient's strength, and risk for falls and size. In the second major category, these safety concerns were overcome by applying a multiple step process which resulted in nurses performing EM despite their concerns. That process included: gaining comfort through experience, performing patient safety checks, working with therapists, learning from adverse events, and understanding existing evidence about the benefits of EM. ConclusionsThe overarching theme was nurses' determination to preserve patient safety while ensuring patients could receive the benefits of EM. This theme describes the decisions, behaviors and processes that nurses enact to become more comfortable with EM despite their concerns for patient safety and potential adverse events while performing mobility activities. Practice implicationsCreating opportunities for nurses to participate in EM may increase their willingness to overcome safety concerns and engage in these activities.

Transferring critical pediatric patients from emergency department to intensive care: A quality improvement initiative

BackgroundTransfer of care, moving hospitalized patients between care areas, is a critical point of vulnerability for healthcare organizations. Patient information handoff is an essential activity occurring frequently in hospital environments. Poor communication has been linked with adverse events and poor patient outcomes. This evidence-based quality project aimed to enhance the handoff process between the Emergency Department (ED) and Pediatric Intensive Care Unit (PICU) by standardizing transfer of care steps. This was accomplished through customizing a reporting tool to contain all the information the receiving department deemed necessary for safe patient care. MethodsA customized situation, background, assessment, recommendation (SBAR) form handoff tool was developed for ED to PICU transfers. This SBAR tool included information that PICU nurses identified as critical to transfer of care. Nurse perceptions were surveyed pre- and post-implementation. Patient safety event reports were tracked to evaluate events related to transfer of care before and after the practice change. FindingsAn increased number of PICU nurses agreed the customized handoff tool was complete and organized. Additionally, more nurses agreed that handoff gave all information needed to safely care for critically ill patients transferred from the ED. Lastly, bedside patient checks increased, and patient safety events related to transfer of care decreased. DiscussionThis project demonstrated that implementation of a standardized transfer of care process coupled with a customized handoff tool increased PICU nurse perceptions that handoff was organized, and all information needed to safely care for critically ill patients was conveyed. Application to practiceTransfer of care processes between the ED and PICU should be standardized. The use of customized tools may improve information exchange between nurses and ensure that all vital patient information is communicated.

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.

Effects of a Multifaceted Pediatric Delirium Education Program for Pediatric Intensive Care Unit Nurses on their Delirium Knowledge, Self-confidence in Delirium Nursing, and Delirium Assessment Accuracy: A One Group Pretest-Posttest Design

Purpose : This study aimed to identify the effects of a multifaceted pediatric delirium education program for pediatric intensive care unit (PICU) nurses on their delirium knowledge, confidence in delirium nursing, and delirium evaluation accuracy.Methods : This study used a one-group pretest-posttest design. The participants were 50 nurses in two units of the PICU at S General Hospital in Seoul. All participants took a 1-hour lecture with case-based practice for the first two weeks, and received feedback as they applied the program to clinical practice over the next two weeks. Test measures were completed before and after the four week intervention period for all participants. The delirium evaluation accuracy was measured using the Korean version of the Cornell Assessment of Pediatric Delirium. Data were analyzed using the chi-square and paired t-tests.Results : After the Pediatric Delirium Education Program, nurses’ delirium knowledge (&lt;i&gt;x&lt;/i&gt;&lt;sup&gt;2&lt;/sup&gt; =11.65, &lt;i&gt;p&lt;/i&gt; =.001), confidence in delirium nursing (t=9.71, &lt;i&gt;p&lt;/i&gt;＜.001), and delirium evaluation accuracy (t=6.07, &lt;i&gt;p&lt;/i&gt;＜.001) improved significantly.Conclusions : Pediatric delirium education programs for PICU nurses were effective. For active application of the program in clinical practice in the future, various cases of childhood delirium and specific strategies for each subject must be developed. To achieve this, long-term intervention and research for multiple organizations are required.

Outgrowing the Pediatric Intensive Care Unit: Adults With a Pediatric Medically Complex Condition.

With more than 20 years of experience as pediatric and adult critical care nurses, we have observed an increase in the number of medically complex children who are living into adulthood and a troubling lack of adult intensive care unit (ICU) systems and processes for these patients.Medical advances have resulted in a significant decline in the mortality rate in the pediatric ICU (PICU), from 15% in 1980 to 4% in 2006. However, an unintended consequence is that more children experience significant morbidity. In fact, more than 50% of all PICU admissions are children with medical complexity.1,2 Families caring for a child who is chronically critically ill have special care requirements. Nurses in the PICU have extensive experience with pediatric-onset conditions such as congenital heart defects, sickle cell disease, neurodegenerative diseases, chromosomal abnormalities, and muscular dystrophies. They are also familiar with growth and development and have expertise in providing developmentally appropriate care. In addition, PICU nurses are trained in the principles of family- and patient-centered care, which include communicating and collaborating with family caregivers about the processes of care to a much greater extent than usually done in an adult ICU. Certified child life specialists are also available in the PICU to provide specific tools to assist in meeting the needs of the family, including siblings. When medically complex children become adults, many of them transition to adult ICUs that may not be ready for them. As a result, approximately 2% of PICU admissions (range 0%-9%) are adults who have had complex medical needs as children.3,4 However, as the number of medically complex children reaching adulthood continues to grow, the “PICU for adults” model is not sustainable.At this time, many adult ICUs are not prepared for patients with pediatric conditions. Creating an environment in which adult and pediatric health care professionals work collaboratively is essential to providing quality care to these patients and families. Systems need to be developed and expanded to provide complex care in the adult ICU. A proactive, interdisciplinary approach including specialized training for the adult ICU team is needed to sustain a high level of quality care and to support the transition to adult care. Staff in the PICU can help to prepare families for the transition as well as provide education and support to the adult ICU team. Issues to consider include differences in anatomy and physiology of pediatric patients, the unique developmental needs of this population, expansion of specialized services (ie, child life specialists), dedicated sleep areas for parents, and involving parents in decisions and patient care.

Mixed-methods process evaluation of a respiratory-culture diagnostic stewardship intervention.

To conduct a process evaluation of a respiratory culture diagnostic stewardship intervention. Mixed-methods study. Tertiary-care pediatric intensive care unit (PICU). Critical care, infectious diseases, and pulmonary attending physicians and fellows; PICU nurse practitioners and hospitalist physicians; pediatric residents; and PICU nurses and respiratory therapists. This mixed-methods study was conducted concurrently with a diagnostic stewardship intervention to reduce the inappropriate collection of respiratory cultures in mechanically ventilated children. We quantified baseline respiratory culture utilization and indications for ordering using quantitative methods. Semistructured interviews informed by these data and the Consolidated Framework for Implementation Research (CFIR) were then performed, recorded, transcribed, and coded to identify salient themes. Finally, themes identified in these interviews were used to create a cross-sectional survey. The number of cultures collected per day of service varied between attending physicians (range, 2.2-27 cultures per 100 days). In total, 14 interviews were performed, and 87 clinicians completed the survey (response rate, 47%) and 77 nurses or respiratory therapists completed the survey (response rate, 17%). Clinicians varied in their stated practices regarding culture ordering, and these differences both clustered by specialty and were associated with perceived utility of the respiratory culture. Furthermore, group "default" practices, fear, and hierarchy were drivers of culture orders. Barriers to standardization included fear of a missed diagnosis and tension between practice standardization and individual decision making. We identified significant variation in utilization and perceptions of respiratory cultures as well as several key barriers to implementation of this diagnostic test stewardship intervention.

Perspectives of Pediatric Nephrologists, Intensivists and Nurses Regarding AKI Management and Expected Outcomes.

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). 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. 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. All Canadian pediatric nephrologists, PICU physicians, and nurses treating children in the ICU were eligible for the survey. N/A. 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. 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. 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). 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. 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.

Implementing Standardized Post-Intensive Care Syndrome Education by an Advanced Practice Registered Nurse in the Pediatric Intensive Care Unit

Implementing Standardized Post-Intensive Care Syndrome Education by an Advanced Practice Registered Nurse in the Pediatric Intensive Care Unit

Continuous Kidney Replacement Therapy Practices in Pediatric Intensive Care Units Across Europe

Continuous kidney replacement therapy (CKRT) is the preferred method of kidney support for children with critical illness in pediatric intensive care units (PICUs). However, there are no data on the current CKRT management practices in European PICUs. To describe current CKRT practices across European PICUs. This cross-sectional survey of PICUs in 20 European countries was conducted by the Critical Care Nephrology Section of the European Society of Pediatric and Neonatal Intensive Care from April 1, 2020, to May 31, 2022. Participants included intensivists and nurses working in European PICUs. The survey was developed in English and distributed using SurveyMonkey. One response from each PICU that provided CKRT was included in the analysis. Data were analyzed from June 1 to June 30, 2022. Demographic characteristics of European PICUs along with organizational and delivery aspects of CKRT (including prescription, liberation from CKRT, and training and education) were assessed. Of 283 survey responses received, 161 were included in the analysis (response rate, 76%). The attending PICU consultant (70%) and the PICU team (77%) were mainly responsible for CKRT prescription, whereas the PICU nurses were responsible for circuit setup (49%) and bedside machine running (67%). Sixty-one percent of permanent nurses received training to use CKRT, with no need for certification or recertification in 36% of PICUs. Continuous venovenous hemodiafiltration was the preferred dialytic modality (51%). Circuit priming was performed with normal saline (67%) and blood priming in children weighing less than 10 kg (56%). Median (IQR) CKRT dose was 35 (30-50) mL/kg/h in neonates and 30 (30-40) mL/kg/h in children aged 1 month to 18 years. Forty-one percent of PICUs used regional unfractionated heparin infusion, whereas 35% used citrate-based regional anticoagulation. Filters were changed for filter clotting (53%) and increased transmembrane pressure (47%). For routine circuit changes, 72 hours was the cutoff in 62% of PICUs. Some PICUs (34%) monitored fluid removal goals every 4 hours, with variation from 12 hours (17%) to 24 hours (13%). Fluid removal goals ranged from 1 to 3 mL/kg/h. Liberation from CKRT was performed with a diuretic bolus followed by an infusion (32%) or a diuretic bolus alone (19%). This survey study found a wide variation in current CKRT practice, including organizational aspects, education and training, prescription, and liberation from CKRT, in European PICUs. This finding calls for concerted efforts on the part of the pediatric critical care and nephrology communities to streamline CKRT education and training, research, and guidelines to reduce variation in practice.

726: SIMULATION CURRICULUM TO IMPROVE NURSING-LED EARLY MOBILITY OF CRITICALLY ILL CHILDREN

Introduction: Early pediatric intensive care unit (PICU) mobilization is safe and associated with improved clinical outcomes. Nurses are the sole PICU staff involved in the majority of mobilizations. Nursing-specific mobility training is desired, improves ICU mobilization compliance, and increases nursing confidence in mobilizing higher-risk patients. Simulation is superior to traditional instruction methods for teaching clinical skills. Thus, the aim of this study is to design and implement a nurse-targeted, simulation-based early mobility curriculum to determine if it improves nurse self-efficacy, knowledge, and skills. Methods: We conducted a pre-post interventional study of PICU nurses. We developed and deployed a half-day simulation curriculum. The educational strategy included group simulations, debriefing sessions, and didactic sessions. The early mobility self-efficacy assessment was on a Likert scale from 1 (not confident) to 4 (very confident). The knowledge assessment was a 20 question test. Individual skills were assessed using a 25 item rubric during Observed Structured Clinical Examinations (OSCE). Results: Data was compiled from 11 PICU nurses who participated in a half-day simulation-based early mobility curriculum. The nurses who participated had a median of 2 years (Interquartile Range [IQR], 0.7-3) of nursing experience and 1.5 years (IQR, 0.7-2.5) of PICU experience. Participation in the curriculum improved the early mobility self-efficacy score from a median of 2.7 (IQR 2.67-3) to a median of 3.6 (IQR 3.1-3.7; p-value 0.001). Knowledge assessment test scores also improved from a median of 14 (IQR 12-16) questions correct to a median of 17 (IQR 16-18) questions correct (p-value 0.001). Additionally, nurses completed more clinical skills during the OSCE with an improvement from a median of 14 (IQR 13.5-16) items to 18 (IQR 17-19) items (p-value 0.002). Conclusions: Development of a simulation-based early mobility curriculum is feasible. Hands-on early mobility education for nurses improves self-efficacy, knowledge, and clinical skills mobilizing critically ill children.

A cross-sectional study of work satisfaction and general health of adult and pediatric Intensive Care Unit nurses

Background: Working in an intensive care environment is known to cause stress to health care providers, especially to nursing staff, with implications for their health. The aim of this study was to investigate the job satisfaction and general health of adult and pediatric Intensive Care Unit nurses, and the sociodemographic/working factors associated with their satisfaction. Design: A multi-center cross-sectional study. Methods: Data collected using a self-report questionnaire consisted of questions about demographics, the Stamps Index of Work Satisfaction, and the General Health Questionnaire. This was distributed to nurses working in adult or pediatric Intensive Care Units. Statistical analysis done using the IBM SPSS 25.0. Results: 150 replies were included in the analyses. Mean age was 40.1 years, and mean work experience were 8.6 years. Moderate job satisfaction [3.65 (SD±0.51)]. and good overall health [24.4 (SD±12.3)]. were found. Job satisfaction was significantly correlated with anxiety/sleep problems and social dysfunction. Gender had a significant effect for the dimensions of remuneration (U = 1464.5, p = 0.034), professional prestige (U = 1480, p = 0.040) and duties (t = -2.968, p = 0.003). Job position and weekend working hours significant correlated with the autonomy subscale (U=474, p=0.014, r = -0.263, p &lt;0.01 respectively). Conclusions: There is a need to design and implement policies in order to improve the working conditions of the Greek Intensive Care nurses.

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.

Barriers and perceived benefits of early mobilisation programmes in Dutch paediatric intensive care units.

Early mobilisation of critically ill adults has been proven effective and is safe and feasible for critically ill children. However, barriers and perceived benefits of paediatric intensive care unit (PICU) staff involvement in mobilising critically ill children are largely unknown. To explore the barriers and perceived benefits regarding early mobilisation of critically ill children as perceived by PICU staff. A cross-sectional survey study among staff from seven PICUs in the Netherlands has been carried out. Two hundred and fifteen of the 641 health care professionals (33.5%) who were invited to complete a questionnaire responded, of whom 159 (75%) were nurses, 40 (19%) physicians, and 14 (6%) physical therapists. Respondents considered early mobilisation potentially beneficial to shorten the duration of mechanical ventilation (86%), improve wake/sleep rhythm (86%) and shorten the length of stay in the PICU (85%). However, staff were reluctant to mobilise patients on extracorporeal membrane oxygenation (ECMO) (63%), and patients with traumatic brain injury (49%). Perceived barriers to early mobilisation were hemodynamic instability (78%), risk of dislocation of lines/tubes (74%), and level of sedation (62%). In total, 40.3% of PICU nurses stated that physical therapists provided enough support in their PICU, but 84.6% of the physical therapists believed support was sufficient. Participating PICU staff considered early mobilisation as potentially beneficial in improving patient outcomes, although barriers were noted in certain patient groups. We identified barriers to early mobilisation which should be addressed in implementation research projects in order to make early mobilisation in critically ill children work.

신생아 및 소아 중환자실 간호사의 도덕적 민감성과 도덕적 고뇌가 돌봄 행위에 미치는 영향*

This study was conducted to investigate the effect of moral sensitivity and moral distress on the caring behavior of neonatal and pediatric intensive care unit nurses. A survey was conducted on 121 nurses working in the neonatal and pediatric intensive care units of five general hospitals in two regions of South Korea. The study found significant differences in moral sensitivity (p =.002), moral distress (p =.001), and caring behavior (p =.013) according to age. There were also significant differences according to career, marriage, and experience in ethics education. A multiple regression analysis confirmed that moral sensitivity (p &lt;.001) and moral distress (p =.027) had a significant effect on caring behavior, accounting for 22.5% and 10.3% of the observed data, respectively. The results of this study may help to identify ways of improving the caring behavior of nurses working in neonatal and pediatric intensive care units.