Pediatric Intensive Care Unit Nurses Research Articles

Harnessing implementation science to optimize harm prevention in critically ill children: A pilot study of bedside nurse CLABSI bundle performance in the pediatric intensive care unit

Central-line associated bloodstream infection (CLABSI) is associated with increased mortality, morbidity, and cost in hospitalized children. An evidence-based bundle of care can decrease CLABSI, but bundle compliance is imperfect. We explored factors impacting bundle performance in the pediatric intensive care unit (PICU) by bedside nurses. Single-center cross-sectional electronic survey of PICU bedside nurses in an academic tertiary care center; using the COM-B (capability, opportunity, motivation) and TDF (theoretical domains framework) behavioral models to explore CLABSI bundle performance and identify barriers to compliance. We analyzed 160 completed surveys from 226 nurses (71% response rate). CLABSI knowledge was strong (capability). However, challenges related to opportunity were identified: 71% reported that patient care requirements impact bundle completion; 32% described the bundle as stressful; and CLABSI was viewed as the most difficult of all bundles. Seventy-five percent reported being highly impacted by physician attitude toward the CLABSI bundle (motivation). PICU nurses are knowledgeable and motivated to prevent CLABSI, but face challenges from competing clinical tasks, limited resources, and complex family interactions. Physician engagement was specifically noted to impact nurse motivation to complete the bundle. Interventions that address these challenges may improve bundle performance and prevent CLABSI in critically ill children.

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 …

Clinical Pearls

Critical care nurses routinely provide end-of-life (EOL) care for patients and their families. Research in the late 1990s identified various obstacles that hindered nurses’ ability to deliver high-quality EOL care. However, it is unknown if progress has been made since that time.Beckstrand and colleagues surveyed critical care nurses to identify the current obstacles and helpful behaviors related to EOL care and compared them with the 1999 survey data. They foundThe authors recommend that nurses take the lead for improved EOL education with the general public. In addition, focused education for nurses can improve communication with and quality of care for families facing EOL.See Article, pp e81-e91Patients have traditionally received nothing by mouth (nil per os [NPO]) after surgery to prevent adverse outcomes such as nausea, vomiting, dysphagia, and aspiration pneumonia. However, oral hydration protocols vary widely among providers, with some causing patients further distress.Ford and colleagues examined the effects of early oral hydration on adverse events in adult patients after cardiac surgery and foundThis comprehensive early oral hydration protocol was easy for nurses to use and safely decreased patients’ thirst during the postoperative recovery period.See Article, pp 292-300Critically ill patients are at risk for delirium, with prevalence rates from 60% to 87%. Longer duration and greater severity of delirium have been associated with higher 1-year morbidity and mortality; however, it is unknown if these associations continue up to 2 years after discharge.Andrews and colleagues used the Confusion Assessment Method for the Intensive Care Unit-7 to measure delirium severity and found the following:Although findings support the association between delirium and higher 2-year posthospital mortality, the authors recommend future research to explore the relationship between delirium and utilization of other types of health care services and other clinical outcomes.See Article, pp 311-317Compassion fatigue is a syndrome of chronic distress that occurs in up to 40% of critical care health care providers. Nurses who work in a pediatric intensive care unit (PICU) have high rates of burnout and secondary traumatic stress, which can result from low compassion satisfaction. Although PICU nurses face high exposure to patient death, it is not known if this influences their compassion satisfaction.Richardson and colleagues surveyed PICU and neonatal intensive care unit nurses and foundAlthough further research is needed, the authors recommend that health care organizations provide education to best support nurses at risk for compassion fatigue.See Article, pp 285-291

Using Simulation With Deliberate Practice to Improve Pediatric ICU Nurses' Knowledge, Clinical Teamwork, and Confidence

PurposeThe purpose of this quality improvement project was to implement an educational intervention involving High-Fidelity Simulation (HFS) with deliberate practice for low-frequency, high-impact events in a Pediatric Intensive Care Unit (PICU), with the goal of improving nurses' crisis management skills. Design and methodsFour interprofessional simulation education sessions with scenarios were created for this project. A list of knowledge and skills points was used to guide debriefings. All scenarios were based on low-frequency, high-impact events that required the use of Pediatric Advanced Life Support algorithms. Participants included 24 PICU nurses with less than two years of nursing experience. Knowledge and confidence were measured at three timepoints: pre-simulation, one-week post-simulation, and one-month post-simulation series. Clinical teamwork performance was measured twice, during the first and second scenario of each simulation session. ResultsScores for knowledge, confidence, and clinical teamwork performance improved from pre- to post-simulation, with confidence scores showing the largest increase. ConclusionsRegular simulation training with deliberate practice can improve PICU nurses' knowledge, clinical teamwork skills, and confidence when managing low-frequency, high-impact events. Practice implicationsRegular in-situ simulation training with deliberate practice can improve nursing comfort with managing high-impact, low-frequency events in the PICU. This could lead to improved management of actual events, especially for novice nurses with less than one year of PICU experience.

A hermeneutic-phenomenological study of paediatric intensive care unit nurses' professional identity following hospital redesign: Lessons learned for managers.

To provide insights for health care managers by exploring paediatric intensive care unit nurses' lived experience of professional identity in the context of organisational change. While professional identity improves retention of nurses and provision of quality care, outcomes of importance for managers, organisational change perturbs this identity. The study used a hermeneutic-phenomenological design. Data were collected via individual interviews, photographs, participant observation and document review. A purposive sampling strategy was used to recruit paediatric intensive care unit nurses (n=15) in a large Canadian paediatric hospital. Nurses' critical care identity eroded in this organisation due to the interplay between hospital redesign and new eligibility criteria for patient admissions. Interactions between multiple projects and the unit context, as well as nursing professional identity, need to be considered early on during project planning. This study fills an important gap in research concerning the management challenges brought about by the intersection of multiple changes. The results from this study bring to light three important lessons for nurse managers: 1) the specific unit context should be evaluated before a project is initiated; 2) the physical environment needs to be considered when determining staffing requirements; and 3) identity transitions need to be managed.

The investigation and influencing factors analysis of analgesia and sedation nursing behavior of pediatric intensive care unit nurses in Northeast China and Inner Mongolia

Objective Based on a cross-sectional survey about the status of analgesia and sedation nursing behavior of PICU nurses in Northeast China and Inner Mongolia, to analyze the influencing factors and to provide reference for further constructing standardized training programs and developing standardized for analgesia and sedation nursing process. Methods The self-designed questionnaire was made for investigation from 435 PICU nurses in 18 hospitals in Northeast China and Inner Mongolia. Results The average questionnaire score of the analgesia and sedation nursing behavior of PICU nurses was(70.54±13.63)in Northeast China and Inner Mongolia.The behavioral scores were different in each group between different age, nursing age, PICU nursing age, educational background, professional title, and whether was the intensive care unit nurse, whether trained in analgesia and sedation, whether have experience in caring children with analgesia and sedation, and the differences were all statistically significant(P<0.05). The main factors influencing the analgesia and sedation behavior of PICU nurses were whether have received training in analgesia and sedation, whether have experience in caring children with analgesia and sedation treatment and their attitude score to analgesia and sedation. Conclusion There is still much space for development in analgesia and sedation nursing behavior of PICU nurses in Northeast China and Inner Mongolia.The more analgesia and sedation training PICU nurses take participate in, the more experience and positive attitudes they have in nursing children with analgesia and sedation, their clinical nursing practice ability could become more stronger. Key words: Pediatric intensive care unit; Nurse; Analgesia and sedation; Nursing behavior; Influence factors

Characteristics of a Brisk or Sluggish Pupillary Light Reflex: A Nursing Perspective.

Pupillary light reflex (PLR) has traditionally been assessed using a pen torch (light). Although the terms "brisk" or "sluggish" are often used, it is unclear what characteristics of the PLR result in this description. More recently, automated infrared pupillometry has enabled us to quantify the different components of a PLR. We conducted a 2-part questionnaire survey of pediatric intensive care unit (PICU) nurses. In part 1, nurses were requested to describe the key characteristics that they associate with a brisk or sluggish PLR in free-text responses. In part 2, after an introduction to pupillometry and the different components of a PLR, nurses were asked to rank the relative importance of latency (time taken for pupil to start reacting to light), percentage change (in pupil size after light stimulus), and constriction velocity (rate of constriction after light stimulus) in relation to a pupil being described as "brisk" and "sluggish. Fifty nurses responded. In part 1, "Quick" was the commonest term used (36% of respondents) to describe a brisk PLR, and 72% used "slow" for a sluggish PLR. Most descriptions most closely mapped to features of latency and/or constriction velocity. In part 2, latency was ranked the most important component on pupillometry for describing brisk (32%) and sluggish (34%) PLRs. Constriction velocity was ranked as the most important by 18% (brisk) and 20% (sluggish), whereas 44% (brisk) and 46% (sluggish) ranked percentage change behind the other 2 characteristics. Latency, followed by the constriction velocity, was felt by PICU nurses to be the most important characteristic of the PLR that results in terms "brisk" or "sluggish" being used at the bedside to describe a PLR. We plan to compare these subjective opinions with objective findings from pupillometry.

EFFECT OF SIMULATION-BASED SUCTION EDUCATION ON THE KNOWLEDGE AND PERFORMANCE OF PEDIATRIC INTENSIVE CARE UNIT NURSES

Introduction: Nursing interventions have a direct effect on the health and clinical improvement of children. Therefore, nurses should be aware of the risks of endotracheal suctioning and receive continuous education in this field. The present study aimed to investigate the effect of simulation-based suction education on knowledge and performance of pediatric intensive care unit nurses. Methods: In a quasi-experimental study between 2019 and 2020, 33 nurses working in pediatric and neonatal intensive care units were selected as availability samples. First, nurses' performance in suctioning was evaluated by a standard checklist, then, suction education was performed by simulation method. Six months after the education, nurses' performance in standard suctioning was re-evaluated and analyzed by SPSS 22 software. Results: The mean score of knowledge and performance after the education (43.99 ± 6.03) was significantly different from before the education (5.58 ± 5.3) (P

Capturing Lived Experience: Methodological Considerations for Interpretive Phenomenological Inquiry

Interpretive phenomenology presents a unique methodology for inquiring into lived experience, yet few scholarly articles provide methodological guidelines for researchers, and many studies lack coherence with the methodology’s philosophical foundations. This article contributes to filling these gaps in qualitative research by examining the following question: What are the key methodological and philosophical considerations of leading an interpretive phenomenological study? An exploration of interpretive phenomenology’s foundations, including Heideggerian philosophy and Benner’s applications in health care, will show how the philosophical tradition can guide research methodology. The interpretive phenomenological concepts of Dasein, lived experience, existentialia, authenticity are at the core of the discussion while relevant methodological concerns include research paradigm, researcher’s stance, objective and research question, sampling and recruitment, data collection, and data analysis. A study of pediatric intensive care unit nurses’ lived experience of a major hospital transformation project will illustrate these research considerations. This methodological article is innovative in that it explicitly describes the ties between the operational elements of an interpretive phenomenological study and the philosophical tradition. This endeavor is particularly warranted, as the essence of phenomenology is to bring to light what is taken for granted, and yet phenomenological research paradoxically makes frequent assumptions concerning the philosophical underpinnings.

Association Between Mobile Telephone Interruptions and Medication Administration Errors in a Pediatric Intensive Care Unit

Incoming text messages and calls on nurses' mobile telephones may interrupt medication administration, but whether such interruptions are associated with errors has not been established. To assess whether a temporal association exists between mobile telephone interruptions and subsequent errors by pediatric intensive care unit (PICU) nurses during medication administration. A retrospective cohort study was performed using telecommunications and electronic health record data from a PICU in a children's hospital. Data were collected from August 1, 2016, through September 30, 2017. Participants included 257 nurses and the 3308 patients to whom they administered medications. Primary exposures were incoming telephone calls and text messages received on the institutional mobile telephone assigned to the nurse in the 10 minutes leading up to a medication administration attempt. Secondary exposures were the nurse's PICU experience, work shift (day vs night), nurse to patient ratio, and level of patient care required. Primary outcome, errors during medication administration, was a composite of reported medication administration errors and bar code medication administration error alerts generated when nurses attempted to give medications without active orders for the patient whose bar code they scanned. Participants included 257 nurses, of whom 168 (65.4%) had 6 months or more of PICU experience; and 3308 patients, of whom 1839 (55.6%) were male, 1539 (46.5%) were white, and 2880 (87.1%) were non-Hispanic. The overall rate of errors during 238 540 medication administration attempts was 3.1% (95% CI, 3.0%-3.3%) when nurses were uninterrupted by incoming telephone calls and 3.7% (95% CI, 3.4%-4.0%) when they were interrupted by such calls. During day shift, the odds ratios (ORs) for error when interrupted by calls (compared with uninterrupted) were 1.02 (95% CI, 0.92-1.13; P = .73) among nurses with 6 months or more of PICU experience and 1.22 (95% CI, 1.00-1.47; P = .046) among nurses with less than 6 months of experience. During night shift, the ORs for error when interrupted by calls were 1.35 (95% CI, 1.16-1.57; P < .001) among nurses with 6 months or more of PICU experience and 1.53 (95% CI, 1.16-2.03; P = .003) among nurses with less than 6 months of experience. Nurses administering medications to 1 or more patients receiving mechanical ventilation and arterial catheterization while caring for at least 1 other patient had an increased risk of error (OR, 1.21; 95% CI, 1.03-1.42; P = .02). Incoming text messages were not associated with error (OR, 0.97; 95% CI, 0.92-1.02; P = .22). This study's findings suggest that incoming telephone call interruptions may be temporally associated with medication administration errors among PICU nurses. Risk of error varied by shift, experience, nurse to patient ratio, and level of patient care required.

When the paediatric intensive care unit becomes home: A hermeneutic-phenomenological study.

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

Interobserver Agreement on Clinical Judgment of Work of Breathing in Spontaneously Breathing Children in the Pediatric Intensive Care Unit.

Clinical assessment of the work of breathing (WOB) remains a cornerstone in respiratory support decision-making in the pediatric intensive care unit (PICU). In this study, we determined the interobserver agreement of 30 observers (PICU physicians and nurses) on WOB and multiple signs of effort of breathing in 10 spontaneously breathing children admitted to the PICU. By reliability analysis, the agreement on overall WOB was poor to moderate, and only three separate signs of effort of breathing (breathing rate, stridor, and grunting) showed moderate-to-good interobserver reliability. We conclude that the interobserver agreement on the clinical WOB judgment among PICU physicians and nurses is low.

The sedation practices of paediatric intensive care unit nurses and the influencing factors in China.

Nurses play a key role in administering sedation to mechanically ventilated children, which impacts children's psychological, physiological and cognitive changes in the paediatric intensive care unit. This study aimed to survey the sedation practices of paediatric intensive care unit nurses on mechanically ventilated children in China and explored the influencing factors. A cross-sectional survey was conducted based on electronic questionnaires comprised of the Nurse Sedation Practices Scale (Chinese version) in 14 different types of paediatric intensive care units of 11 academic hospitals in China from 15 February to 15 April 2017. A convenience sample of 495 nurses [73·4% response rate, (674)] completed the survey. Seven units applied Ramsay Sedation Scale as a sedative assessment tool. The majority of the nurses used observed behaviours and physiological changes of the ventilated children as indicators to assess the sedation level, and they had a positive attitude and intention, which may influence practice positively, whereas high clinical workload and the lack of communication between the nurses and families might hinder practice. The practice of sedation varied greatly in different regions, and the respondents of the northwest region scored lower. Paediatric nurses in China rarely used a validated paediatric instrument to assess sedation, and most nurses relied on physiological and behavioural cues. The quality of sedation training, nursing workload and regional economic disparity affected the sedation practice. The restricted visiting policy and lack of clearly defined nursing responsibilities around sedation may hinder effective sedation assessment and management. This study found that there was no paediatric-validated tool popularized in paediatric intensive care units in China and explored influencing factors. We suggest that a validated tool, high-quality training and hospital's policy, such as visiting regulation, should be promoted to improve the sedation practice.

001–Understanding Stress of Inpatient Nurses Caring for Pediatric Diabetes Patients

Background: With the opening of an outpatient Pediatric Diabetes Center, patients with diabetes were more often being admitted. In order to focus inpatient nurse education, we wanted to understand their level of comfort with diabetes management. Aims: This Quality Improvement (QI) project’s goal was to understand and reduce the stress levels of inpatient nurses caring for pediatric diabetes patients by assessing stress and providing educational in-services over 12 months. Methods: The diabetes team provided in-services for pediatric medical (PM) and intensive care unit (PICU) nurses. Pre-education, nurses reported stress related to each diabetes topic using a stress thermometer (stress assessing tool, 0=mild, 10=severe). Education included: pathophysiology, meters, injections, insulin pens, vial/syringe, hyperglycemia, ketones, hypoglycemia, carbohydrate counting, calculating insulin doses, technology, and overall management. Nurses were also administered a stress thermometer post-education. Results: Aspects of diabetes care most stressful were identified. For PM nurses, average stress scores decreased from pre to post education for the topics that had the highest stress: technology (4.7 vs. 3.9), pathophysiology (4.0 vs. 2.7), and carbohydrate counting (3.9 vs. 3.4). For PICU nurses, average stress scores decreased from pre to post education for: pathophysiology (5.5 vs. 2.7), meters (4.2 vs. 2.2), hyperglycemia (4.0 vs. 2.8), and hypoglycemia (4.0 vs.1.4). However, the average stress score increased for PICU nurses from pre to post education for the topic of carbohydrate counting (4.0 vs. 4.7). Conclusions: Post-education, nurses’ average stress mostly decreased however the most stressful topics differed between PM and PICU nurses. Also, the stress level increased for one of the topics for the PICU nurses. This may indicate many were not aware of the magnitude of knowledge needed or education provided was not suited for them. These findings furthermore suggest it is necessary to develop educational tools targeted to the type of care delivered on the unit. Clinical Implications: Diabetes management requires in-depth education. The stress thermometer is a useful tool to evaluate nurses’ stress levels and understand where to focus education.

Identification of Low Cardiac Output Syndrome at the Bedside: A Pediatric Cardiac Intensive Care Unit Survey

Low cardiac output syndrome is a transient constellation of signs and symptoms that indicate the heart's inability to supply sufficient oxygen to tissues and end-organs to meet metabolic demand. Because the term lacks a standard clinical definition, the bedside diagnosis of this syndrome can be difficult. To evaluate concordance among pediatric cardiac intensive care unit nurses in their identification of low cardiac output syndrome in pediatric patients after cardiac surgery. An anonymous survey was distributed to 69 pediatric cardiac intensive care unit nurses. The survey described 10 randomly selected patients aged 6 months or younger who had undergone corrective or palliative cardiac surgery at a freestanding children's hospital in a tertiary academic center. For each patient, data were presented corresponding to 5 time points (0, 6, 12, 18, and 24 hours postoperatively). The respondent was asked to indicate whether the patient had low cardiac output syndrome (yes or no) at each time point on the basis of the data presented. The response rate was 46% (32 of 69 nurses). The overall Fleiss k value was 0.30, indicating fair agreement among raters. When the results were analyzed by years of experience, agreement remained only slight to fair. Regardless of years of experience, nurses have difficulty agreeing on the presence of low cardiac output syndrome. Further research is needed to determine whether the development of objective guidelines could improve recognition and facilitate communication between the pediatric cardiac intensive care unit nurse and the medical team.

(116) Pain Assessment in the Pediatric Intensive Care Unit: FLACC in Action

Pain assessment in the pediatric intensive care unit (PICU) is complex, as the patient population is diverse in age, cognitive development, and acuity. Appropriate use of pain assessment instruments is vital for clinicians to identify patients experiencing pain and to evaluate the effectiveness of interventions provided. The Face, Legs, Activity, Cry, and Consolability (FLACC) pain scale is commonly used in North American PICUs to assess pain in patients who are unable to provide self-report. However, clinical application of the FLACC has not been studied in this setting. The purpose of this study was to examine use of the FLACC in a cohort of PICU patients. Data was extracted from electronic health records between September 1, 2013 and August 31, 2014. In that time, nurses assessed 708 patients 7,972 times using the FLACC scale. Assessments were complete (a value entered for all five components) for 2,703 (34%) of the assessments in 540 (76%) children. The Cry component was most often missing (3,456 assessments, 43%), followed by Legs (2,714 assessments, 34%) and Activity (2,703 assessments, 34%). Of the completed scores (range 0-10), a total score of 0 was most frequent (1,413 assessments, 52%), followed by scores of 5 (581 assessments, 21%) and 10 (167 assessments, 6%). All components had similar mean scores. A high proportion of incomplete components and patterns in scoring (all 0, all 1, all 2) brings to question the clinical utility of the FLACC in PICU. However, the use of retrospective data limits our ability to interpret findings. Nurses may use FLACC to guide pain assessment, but fail to complete documentation, or they may be systematically avoiding completion of components that cannot be assessed in some patients. More research is needed to determine how PICU nurses score and use FLACC scores to inform pain management.

Delirium Knowledge, Self-Confidence, and Attitude in Pediatric Intensive Care Nurses

PurposeA diagnosis of delirium places a critically ill child at risk of increased morbidity/mortality. Although delirium is common in critically ill children, only 2% of pediatric intensive care units (PICU) screen for delirium. The impediments to screening include knowledge deficits regarding delirium and delirium screening tools. The purpose of this improvement science project was two-fold. The first was to implement delirium screening in a PICU. The second was to evaluate the impact of multifaceted education on PICU nurses' delirium knowledge, self-confidence and attitude towards delirium. Design & methodA series of three plan-do-study-act cycles (PDSA) were used to implement this practice change. Multifaceted education was provided during the PDSA cycles. Two questionnaires were used to assess for changes in delirium knowledge, self-confidence and attitude towards delirium among PICU nurses. Analysis of variance (ANOVA) was used for data analysis. ResultsForty-two PICU nurses completed a questionnaire measuring delirium knowledge, self-confidence, and attitude during each PDSA cycle. A significant increase in delirium knowledge, self-confidence, and attitude towards delirium was found after education (p = .003; p < .001; p = .036) and 3 months post implementation of delirium screening (p = .023; p < .001; p = .027) as compared to pre-education. Conclusion & practice implicationsMultifaceted education is a successful tool in improving nurses' knowledge, self-confidence and attitude regarding delirium. The use of PDSA cycles is a practical systematic method to improve quality of care. Improving knowledge, self-confidence and attitude have the potential to mitigate adverse effects of delirium in the critically ill child.

What Are You Doing to My Child? A Novel Approach to Family Teaching in the Pediatric Intensive Care Unit.

What Are You Doing to My Child? A Novel Approach to Family Teaching in the Pediatric Intensive Care Unit.

NUTRI-REAPED study: nutritional assessment of French critically ill children and nutrition practice survey in French-speaking pediatric intensive care units

BackgroundImpaired nutritional status is adversely associated with suboptimal outcomes in critically ill children. Undernutrition at pediatric intensive care unit (PICU) admission ranges from 15 to 65%. A lack of knowledge of the nutritional status of children in French PICUs prevents us from specifically targeting education. This study aims to describe the nutritional status of children in French PICUs and to assess nutritional practices and physicians’ knowledge of nutrition, in order to focus NutriSIP (the French-speaking PICU nutrition group) future education programs. A prospective observational multicenter point prevalence study was conducted in French PICUs, recruiting all children admitted over three different weeks. Anthropometric measurements were taken (weight, height/length, mid-upper arm, and head circumferences), in order to calculate nutritional indices. Nutritional status was defined according to WHO Body Mass Index z-score and dynamic assessment based on growth faltering detection. Concurrently, PICU physicians and PICU nurses from seven French-speaking countries completed a survey to ascertain knowledge about local nutritional care practices and overall nutrition knowledge. PICU physicians’ responses were compared to PICU nurses’ responses (previously published).ResultsFour hundred and thirty-two children were included in the observational study from 27 French PICUs. Undernutrition was diagnosed in 18.5% of them, young age and underlying chronic condition being the two independent risk factors. Faltering growth was diagnosed in 4.8% and overweight in 7.4%. Subjective nutritional assessment was not accurate. Thirty-eight French-speaking PICUs completed the survey. These showed nutritional practices frequently did not comply with international guidelines, especially regarding nutritional goals, and the reasons for withholding enteral nutrition. Comparison between physicians’ and nurses’ responses to the survey showed large discrepancies.ConclusionUndernutrition is frequent at admission in French PICUs. Nutritional status should be assessed using a holistic approach, because of the potential impact on outcome. French-speaking PICU healthcare professionals need further nutrition education, in order to improve nutritional practices to comply with international recommendations. This study will serve as a baseline to focus NutriSIP teaching programs in the future.

Impact of an education program on the performance of nurses in providing oral care for mechanically ventilated children

BackgroundMechanically ventilated children are prone to pneumonia due to immobilization and lack of laryngeal (cough) reflex and swallowing. Nurses are directly responsible for many clinical approaches used to prevent ventilator-associated pneumonia. ObjectiveThe research objective is to determine the effectiveness of the nurse education program on the performance of nurses in providing oral care for mechanically ventilated children. MethodsThis quasi-experimental pretest-posttest design was conducted on 100 nurses (50 in each of the control and intervention groups) in pediatric intensive care units (PICU) in Tehran, 2015. The research tools included a demographic form and three checklists for evaluation of performance according to the clinical practice guidelines for the oral health status of children in PICU. Before intervention, the performance of nurses in both groups was observed at three stages and three different shifts, using an observational checklist. After one month, their performance was observed again with the same checklist at three stages and three different shifts in the PICU. The training was done in four 40-50 minute sessions in a workshop with a 4-week follow-up. The Chi-square test, Fisher’s exact test, paired t-test, independent t-test, and regression analysis comprised the tools used to analyze the data. FindingsThe mean performance scores of nurses before the education program in the intervention and control groups were 42.8 (±18.5) and 48.7 (±15.7), respectively. These scores improved to 68.6 (±31.4) and 48.6 (±15.4) four weeks after the intervention (p < 0.001). ConclusionThe performance of nurses in providing oral care for mechanically ventilated children improved after the intervention. It is recommended to implement this program for all nurses, regardless of their ward or specialty, based on the clinical practice guidelines. The periodic refreshing in-service training program should be provided to nurses in PICU in order to enhance their performance in providing oral care.