Pediatric Resuscitation.

This article describes evidence-based nursing practices for detecting pediatric decompensation and prevention of cardiopulmonary arrest and outlines the process for effective and high-quality pediatric resuscitation and postresuscitation care. Primary concepts include pediatric decompensation signs and symptoms, pediatric resuscitation essential practices, and postresuscitation care, monitoring, and outcomes. Pediatric-specific considerations for family presence during resuscitation, ensuring good outcomes for medically complex children in community settings, and the role of targeted temperature management, continuous electroencephalography, and the use of extracorporeal membrane oxygenation in pediatric resuscitation are also discussed.

Assessing Nursing and Pediatric Resident Understanding of Delirium in the Pediatric Intensive Care Unit.

Delirium is a common disease process in the pediatric critical care unit, yet practices for screening and prevention vary drastically between institutions. The authors hypothesized that surveying pediatric residents and nurses who care for patients in the intensive care setting would expose misunderstandings about delirium. They brought to light common incorrect beliefs that benzodiazepines are appropriate therapy for delirium and that children who are delirious will not have memories of the experience. Many nurses and residents listed that they were not comfortable or were extremely uncomfortable identifying delirious patients. Findings demonstrate an opportunity to improve on nursing and resident knowledge.

Delirium in Children: Identification, Prevention, and Management.

Delirium in children is an often underrecognized but serious complication of hospitalization. Delirium in this age group has been described as behaviors such as refractory agitation and restlessness, visual or auditory hallucinations, children being "not themselves," and a lethargic state. Often, children with delirium are at risk for harming themselves by dislodging tubes, falling, or refusing care. Pediatric nurses must recognize and intervene to prevent and treat delirium in hospitalized children because the delirium may be an indicator of worsening clinical status and is associated with high mortality and morbidity in children of all ages and with posttraumatic stress disorder. Pediatric nurses are uniquely positioned to design care interventions to both reduce risk for delirium and treat active delirium. Many treatment recommendations are nonpharmacological and are part of excellent nursing care.

Caring for Pediatric Patients' Families at the Child's End of Life.

Nurses play an important role in supporting families who are faced with the critical illness and death of their child. Grieving families desire compassionate, sensitive care that respects their wishes and meets their needs. Families often wish to continue relationships and maintain lasting connections with hospital staff following their child's death. A structured bereavement program that supports families both at the end of their child's life and throughout their grief journey can meet this need.

Pediatric brain death: updated guidelines.

Logan, a 5-year-old boy, was riding his bike with his 7-year-old brother when he was struck from behind by a car traveling at approximately 40 mph. The driver indicated that she did not see the riders until she hit Logan, who was not wearing a helmet at the time of the accident. Logan was thrown from his bike and was found at the side of the road, unresponsive and posturing. Although he was uninjured, Logan's brother witnessed the incident.Emergency medical services arrived and placed Logan on a backboard with a c-collar. Because he was not protecting his airway, he was intubated and then given sodium chloride fluids and brought to the pediatric emergency department. Upon arrival, his Glasgow Coma Scale score was 5, and his right pupil was 6 mm and not reactive.Logan's initial head computed tomographic scan showed diffuse brain edema, with early downward transtentorial brain herniation. The pediatric neurosurgeon determined that no operative management was appropriate for Logan. Besides a small laceration on his forehead, Logan had no other injuries. At this time, he was taking a few spontaneous respirations and had occasional posturing of his extremities.

Prevention of central venous catheter-associated bloodstream infections in pediatric intensive care units: a performance improvement collaborative.

OBJECTIVE: The goal of this effort was to reduce central venous catheter (CVC)-associated bloodstream infections (BSIs) in pediatric intensive care unit (ICU) patients by means of a multicenter evidence-based intervention. METHODS: An observational study was conducted in 26 freestanding children's hospitals with pediatric or cardiac ICUs that joined a Child Health Corporation of America collaborative. CVC-associated BSI protocols were implemented using a collaborative process that included catheter insertion and maintenance bundles, daily review of CVC necessity, and daily goals. The primary goal was either a 50% reduction in the CVC-associated BSI rate or a rate of 1.5 CVC-associated BSIs per 1,000 CVC-days in each ICU at the end of a 9-month improvement period. A 12-month sustain period followed the initial improvement period, with the primary goal of maintaining the improvements achieved. RESULTS: The collaborative median CVC-associated BSI rate decreased from 6.3 CVC-associated BSIs per 1,000 CVC-days at the start of the collaborative to 4.3 CVC-associated BSIs per 1,000 CVC-days at the end of the collaborative. Sixty-five percent of all participants documented a decrease in their CVC-associated BSI rate. Sixty-nine CVC-associated BSIs were prevented across all teams, with an estimated cost avoidance of $2.9 million. Hospitals were able to sustain their improvements during a 12-month sustain period and prevent another 198 infections. CONCLUSIONS: We conclude that our collaborative quality improvement project demonstrated that significant reduction in CVC-associated BSI rates and related costs can be realized by means of evidence-based prevention interventions, enhanced communication among caregivers, standardization of CVC insertion and maintenance processes, enhanced measurement, and empowerment of team members to enforce adherence to best practices.

Supporting families of technology-dependent patients hospitalized in a pediatric intensive care unit.

Having a child hospitalized in the PICU is a stressful event and may be even worse for parents when their child is technology dependent. These parents are often experts at knowing their child, are used to being strong caregivers and advocates for their child, and may experience long-term sorrow or grief over their child's lifespan. Although there is little research about effective PICU nursing interventions for this parent group, several suggestions can be inferred. Armed with this knowledge, the PICU nurse can be instrumental in helping these parents decrease their stress and improve coping skills not only for dealing with the child's PICU stay but also for improving their experiences at home.

Implementation of a nursing professional practice model of care in a pediatric hospital.

Professional nursing practice models provide a theoretical and conceptual framework that nurses can use as a foundation for practice. The utilization of a practice model helps establish professional identity and improves quality outcomes. A freestanding children's hospital sought to identify and adopt a professional practice model to optimize outcomes for patients and families, the nursing staff, and the organization. Once a model was selected, two subgroups formed and focused on revising job descriptions and educating the nursing staff. Various strategies were used to implement the model and sustain the culture change. Examples include providing periodic education, incorporating the model into nursing procedures, and assisting nurses in using the model at the bedside. The model of care has been successfully implemented in both the inpatient and outpatient areas of this pediatric hospital.