Pediatric Murmurs.

Many healthy children may be found to have a murmur on physical exam. Whether this murmur is discovered at a routine health maintenance visit or as a result of a focused exam on a child with illness, it is just one finding and must be considered in the context of the child's history and other physical exam findings. Murmurs associated with heart defect or dysfunction occur most often in infancy. Most murmurs discovered in children, especially after infancy, between ages 3 to 6 and in young-adulthood, are innocent or benign murmurs and less likely a symptom of cardiac dysfunction or defect.

Implementing IPASS Handoff to Improve Patient Safety in Pediatric Critical Care Transport.

INTRODUCTION: The aim of this study was to implement a standardized, hospital-based bedside handoff report (IPASS [Illness severity, Patient summary, Action items, Situational awareness, and Synthesis]) in prehospital pediatric critical care transport to increase patient safety by eliminating the risk of misreporting or omitting critical patient care information received before arrival at a tertiary care center. The setting for this project was a level 1 pediatric trauma center in the Southern United States. METHODS: Pre- and postsurveys were used to assess staff perception of clinical handoff comprehensiveness and satisfaction with the use of a standardized IPASS handoff tool. RESULTS: Improvement was identified in 6 of 8 survey items. Team members were better able to hear all the information provided in the handoff, the format was functional, and physical transfers of patients from the transport team to the ED went more smoothly. Overall, satisfaction of the handoff process increased by 80%. CONCLUSION: Many factors contribute to patient safety events and errors in health care, with communication failures contributing to the majority. Overall, findings support the use of standardized IPASS handoffs in pediatric critical care transport to promote patient safety, increase comprehension of patient information, and increase staff satisfaction.

Extending the radius of family-centered care in the pediatric cardiac intensive care unit through virtual rounding.

BACKGROUND: The arrival of COVID-19 brought urgent limitation of visitation in hospitals across the country. Family-centered care and its delivery rapidly changed and left the family behind-unable to actively participate in their loved one's care. LOCAL PROBLEM: A southeastern academic medical center pediatric cardiac intensive care unit (PCICU) needed to augment family-centered medical rounds when parents could not be at the bedside. No alternative to physical presence for daily medical rounds existed in the PCICU. METHODS: A virtual rounding (VR) program was implemented allowing parents of patients admitted to PCICU to join medical rounds remotely through teleconferencing. Preintervention and postintervention rounding times, staff perceptions of the program, and parental satisfaction scores using the Pediatric Family Satisfaction in the Intensive Care Unit (pFS-ICU) tool were measured. INTERVENTIONS: This quality improvement project implemented a VR program offered to all families of patients in the PCICU. RESULTS: VR did not increase rounding times after implementation (p = .673). Staff satisfaction surveys revealed that staff felt the VR program did not prolong rounding times (p ≤ 0.001), workload impact perceptions improved after intervention (p = <0.001), and staff felt VR should be offered to families in PCICU (p ≤ 0.001). Only nine pFS-ICU surveys were completed giving the family a limited voice in the evaluation of this project. CONCLUSIONS: This project demonstrates that VR can be successfully implemented for family engagement without increased burden on staff.

Embracing Disruption: Measuring Effectiveness of Virtual Simulations in Advanced Practice Nurse Curriculum.

Changes in academia have occurred quickly in response to the COVID-19 pandemic. In-person simulation-based education has been adapted into a virtual format to meet course learning objectives. The methods and procedures leveraged to onboard faculty, staff, and graduate nurse practitioner students to virtual simulation-based education while ensuring simulation best practice standards and obtaining evaluation data using the Simulation Effectiveness Tool-Modified (SET-M) tool are described in this article.

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

PURPOSE: The 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 METHODS: Four 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. RESULTS: Scores for knowledge, confidence, and clinical teamwork performance improved from pre- to post-simulation, with confidence scores showing the largest increase. CONCLUSIONS: Regular simulation training with deliberate practice can improve PICU nurses' knowledge, clinical teamwork skills, and confidence when managing low-frequency, high-impact events. PRACTICE IMPLICATIONS: Regular 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.

Usability Assessment of an Electronic Handoff Tool to Facilitate and Improve Postoperative Communication Between Anesthesia and Intensive Care Unit Staff.

The handoff or handover is the exchange of pertinent medical information from one provider to another. Inadequate handoff communication between healthcare providers can negatively impact patient outcomes. In an effort to improve handoff communication, many studies have developed and evaluated the use of a handoff tool such as a handoff checklist or handoff form to facilitate handoff communication. Recently, the use of the IPASS handoff form, based on the mnemonic for the process, has been associated with a reduction in the rate of adverse events and improvement in information transfer and nurse satisfaction. This quality improvement project adapted the IPASS handoff form for postoperative use in an iterative approach over a series of four phases: (1) requirements/information gathering, (2) adaptation/development, (3) evaluation and modification, and (4) usability testing. Results of this project show that participants viewed the postoperative IPASS handoff form to be easy to use (87.5%), satisfactory (75.0%), and user-friendly (75.0%), which can facilitate its widespread adoption. The key feature identified in making the handoff form user-friendly was its customization feature, which allowed the handoff report to be shortened or expanded to meet the provider- or unit-specific needs.

Top Ten Tips Palliative Care Clinicians Should Know About Caring for Children in Neonatal and Pediatric Intensive Care Units.

Over the past several years, pediatric critical care units increasingly count on the expert advisement of palliative care specialists. Given the limited availability of pediatric palliative care specialists, all palliative care clinicians may be required to care for pediatric patients and their families. Special considerations in caring for these patients include the relative importance of prognosis, involvement of child life, music and pet therapy, incorporation of parents in end-of-life rituals, care for siblings, use of medical technology, and prolonged duration of stay. The following top 10 tips provide recommendations for caring for seriously ill infants, children, adolescents, and the families of these critically ill pediatric patients. They are written by pediatric intensive care providers to address common issues around palliative care in intensive care units.

Structured Documentation of Home Ventilator Settings in Children: A Quality Improvement Project.

INTRODUCTION: In children requiring long-term mechanical ventilation (LTMV), insufficient admission charting can lead to adverse events. Our purpose in this study was to create and evaluate a structured documentation tool of home LTMV settings to improve communication, documentation, and patient safety. METHOD: This study used a pretest-posttest survey of pulmonary unit nurses' satisfaction with the tool and perceptions of patient safety, chart reviews of documentation compliance, and reports of education session attendance. Mann-Whitney U and Fisher exact tests, category analyses, and descriptive statistics were applied. RESULTS: Nurses' reports of positive communication of LTMV settings increased from 54.5% to 100% (p = .002), overall satisfaction with associated documentation increased (p < .001), and witnessed related adverse events decreased from 50% to 18.75%. Nurse compliance for education attendance and documentation was 97.4% and 97.3%, respectively. DISCUSSION: Structured admission charting of LTMV settings should be continued and yielded improvements in pulmonary unit nurses' perceptions of communication, patient safety, and documentation compliance.

Integrating Telepresence Robots Into Nursing Simulation.

This article provides an overview of the use of telepresence robots in clinical practice and describes an evaluation of an educational project in which distance-based nurse practitioner students used telepresence robots in clinical simulations with on-campus Accelerated Bachelor of Science in Nursing students. The results of this project suggest that the incorporation of telepresence in simulation is an effective method to promote engagement, satisfaction, and self-confidence in learning.

An Innovative Use of Telepresence Robots for Educating Healthcare Professional.

Telehealth enhances communication across distances, facilitates teamwork, and increases access to care, particularly in rural areas. As the use of telehealth technology assimilates into clinical practice, its integration is also needed in clinical curricula. Students participated in 2 pediatric scenarios in teams of 3 to 4 prelicensure nursing students, with one nurse practitioner student participating via a telepresence robot. Forty-eight prelicensure and 5 nurse practitioner students completed surveys following the clinical simulations. We found that it was feasible to use a telepresence robot as a tool in clinical simulation, to introduce telehealth, and students reported high mean scores on the acceptability of using the robot. While there are challenges, incorporating telepresence technology into simulations opens up many opportunities to both engage students in telehealth with patients and other clinicians, and to engage students in their education when they are learning at a distance.

Writing Across the Curriculum: Strategies to Improve the Writing Skills of Nursing Students.

BACKGROUND: Writing across the curriculum (WAC) is a strategy in which writing instruction occurs in classes outside of composition, literature, and other English courses. This literature review was conducted to identify and synthesize the peer-reviewed literature about WAC in nursing education. METHODS: The team performed searches of MEDLINE (PubMed), CINAHL Plus With Full Text, and ERIC for articles published between January 2003 and April 2014. A combination of Medical Subject Heading terms (or equivalent) and keywords were used to create the database search strategies. RESULTS: There were 48 articles that discussed WAC. Most of the papers described writing courses in nursing programs, strategies to teach writing to nursing students, and writing activities or assignments within nursing courses. High-level evidence examining the impact of writing strategies and exercises in courses and occurring across the curriculum was lacking. Only 18 (37.5%) of these papers were evaluative; most of the databased articles were either author observations or perceptions of changes in students' writing ability, or low-level research studies. CONCLUSIONS: Strategies, assignments, and courses intended to promote writing skills of nursing students were documented in this literature review; however, further evaluation is needed to determine which are most effective. Hawks Turner Derouin Hueckel Leonardelli Oermann.

Use of Workshops to Develop Nurses' and Nursing Students' Writing Skills.

Workshops have been described in the literature as a strategy for preparing nurses to publish their work and develop their writing skills. Articles about the use of workshops for these purposes have not been integrated systematically. Seventeen articles were included in the current review. The workshop method has been found to be effective for preparing nurses to write for publication and for improving nurses' and nursing students' writing skills. However, workshops must be combined with one-to-one mentoring and feedback on writing to be successful.

Cultivating a Culture of Medication Safety in Prelicensure Nursing Students.

Safety education in nursing has traditionally focused at the level of individual nurse-patient interactions. Students and novice clinicians lack clinical experience to create context and understand the complexity of the health care system and safety science. Using the Quality and Safety Education for Nurses quality and safety competency as a framework, the objective of this education project was to design comprehensive, engaging, learner-centered, online modules that increase knowledge, skills, and attitudes about medication safety.

Systematic review of educational programs and strategies for developing students' and nurses' writing skills.

The purpose of this article is to describe the outcomes of a systematic review of educational programs and strategies for developing the writing skills of nursing students and nurses. Of 728 screened citations, 80 articles were included in the review. Writing assignments in nursing courses were the most common, followed by strategies for writing across the curriculum and specific courses to improve the writing skills of nursing students. To improve nurses' writing skills, workshops were used most frequently. Only 28 (35%) of the articles were data based, and most articles described the writing program, strategy, or assignment but did not evaluate its effectiveness.

Standardization of health care provider competencies for intrathecal access procedures.

INTRODUCTION: This quality improvement (QI) project addresses a method for experienced health care providers to maintain skill-based competence for intrathecal access procedures. METHODS: A prospective QI design using intrathecal access simulation to assess, educate, and evaluate skill competency. Simulation was used as a strategy to promote patient safety and standardize practice patterns. Pretest and posttest methodology using paired t tests were performed to assess anxiety, confidence, and knowledge. RESULTS: Fourteen pediatric providers participated in this QI project. There was a statistically significant improvement in confidence measuring intracranial pressure (ICP; t = -2.92, P = .013), performance-related overall anxiety (t = -2.132, P = .05) and administering intrathecal chemotherapy (t = -2.144, P = .053). Fifty percent of participants missed a medication error demonstrating confirmation bias. CONCLUSION: This simulation strategy resulted in improved confidence in measuring ICP, performance-related overall anxiety, and confidence in administering chemotherapy. Confirmation bias occurred during simulation testing for a medication error. We propose this method for maintaining clinical competencies in health care providers and introducing new skills to existing practices.

Implementation of the Josie King Care Journal in a pediatric intensive care unit: a quality improvement project.

The Care Journal is a tool developed by the Josie King Foundation to promote interactive exchange among providers and patients/families. The Care Journal was implemented in a pediatric intensive care unit, and surveys were administered to assess perceptions about use. Parents who used the Care Journal and nursing staff found it to be a useful tool that improved communication, made parents feel more knowledgeable and empowered, and improved parents' overall perception of the hospital stay.

Transient myeloproliferative disease: keeping a high index of suspicion.

Transient myeloproliferative disorder (TMD) can be found in well or ill newborns with Down syndrome. Although it is a relatively harmless process for most, in some children, TMD can present as a life-threatening state requiring critical care. As the disease is seemingly uncommon, some providers may lack a sense of urgency in the dissemination of TMD awareness; however, one can never know on whose door this patient may knock tomorrow. Advanced practice professionals should be prepared for the TMD patient that may present without warning. The goals of this article are to discuss common presentations, diagnosis, and management; and to bring attention to this often de-emphasized disease.

Implementation of condition help: family teaching and evaluation of family understanding.

Partnering with families to deliver safe care includes teaching how to activate the rapid response team (RRT) if their hospitalized child's condition worsens. Condition Help (Condition H) is how families call the RRT. Pediatric nurses used scripted Condition H teaching and follow-up surveys to evaluate family understanding about Condition H. Although there were only 2 Condition H calls during the study period, 53% to 90% of families received Condition H teaching, and family understanding was greater than 75%.

Children with new tracheostomies: planning for family education and common impediments to discharge.

OBJECTIVES: To describe an educational program and timeline for the discharge of children with a new tracheostomy and identify common impediments to the education and discharge process. METHODS: Retrospective pilot case series of 70 children and adolescents undergoing tracheostomy placement over a 24-month period in a large urban academic pediatric hospital. RESULTS: Eleven healthcare providers with expertise with technology dependent children identified the eight most common impediments to education and discharge for children with new tracheostomies. Length of stay, impediments to both education and discharge, and medical equipment needed at the time of discharge were extracted from hospital records. Caregivers of children with new tracheostomies needed a median of 14 days (range 5-110 days) to successfully complete a tracheostomy education program. Discharge occurred a median of 6.5 days (range 0-71 days) after education was completed. Common impediments to completing the education program included social issues (e.g., lack of sibling childcare), inter-current illness of the patient and/or language barriers. Impediments to discharge included patient's inter-current illnesses, social issues (e.g., lack of running water) and unavailability of home nursing. Our cohort of patients had a total median length of stay (LOS) of 46 days. At discharge, 55% of children required two or more medical devices (in addition to their tracheostomy) and 61% had some level of dependency on positive pressure ventilation. CONCLUSIONS: Pediatric patients with a new tracheostomy undergo lengthy initial hospitalizations and have complex educational and discharge needs. Multiple factors (both medical and social) can impede the child's transition to the outpatient setting. A structured education and discharge program may result in a shorter LOS for children with new tracheostomies. Impediments to family education and discharge should be anticipated.