Collaborative development of a patient simulator for educating nurses in hemofiltration therapies.

As the complexity and variety of the treatment modalities in critical care continue to expand, the clinician is faced with the task of providing a safe environment for the education of staff and the evaluation of these new modalities. The use of simulators, similar to the one described in this article, is one economical solution that can provide this education and evaluation. For instance, the major components of the hemofiltration simulator can be fabricated and purchased for under $1,000. This estimate excludes the medical cart, which retails for $437. The success of such a solution, however, necessitates that the simulator meet the defined clinical needs while meeting or exceeding the biomedical equipment standards set by AAMI or other regulatory agencies that might govern the use of such devices.

Immunosuppression in pediatric critical care patients.

The pediatric critical care patient not only ranges in age, size, diagnosis, and outcome but also in immunologic capability and function. The neonate, once thought to be devoid of any immunological function, is relatively immunocompetent in some areas and immature in immunologic function in other areas. The newborn's impaired immune function is a reflection of immature and inexperienced cellular interrelations rather than the absence or immature function of a single cell line. The exact time that an infant/young child's immune system becomes mature is not definitive. The maturational process of the immune system is complex and unpredictably long. Although some components of a mature immune function occur quickly following birth (for example, colonization and secretory functions of the skin and mucous membranes), other components may take years and occur sometime before the child reaches puberty (for example, adult levels of IgG, IgD, IgA, and IgE). The critically ill infant and child have both developmental aspects of immunocompromise but also the PICU situational or clinical stressors that may impede immune function. The long-term impact of the situational stressors on the development of immune system is unknown. The PICU nurse should recognize that the critically ill child is vulnerable to immunocompromise, and provide assessment and intervention to provide optimal immune function by preventing infection and promoting host defenses.

Pediatric/neonatal graduate nurse internship: a collaborative effort.

An internship was developed as a single unit program to prepare graduate nurses to function competently and confidently in the Pediatric Intensive Care Unit (PICU). An analysis of resources, common goals, and philosophies subsequently led to the development of a collaborative internship program between the Pediatric and Neonatal Intensive Care Units. This innovative approach enhanced the internship program and met the mutual goals of each nursing unit.