Hematologic and Oncologic Emergencies in the Pediatric Intensive Care Unit: What Nurses Should Know.

Most children admitted to the pediatric intensive care unit with a new or reoccurring hematology or oncology diagnosis are at high risk for developing a hematologic or oncologic emergency. Although these children represent a low percentage of pediatric critical care admissions, their acuity is high, and their care is complicated and challenging. Nurses are an essential part of the interprofessional team of providers who care for these critically ill patients. Experience recognizing acute decompensation and excellent assessment and communication skills significantly improve patient outcomes.

Overcoming COVID-19 Challenges: Using Remote and Hybrid Simulation Designs in DNP Programs.

Simulation is a critical component of nursing and medical education used to teach skills and assess student performance. In March 2020, faculty members-including the authors-at the Grace Center for Innovation in Nursing Education at the Edson College of Nursing and Health Innovation (Edson College) simulation programs at Arizona State University quickly responded to the crisis presented by COVID-19. Within a few days, all nursing simulations were transitioned from a predominately in-person design to fully online. Maintaining simulation activities throughout the first several months of the pandemic allowed students at Edson College to meet clinical assessment objectives. This transition, implemented in 2 phases, included a detailed plan of action for all Doctor of Nursing Practice (DNP) nurse practitioner objective structured clinical exams (OSCEs). The challenges required innovative planning and flexibility while maintaining the integrity of the OSCE and simulation experience. The methods implemented out of necessity are now an important part of the authors' curricular toolbox, providing options for continued and future educational practice. This paper details the simulations designed and implemented in 2 DNP programs: the family nurse practitioner and acute care pediatric nurse practitioner programs.

The Impact of Provider Education on Pediatric Palliative Care Referral.

INTRODUCTION: Palliative care can significantly benefit children managing a life-limiting illness; unfortunately, services are still generally reserved for end of life. The aim of this project was to demonstrate how established guidelines and provider education could impact referrals. METHODS: Educational sessions outlining national referral recommendations were offered to providers in the neonatal intensive care unit, pediatric intensive care unit, and Center for Cancer and Blood Disorders at a tertiary care facility. Presurveys and postsurveys were administered at the time of the intervention, and referral rates for the organization were collected for 2 months before and 2 months after the intervention. RESULTS: While there was a clinically significant increase in hospital-wide referral rates, most important was the statistically significant (p < .1) increase in provider comfortability with established guidelines. DISCUSSION: Palliative care is essential for optimizing quality of life. Provider knowledge of referral criteria ensures that patients receive this service early in their disease trajectory and can benefit from its inclusion within their care team.

Pediatric Delirium: Early Identification of Barriers to Optimize Success of Screening and Prevention.

INTRODUCTION: Pediatric delirium has a 25% prevalence rate in the pediatric intensive care unit. The purpose of this project was to evaluate the impact/effect of implementing nonpharmacologic nursing bundles on the incidence of pediatric delirium. It is not yet known whether or not bundles consistently reduce the incidence of delirium. METHOD: A nonpharmacologic nursing bundle was implemented for pediatric intensive care unit patients, 2 to 18years of age, admitted to an Arizona metropolitan children's hospital. Data were collected using the Cornell Assessment of Pediatric Delirium (CAP-D) screening tool. RESULTS: Control group scores and post-bundle CAP-D scores (mean = 5.57, standard deviation = 5.78 and mean = 7.10, standard deviation = 5.61, respectively) did not differ among the participants. Control participants required an intervention 26.7% of the time for delirium compared with 31.6% in the post-bundle population. No statistical significance was seen between the control group and the post-bundle CAP-D scores t(59) = 7.46; t(205) = 18.17 (p = .08, Fisher exact test). DISCUSSION: The use of nonpharmacologic bundles for delirium prevention have shown some promising results in helping with delirium reduction. Whether they consistently reduce the incidence has yet to be fully proven. This project shows that significant barriers exist when implementing them in a complex pediatric intensive care environment.