An IDEA: Safety Training to Improve Critical Thinking by Individuals and Teams.

Errors in thinking contribute to harm, delays in diagnosis, incorrect treatments, or failures to recognize clinical changes. Models of cognition are useful in understanding error occurrence and avoidance. Intra-team conflict can represent failures in joint cognitive processing. The authors developed training focused on recognizing and managing cognitive bias and resolving conflicts. The program provides context and introduces models of cognition, concepts of bias, team cognition, conflict resolution, and 2 tools. "IDEA" incorporates 4 de-biasing strategies: Identify assumptions; Don't assume correctness; Explore expectations; Assess alternatives. "TLA" presents strategies for resolving conflicts: Tell your thoughts; Listen actively, and Ask questions. A total of 4941 care providers participated in training using didactic presentations, group discussion, and simulation. Learners rated training effectiveness at 4.68 on a scale of 1 to 5 (5 as optimum) and perceived improvement in recognizing or managing errors. Nonphysician caregivers reported greatest improvement. Training to improve critical thinking is feasible, well received, and effective.

Pediatric thoracic organ transplants: challenges in primary care.

Pediatric nurse practitioners (PNP) confront numerous challenges when delivering care to infants, children, and adolescents who receive thoracic organ transplants. Today, thoracic organ transplantation is an acceptable and viable option for infants, children, and adolescents with end stage cardiac and pulmonary disease. Despite the plateau in the actual numbers of thoracic organ transplants performed annually in the United States, they are still being performed in a significant number. The care of children who receive transplants includes long-term use of immunosuppressants, dealing with infectious diseases, and utilizing principles of well child and family care. PNPs play a vital role in providing holistic care to infants, children, and adolescents who receive a thoracic organ transplant.