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Chang N, Louderback L, Hammett H, Hildebrandt K, Prendergast E, Sperber A, Casazza M, Landess M, Little A, Rasmussen L. Multidisciplinary Consensus on Curricular Priorities for Pediatric Neurocritical Care Nursing Education: A Modified Delphi Study in the United States. Neurocrit Care 2024:10.1007/s12028-024-01976-6. [PMID: 38570410 DOI: 10.1007/s12028-024-01976-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2024] [Accepted: 03/07/2024] [Indexed: 04/05/2024]
Abstract
BACKGROUND Nurses are vital partners in the development of pediatric neurocritical care (PNCC) programs. Nursing expertise is acknowledged to be an integral component of high-quality specialty patient care in the field, but little guidance exists regarding educational requirements to build that expertise. We sought to obtain expert consensus from nursing professionals and physicians on curricular priorities for specialized PNCC nursing education in pediatric centers across the United States. METHODS We used a modified Delphi study technique surveying a multidisciplinary expert panel of nursing professionals and physicians. Online surveys were distributed to 44 panelists over three rounds to achieve consensus on curricular topics deemed essential for PNCC nursing education. During each round, panelists were asked to rate topics as essential or not essential, as well as given opportunities to provide feedback and suggest changes. Feedback was shared anonymously to the panelist group throughout the process. RESULTS From 70 initial individual topics, the consensus process yielded 19 refined topics that were confirmed to be essential for a PNCC nursing curriculum by the expert panel. Discrepancies existed regarding how universally to recommend topics of advanced neuromonitoring, such as brain tissue oxygenation; specialized neurological assessments, such as the serial neurological assessment in pediatrics or National Institutes of Health Stroke Scale; and some disease-based populations. Panelists remarked that not all centers see specific diseases, and not all centers currently employ advanced neuromonitoring technologies and skills. CONCLUSIONS We report 19 widely accepted curricular priorities that can serve as a standard educational base for PNCC nursing. Developing education for nurses in PNCC will complement PNCC programs with targeted nursing expertise that extends comprehensive specialty care to the bedside. Further work is necessary to effectively execute educational certification programs, implement nursing standards in the field, and evaluate the impact of nursing expertise on patient care and outcomes.
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Affiliation(s)
- Nathan Chang
- Pediatric Neurocritical Care, Lucile Packard Children's Hospital Stanford, 725 Welch Rd., Palo Alto, CA, 94404, USA.
| | - Lauren Louderback
- Pediatric Critical Care, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Heather Hammett
- Pediatric Critical Care, Children's Hospital Colorado, Aurora, CO, USA
| | - Kara Hildebrandt
- Pediatric Neurocritical Care, Phoenix Children's Hospital, Phoenix, AZ, USA
| | - Erica Prendergast
- Pediatric Neurocritical Care, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - Amelia Sperber
- Pediatric Neurocritical Care, Lucile Packard Children's Hospital Stanford, 725 Welch Rd., Palo Alto, CA, 94404, USA
| | - May Casazza
- Pediatric Neurocritical Care, Lucile Packard Children's Hospital Stanford, 725 Welch Rd., Palo Alto, CA, 94404, USA
| | - Megan Landess
- Pediatric Critical Care, Children's Hospital Colorado, Aurora, CO, USA
| | - Aubree Little
- Pediatric Critical Care, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Lindsey Rasmussen
- Pediatric Neurocritical Care, Lucile Packard Children's Hospital Stanford, 725 Welch Rd., Palo Alto, CA, 94404, USA
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Liu J, Jackson SS, Xie J, Rowland MJ, Michelson CD. National Survey of Combined Pediatrics-Anesthesiology Residents and Graduates: Factors Contributing to Changing Career Aspirations Over Time. Anesth Analg 2023; 137:1250-1256. [PMID: 36729970 DOI: 10.1213/ane.0000000000006308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND The Dual Pathway for Certification in Pediatrics and Anesthesiology was created in 2011 to develop leaders in caring for children with complex medical and surgical conditions. While existing dual-trained practitioners report continued practice in both pediatric anesthesiology (PA) and pediatric critical care medicine (PCCM), recent surveys of dual pathway trainees have shown that only one-quarter still currently plan to pursue training in PCCM, a change from their initial plans to complete training in both PA and PCCM. The aim of this study was to further characterize the motivations driving shifts in career trajectory during training as well as factors affecting the combined training experience. METHODS We conducted an online mixed-methods survey of all individuals who had matriculated at 1 of the 7 Accreditation Council for Graduate Medical Education-accredited combined pediatrics-anesthesiology residencies from 2011 to 2018. The survey consisted of a 30-item questionnaire addressing training experience, anticipated career trajectory, and respondent demographics. Descriptive statistics were used for closed-format questions. Responses to open-ended questions were systematically analyzed through inductive iterative review by 2 of the authors to elicit a set of overarching themes. RESULTS We achieved a response rate of 85% (n = 53/62) with respondents from 7 of 7 combined residency programs. When asked about career goals, the majority of respondents planned to pursue both PA and PCCM (60%, n = 32) at the start of residency. However, at the time of survey completion, the percentage of respondents who were still planning to (or had already completed) train in both PA and PCCM had decreased to 23% (n = 12). Factors such as lifestyle and length of training contributed more to career choices during/after training compared to before residency. Thematic analysis of open-ended questions regarding transition between specialties, impact of dual training, and general comments revealed 3 major themes: (1) challenges of transitioning between specialties, (2) dual training is mutually beneficial, and (3) the need for an established fellowship training pathway. CONCLUSIONS While there is continued interest in dual training in PA/PCCM for residents who enter the combined pediatrics-anesthesiology residency, factors such as duration of training and lifestyle become more important during residency and alter their career trajectories, often away from PCCM. Optimization of dual-subspecialty fellowship training will be critical to sustaining interest in dual-subspecialty training in PA/PCCM.
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Affiliation(s)
- Jia Liu
- From the Department of Anesthesia, Critical Care and Pain Medicine, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Shawn S Jackson
- From the Department of Anesthesia, Critical Care and Pain Medicine, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
| | - James Xie
- Division of Pediatric Anesthesiology, Department of Anesthesiology, Perioperative and Pain Medicine, Lucile Packard Children's Hospital-Stanford Children's Health, Stanford University School of Medicine, Stanford, California
| | - Matthew J Rowland
- Division of Critical Care, Ann and Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Catherine D Michelson
- Department of Pediatrics, Boston University School of Medicine/Boston Medical Center, Boston, Massachusetts
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谭 子, 李 恩, 钟 卫, 杨 东, 马 可, 赖 志, 陈 素, 郑 曼. [Etiology composition and prognosis of pediatric chronic critical illness in a pediatric intensive care unit]. ZHONGGUO DANG DAI ER KE ZA ZHI = CHINESE JOURNAL OF CONTEMPORARY PEDIATRICS 2023; 25:843-848. [PMID: 37668033 PMCID: PMC10484089 DOI: 10.7499/j.issn.1008-8830.2302053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Accepted: 06/12/2023] [Indexed: 09/06/2023]
Abstract
OBJECTIVES To explore the etiology composition and outcomes of pediatric chronic critical illness (PCCI) in the pediatric intensive care unit (PICU). METHODS The children who were hospitalized in the PICU of Dongguan Children's Hospital Affiliated to Guangdong Medical University and met the diagnostic criteria for PCCI from January 2017 to December 2022 were included in the study. The etiology of the children was classified based on their medical records and discharge diagnoses. Relevant clinical data during hospitalization were collected and analyzed. RESULTS Among the 3 955 hospitalized children in the PICU from January 2017 to December 2022, 321 cases (8.12%) met the diagnostic criteria for PCCI. Among the 321 cases, the most common etiology was infection (71.3%, 229 cases), followed by unintentional injury (12.8%, 41 cases), postoperation (5.9%, 19 cases), tumors/immune system diseases (5.0%, 16 cases), and genetic and chromosomal diseases (5.0%, 16 cases). Among the 321 cases, 249 cases (77.6%) were discharged after improvement, 37 cases (11.5%) were discharged at the request of the family, and 35 cases (10.9%) died in the hospital. Among the deaths, infection accounted for 74% (26/35), unintentional injury accounted for 17% (6/35), tumors/immune system diseases accounted for 6% (2/35), and genetic and chromosomal diseases accounted for 3% (1/35). From 2017 to 2022, the proportion of PCCI in PICU diseases showed an increasing trend year by year (P<0.05). Among the 321 children with PCCI, there were 148 infants and young children (46.1%), 57 preschool children (17.8%), 54 school-aged children (16.8%), and 62 adolescents (19.3%), with the highest proportion in the infant and young children group (P<0.05). The in-hospital mortality rates of the four age groups were 14.9% (22/148), 8.8% (5/57), 5.6% (3/54), and 8.1% (5/62), respectively. The infant and young children group had the highest mortality rate, but there was no statistically significant difference among the four groups (P>0.05). CONCLUSIONS The proportion of PCCI in PICU diseases is increasing, and the main causes are infection and unintentional injury. The most common cause of death in children with PCCI is infection. The PCCI patient population is mainly infants and young children, and the in-hospital mortality rate of infant and young children with PCCI is relatively high.
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Bitencourt VN, Crestani F, Peuckert MZ, Andrades GRH, Krauzer JRM, Cintra CDC, Cunha MLDR, Eckert GU, Girardi L, Santos IS, Garcia PCR. Net Promoter Score (NPS) as a tool to assess parental satisfaction in pediatric intensive care units. J Pediatr (Rio J) 2023; 99:296-301. [PMID: 36720434 DOI: 10.1016/j.jped.2022.11.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 11/23/2022] [Accepted: 11/24/2022] [Indexed: 01/30/2023] Open
Abstract
OBJECTIVE To verify the performance of the Net Promoter Score (NPS) as a tool to assess parental satisfaction in pediatric intensive care units (PICUs). METHODS The authors conducted an observational cross-sectional multicenter study in the PICUs of 5 hospitals in Brazil. Eligible participants were all parents or legal guardians of PICU-admitted children, aged 18 years or over. The NPS was administered together with the EMpowerment of PArents in THe Intensive Care (EMPATHIC-30), used as the gold standard, and a sociodemographic questionnaire. For analysis, the results were dichotomized into values greater than or equal to the median of the tests. The associations between the 2 tools were evaluated and the distribution of their results was compared. RESULTS The parents or legal guardians of 78 PICU-admitted children were interviewed. Of the respondents, 85% were women and 62% were in a private hospital. The median NPS was 10 (IQR, 10-10), and the median EMPATHIC-30 score was 5.7 (IQR, 5.4-5.9). Compared with the gold standard, the NPS had a sensitivity of 100% at all cutoff points, except at cutoff 10, where the sensitivity was slightly lower (97.5%). As for specificity, NPS performance was poorer, with values ranging from 0% (NPS ≥ 5) to 47.4% (NPS = 10). CONCLUSIONS NPS proved to be a sensitive tool to assess parental satisfaction, but with poor ability to identify dissatisfied users in the sample.
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Affiliation(s)
- Victoria Noremberg Bitencourt
- Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Programa de Pós-Graduação em Pediatria e Saúde da Criança da Escola de Medicina, Porto Alegre, RS, Brazil.
| | - Francielly Crestani
- Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Programa de Pós-Graduação em Pediatria e Saúde da Criança da Escola de Medicina, Porto Alegre, RS, Brazil
| | - Marina Zanette Peuckert
- Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Programa de Pós-Graduação em Pediatria e Saúde da Criança da Escola de Medicina, Porto Alegre, RS, Brazil
| | - Gabriela Rupp Hanzen Andrades
- Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Programa de Pós-Graduação em Pediatria e Saúde da Criança da Escola de Medicina, Porto Alegre, RS, Brazil
| | | | | | | | | | - Leandra Girardi
- Hospital Materno Infantil Presidente Vargas, Porto Alegre, RS, Brazil
| | - Iná S Santos
- Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Programa de Pós-Graduação em Pediatria e Saúde da Criança da Escola de Medicina, Porto Alegre, RS, Brazil
| | - Pedro Celiny Ramos Garcia
- Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Programa de Pós-Graduação em Pediatria e Saúde da Criança da Escola de Medicina, Porto Alegre, RS, Brazil; Hospital São Lucas da PUCRS, Porto Alegre, RS, Brazil
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A Celebration of the Society of Critical Care Medicine at the Half-Century Mark. Crit Care Med 2021; 49:167-168. [PMID: 33438969 DOI: 10.1097/ccm.0000000000004802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Panesar RS, Hulfish E, Harwayne-Gidansky I. Adhering to Social Distancing Rules Using a "Split Patient" Model With Rapid Cycle Deliberate Practice in Pediatric High-Fidelity Simulations. Cureus 2021; 13:e14117. [PMID: 33907650 PMCID: PMC8068557 DOI: 10.7759/cureus.14117] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/25/2021] [Indexed: 11/12/2022] Open
Abstract
The coronavirus disease 2019 (COVID-19) pandemic has required simulation-based medical education to adapt to physical distancing regulations in order to protect learners and facilitators. The "split patient" model allows for physical distancing of learners in pediatric high-fidelity simulations. This model was able to be used with the Rapid Cycle Deliberate Practice to teach pediatric residents basic and advanced life support skills and the principles of Crisis Resource Management.
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Affiliation(s)
- Rahul S Panesar
- Pediatric Critical Care Medicine, Stony Brook Children's Hospital, Stony Brook, USA
| | - Erin Hulfish
- Pediatrics, Stony Brook Children's Hospital, Stony Brook, USA
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