• Evaluation of an Early Mobilization Program in a Pediatric Intensive Care Unit

      Wieczorek, Beth (2015)
      Introduction: The focus of care in a pediatric intensive care unit (PICU) is on resuscitation, stabilization, management of critical disease processes, and reversal of organ failure. As a result, the child is often sedated, restrained and confined to bed for prolonged periods of time for perceived needs of safety, comfort and hemodynamic stability. Multi-system anatomic and physiologic alterations are known to occur in response to critical illness and may be compounded by immobility. These sequelae may have long- term implications for the patient and the patient’s family. A robust body of literature has showed that early mobilization in the intensive care unit can decrease these sequelae and reduce length of stay for the critically ill adult, but little has been published in regards to the pediatric population. Objective: To determine the safety and feasibility of an early rehabilitation and progressive mobilization program in a pediatric intensive care unit. Method: A before/after retrospective design was used for this QI project that focused on evaluating an early mobility program as it became routine care for the children hospitalized in this PICU. Data was collected and analyzed from July to August 2014 (pre-implementation phase) and July to August 2015 (post-implementation). Program implementation was completed in April to May 2015. Setting: Pediatric intensive care unit (PICU) in a tertiary academic hospital in the US. Results: Analysis of 200 children aged 1 day through 17 years admitted to a Pediatric Intensive Care Unit with a length of stay of at least three days demonstrated a significant increase in occupational and physical therapy consultations after implementation of the early mobility program (p <0.05) . In addition the number of mobilization activities increased post-implementation (p <0.05). No adverse events, such as unplanned extubations, occurred as a result of early mobilization. Conclusions: Implementation of a structured and stratified early mobilization program in a pediatric intensive care unit resulted in an increase in occupational and physical therapy consultations, increased patient activity, without adverse events.
    • Simulation to Improve Confidence among Newly Licensed Nurses in the Pediatric Intensive Care Setting

      Hamilton, Hannah; Franquiz, Renee (2020-05)
      Introduction: Communication and critical thinking are essential practice competencies for every registered nurse. However, newly licensed registered nurses (NLRN) often lack these skills on entry into practice contributing to low levels of clinical confidence. Aims: The purpose of this Quality Improvement (QI) project was to implement and evaluate the effectiveness of simulation on clinical confidence among NLRNs. Methods: This QI project was guided by the MAP-IT model and involves NLRNs in a Pediatric Intensive Care Unit within an urban academic teaching hospital. NLRNs participated in three clinical simulations reflecting common PICU clinical practice, utilizing the Simulation Module for Assessment of Resident’s Targeted Event Responses (SMARTER) and the Behavior Assessment Tool (BAT). NLRN confidence data were collected immediately pre-simulation and post-simulation, as well as one-month post-simulation using the self-report C-Scale Instrument of Clinical Confidence. Qualitative data was collected via observation by the NLRN preceptor using the C-Scale Instrument of Clinical Confidence. Paired sample t-tests were used to determine a significant change in confidence, and content analysis was performed by two evaluators on the qualitative data derived from the C-Scale observations to identify confidence themes and patterns. Results: Paired sample t-tests revealed a significant increase in clinical confidence between baseline and sustained one-month post simulation. Qualitative data collection of preceptor observations revealed improved clinical confidence and communication abilities. Conclusions and Implications: Data indicates that simulation is an effective strategy to increase clinical confidence as perceived by the NLRNs. Incorporation of simulation into transition-to-practice programs such as Nurse Residency or facility orientation is an evidence-based recommendation to improve development of clinical confidence and communication abilities in this population.