Establishing excellence: Implementation of an onboarding and continuing education curriculum for pediatric intensive care unit nurse practitioners and physician associates.

ABSTRACT: This study describes a novel curriculum for onboarding and clinical education for nurse practitioners and physician associates (NPs and PAs) in the pediatric intensive care unit setting. The objective was to provide details on the initial orientation and continuing education program to ensure the attainment of knowledge and skills needed to care for critically ill patients safely and effectively. A needs assessment was completed, and a knowledge gap identified in five themes: (1) in-depth knowledge on common critical care diagnoses; (2) understanding of pathophysiology; (3) disease management processes; (4) critical thinking; and (5) procedure competency. Using Kern 6-step curriculum and the Kirkpatrick evaluation model, we designed a program for orientation and continuing education for critical care NPs and PAs. Transformative learning theory provided the framework for the program because the cyclical steps of disorienting dilemma, critical reflection, discourse, and action were used repeatedly to transform a new graduate to a competent critical care provider and then into an expert who is able to, in turn, teach others. A total of 31 NPs and 5 PAs completed the 12-week orientation phase. Participants reported that the orientation phase was valuable to their educational advancement and increased critical care knowledge. All participants showed improvement in knowledge, skills, and ability to provide competent patient care.

Children with Near-Fatal Asthma: The Use of Inhaled Volatile Anesthetics and Extracorporeal Membrane Oxygenation.

Background and Purpose: The use of extracorporeal membrane oxygenation (ECMO) has been described for near-fatal asthma that continues to be refractory despite maximal medical therapy. Methods: Patients admitted to the pediatric intensive care unit at Texas Children's Hospital from 2012 to 2020 with the diagnosis of asthma who were supported on ECMO or isoflurane were included in the study. Patient demographics, medication usage, and complications were compared between the case group (ECMO, n = 12) and the control group (isoflurane only, n = 8). Results: All patients survived to discharge. ECMO patients received shorter durations of albuterol (12 versus 104 h, P = 0.0002) and terbutaline (13.3 versus 31.5 h, P = 0.0250). There were no differences in complication rates between the 2 groups. Conclusion: ECMO is a reasonable and safe support method for patients with near-fatal asthma and may lead to less bronchodilator medication exposure when compared with inhaled volatile anesthetic use.

Health-related quality of life outcome measures for children surviving critical care: a scoping review.

PURPOSE: Health-related quality of life (HRQL) has been identified as one of the core outcomes most important to assess following pediatric critical care, yet there are no data on the use of HRQL in pediatric critical care research. We aimed to determine the HRQL instruments most commonly used to assess children surviving critical care and describe study methodology, patient populations, and instrument characteristics to identify areas of deficiency and guide investigators conducting HRQL research. METHODS: We queried PubMed, EMBASE, PsycINFO, Cumulative Index of Nursing and Allied Health Literature, and the Cochrane Registry for studies evaluating pediatric critical care survivors published 1970-2017. We used dual review for article selection and data extraction. RESULTS: Of 60,349 citations, 66 articles met inclusion criteria. The majority of studies were observational (89.4%) and assessed HRQL at one post-discharge time-point (86.4%), and only 10.6% of studies included a baseline assessment. Time to the first follow-up assessment ranged from 1 month to 10 years post-hospitalization (median 3 years, IQR 0.5-6). For 26 prospective studies, the median follow-up time was 0.5 years [IQR 0.25-1]. Parent/guardian proxy-reporting was used in 83.3% of studies. Fifteen HRQL instruments were employed, with four used in >5% of articles: the Health Utility Index (n = 22 articles), the Pediatric Quality of Life Inventory (n = 17), the Child Health Questionnaire (n = 16), and the 36-Item Short Form Survey (n = 9). CONCLUSION: HRQL assessment in pediatric critical care research has been centered around four instruments, though existing literature is limited by minimal longitudinal follow-up and infrequent assessment of baseline HRQL.