Initial Development of C.A.T.E.S.: A Simulation-Based Competency Assessment Instrument for Neonatal Nurse Practitioners.

PURPOSE: Determine content validity of global statements and operational definitions and choose scenarios for Competency, Assessment, Technology, Education, and Simulation (C.A.T.E.S.), instrument in development to evaluate multidimensional competency of neonatal nurse practitioners (NNPs). DESIGN: Real-time Delphi (RTD) method to pursue four specific aims (SAs): (1) identify which cognitive, technical, or behavioral dimension of NNP competency accurately reflects each global statement; (2) map the global statements to the National Association of Neonatal Nurse Practitioners (NANNP) core competency domains; (3) define operational definitions for the novice to expert performance subscales; and (4) determine the essential scenarios to assess NNPs. SAMPLE: Twenty-five NNPs and nurses with competency and simulation experience Main outcome variable: One hundred percent of global statements correct for competency dimension and all but two correct for NANNP domain. One hundred percent novice to expert operational definitions and eight scenarios chosen. RESULTS: Content validity determined for global statements and novice to expert definitions and essential scenarios chosen.

Simulation with synergy and community energy.

Neonatal nurse practitioners (NNPs) have a crucial role in the management and care of critically ill newborns and infants in the neonatal intensive care unit. Their role responsibilities range from daily management of care, oversight of unit and bedside education, execution of advanced procedures, and attendance at high-risk deliveries. During their educational program, there is a mix of didactic and clinical training. To ensure that their graduates are able to competently care for neonatal patients in the ever-advancing neonatal world, the NNP program at the University of Texas Medical Branch-Galveston (UTMB), has implemented simulation-based training into every clinical course. This article describes the history of simulation in the NNP program at UTMB, discusses the current use of simulation at UTMB, explores the synergistic use of undergraduate students in simulations at UTMB, and details the use of professional volunteers from the local medical community to execute the simulations and debriefing process.

Simulation training: a multidisciplinary approach.

Emergency situations arise in health care every day. High-risk environments such as Neonatal Intensive Care Units and labor and delivery units are more susceptible to such emergencies. Occasionally, newborns require assistance with their breathing in the delivery room, while others demand intensive resuscitation including intubation and chest compressions. Delivering resuscitative efforts can be difficult when the team trains in separate venues. This article will discuss the importance of multidisciplinary high-fidelity simulation training as an effective tool in the development and maintenance of resuscitation expertise across disciplines, the history of simulation, simulation legislation, and the evidence behind simulation and explore the art and utilization of medical simulation in a multidisciplinary setting.

Acquisition and maintenance of competencies through simulation for neonatal nurse practitioners: beyond the basics.

Turmoil in the economy, looming health care reform, and the convergence of a shortage of nursing professionals accompanied by the demand for improving patient safety and decreasing medical errors with limited resources has created an environment likened to the perfect storm. As nurses make up the single largest component of the health care system, it is imperative that nurses achieve and maintain the highest level of competency. The Institute of Medicine's report on the future of nursing identified simulation as a key technological component in facilitating nurses in acquiring and maintaining competencies. This article will review the evidence supporting simulation, define the core elements of health care simulation, describe the bodies that regulate advanced practice nursing, identify the principle areas in which neonatal nurse practitioners (NNPs) must maintain proficiency and expertise, and illustrate how simulation is utilized in acquisition, maintenance and competency evaluation for NNPs in 1 of the largest NICUs in the country.

Informing parents about the actual or impending death of their infant in a newborn intensive care unit.

Modern perinatal and neonatal care practices have increased survival of infants that in previous care eras would have perished. The majority of infants admitted to a newborn intensive care unit following delivery currently do well and are discharged home. Unfortunately for others, the ultimate outcome may be death. The death of a newborn infant is clearly a devastating loss to parents. How parents are informed of their infant's actual or impending death can either add to a grief reaction, or help support parents through their loss. The literature supports that most healthcare professionals frequently feel inept while discussing the death of a newborn with the baby's family. This article will present parents' descriptions of what helped or did not help when they were informed of their infant's inevitable death. It will also demonstrate how simulation may be effective in improving communication of bad or sad news to families in a manner that sustains them in the immediate present, as well as adds to their future well-being.

Pigtail catheters used in the treatment of pneumothoraces in the neonate.

Air leak in the neonatal population can be a deadly situation. Neonates have many risk factors that can contribute to air leak. These include, but are not limited to, respiratory distress syndrome; mechanical ventilation; sepsis; pneumonia; aspiration of meconium, blood, or amniotic fluid; and congenital malformations. In the NICU, the staff must be prepared to diagnose and treat pneumothoraces in a timely manner. Pathophysiology of air leaks in the neonate including the anatomy of the chest and diagnosis, indications, and common methods for the treatment of a pneumothorax in an infant is explained in this article. In addition, the latest form of treatment for neonates, known as the modified pigtail catheter, is described. A comprehensive literature review of the evidence behind the use of the pigtail catheter in neonates will be incorporated. Finally, the step-by-step placement of this catheter using the modified Seldinger technique will be illustrated and described in detail.