Between hope and disillusionment: ECMO seen through the lens of nurses working in a neonatal and paediatric intensive care unit.

BACKGROUND: Using extracorporeal membrane oxygenation (ECMO) in paediatric and neonatal intensive care units (PICU/NICU) creates ethical challenges and carries a high risk for moral distress, burn out and team conflicts. AIM: The study aimed to gain a more comprehensive understanding of the underlying factors affecting moral distress when using ECMO for infants and children by examining the attitudes of ECMO nurses. METHODS: Four focus groups discussions were conducted with 21 critical care nurses working in a Swiss University Children's Hospital. Purposive sampling was adopted to identify research participants. The data were analysed using reflexive thematic analysis. RESULTS: Unlike "miracle machine" stories in online media reports, specialized nurses working in PICU/NICU expressed both their hopes and fears towards this technology. Their accounts also contained references to events and factors that triggered experiences of moral distress: the unspeakable nature of the death of a child or infant; the seemingly lack of honest and transparent communication with parents; the apparent loss of situational awareness among doctors; the perceived lack of recognition for the role of nurses and the variability in end-of-life decision-making; the length of time it takes doctors to take important treatment decisions; and the resource intensity of an ECMO treatment. CONCLUSION: The creation of a multidisciplinary moral community with transparent information among all involved health care professionals and the definition of clear treatment goals as well as the implementation of paediatric palliative care for all paediatric ECMO patients should become a priority if we want to alleviate situations of moral distress. RELEVANCE FOR CLINICAL PRACTICE: The creation of a multidisciplinary moral community, clear treatment goals and the implementation of palliative care for all paediatric ECMO patients are crucial to alleviate situations of moral distress for nurses, and thus to improve provider well-being and the quality of patient care in PICU/NICU.

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.