[Acute care of patients with cerebral palsy in neuro-resuscitation surgery]. / La prise en soins des patients cérébrolésés à la phase aiguë en neuroréanimation chirurgicale.

Severe head trauma, with or without polytrauma, subarachnoid haemorrhage due to aneurysm rupture, is an unexpected tragedy for patients and their families. These accidents are likely to result in extremely serious neurological damage, with many of the patients under our care facing a life-threatening prognosis. To protect the brain, one solution is to put the patient into a deep sleep during the so-called "acute" phase, making it impossible to assess the repercussions of the initial injuries at the time: this is what we call "waiting resuscitation".

[Reducing False Alarms and Absent Treatments by Nurses During Resuscitation in the Emergency Department].

BACKGROUND & PROBLEMS: Medical management protocols prioritize the safety of patients during emergency resuscitation situations. According to a medical center in Taiwan statistics gathered in 2017, the unnecessary activation of resuscitation teams by new nurses because of their improper assessment of patient conditions was a significant cause of anxiety in patient relatives and source of complaints directed at the medical center. In June 2018, 18.7% of the emergency resuscitation calls in the emergency department (ED) were false alarms or absent treatment incidents. After investigation, lack of clearly stated resuscitation team member responsibilities and insufficient practical training for new nurses were primary factors associated with the high rate of false alarm/absent treatment incidents in the ED. PURPOSE: To decrease the rate of absent treatment by nurses during resuscitation from 18.7% to 0% in the ED. RESOLUTION: The assignments of emergency team members were revised, a new "Emergency app" was introduced, the assignment schedule of the emergency resuscitation team was distributed, SIM realistic education training was held, stronger team work was promoted, and a standard assignment review schedule was established and regularly monitored. RESULTS: After the introduction of the resolution measures, the false alarm / absent treatment incidents in the ED caused by ED nurses dropped from 18.7% to 0%. CONCLUSIONS: Resuscitation workflow is closely related to patient safety, and teamwork among colleagues critical to successful resuscitation. The project revised resuscitation teamwork assignments and organized resuscitation education training, including simulation courses, to enhance the understanding of team members. The strategy outlined in this paper may be used to raise awareness using posters and resuscitation record checklists to track and manage the team`s progress. This project was designed to enhance teamwork to decrease the rate of absent treatment and to provide safe and quality resuscitation care in order to improve resource management by the team to increase productivity.

The Effects of Simulation-Based Advanced Life Support Education for Nursing Students.

Advanced life support education for nursing students is very important because nurses are first responders in emergency situations. The purpose of this study was to identify the effects of simulation-based advanced life support education on nursing students' knowledge, performance, self-efficacy, and teamwork. A nonequivalent control group posttest-only design was used. Fourth-year nursing students were randomly assigned to either simulation-based Korean Advanced Life Support (n = 30) or lecture-based education (n = 30) groups. Data were analyzed using descriptive statistics and the Mann-Whitney U test. The experimental group showed statistically significant higher scores in knowledge (P < .001), performance (P < .001), and self-efficacy (P = .049) when compared with the control group. However, there was no significant difference in teamwork scores between the two groups (P = .529). The 4.5-hour simulation-based Korean Advanced Life Support education was more effective than the 4.5-hour lecture-based education for nursing students in terms of knowledge, performance, and self-efficacy. Nurse educators should adopt simulation-based advanced life support education into the curriculum for the optimal competence of nursing students.

The effectiveness of crisis resource management and team debriefing in resuscitation education of nursing students: A randomised controlled trial.

AIMS AND OBJECTIVES: The aim of this study was to investigate (i) whether integrating a course on crisis resource management principles and team debriefings in simulation training, increases self-efficacy, team efficacy and technical skills of nursing students in resuscitation settings and (ii) which phases contribute the most to these outcomes. BACKGROUND: Crisis resource management principles have been introduced in health care to optimise teamwork. Simulation training offers patient safe training opportunities. There is evidence that simulation training increases self-efficacy and team efficacy but the contribution of the different phases like crisis resource management principles, simulation training and debriefing on self-efficacy, team efficacy and technical skills is not clear. DESIGN: Randomised controlled trial in a convenience sample (n = 116) in Belgium. Data were collected between February 2015-April 2015. METHODS: Participants in the intervention group (n = 60) completed a course on crisis resource management principles, followed by a simulation training session, a team debriefing and a second simulation training session. Participants in the control group (n = 56) only completed two simulation training sessions. The outcomes self-efficacy, team efficacy and technical skills were assessed after each simulation training. An ancillary analysis of the learning effect was conducted. RESULTS: The intervention group increased on self-efficacy (2.13%, p = .02) and team efficacy (9.92%, p < .001); the control group only increased significantly on team efficacy (4.5%, p = .001). The intervention group scored significantly higher on team efficacy (8.49%, p < .001) compared to the control group. CONCLUSION: Combining crisis resource management principles and team debriefings in simulation training increases self-efficacy and team efficacy. The debriefing phase contributes the most to these effects. RELEVANCE TO CLINICAL PRACTICE: By partnering with healthcare settings, it becomes possible to offer interdisciplinary simulation training that can increase patient safety.

At the Post-anaesthesia Care Unit.

Pierre is assigned to the Post-operational Recovery room. The care team comprises two anaesthetic nurses, a trainee anaesthetic nurse, a qualified registered nurse, and a healthcare assistant. In addition, an anaesthetist is available to intervene at any time.

Core Team Members' Impact on Outcomes and Process Improvement in the Initial Resuscitation of Trauma Patients.

Genesis Trauma Center is an American College of Surgeons-The Committee on Trauma-verified Level III facility located in Southeastern Ohio. Process improvement and patient safety showed inconsistencies in trauma documentation and comfort level of the nursing staff. In February 2014, Genesis implemented a trauma nurse leader program to provide a core team of trauma nurses for the initial resuscitation. The overall goal of implementing a trauma nurse leader (TNL) program was to focus education on a core team, providing an increased level of skill of experience to oversee trauma patient care. The TNL program has shown promise in the pilot phase by decreasing emergency department length of stay and improving trauma documentation.

Health professionals' perceptions regarding family witnessed resuscitation in adult critical care settings.

AIMS AND OBJECTIVES: To deepen our understanding of the perceptions of health professionals regarding family witnessed resuscitation in Jordanian adult critical care settings. BACKGROUND: The issue of family witnessed resuscitation has developed dramatically in the last three decades. The traditional practice of excluding family members during cardiopulmonary resuscitation had been questioned. Family witnessed resuscitation has been described as good practice by many researchers and health organisations. However, family witnessed resuscitation has been perceived by some practitioners to be unhealthy and harmful to the life-saving process. The literature showed that there are no policies or guidelines to allow or to prevent family witnessed resuscitation in Jordan. DESIGN: An exploratory qualitative design was adopted. METHODS: A purposive sample of 31 health professionals from several disciplines was recruited over a period of six months. Individual semi-structured interviews were used. These interviews were transcribed and analysed using thematic analysis. FINDINGS: It was found that most healthcare professionals were against family witnessed resuscitation. They raised several concerns related to being verbally and physically attacked if they allowed family witnessed resuscitation. Almost all of the respondents expressed their fears of patients' family members' interfering in their work. Most of the participants in this study stated that family witnessed resuscitation is traumatic for family members. This was viewed as a barrier to allowing family witnessed resuscitation in Jordanian critical care settings. CONCLUSION: The study provides a unique understanding of Jordanian health professionals' perceptions regarding family witnessed resuscitation. They raised some views that contest some arguments in the broader literature. Further research with patients, family members, health professionals and policy makers is still required. RELEVANCE TO CLINICAL PRACTICE: This is the first study about family witnessed resuscitation in Jordan. Considering multi-disciplinary healthcare professionals' views would be helpful when starting to implement this practice in Jordanian hospitals.

Nurses' Perceptions of Role, Team Performance, and Education Regarding Resuscitation in the Adult Medical-Surgical Patient.

The purpose of this study was to explore nurses' perception of their roles, team performance, and educational needs during resuscitation using an electronic survey. Findings provide direction for clinical practice, nursing education, and future research to improve resuscitation care.

When early and often counts.

In 2000, Millennium Development Goal 4 called for global deaths in under fives, to be reduced by two thirds by 2015 (United Nations Millennium Declaration (UNMD) 2000). Birth asphyxia - failure to initiate or sustain spontaneous breathing at birth - causes up to one million neonatal deaths per year (Ersdal and Singhal 2013). A high proportion.of these are in low-resource countries. In 2009, a group of doctors and academics from hospitals and universities in Norway and the United States wanted to find out if the Helping babies breathe (HBB) simulation-based programme for midwives in low-resource countries helped reduce newborn fatalities in a hospital in Tanzania. I was one of those doctors and our research showed that when teaching switched from a one-day programme to a low-dose, high-frequency model, emphasising immediate basic steps, there was a significant increase in the number of infants stimulated at birth, and a 40 per cent decrease in early neonatal mortality.

An electronic delphi study to establish pediatric intensive care nursing research priorities in twenty European countries*.

OBJECTIVES: To identify and to establish research priorities for pediatric intensive care nursing science across Europe. DESIGN: A modified three-round electronic Delphi technique was applied. Questionnaires were translated into seven different languages. SETTING: European PICUs. PARTICIPANTS: The participants included pediatric intensive care clinical nurses, managers, educators, and researchers. In round 1, the qualitative responses were analyzed by content analysis and a list of research statements and domains was generated. In rounds 2 and 3, the statements were ranked on a scale of one to six (not important to most important). Mean scores and SDs were calculated for rounds 2 and 3. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Round 1 started with 90 participants, with round 3 completed by 64 (71%). The seven highest ranking statements (≥ 5.0 mean score) were related to end-of-life care, decision making around forgoing and sustaining treatment, prevention of pain, education and competencies for pediatric intensive care nurses, reducing healthcare-associated infections, identifying appropriate nurse staffing levels, and implementing evidence into nursing practice. Nine research domains were prioritized, and these were as follows: 1) clinical nursing care practices, 2) pain and sedation, 3) quality and safety, 4) respiratory and mechanical ventilation, 5) child- and family-centered care, 6) ethics, 7) professional issues in nursing, 8) hemodynamcis and resuscitation, and 9) trauma and neurocritical care. CONCLUSIONS: The results of this study inform the European Society of Pediatric and Neonatal Intensive Care's nursing research agenda in the future. The results allow nurse researchers within Europe to encourage collaborative initiatives for nursing research.

Medical-surgical nurses' perceived self-confidence and leadership abilities as first responders in acute patient deterioration events.

AIMS AND OBJECTIVES: To explore and understand medical-surgical nurses' perceived self-confidence and leadership abilities as first responders in recognising and responding to clinical deterioration prior to the arrival of an emergency response team. BACKGROUND: Patients are admitted to hospitals with multiple, complex health issues who are more likely to experience clinical deterioration. The majority of clinical deterioration events occur on medical-surgical units, and medical-surgical nurses are frequently the first healthcare professionals to identify signs and symptoms of clinical deterioration and initiate life-saving interventions. DESIGN: A prospective, cross-sectional, descriptive quantitative design using a survey method was used. METHODS: Nurses were recruited from an integrated healthcare system located in the south-east United States. Nurses completed a demographic, a self-confidence and a leadership ability questionnaire. RESULTS: One hundred and forty-eight nurses participated in the study. Nurses felt moderately self-confident in recognising, assessing and intervening during clinical deterioration events. In addition, nurses felt moderately comfortable performing leadership skills prior to the arrival of an emergency response team. A significant, positive relationship was found between perceived self-confidence and leadership abilities. Age and certification status were significant predictors of nurses' leadership ability. CONCLUSION: Although nurses felt moderately self-confident and comfortable with executing leadership abilities, improvement is needed to ensure nurses are competent in recognising patients' deterioration cues and making sound decisions in taking appropriate, timely actions to rescue patients. Further strategies need to be developed to increase nurses' self-confidence and execution of leadership abilities in handling deterioration events for positive patient outcomes. RELEVANCE TO CLINICAL PRACTICE: Educational provisions should focus on various clinical deterioration events to build nurses' self-confidence and leadership abilities in handling clinical deterioration. Nurses should obtain national certification to increase their knowledge and clinical reasoning skills.

Telemedicine for neonatal resuscitation.

Maintaining high levels of readiness for neonatal resuscitation in low-risk maternity settings is challenging. The neonatal resuscitation program (NRP) algorithm is a community standard in the United States; yet training is biannual, and exposure to enough critical events to be proficient at timely implementation of the algorithm and the advanced procedures is rare. Evidence supports hands-free leadership to help prevent task saturation and communication to promote patient safety. Telemedicine for neonatal resuscitation involves the addition of remote, expert NRP leadership (a NICU-based neonatal nurse practitioner) via camera link to augment effectiveness of the low-risk birth center team. Unanticipated outcomes to report include faster times to transfer initiation and neuroprotective cooling. The positive impact of remote NRP leadership could lead to use of telemedicine to support teams at birthing centers throughout the United States as well as around the world.

Preventing admission hypothermia in very low birth weight neonates.

Neonatal hypothermia, temperature < 36.5°C, is a major contributor to neonatal mortality and morbidity. hypothermia of preterm infants remains a challenge in the NiCU for many reasons. preterm very low birth weight (VlBW) infants, those infants born <1,500 g, are prone to very rapid heat losses through mechanisms of convection, evaporation, conduction, and radiation. this article reviews current research to reduce and prevent mortality and morbidity from hypothermia in preterm VlBW infants by implementing interventions in the delivery room to minimize heat loss and maintain core body temperatures.

[Experiences of relatives, who witnessed resuscitation or invasive procedures in life-threatening situations at the bedside of the next of kin or attending in a waiting room]. / Erfahrungen von Angehörigen, die während der kardiopulmonalen Reanimation oder während invasiver Prozeduren in lebensbedrohlichen Situationen an der Seite ihres Nächsten anwesend waren oder in einem Nebenraum warteten.

Worldwide the majority of relatives endorsed family witnessed resuscitation and witnessed invasive procedures (FWR) and considered this practice as helpful. However, professionals are primarily against this practice. How relatives in Swiss hospitals experience these difficult situations is unknown. The aim of this qualitative study is to describe and understand the experiences of relatives who witnessed resuscitation in a Swiss hospital at the bedside of her next of kin or attending in a waiting room. Interviews were conducted with ten relatives between September 2011 and June 2012 and analyzed with the method of interpretive phenomenology. Four themes derived from the data: "be present", "want to be informed", "have confidence" and "looking for support". Attending relatives gave to protocol that FWR allowed them to assist their next of kin. Relatives, who were waiting outside, felt uncertainty and fear. Relatives wanted FWR and other relatives didn't want FWR. Relatives experienced a rapid flow of clear information, but also vague, insufficient or delayed messages. They spoke of great faith, as well as of ambivalence and mistrust in medical and nursing skills of professionals. Relatives reported to cope with the difficult situation: by providing support within the family, pray with the family and professional support. It is therefore recommended to offer relatives FWR and to develop guidelines that direct the support of relatives.

Efficiencies gained by using electronic medical record and reports in trauma documentation.

Despite successful implementation of an electronic medical record (EMR) by many health care organizations, information regarding EMR for trauma resuscitation is limited, and few have created reports that facilitate trauma registry data abstraction, performance improvement reviews, and provider care requirements. In October 2010, our organization implemented an EMR for trauma resuscitations. A collaborative committee was formed to standardize data elements. Documentation compliance was monitored pre- and post-EMR implementation. Median monthly documentation completion improved from 82% to a sustained median score of 96.5% for the past 603 activations. Documentation compliance enabled the development of succinct reports that facilitate our internal needs and supported our trauma center reverification site visit.

[The nurse faced with sudden cardiac arrest]. / Pratique infirmière en situation d'arrêt cardiaque.

The nursing intervention in a sudden cardiac arrest only comes as a continuation of the resuscitation procedures undertaken by the first person on the scene. Hence the importance of raising the awareness of and training the general public. In a healthcare facility, experts recommend putting in place an emergency procedure, a standard crash trolley and a dedicated life-threatening emergency response team.

Testing of midwife neonatal resuscitation skills with a simulator manikin in a low-risk delivery unit.

BACKGROUND: Expertise in neonatal resuscitation is essential for personnel involved in the care of newborns. In this observational cohort study the skills of 52 midwives in a simulated scenario were assessed. METHODS: A total of 52 midwives in a low-risk unit and five specialist nurses in a high-risk unit were tested to establish their competence in newborn resuscitation. The 52 midwives were divided into groups 1 (n = 39; no pretest training) and 2 (n = 13; 1 day training prior to study). The video-recorded test scenario was a newborn with asphyxia. Thirty items were graded by a neonatologist and nursing team in real time. Using the Angoff method, a pass score was 18.71 for skills that were graded 0 or 1. RESULTS: The average score of specialist nurses was 26 (range, 23-29). A total of 49% of midwives in group 1 and 92% in group 2 passed the test. The average score was 17.7 (range, 9-25) in group 1 and 21.9 (range, 17-27) in group 2. A total of 27% and 77% of midwives in groups 1 and 2, respectively, carried out ventilation at a frequency as per the algorithm. Mask leakage was higher in group 1 (44%) versus group 2 (23%). Five and three midwives in groups 1 and 2, respectively, overexpanded the lungs. CONCLUSION: Many midwives had imperfect resuscitation skills. A 1 day course improved such skills. The standard scenario is an objective and useful performance marker in assessing and documenting improvements in competence in delivery room resuscitation.

Recognition of clinical deterioration: a clinical leadership opportunity for nurse executive.

Recognition and avoidance of further clinical deterioration can be termed a critical success factor in every care delivery model. As care resources become more constrained and allocated to the most critical of patients, some patients are being shifted to less intense and costly care settings where continuous physiologic monitoring may not be an option. Nurse executives are facing these complex issues as they work with clinical experts to develop systems of safety in the patient care arena. A systematic review of the literature related to the recognition of clinical deterioration is needed to identify areas for further leadership, research, and practice advancements.

The implementation of PEARS training: supporting nurses in non-critical care settings to improve patient outcomes.

Children's Hospital Boston's Life Support Program began offering the newly developed American Heart Association Pediatric Emergency Assessment, Recognition and Stabilization (PEARS) course for nurses working in non-critical care settings in December of 2007. The goal was to provide an appropriate alternative to pediatric advanced life support (PALS) training for clinical staff caring for the general pediatric population. To date, more than 900 nurses have completed the course with feedback from the participants being extremely positive. Even more impressive is a more appropriate use of the hospital's emergency medical response system promoting early intervention and the significant reduction in cardiac arrests on inpatient units. During a 12-month period, nurses involved in activations of the response system were asked to rate their ability to assess, categorize, decide and act after each event. The overwhelming majority agreed they were able to apply the PEARS systematic approach of assessment and early intervention to the situation. This article describes the planning and implementation of PEARS training for non-critical care nursing staff and provides data that demonstrates improved patient outcomes. Supporting activities and strategies promoting early recognition and interventions contributing to the successful reduction of cardiac arrests on inpatient units are also discussed.