Estado actual y tendencias en el proceso de formación de enfermeras(os) de cuidados críticos / Current status and trends in the training process of critical care nurses

Introducción: Las Organizaciones Internacionales reconocen que, para las profesiones de la salud, es trascendental el desarrollo de sus especialidades dado que les permite profundizar conocimientos y habilidades para una práctica profesional más cualificada que permita mejorar la calidad de atención.Objetivo: Explorar el estado del arte, aplicación de modelos y teorías de enfermería en unidades de cuidado intensivo y las tendencias en la formación en la formación del especialista en enfermería del paciente en estado crítico. Método: Investigación documental cuyo objeto de estudio fueron 17 artículos de investigaciones relacionadas con el tema, los artículos fueron capturados en bases de datos internacionales Scielo, Elsevier, ScienceDirect, publicados entre los años 2011-2021. Se utilizó como instrumentos de recolección de información una matriz para la selección de investigaciones y la Ficha Analítica de Investigación. El análisis se orientó con base a la evolución del proceso formativo, enfoques teóricos-disciplinares y tendencias y retos de la formación. Resultados: Se encontró artículos provenientes de revisiones documentales y en menor proporción de estudios de investigación cualitativa o cuantitativa. Conclusiones: El estudio permitió reconocer los avances del proceso formativo y la evolución de estrategias de enseñanza aprendizaje propias de modelos educativos tradicionales a otras que estimulan el pensamiento reflexivo y crítico. Es escasa la literatura que da cuenta de la aplicación de modelos y teorías de enfermería en las unidades de cuidado crítico, se encontró perspectivas novedosas relacionadas con la formación en enfermería para el cuidado crítico (AU)

Introduction: International Organizations recognize that, for the health professions, the development of their specialties is transcendental since it allows them to deepen knowledge and skills for a more qualified professional practice that allows improving the quality of care. Objective: To explore the state of the art, application of nursing models and theories in intensive care units and trends in the training of nursing specialists for critically ill patients.Method: Documentary research whose object of study were 17 research articles related to the subject, the articles were captured in international databases Scielo, Elsevier, ScienceDirect, published between 2011-2021. A matrix for the selection of investigations and the Investigation Analytical Sheet were used as information collection instruments. The analysis was oriented based on the evolution of the training process, theoretical-disciplinary approaches and training trends and challenges Results: Articles from documentary reviews were found and, to a lesser extent, from qualitative or quantitative research studies. Conclusions: The study allowed us to recognize the progress of the training process and the evolution of teaching-learning strategies typical of traditional educational models to others that stimulate reflective and critical thinking. The literature that accounts for the application of nursing models and theories in critical care units is scarce; novel perspectives related to nursing training for critical care were found (AU)

The comparison of the Nursing Activities Score and TrendCare to accurately measure critical care nursing workload: A prospective observational design.

INTRODUCTION: Intensive care units commonly use the Nursing Activities Score (NAS) to measure nursing workload, however, some settings use TrendCare. Historically 100 NAS points reflected one nurse, however research now suggests greater than 61 NAS points per nurse increases hospital mortality. OBJECTIVES: To determine if: 1) TrendCare accurately reflects critical care nursing workload as measured by the NAS and 2) the required nursing hours calculated by each of the scoring systems differed between indigenous and non-indigenous patients. METHODS: Using a prospective observational design, data were collected between 9 August - 25 November 2021. Nursing workload was assessed over three shifts using TrendCare and the NAS. RESULTS: Analysis included 183 patients and 829 TrendCare and NAS scores. The mean NAS for intensive care patients was >61 on all three shifts (morning M = 67.1 ± 18.2, afternoon M = 66.1 ± 18.1, night M = 64.0 ± 18.1). The mean NAS for high dependency patients (morning M = 46.1 ± 11.1, afternoon M 45.9 ± 11.0, night Mdn 46.1 [40.5-54.1]) identified a nurse:patient ratio of 1:2 reflected a NAS >90. The NAS and TrendCare found no difference in nursing hours between indigenous and non-indigenous patients, however higher scores for respiratory (H = 7.3, p = <.01), cardiovascular (H = 12.7, p = <.001) and renal (H = 12.7, p = <.001) support, and care for relatives and patients (H = 13.8, p = <.001) on some shifts were identified in indigenous patients. CONCLUSION: TrendCare nursing hours likely reflect a 1:1 nurse: patient ratio for intensive care patients but likely under-estimates high dependency care nursing workload. The NAS activities highlighted some activities required more time for indigenous patients on some shifts. IMPLICATIONS FOR CLINICAL PRACTICE: TrendCare likely reflects intensive care nursing workload but not high dependency nursing workload. A NAS of no greater than 61 points per nurse better reflects nursing workload in both the intensive and high dependency care units. Indigenous patients may require more nursing hours for nursing activities related to severity of illness.

Remote Didactic Education Effectively Increases Cardiac Critical Care Nursing Staff Knowledge in Low-Resource Settings.

Background: While progress has been made to decrease mortality in children under age five, there continues to be a need for improvement in the treatment of children with congenital heart disease. Many of these patients require surgical correction and live in areas without the expertise of surgical teams. Research has shown that appropriate training is critical to ensure the best clinical outcomes. The Ethiopian government has identified the need for increased training of health care professionals as a method to improve hospital outcomes. Methods: Twenty-five cardiac critical nurses participated in a remote didactic education curriculum over the course of multiple months. We used a pre- and post-test model to evaluate knowledge acquisition and retention after the curriculum. Nurses completed post-tests at 1-, 3-, 6-, and 12-month intervals to monitor knowledge retention over time. Results: We found a significant increase in nursing knowledge that was retained over the course of 12 months. Nursing knowledge on pre- and post-tests was impacted by experience level. However, after completion of the curriculum experience was not a significant factor. Conclusion: Virtual curriculum delivered via remote didactic education is an inexpensive and effective way to increase nursing knowledge in cardiac critical care. It encourages bidirectional learning and allows the sharing of expertise from individuals who may otherwise be limited by travel or finances. Our approach is generalizable and further research needs to be done to evaluate the effectiveness of this type of curriculum in other environments.

Conocimiento del Equipo de Enfermería sobre Prevención de Lesiones por Presión en un hospital de Barranquilla, Colombia / Knowledge by the Nursing Team about Prevention of Pressure Ulcers at a hospital in Barranquilla, Colombia

Objetivo: determinar el nivel de conocimiento sobre prevención de lesiones por presión (LPP) en el equipo de Enfermería (enfermeros/as y auxiliares de Enfermería) en un hospital de cuarto nivel en Barranquilla, Colombia.Material y método: estudio descriptivo transversal realizado en los servicios de Medicina Interna y Cuidados Intensivos (N= 77). Se midieron la edad, el tiempo de formación, el tiempo de experiencia y el nivel de conocimientos sobre LPP mediante el porcentaje de aciertos en el Cuestionario Pieper y Mott Pressure Ulcer Knowledge de 41 ítems, traducido ad hoc, para los apartados de evaluación y clasificación y prevención. Se efectuó estadística descriptiva y bivariante.Resultados: participaron 77 personas. El porcentaje promedio de aciertos en la prueba de conocimiento fue de un 62% (DE= 27) en el apartado de evaluación y clasificación de las LPP (auxiliares de Enfermería [x–= 61%; DE= 26]; enfermeros/as [x–= 64%; DE= 30]; valor p= 0,663) y de un 72% (DE= 17) en el apartado de prevención (auxiliares de Enfermería [x–= 72%; DE= 16]; enfermeros/as [x–= 71%; DE= 22]; valor p= 0,663). En total, diez de los ítems superaron un 90% de aciertos en el caso de las/os enfermeras/os y uno en el caso de las/os auxiliares.Conclusiones: las/os enfermeras/os y auxiliares de Enfermería presentaron un conocimiento aceptable en prevención de LPP. Es necesario implementar estrategias exitosas para mejorar la prevención e incentivar la actualización de conocimientos. (AU)

Objective: to determine the level of knowledge about prevention of pressure ulcers (PU) by the Nursing Team (nurses and nursing assistants) at a fourth level hospital in Barranquilla, Colombia.Material and method: a descriptive, cross-sectional study conducted at the Internal Medicine and Intensive Care Units (N= 77). Their age, time of training, time of experience, and level of knowledge about PU prevention were measured through the percentage of right answers at the 41-item Pressure Ulcer Knowledge Questionnaire by Pieper and Mott, translated ad hoc, for the sections of evaluation and classification and prevention. Descriptive and bivariate statistics were conducted.Results: the study included 77 persons. The average proportion of right answers at the knowledge test was of 62% (SD= 27) in the section of evaluation and classification of PU prevention (nursing assistants [x–= 61%; SD= 26]; nurses [x–= 64%; SD= 30]; p value= 0.663) and 72% (SD= 17) in the prevention section (nursing assistants [x–= 72; SD= 16]; nurses [x–= 71%; SD= 22]; p value= 0.663). In total, ten of the items exceeded 90% of right answers in the case of nurses, and one in the case of assistants.Conclusions: nurses and Nursing assistants presented an acceptable knowledge regarding PU prevention. It is necessary to implement successful strategies in order to improve prevention and encourage the updating of knowledge. (AU)

Healthy Work Environment Standards in Tele-Critical Care Nursing.

The COVID-19 pandemic exacerbated staffing challenges in intensive care units, with increased burnout and moral distress cited as major problems. A healthy work environment is critical to nurses' success and wellbeing. During the pandemic, a survey by the American Association of Critical-Care Nurses revealed decreased composite scores in each of the 6 critical elements of a healthy work environment. Hospital units that improved even 1 critical element reported higher job satisfaction. The use of telehealth tools by expert nurses expanded care delivery during the pandemic by improving response to acutely and critically ill patients while supporting hospital-based nurses. All of the critical elements of a healthy work environment are relevant to the tele-critical care nurse's role and challenges. This article describes how tele-critical care nurses were affected by the pandemic and how healthy work environment strategies promoted successful nurse and patient outcomes.

Innovation in Nurse Staffing Models: Implementing a Tele-Critical Care Nurse Program in a Pediatric Cardiac Intensive Care Unit.

A pediatric tele-critical care nursing program provides an extra layer of surveillance for patients and alerts bedside nurses of abnormal trends to mitigate adverse events. Although workforce turnover combined with patient complexity and acuity in a pediatric cardiac intensive care unit strains the sustainability of a healthy work environment, these variables have also opened the door to an innovative approach to tele-critical care nursing care delivery. In addition to virtual surveillance, a clinical bedside intervention was developed to provide hands-on assistance to bedside nurses. This article describes the evolution of this novel technique for enhancing nursing care delivery.

Innovations in Tele-Critical Care Nursing During the COVID-19 Pandemic.

For decades, tele-critical care (TCC) programs have provided expert population surveillance with standardized clinical interventions for critically ill patients. The COVID-19 pandemic created massive strains on critical care resources. For this report, standard questions were used to solicit COVID-19 pandemic workflow and service modifications from a network of TCC leaders to describe the rapid expansion of TCC-supported services during the pandemic. In this article, leaders from 7 TCC programs report on the effective use of services to support changing hospital needs during the pandemic in areas such as clinical education, personal protective equipment stewardship, expansion of virtual care, and creative staffing models, among others.

Evaluation of a blended training solution for critical care nurses' work environment: Lessons learned from focus groups in four European countries.

AIM: The aim of this study was to evaluate a blended pilot training course on Healthy Work Environments (HWEs) for critical care nurses as follows: 1) to explore the experience of trainees and trainers who took part in the training; and 2) to identify the strengths and weaknesses of the training program in its potential transferability to nursing practice in Intensive Care Units (ICUs). BACKGROUND: Despite the evidence supporting the association between HWEs and job satisfaction, nursing retention, and patient outcomes, nurses still have high rates of burnout, mental health problems and intent to leave. To address this challenge, a blended training was created and piloted with the aim to highlight the relevance and impact of HWEs, enhancing its transferability to daily practice. The training was based on the six standards of HWEs as proposed by the American Association of Critical Care Nurses and created within an Erasmus + project. The pilot was delivered by trainers (critical care nursing educators) to critical care nurses and included six workshops of eight hours each (48 h in total) in each country. DESIGN: After the pilot testing, a qualitative approach, with focus group discussions was used. METHODS: All the trainees (n=82), who had attended at least one workshop were invited to participate in the focus groups. Overall, eight focus groups were held with critical care nurses who participated as trainees (n=39) from four testing countries: Cyprus, Croatia, Spain and Poland. One international focus group was held with trainers who conducted the training (n=4). Four more trainers completed the questionnaire online. All focus group were video recorded, and transcribed verbatim. Then, the national transcripts were translated into English. An inductive thematic analysis was carried out. FINDINGS: Three themes were identified: 1) Valuing the relevance of the training program and a positive learning experience; 2) A powerful insight leading to increased awareness and empowerment in personal and professional life; 3) Challenges identified in terms of training, follow up and management of change. Both trainees and trainers expressed a positive opinion with regard to the content of the training and the didactic methods used. They emphasized the strong influence of the training on their understanding of a HWEs, its impact in an ICU context and the need for action, mainly related to communication issues. CONCLUSION: The proposed blended training program may be used by trainers, who can enable nurses develop the competencies required to influence their work environment, in a context of shared responsibility.

"I didn't know anything, but I learned over time": The process of nurses attaining autonomy in Intensive Care Units / "No sabía nada, con el tiempo lo aprendí": El proceso de los enfermeros de alcanzar la Autonomía en Unidades de Cuidado Intensivos / "Não sabia nada, com o tempo aprendi": O processo de autonomia do enfermeiro em Unidade de Terapia Intensiva

Objective. Understand the social processes experienced by nursing professionals and the meanings underlying autonomy in adult Intensive Care Units in the city of Cartagena (Colombia). Methods. A qualitative study with a grounded theory approach was conducted. Fifteen semi-structured interviews were carried out with nursing professionals, and the analysis was based on the coding technique proposed by Strauss & Corbin. Results. Of the respondents, fourteen were female and one was male, with ages ranging from 23 to 57 years. Experience in intensive care units ranged from 1 to 28 years, and none had postgraduate studies. After thematic analysis, the central category was obtained from four categories: adaptation process, applicability of autonomy exercise, building autonomous competence, and limitations to the exercise of autonomy. Conclusion. Nursing professionals achieve their autonomy through a social process, based on different stages of learning when facing the environment of the units. It is grounded in decision-making and the power to act freely. However, barriers continue to hinder it, including limitations imposed by institutions, protocol-based interventions, social status, and individual differences among professionals.

Objetivo. Comprender el proceso social que viven los profesionales de enfermería y los significados que subyacen a la autonomía en las Unidades de Cuidados Intensivos adultos en la ciudad de Cartagena (Colombia). Métodos. Estudio cualitativo con enfoque de la teoría fundamentada, se realizaron quince entrevistas semiestructuradas en profesionales de enfermería, el análisis se realizó basado en la técnica de codificación propuesta por Strauss y Corbin. Resultados. Los entrevistados eran catorce de sexo femenino y uno de sexo masculino, con edades entre los 23 y 57 años, la experiencia en unidades de cuidados intensivos oscilo entre 1 y 28 años y ninguno conto con estudios de posgrados. Tras el análisis temático se obtuvo la categoría central "Cuando yo entré no sabía, con el tiempo lo aprendí" a partir de cuatro categorías: proceso de adaptación; aplicabilidad ejercicio de la autonomía; construyendo la competencia autónoma; y limitaciones para el ejercicio de la autonomía. Conclusión. El profesional de enfermería logra su autonomía a través de un proceso social, basado en diferentes etapas de aprendizaje al enfrentarse al ambiente de las unidades, se sustenta en la toma de decisiones y el poder de hacer las cosas de forma libre. Sin embargo, existen barreras que la siguen obstaculizando, entre ellas las limitaciones dadas por las instituciones, intervenciones basadas en protocolos, el estatus social y la individualidad entre los profesionales.

Objetivo. Compreender o processo social vivenciado pelos profissionais de enfermagem e os significados subjacentes à autonomia nas Unidades de Terapia Intensiva adulto da cidade de Cartagena (Colômbia). Métodos. Estudo qualitativo com abordagem da teoria fundamentada, foram realizadas quinze entrevistas semiestruturadas com profissionais de enfermagem, a análise foi realizada com base na técnica de codificação proposta por Strauss y Corbin. Resultados. Os entrevistados foram quatorze mulheres e um homem, com idade entre 23 e 57 anos, a experiência em unidades de terapia intensiva variou entre 1 e 28 anos e nenhum possuía pós-graduação. Após a análise temática, obteve-se a categoria central "Quando entrei não sabia, aprendi com o tempo" a partir de quatro categorias: processo de adaptação; aplicabilidade exercício de autonomia; construção de competência autônoma; e limitações para o exercício da autonomia. Conclusão. O profissional de enfermagem conquista sua autonomia por meio de um processo social, baseado em diferentes etapas de aprendizagem diante do ambiente das unidades, baseado na tomada de decisão e no poder de fazer livremente. No entanto, existem barreiras que continuam a dificultá-lo, incluindo limitações dadas pelas instituições, intervenções baseadas em protocolos, status social e individualidade entre os profissionais.

E se a catástrofe acontece .. Que preparação dos enfermeiros do serviço de urgência / What if disaster strikes..... How prepared are emergency room nurses?

O progresso nos cuidados de saúde no decurso do tempo tem exigido, não só, processos cada vez mais complexos, bem como a formação de profissionais com níveis de competência e conhecimento progressivamente mais elevados, no sentido de corresponderem com maior exatidão ao aumento gradual das suas funções e responsabilidades. Neste contexto, a Enfermagem converte-se numa disciplina mais complexa e altamente exigente em cuidados especializados impondo o desenvolvimento contínuo dos seus profissionais. O presente relatório insere-se no âmbito do Estágio de Natureza Profissional (ENP) do Curso de Mestrado em Enfermagem Médico-Cirúrgica (MEMC), realizado num Serviço de Urgência Básica (SUB) da região norte de Portugal e procura evidenciar de forma crítica e reflexiva o percurso e o processo de aquisição e desenvolvimento de competências especializadas em Enfermagem Médico-Cirúrgica na área da Pessoa em Situação Crítica (EMCPSC). Para o desenvolvimento de competências procurou basear-se a prática clínica na evidência científica e alcançar o máximo de experiências que incorporassem as dimensões da prestação de cuidados à PSC e família, da formação, da gestão e da investigação. A preparação dos profissionais de saúde para atuarem em situações de exceção e catástrofe que originam multivítimas, inclui atividades, programas e sistemas desenvolvidos e implementados antes do evento. A pandemia recentemente enfrentada mostrou muito claramente a velocidade com que mesmo os melhores sistemas de saúde em diferentes países podem ser sobrecarregados e devastados. A evidência científica demonstra que o atual sistema de formação não promove as competências necessárias e não prepara os profissionais de saúde para a resposta a eventos catastróficos. Estas constatações conduziram-nos à investigação da perceção dos enfermeiros do SUB sobre a sua preparação para intervir em situação de catástrofe, com recurso à Disaster Preparedness Evaluation Tool (DPET®), através de um estudo descritivo-correlacional. Verificou-se que os enfermeiros assinalaram uma fraca preparação para atuar em situação de catástrofe. Contudo, os elementos do sexo masculino revelaram maior perceção de preparação face à situação de catástrofe comparativamente com os do sexo feminino, tendo apresentado diferenças estatisticamente significativas no score global da escala, na dimensão das competências relacionadas com o "saber" e a "gestão pós-catástrofe". Também nestas dimensões comprovaram-se diferenças estatisticamente significativas entre o nível de perceção da preparação para a catástrofe em função da formação avançada desenvolvida na área da emergência, sendo que, os enfermeiros detentores de formação avançada em áreas onde há alusão a atendimento em catástrofe apresentaram valores médios superiores para a perceção de preparação. Atentando à minimização das consequências impactantes que a catástrofe acarreta, é vital que haja uma crescente preparação para este tipo de ocorrências, minimizando erros e agilizando a atuação das equipas envolvidas. Para que o Plano de Emergência em Catástrofe (PEC) hospitalar seja executado de forma eficaz é necessário que cada profissional (particularmente, o enfermeiro) conheça a sua missão, o seu papel e a sua ação, de modo a desempenhar as suas funções de forma sistemática e coordenada. Desta experiência, destaca-se o papel preponderante do Enfermeiro Especialista em Enfermagem Médico-Cirúrgica (EEEMC) na diferenciação e melhoria contínua dos cuidados de Enfermagem, na promoção da consciencialização da importância da formação ao longo da vida e do trabalho em equipa, na gestão e organização dos serviços de saúde e dos cuidados de Enfermagem e na investigação, num contexto tão complexo como um SU.

Progress in healthcare over time has required not only increasingly complex processes, but also the training of professionals with progressively higher levels of competence and knowledge, in order to correspond more accurately to the gradual increase in their functions and responsibilities. In this context, nursing becomes a more complex and highly demanding discipline in terms of specialized care, imposing the continuous development of its professionals. This report is part of the Professional Internship of the Master's Course in Medical-Surgical Nursing, carried out in a basic emergency service in the north of Portugal and seeks to critically and reflectively highlight the path and process of acquisition and development of specialized skills in Medical-Surgical Nursing in the area of the person in critical situation. For the development of competences, efforts were made to base clinical practice on scientific evidence and to achieve the maximum of experiences that incorporated the dimensions of providing care to the person in critical situation and family, training, management and research. The preparation of health professionals to act in exceptional and catastrophic situations that lead to multiple casualties includes activities, programs and systems developed and implemented before the event. The recently faced pandemic has shown very clearly the speed with which even the best health systems in different countries can be overwhelmed and devastated. Scientific evidence shows that the current training system does not promote the necessary skills and does not prepare health professionals to respond to catastrophic events. These findings led us to investigate the perception of basic emergency service nurses about their preparation to intervene in a catastrophe situation, using the Disaster Preparedness Evaluation Tool (DPET®), through a descriptive-correlational study. It was verified that the nurses indicated a weak preparation to act in a catastrophe situation. However, the male elements revealed a greater perception of preparedness in the face of a catastrophe situation compared to the female ones, having shown statistically significant differences in the overall score and in the dimension of competences related to "knowledge", "post-disaster management". Also, in these dimensions, there were statistically significant differences between the level of perception of preparedness for a catastrophe as a function of the advanced training developed in the emergency area, and nurses with advanced training in areas where there is an allusion to care in a catastrophe had higher mean values for the perception of preparedness. Bearing in mind the minimization of the impacting consequences that the catastrophe entails, it is vital that there is increasing preparation for this type of occurrence, minimizing errors and streamlining the performance of the teams involved. For the hospital disaster emergency plan to be carried out effectively, it is necessary that each professional (particularly the nurse) knows his mission, his role and his action, in order to perform his functions in a systematic and coordinated way. From this experience, the preponderant role of the specialist nurse in Medical-Surgical Nursing stands out in the differentiation and continuous improvement of nursing care, in promoting awareness of the importance of lifelong training and teamwork, in the management and organization of health services and nursing care and in research, in a context as complex as an emergency service

Critical Care Nursing.

These nurses care for patients with complex clinical conditions.

An integrative review of potassium replacement protocol use in critical care: Development, use and critical care nurse autonomy.

BACKGROUND: Potassium replacement protocols are used to standardise practice, reduce risk, and ensure timely potassium replacement, but there is considerable variability in their development and use, particularly as part of critical care nursing practice. AIM: To synthesise the research evidence on how potassium replacement protocols are used in adult critical care; and how critical care nurses' role and practice is influenced by a potassium replacement protocol. The research question was 'How are protocols used by intensive care clinicians to guide potassium replacement in adult critical care?' DESIGN: A structured integrative review was undertaken. A combination of keywords, synonyms, and Medical Subject Headings were used across the Ovid Medline and Embase databases. Records were independently assessed against inclusion and exclusion criteria. All papers were assessed for quality. A narrative synthesis was used to analyse and present the findings. RESULTS: Ten studies were included in this review from 4076 records identified. Narrative synthesis revealed five categories: (i) protocol design demonstrating variation in protocol mechanisms, (ii) protocol rationale eliciting reasonings for protocol implementation, (iii) protocol use describing how protocols were nurse-driven enabling nursing autonomy (iv) protocol adherence highlighting variability in protocol compliance and (v) critical care nurse acceptability and feasibility coupling greater shared responsibility for patient care and improved clinician satisfaction. CONCLUSION: Safe, high-quality care, supported by evidence continues to be a priority. Protocolised potassium replacement can improve patient outcomes and promote nurses' autonomy, efficiency, and job satisfaction. IMPLICATIONS FOR CLINICAL PRACTICE: Recognising and promoting critical care nurses' expert assessment skills and clinical decision-making is essential for optimising efficient, safe, and high-quality patient care. Although protocol deviations are accommodated in protocol development, comprehensive documentation to justify protocol deviations is key to justifying practice. Understanding protocol deviations are crucial to inform future protocol development, improvements, and evaluation to further enhance critical care nursing practice.

Evolution of Pediatric Critical Care Nursing.

Pediatric critical care nursing is a key pillar in patient care and outcomes for children who are ill and injured. Tremendous advances have occurred in pediatric critical care and nursing. This article provides an overview of the key advances in pediatric critical care nursing through the decades.

Overcoming patient safety concerns and integrating early mobility into pediatric intensive care unit nursing practice.

PURPOSE: Early Mobilization (EM) in Pediatric Intensive Care Units (PICU) is safe, feasible and improves outcomes for PICU patients, yet patient safety concerns persist among nurses which limits EM adoption. The purpose of this study was to explore how nurses incorporate EM into practice and balance their concerns for patient safety with the benefits of EM. DESIGN & METHODS: This focused ethnographic study included 15 in-depth interviews with 10 PICU nurses. Data were analyzed using thematic analysis. RESULTS: Two major categories were found which describe the clinical judgement and decision-making of PICU nurses regarding EM. The nurses' concerns for patient safety was the first major category. This included patient-level factors: hemodynamic stability, devices attached, patient's strength, and risk for falls and size. In the second major category, these safety concerns were overcome by applying a multiple step process which resulted in nurses performing EM despite their concerns. That process included: gaining comfort through experience, performing patient safety checks, working with therapists, learning from adverse events, and understanding existing evidence about the benefits of EM. CONCLUSIONS: The overarching theme was nurses' determination to preserve patient safety while ensuring patients could receive the benefits of EM. This theme describes the decisions, behaviors and processes that nurses enact to become more comfortable with EM despite their concerns for patient safety and potential adverse events while performing mobility activities. PRACTICE IMPLICATIONS: Creating opportunities for nurses to participate in EM may increase their willingness to overcome safety concerns and engage in these activities.