Background

Iatrogenic Withdrawal Syndrome(IWS) is a well-known adverse effect of sedatives that are used in mechanically ventilated patients admitted to the Pediatric Intensive Care Unit(PICU). The incidence of IWS may be up to 57%. In many patients, standard sedative treatment is inadequate and they consistently show signs of discomfort. In those patients dexmedetomidine is added, alongside the conventionally used sedatives. The effect of additional dexmedetomidine on IWS is unclear.

Objectives

The aim of this study is to explore the protective effect of additional dexmedetomidine on IWS in patients who receive sedative treatment.

Methods

In a 10-beds PICU in Amsterdam, data from mechanically ventilated and sedated patients were used. Excluded were (a)patients transferred to another PICU during treatment, (b)patients who received clonidine and (c)patients who deceased during treatment. IWS was measured with Sophia Observation withdrawal symptoms Scale(SOS) score.

Results

In a sample of 102 patients there were significant differences in the cumulative dosage of morphine(p<0.001) and midazolam(p<0.0001) between patients with and without additional dexmedetomidine. No significant difference was found in IWS(p=0.41). When the cumulative dosage of morphine, midazolam and dexmedetomidine and age are combined in a multivariate model, the cumulative dosage of midazolam is a significant variable for IWS(p=0.005). The cumulative dosage of dexmedetomidine did not influence the risk of IWS(p=0.12).

Conclusion

Additional dexmedetomidine has no preventive effect on IWS and does not influence the risk of IWS in patients admitted to the PICU who receive mechanical ventilation and sedative treatment.

Background

Nursing leadership is important as the nursing profession needs leaders at all levels.

PICU leaders have to be adequately prepared and educated for this role. Most nurses have the potential to lead, but do not always know how to lead.

Objectives

The purpose of this study was to identify from PICU nurses¢ perspectives the leadership characterictics they consider as most important.

Methods

A study performed in December 2019 among nurses in Pediatric intensive care unit of Department for pediatric surgery and intensive care unit of UMC Ljubljana. The questionnaire was distributed to 35 nurses in PICU, 26 of them were complete – 6 of them not corectly (57,1% response rate).

The participants had to answer four research questions about leaders attitudes, qualities, acuired skills and personal attributes and rank top three preferences.

Results

Most prefered leader attitude is fairness (70%, n=14), the second most is being approachable (35%; n=7) and the third being respectful (35%; n=7). Most prefered intrinsic qualities of leader were being dependable, thrustworthy and honest.

Nurses appreciate among leaders skills profesionalism (55%; n=11) and decisiveness (35%; n=7). As least important leaders¢ skill is in nurses opinion creativity (70%; n=14).

The first most preffered personal attribute of the leader was being a leader and team player (70%; n=14). Nurses believe that having a positive energy and being a good mentor are important attributes as well.

Conclusion

The results of the study show that nurses expect from their leaders to be fair, dependable and professional as well as a good team player.

Background

Children who are critically ill are vulnerable and the nurse has a responsibility to meet the child`s needs in a pediatric intensive care unit (PICU).

Objectives

The aim was to explore the vulnerable child's participation and how it can be understood through the nurses’ perspective in the nursing care intervention.

Methods

The study design was an exploratory inductive qualitative approach. Data collection was done through observations and interviews. The data from the observations were analyzed through interpretive phenomenology.

Conclusion

The affective elements were viewed as essential for uncover how children participate in the PICU. Three themes emerged through the analysis: Mediated participation, Bodily participation and Participation by proxy. They all highlight different aspect of the vulnerable child's way of participating in the nursing care given, through nurses’ awareness and situated salience. The concept participation should be redefined and broadened; as participation can present itself through the child’s body in diverse ways.

Background

BACKGROUND

Early mobilisation (EM) on intensive care is well researched in adults. Benefits include decreased time on mechanical ventilation, improved physical outcomes and a decreased length of hospital stay. However, data in paediatrics is limited.

Objectives

OBJECTIVES

To review the current practice of EM in a large UK PICU, prior to launching ‘Move4Ward’: a multi-disciplinary, quality improvement project to promote EM.

Methods

METHODS

A prospective review of 85 patients newly admitted to PICU was completed for four weeks in July 2018, using a piloted data collection tool. Daily data collection recorded the level of mobility achieved and continued until the patient was fully mobile, reached a consistent mobility level or was discharged from PICU. Barriers to mobilisation and the healthcare professionals completing the EM activity were also recorded.

Results

RESULTS

77% (65/85) of patients received at least one form of EM on day one, from either nursing staff or physiotherapists. The most commonly achieved maximum levels of mobility on day one were ‘sitting up in bed’ [21/85 (25%)] and ‘fully assisted transfer out of bed’ [17/85 (20%)]. The most frequently reported barriers were airway concerns, presence of lines and drains, and agitation/ excessive sedation.

Conclusion

CONCLUSION

Although the majority of patients completed some form of EM on day one, current provision is variable. ‘Move4Ward’ proposes an MDT approach involving education and training to empower staff to overcome perceived barriers and ensure more consistent provision of EM.