A Note To Those Working With Peds In Critical Care

A Note To Those Working With Peds In Critical Care

Infants and children cared for in critical care units leave a legacy. Beyond the lessons learned from the phenomenal resilience of children and their amazing will to survive, the collaborative experience of working together as a team to support children in their battle for recovery provides knowledge that we cannot provide in a text. The art and science of pediatric critical care nursing has grown exponentially over my career and it has been exciting to witness, from our very early hybridization of the adult critical care model and “downsized” adult interventions to the development of an independent evidence-based, family-centered, specialty discipline. Our patient population is challenging, requiring the knowledge and contributions of multiple disciplines and a cohesive team of care providers.

Although skilled and technically competent nursing care has made significant contributions to patient outcomes, much more is required: Compassion—an affirmation to families that although we cannot fully know their pain, we will always be there for them; persistence balanced by realism so that we know when it is time to let go; caring focused not only on the children, but on their parents, siblings, and extended family, all of whom are impacted; evidence-based practice and monitoring of quality to ensure best practices; and a sense of humor and acceptance to find the sun in the clouds and the path to tomorrow.

The Core Curriculum for Pediatric Critical Care Nursing, last published in 2006, has always been a resource for nurses caring for acutely ill or injured children. This third edition has been retitled: AACN Core Curriculum for Pediatric High Acuity, Progressive, and Critical Care Nursing, which reflects the increasing acuity in all inpatient departments and the fact that these children are cared for in a variety of settings, including many specialty units in hospitals and in the emergency department, cath lab, diagnostic testing, and more. Experienced contributing author representing diverse geographic regions have created a thorough and relevant source of information, providing a review of a wide variety of conditions.

Using a systems approach and narrative outline for easy reference, each chapter reviews developmental anatomy and physiology, pathophysiology and defining characteristics of neonatal and pediatric disorders, clinical assessment, pharmacology, monitoring, diagnostic testing, pain and palliative care management, and a multidisciplinary approach to the plan of care. Each health problem is discussed along the continuum of the American Association of Critical-Care Nurses (AACN) Synergy Model for Patient Care and family-centered care with integration of ethical, legal, and environmental issues. Application of the principles of care is exemplified in the embedded case studies.

This third edition builds on and updates the information provided in the first two editions, with expansion to the acute and progressive phase of care. The content is based on the most current standards of care, scope of practice, national guidelines, key AACN initiatives, and the AACN Certification Corporation Pediatric CCRN Test Plan (AACN, 2017). In addition, based on focus group feedback from critical care nurses, we have added a chapter on professional issues. This new chapter includes content on quality, safety, communication, teamwork, work environment, and personal wellness. In 2008, Berwick, Nolan, and Whittington’s Triple Aim framework was introduced to influence quality and ensure high-value care in the United States, focusing on improving the individual experience of care, improving the health of populations, and reducing the per capita cost of healthcare.

More recently, the Quadruple Aim added the aim of improving the experience of providing care (Sikka, Morath, & Leape, 2015). Workforce engagement and safety are significant in this. Achieving the metrics of this goal would ensure that we remember what motivated us to choose this career in the first place and allow us to find joy and meaning in our work. Our work as pediatric critical care nurses is dedicated to the memory of the children and families we have cared for; those for whom our best technology, knowledge, effort, and compassion were not enough for survival; and those children who have recovered from critical illness and injury, able to smile and play again . . this gives us strength.

As critical care nurses, you make a difference in someone’s life in ways you cannot imagine every single day that you work. I cannot imagine a greater gift from a profession.

Margaret C. Slota , DNP , RN , FAAN

REFERENCES

American Association of Critical-Care Nurses. (2017). CCRN exam

handbook. Aliso Vieja, CA: AACN Certification Corporation.

Berwick, D. M., Nolan T. W., & Whittington, J. (2008). The Triple

Aim: Care, health and cost. Health Affairs, 27, 759–769.

Sikka, R., Morath, J. M., & Leape, L. (2015). The quadruple aim:

Care, health, cost and meaning in work. BMJ Quality &

Safety, 24, 608–610. doi:10.1136/bmjqs-2015-004160