Overview of pediatric nursing

1. 1
Introduction,
Role
&
qualities
of
PSICU nurse

2. presented by
Mohamed kheder
Pediatric nursing department

3. 3
Objectives
At the end of this lecture the candidate will be able to:
Define critical care concept.
Review critical care historical background.
Illustrate important definition related to critical care.
Discuss classification of critically ill child
Explain condition consider critical.
Discuss characteristics of ideal SICU.

4. Objective cont.
Identify levels of critical care units.
Identify types of pediatric critical care units.
Apply the Roles of pediatric surgical Critical Care
Nurses.
Discus principles of pediatric surgical critical care
nursing.
Point out core competencies of PSICU nurse.
4

5. Outlines
Introduction.
Define critical care concept .
 Review Critical care historical background.
important definition related to critical care.
classification of critically ill child.
condition consider critical.
characteristics of ideal SICU.
5

6. CONT.
levels of critical care units.
Types of pediatric surgical critical care units.
 Roles of Critical Care Nurses.
Principles of pediatric critical care nursing.
Point out core competencies of PICU nurse.
6

7. CRITICAL
1. Crisis.
2. Emergency.
3. Serious.
4. Requiring immediate action.
5. Crucial.
6. Thorough and constant observation.
7. Total dependent.
(Oxford Dictionary)
7

8. CRITICAL CARE NURSING
 The care of seriously ill child from point of injury or
illness until discharge from intensive care.
 Deals with child responses to life threatening problems
-trauma /major surgery.
8

9. Historical
Background
9

10. World War II
Shock wards established for resuscitation.
Transfusion practices in early stages.
10

11. Polio epidemic
 1950’s: use of mechanical ventilation(“iron
lung”) for treatment of polio.
 Development of respiratory intensive care units.
 At the same time, general ICU’s developed for
sick and postoperative patients.
 Collaboration between nurses and physicians.
11

12. CRITICAL CARE NURSING
 Critical care nursing was organized as a specialty less
than 60 years ago; before that time, critical care nursing
was practiced wherever there were critically ill patients.
12

13. CONT.
 The development of new medical interventions and
technology prompted recognition that nursing was
important in the monitoring and observation of critically
ill patients.
 Physicians depended on nurses to watch for critical
changes in the condition of patients in the physicians’
absence, and they sometimes depended on the nurses to
initiate emergency medical treatment.
13

14. American Association of Critical-Care
Nurses - AACN
1969.
Largest professional specialty nursing organization.
Research.
Political awareness.
Provides standards of practice.
Educational support.
Certification.
Scholarships.
14

15. DEFINITION OF TERMS
CRITICAL CARE:-
critical care is a term used to describe as the care of child
who are extremely ill and whose clinical condition is
unstable or potentially unstable.
15

16. CRITICAL CARE UNIT
It is defined as the unit in which comprehensive care of a
critically ill child which is deemed to recoverable stage is
carried out.
16

17. CRITICAL CARE NURSING
It refers to those comprehensive, specialized and
individualized nursing care services which are rendered
to child with life threatening conditions and their
families.
17

18. Pediatric Intensive care nursing
18
A highly specialized area of
expertise requiring astute
assessment skill, development of
critical thinking while
understanding the implications of
growth and development on
physiologic and pathophysiological
process.

19. Definition of PSICU nurse
Critical care Pediatric nursing is that specialty within
nursing that deals specifically with child responses to life-
threatening surgical problems and is responsible for
ensuring that critically ill child and their families receive
optimal care.
19

20. Critically ill child are defined as those
children who are at high risk for actual or
potential life-threatening health problems.
The more critically ill the child is, the
more likely he or she is to be highly
vulnerable, unstable and complex, thereby
requiring intense and vigilant nursing care.
20
Definition of a Critically Ill Child

21. CLASSIFICATION OF CRITICAL CARE
child
 Level O :- normal ward care.
 Level 1:- at risk of deteriorating , support from
critical care team.
 Level 2 :- more observation or intervention, single
failing organ or postoperative care.
 Level 3:- advanced respiratory support or basic
respiratory support ,multi organ failure.
21

22. What are the conditions considered as
Critical?
1) Any child with life threatening condition.
2) Child with :-
 ARF.
 Cardiac dysfunction.
 cardiac tamponade.
 severe shock.
22

23. CONT.
 Acute renal failure.
 Poly trauma, multiple organ failure and organ
dysfunction.
 Severe burns.
 Motor car accident
23

24. An
Ideal
SICU
24

25. A Good SICU
 Well organized.
 Coordinated care.
 Full-time intensivist: daily round.
 Protocol & policies.
 Bedside nurses (master degree).
 No intern.
25

26. A Good SICU cont.
 A team:-
 doctors, nurses, pharmacists led by full time
pediatrician intensivists critical care trained.
 available in a timely fashion (24hr/day).
 no competing clinical responsibilities during duty.
 closed units.
26

27. Multidisciplinary & Collaborative
approach to SICU care
 Medical & nursing directors :
co-responsibility for ICU management.
 A team approach :
 doctors, nurses, pharmacist and other team profession
 Use of standard, protocol, guideline
consistent approach to all issues.
 Dedication to coordination and communication for all
aspects of ICU management
emphasis on research, education, ethical issues., patient
advocacy
27

28. CONTEMPORARY CRITICAL CARE
Modern critical care is provided to children by a
multidisciplinary team of health care professionals who have
in-depth education in the specialty field of pediatric critical
care.
 The team consists of pediatrician intensivists, specialty
physicians, nurses, advanced practice nurses and other
specialty nurse clinicians, pharmacists, respiratory therapy
practitioners, other specialized therapists and clinicians and
social workers.
 Critical care is provided in specialized units.
28

29. CLASSIFICATION OF SURGICAL
CRITICAL CARE UNITS
 LEVEL - I :-
Provides monitoring, observation and short term
ventilation.
Nurse child ratio is 1:3 and the medical staff are not
present in the unit all the time.
29

30. CONT.
LEVEL - II :-
Provides observation, monitoring and long term ventilation
with resident doctors. The nurse-child ratio is 1:2 and
junior medical staff is available in the unit all the time and
consultant medical staff is available if needed.
30

31. CONT.
 LEVEL – III :-
Provides all aspects of intensive care including invasive
hemodynamic monitoring and dialysis.
Nurse child ratio is 1:1.
31

32. TYPES OF CRITICAL CARE UNIT
 NEONATAL INTENSIVE UNIT (NICU).
 SPECIAL CARE NURSERY (SCN).
 PAEDIATRIC INTENSIVE CARE UNIT (PICU).
 CARDIAC SURGERY INTENSIVE CARE UNIT
(CSICU).
32

33. CONT.
 TRAUMA – NEURO CRITICAL CARE INTENSIVE
CARE UNIT (TNCC).
 NEURO INTENSIVE CARE UNIT (NICU).
 BURN INTENSIVE CARE UNIT (BNICU).
 SURGICAL INTENSIVE CARE UNIT (SICU).
33

34. Pediatric
SURGICAL
CRITICAL
CARE
NURSING ROLES
34

35. General Roles of pediatric nurse
35
1. Primary care giver.
2. Coordinator & Collaborator.
3. Nurse Advocate.
4. Health Educator.
5. Nurse Consultant.
6. Nurse Counselor.
7. Case Manager.
8. Recreationist.
9. Social Worker.
10. Nurse researcher.

36. CONT.
36
1. Primary care giver:-
Pediatric nurse should provide preventive, promotive,
curative and rehabilitative care in all levels of health
services.
2. Coordinator & Collaborator:-
 The nurse plays an extremely important role with the
combination of health care team members.
 Nurse maintains good inter personal communication
with the child, family and health team members.
 The nurse coordinates nursing care with other services
for meeting the needs of child. For ex: physician, social
worker, surgeon, physiotherapist, dietician.

37. 3. Nurse Advocate:
The pediatric nurse acts as an advocate to safeguard the
child’s right, to assist & to provide best care from the
health care team.
4. Health Educator:
The nurse’s goal of health teaching is to provide information
to the child, parents and significant other about prevention
of illness, promotion or health maintenance.
5. Nurse Consultant:
The pediatric nurse can act as consultant to guide parents for
maintenance and promotion of health. For ex: Guiding
parents about feeding practices, accident prevention.
37
CONT.

38. 38
6. Nurse Counselor:-
Providing guidance to parents in health hazards of children
and health them for own decision making in different
situations.
7. Case Manager:-
The pediatric nurse should organize care, monitor and
evaluate patient treatment for successful outcome. She/he
acts as a manager of pediatric care units in hospital clinics
and community.
8. Recreationist:-
The pediatric nurse plays supportive role for the child to
provide play facilities for recreation and diversion. It helps
to decrease crisis imposed by illness or hospitalization
CONT.

39. 9. Social Worker:-
Pediatric nurse can participate in social services or refer
child & family child welfare agencies for necessary
support.
10. Nurse researcher:-
Research is an integral part of professional nursing. Pediatric
nurse should participate or perform research activities.
It helps to provide basis for changes in nursing practice,
improvement in the child health care and evaluate the care.
39
CONT.

40. PEDIATRIC SURGICAL CRITICAL
CARE NURSING ROLES
The American Association of Critical-Care Nurses
(AACN) has delineated role responsibilities important
for the pediatric critical care nurse.
Nurses provide and contribute to the care of critically ill
child in a variety of roles.
The most prevalent role for the professional pediatric
nurse is that of direct care provider.
40

41. AACN critical care nurse
role responsibilities
 Respect and support the right of the child and family to
autonomy and informed decision making.
 Intervene when the best interest of the patient is in
question.
 Help the child and family obtain necessary care.
 Provide education and support help to child and family
to make decisions.
41

42. CONT.
 Monitor and safeguard the quality of care that the child
receives.
 Intercede for child who cannot speak for themselves in
situations that require immediate attention.
 Act as a liaison between the child and the child’s family
and other health care professionals.
 Respect the values, beliefs, and rights of the child and
family.
42

43.  Nurse working in the intensive care should be aware of
the specific requirements of each child.
 They provide direct child care, including assessing,
diagnosing, planning and prescribing pharmacological
and non pharmacological treatment of health problems.
 Their activities include risk appraisal, interpretation of
diagnostic tests and providing treatment, which may
include prescribing medication.
43
CONT.

44. Core Competencies
Child Care.
Growth and development.
Medical Knowledge.
Professionalism & Ethics.
Interpersonal Communication Skills.
Practice-based Learning and *Improvement.
Systems-based Practice.
44

45. Characteristics of PSICU nurse
To be consider in recruiting pediatric critical care nurses
have:-
1)Technical qualification.
2)Educational background.
3)Clinical experience.
4)Have knowledge.
45

46. PRINCIPLES OF CRITICAL CARE
NURSING
 ANTICIPATION :
 The first principle in critical care is Anticipation.
 One has to recognize the high risk patients and
anticipate the requirements, complications and be
prepared to meet any emergency.
 Unit is properly organized in which all necessary
equipment and supplies are mandatory for smooth
running of the unit.
43

47. CONT.
EARLY DETECTION AND PROMPT ACTION :
 The prognosis of the child depends on the early detection
of variation, prompt and appropriate action to prevent or
combat complication.
Monitoring of cardiac respiratory function is of prime
importance in assessment.
47

48. CONT.
COLLABORATIVE PRACTICE:-
Critical Care, which has originated as technical sub-
specialized body of knowledge has evolved into a
comprehensive discipline requiring a very specialized body
of knowledge for the pediatrician and nurses working in
the critical care unit fosters a partnerships for decision
making and ensures quality and compassionate patient
care.
Collaborate practice is more and more warranted for
critical care more than in any other field.
48

49. CONT.
COMMUNICATION :
Intra professional, inter departmental and inter personal
communication has a significant importance in the
smooth running of unit.
49

50. Cont.
Prevention of Infection:-
Nosocomial infection cost a lot in the health care services.
Critically ill child requiring intensive care are at a greater
risk than other child due to the immunocompromised state
with the antibiotic usage and stress, invasive lines,
mechanical ventilators, prolonged stay and severity of
illness and environment of the critical unit itself.
50

51. CONT.
Crisis Intervention and Stress Reduction :
Partnerships are formulated during crisis.
Bonds between nurses, patients and families are stronger
during hospitalization.
As patient advocates, nurses assist the patient to express
fear and identify their grieving pattern and provide
avenues for positive coping.
51

52. Stressors of Hospitalization and Child
reaction
Often, illness an hospitalization are the first crisis children
must face, especially during the early years.
Children are particular vulnerable to the crisis illness and
hospitalization
because :-
1- stress represent a change from the usual state of health
and environmental routine.
2- children have limited number of coping mechanism to
resolve stressors.
52

53. CONT.
Major stressors of hospitalization include :-
1- separation anxiety.
2-loss of control.
3- bodily injury and pain.

54. CONT.
Children reaction to these crises influenced by there
developmental age, their previous experience with
illnesses, separation, or hospitalization, their innate and
acquired coping skills, the seriousness of diagnosis and
the support system available.

55. Effect of Hospitalization on the
Child
Children may react to stress of hospitalization before
admission, during hospitalization, and after discharge.

56. Younger children
This may last from a few minute to a few day, this is
frequently followed by dependency negative behavior
include :-
1) New fears (e.g. nightmares).
2) Résistance to going to bed, night waking.
3) Withdrawal and shyness.
4) Angry.
5) Temper tantrum.
6) Attachment to blanket or toy.
7) Regression in new learned skills( e.g. self-toileting).

57. CONT.
8) Stress of hospitalization may cause Young children
to experience short- and long- term negative
outcomes.
9) Adverse outcomes may be related to length and
number of admission, multiple invasive procedures,
and parent anxiety.
10) Common response include regression, separation
anxiety, apathy, fear, and sleeping disturbance,
especially for children young than 7 years of old.

58. Older children
Negative behavior include :-
1) Emotional coldness, followed by intense, demanding
dependence on parent.
2) Anger toward parent.
3) Jealousy toward other (e.g. sibling).

59. Article
Psychological, emotional and physical experiences of
hospitalized children (Rokach,A.2016).
Conclusion:-
hospitalized children are commonly confused, frightened,
and in need of support, reassurance, explanation of what
they will be exposed to [in a manner that fits their level of
maturity], and mostly, they need to be recognized as ‘little
people’ who are yearning to be treated not just as ‘bodies’
but as humans with emotions, pain, illness, and concerns.

60. Stressor And Reaction Of The Family Of The
Child Who Is Hospitalized
The crisis of the child illness, hospitalization affect every
members of the family.
Factor affecting parents reactions to their child's
illness :-
1) Seriousness of the threat to the child.
2) Previous experience with illness or hospitalization
3) Medical procedures involved in diagnosis and treatment.
4) Available support system.

61. CONT.
5) Personal ego strength.
6)previous coping ability.
7)additional stress on the family system.
8)cultural and religious belief.
9)Communication pattern among family
members.

62. 1- Parental Reaction
Parent reaction to illness in their
child include:-
1. Feeling an overall sense of
helplessness.
2. Questioning the skills of the staff.
3. Accepting the reality of hospitalization.

63. CONT.
Needing to have information explained in
simple language.
Dealing with fear.
Seeking reassurance from care giver.
Coping with uncertainty.

64. 2- Sibling Reaction
Sibling experience loneliness, fear, and
worry, as well as anger, jealousy, and guilt.
Factor Affecting on the Sibling
Reaction:
1. Being younger and experiencing many
change.
2. Being cared for outside the home by care
provider who are not relative.

65. CONT.
3. Receiving little information about
their ill brother or sister.
4. Perceiving that their parents treat
them differently compared with
before their sibling’s hospitalization.
5. Sibling should be prepared for the
visit with developmentally
appropriate information and given
opportunity to ask question.

66. 3- Altered Family Role
One of the most common reaction of
parent is specialized and intensified
attention toward the sick child.
 The other sibling may regard this as
unfair and interpret the parent attitude
toward them as rejection.

67. Article
A study of the emotional reactions of children and
families to hospitalization and illness.(PRUGH, D,
KIRSCHBAU,R.2010.)
Aim
The present study was designed to evaluate the nature of
the immediate reactions and modes of adaptation of
children and parents to the impact of hospitalization on a
medical ward in a children’s hospital.

68. Conclusion
 All children in the series showed some observable
reaction to the experience of hospitalization and
treatment for illness, as distinct from the effect of the
illness itself.
Such reactions were apparently more severe and
persistent in children of preschool age, where
separation from the parents seemed to play a major role,
and in children with previously limited capacities for
adaptation.

69. 69
Thank you

70. References:
70
Potts, N. L. and Mandleco, B. L. 2007 Pediatric
nursing: caring for children and their families. 2nd
edition, Thomson, Delmar learning, Australia
http://www.aacn.org/wd/publishing/content/pre
ssroom/aboutcriticalcarenursing.pcm Accessed
August 2019.
American Association of Critical-Care Nurses.
Fact sheet: about critical care nursing (press room).
http://www.aacn.org. Accessed August 2019.