Jos M. Latour

World Federation of Pediatric Intensive Care and Critical Care Societies: Global Sepsis Initiative*

Background: According to World Health Organization estimates, sepsis accounts for 60%–80% of lost lives per year in childhood. Measures appropriate for resource-scarce and resource-abundant settings alike can reduce sepsis deaths. In this regard, the World Federation of Pediatric Intensive Care and Critical Care Societies Board of Directors announces the Global Pediatric Sepsis Initiative, a quality improvement program designed to improve quality of care for children with sepsis. Objectives: To announce the global sepsis initiative; to justify some of the bundles that are included; and to show some preliminary data and encourage participation. Methods: The Global Pediatric Sepsis Initiative is developed as a Web-based education, demonstration, and pyramid bundles/checklist tool (http://www.pediatricsepsis.org or http://www.wfpiccs.org). Four health resource categories are included. Category A involves a nonindustrialized setting with mortality rate <5 yrs and >30 of 1,000 children. Category B involves a nonindustrialized setting with mortality rate <5 yrs and <30 of 1,000 children. Category C involves a developing industrialized nation. In category D, developed industrialized nation are determined and separate accompanying administrative and clinical parameters bundles or checklist quality improvement recommendations are provided, requiring greater resources and tasks as resource allocation increased from groups A to D, respectively. Results: In the vanguard phase, data for 361 children (category A, n = 34; category B, n = 12; category C, n = 84; category D, n = 231) were successfully entered, and quality-assurance reports were sent to the 23 participating international centers. Analysis of bundles for categories C and D showed that reduction in mortality was associated with compliance with the resuscitation (odds ratio, 0.369; 95% confidence interval, 0.188–0.724; p < .0004) and intensive care unit management (odds ratio, 0.277; 95% confidence interval, 0.096–0.80) bundles. Conclusions: The World Federation of Pediatric Intensive Care and Critical Care Societies Global Pediatric Sepsis Initiative is online. Success in reducing pediatric mortality and morbidity, evaluated yearly as a measure of global child health care quality improvement, requires ongoing active recruitment of international participant centers. Please join us at http://www.pediatricsepsis.org or http://www.wfpiccs.org.

The Presence of Family Members During Cardiopulmonary Resuscitation: European Federation of Critical Care Nursing Associations, European Society of Paediatric and Neonatal Intensive Care and European Society of Cardiology Council on Cardiovascular Nursing and Allied Professions Joint Position Statement

This paper presents the European federation of Critical Care Nursing associations, the European Society of Paediatric and Neonatal Intensive Care, and the European Society of Cardiology Council on Cardiovascular Nursing and Allied Professions Joint Position Statement on The Presence of Family Members During Cardiopulmonary Resuscitation. Copyright of this position statement is jointly owned by the European Federation of Critical Care Nursing associations, the European Society of Paediatric and Neonatal Intensive Care, the Council on Cardiovascular Nursing and Applied Professions, and Connect Healthcare Publishing Ltd.

Parent Satisfaction in the Pediatric ICU

Parents are important partners who collaborate with the multidisciplinary team to improve quality of care. This article discusses a framework for action toward quality improvement in pediatric intensive care by parental empowerment through parent satisfaction with care. Incorporating the concepts of family-centered care and parental needs and experiences into a parent satisfaction instrument may provide quality improvement projects based on the empowerment of parents and eventually may facilitate the implementation and evaluation of quality initiatives.

Research priorities of adult intensive care nurses in 20 European countries: a Delphi study.

AIMS This paper is a report of a three round Delphi study of intensive care nursing research priorities in Europe (October 2006-April 2009). BACKGROUND Internationally, priorities for research in intensive care nursing have received some attention focusing on healthcare interventions and patient needs. Studies as early as the 1980s identified priorities in the United States, United Kingdom, Hong Kong and Australia. Research priorities of intensive care nurses across the European Union are unknown. METHODS The participants, invited in 2006, included 110 intensive care nurses, managers, educators and researchers from 20 European Critical Care Nursing Associations. Delphi round one was an emailed questionnaire inviting participants to list important areas for research. The list was content analysed and developed into an online questionnaire for rounds two and three. In round two, participants ranked the topics on a scale of 1-6 (not important to extremely important). Mean scores of round two were added to the questionnaire of round three and participants ranked the topics again. RESULTS There were 52 research topics in 12 domains. There was a dominance of priorities in five main areas: patient safety; impact of evidence based practice on outcomes; impact of workforce on outcomes; wellbeing of patients and relatives; and impact of end-of-life care on staff and practice. CONCLUSIONS The results reflect worldwide healthcare concerns and objectives and highlight topics that nurses view as fundamental to the care of critically ill patients. These topics provide a platform for future research efforts to improve clinical practice and care of patients in intensive care.

Using a web-based survey tool to undertake a Delphi study: Application for nurse education research

BACKGROUND The Internet is increasingly being used as a data collection medium to access research participants. This paper reports on the experience and value of using web-survey software to conduct an eDelphi study to develop Australian critical care course graduate practice standards. METHODS The eDelphi technique used involved the iterative process of administering three rounds of surveys to a national expert panel. The survey was developed online using SurveyMonkey. Panel members responded to statements using one rating scale for round one and two scales for rounds two and three. Text boxes for panel comments were provided. COLLECTING DATA AND PROVIDING FEEDBACK For each round, the SurveyMonkeys email tool was used to distribute an individualized email invitation containing the survey web link. The distribution of panel responses, individual responses and a summary of comments were emailed to panel members. Stacked bar charts representing the distribution of responses were generated using the SurveyMonkey software. Panel response rates remained greater than 85% over all rounds. DISCUSSION An online survey provided numerous advantages over traditional survey approaches including high quality data collection, ease and speed of survey administration, direct communication with the panel and rapid collation of feedback allowing data collection to be undertaken in 12 weeks. Only minor challenges were experienced using the technology. Ethical issues, specific to using the Internet to conduct research and external hosting of web-based software, lacked formal guidance. CONCLUSIONS High response rates and an increased level of data quality were achieved in this study using web-survey software and the process was efficient and user-friendly. However, when considering online survey software, it is important to match the research design with the computer capabilities of participants and recognize that ethical review guidelines and processes have not yet kept pace with online research practices.

Exciting but exhausting: experiences with participatory research with chronically ill adolescents.

Background  Adolescents with chronic conditions are major users of paediatric hospitals, but seldom participate in the evaluation of services or in research. Little is known about the usefulness of the participatory approach in adolescent health research.

Forgoing life-sustaining or death-prolonging therapy in the pediatric ICU.

Most deaths in the pediatric intensive care unit occur after a decision to withhold or withdraw life-sustaining treatments. The management of children at the end of life can be divided into three steps. The first concerns the decision-making process. The second concerns the actions taken once a decision has been made to forego life-sustaining treatments. The third regards the evaluation of the decision and its implementation. The mission of pediatric intensive care has expanded to provide the best possible care to dying children and their families. Improving the quality of care received by dying children remains an ongoing challenge for every pediatric intensive care unit team member.

What’s new in ICU visiting policies: can we continue to keep the doors closed?

1 Pediatric Intensive Care Unit Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico Via della Commenda 9 20122 Milan, Italy 2 Medical-Surgical Intensive Care Unit Groupe Hospitalièr Paris Saint Joseph 185 rue Raymond Losserand 75014 Paris, France 3 IAME, UMR 1137, INSERM, F-75018 Paris, France IAME, UMR 1137, Paris Diderot University, Sorbonne Paris Cité, F-75018 Paris, France 5 Plymouth University, School of Nursing and Midwifery, Faculty of Health, Education and Society 8 Portland Villas, Drake Circus, Plymouth, PL4 8AA, United Kingdom 6 Curtin University, School of Nursing and Midwifery, Faculty of Health Sciences GPO Box U1987 Curtin University, Perth 6845, Australia 7 Neonatal Intensive Care, Department of Pediatrics Erasmus MC-Sophia Childrens Hospital PO Box 2060 3000 CB Rotterdam, The Netherlands

Perceptions of parents on satisfaction with care in the pediatric intensive care unit: the EMPATHIC study

PurposeTo identify parental perceptions on pediatric intensive care-related satisfaction items within the framework of developing a Dutch pediatric intensive care unit (PICU) satisfaction instrument.MethodsProspective cohort study in tertiary PICUs at seven university medical centers in The Netherlands.ParticipantsParents of 1,042 children discharged from a PICU.ResultsA 78-item questionnaire was sent to 1,042 parents and completed by 559 (54%). Seventeen satisfaction items were rated with mean scores <8.0 (1, completely unimportant, to 10, very important) with standard deviations ≥1.65, and thus considered of limited value. The empirical structure of the items was in agreement with the theoretically formulated domains: Information, Care and Cure, Organization, Parental Participation, and Professional Attitude. The Cronbach’s α of the domains ranged between 0.87 and 0.94.ConclusionsParental perceptions on satisfaction with care measures were identified and prioritized. Reliabilities of the items and domains were of high level.

Development and validation of a neonatal intensive care parent satisfaction instrument

Objective: To develop and test the psychometric properties of the EMPATHIC-N (EMpowerment of PArents in THe Intensive Care-Neonatology) questionnaire measuring parent satisfaction. Design: A psychometric study testing the reliability and validity of a parent satisfaction questionnaire by applying confirmatory factor analysis including standardized factor loadings and subsequently Cronbach’s &agr; reliability estimates across time, congruent validity, and nondifferential validity testing. Setting: A 30-bed neonatal intensive care unit in a university hospital. Patients: Two cohorts with a total of 441 parents whose child was admitted to the neonatal intensive care unit, January to December 2009. Interventions: None. Measurements and Main Results: In the first cohort, 220 of 339 (65%) parents responded; in the second cohort, 59 of 102 (58%) parents responded. Structural equation modeling and confirmatory factor analysis resulted in a sufficient model fit of 57 statements within five domains: Information, Care & Treatment, Organization, Parental Participation, and Professional Attitude. Standardized factor loading of these statements were between 0.58 and 0.91. Reliability measures, Cronbach’s &agr;, of the domains ranged from 0.82 to 0.95. Reliability across time showed no evidence of statistically significant differences between the domains. Congruent validity was confirmed by a good correlation (p = .01) between the domains and four general satisfaction questions. Nondifferential validity showed no significant effect sizes between the infants’ characteristics and the domains, except between ventilated infants and parent participation statements and infants ≥30 wks gestational age and organizational statements. Conclusions: The EMPATHIC-N questionnaire is a valid quality performance indicator to measure the delivered care as perceived by parents.