Judy Rashotte

Psychological outcomes in children following pediatric intensive care unit hospitalization: a systematic review of the research

A systematic review of published research on childrens psychological outcomes following Pediatric Intensive Care Unit (PICU) hospitalization was conducted. Of the 275 papers published between 1970 and April 2008 which were identified using keywords, reference lists and one authors collections, a total of 28 papers met the inclusion criteria for this review. The papers fell into four categories based on the focus of the research: (1) childrens PICU perceptions and recall; (2) childrens psychological outcomes, broadly defined; (3) post-traumatic stress responses; and (4) general health status and quality of life. The findings suggest that PICU hospitalization can result in negative psychological sequelae in children, which can manifest themselves up to one year post-discharge. While a small number of studies have attempted to identify predictors of psychological outcome, this work remains in its infancy. The importance of the childs interpretation of the illness experience in influencing subsequent behavioral and emotional responses is highlighted.

Incorporating Educational Theory Into Critical Care Orientation

This article describes the development and implementation of a critical care total education system, which includes an orientation program. The educational process in this unit reflects Benners model of novice to expert integrated with Schons theory of reflective practice and Crantons transformational learning theory. This program reflects an educational philosophy that facilitates learning on entry into the new workplace, and an established continuum of expected acquisition of knowledge, practice skills, attitudes, and critical thinking abilities promoting the transition from novice to expert.

Measuring psychological outcomes following pediatric intensive care unit hospitalization: psychometric analysis of the Children's Critical Illness Impact Scale.

Objective: Critically ill children are at risk for psychological sequelae following pediatric intensive care unit hospitalization. This article reports on the psychometric testing of the first self-report measure of psychological distress for 6–12-yr-old children post-pediatric intensive care unit hospitalization: The Childrens Critical Illness Impact Scale. This 23-item scale takes approximately 15 mins for children to complete. Design: Psychometric testing based on Classic Test Theory and guidelines for health measurement scale development. Setting: The pediatric intensive care units of four Canadian pediatric hospitals and the ear, nose, and throat clinic of one participating hospital. Patients: A total of 172 children (pediatric intensive care unit group, n = 84; ear, nose, and throat group, n = 88) aged 6–12 yrs and their parents. Interventions: None. Measurements and Main Results: We assessed the factor structure, internal consistency, and test–retest reliability of the Childrens Critical Illness Impact Scale and conducted contrasted group comparisons and convergent and concurrent validation testing. Fit indices and internal consistency were best for a three-factor solution, suggesting three dimensions of psychological distress: 1) worries about getting sick again, 2) feeling things have changed, and 3) feeling anxious and fearful about hospitalization. As expected, Childrens Critical Illness Impact Scale scores were positively correlated with child anxiety and medical fear scores. The ear, nose, and throat group scores were higher than expected. Higher Childrens Critical Illness Impact Scale scores in older children may reflect a better understanding of the situation and its complexity and meaning, and younger childrens tendency to provide more positive self-evaluation. Conclusions: The Childrens Critical Illness Impact Scale is a promising new self-report measure of psychological distress with demonstrated reliability and validation testing in 6–12-yr-old children post-pediatric intensive care unit hospitalization. This new measure has potential to advance the evidence base for pediatric intensive care unit and post-pediatric intensive care unit health promotion interventions.

The transformational journey of nurse practitioners in acute-care settings.

This study explored the nature of the lived experience of being nurse practitioners (NPs) in acute-care settings in Canadian teaching hospitals using hermeneutic phenomenological inquiry guided by van Manens approach. A total of 26 NPs were interviewed. Data analysis revealed that NPs experienced a transformational journey as they searched for being more, the overarching phenomenon that best characterizes their overall experience, which occurred in the context of being pioneers. Five themes emerged: being called to be more--being more connected, in control, visible, challenged, and able to make more of a difference; being adrift--being disconnected, uncertain, lost, and staying afloat; being an acute-care NP--being competent, confident, comfortable, committed, connected, and content; being pulled to be more--being a wearer of two hats; and being more--being an advanced practitioner. The NP journey reveals the complex, largely invisible experience of being an acute-care NP.

The Use of Resources during Shift Hand-offs in a Pediatric Intensive Care Unit

The nursing handoff is a fundamental aspect of continued patient care that involves the transfer of vital medical information through various means. This project qualitatively examined nursing dyads to determine the types of resources used during handoffs and their frequency through the theoretical framework of distributed cognition. Forty handoffs between nurses, with experience ranging from 3 to 40 or more years, were observed within the intensive care unit of a pediatric hospital. The findings revealed that a variety of resources were referred to and appear mildly correlated with handoff durations, where more experienced individuals displayed a greater frequency of resource use in prolonged handoffs.

The experience of being a trauma nurse: a phenomenological study.

The lived experience of being a trauma nurse was explored using a phenomenological qualitative research approach. Seven registered nurses employed in a trauma unit from one large metropolitan Canadian teaching hospital participated in in-depth conversational interviews. Data analysis revealed four sub theme clusters embedded within the overarching theme of Seeing Through Cloudy Situations: being on guard all the time, being caught up short, facing the challenge and sharing the journey. Even though trauma nurses are able to find meaning and satisfaction in their work, the findings of this research reveal the need for support and the assurance of safe work environments as trauma nurses can live with violence and aggression in their daily nursing practice.

Information structure and organisation in change of shift reports: An observational study of nursing hand-offs in a Paediatric Intensive Care Unit

Patient hand-offs involve the exchange of critical information. Ineffective hand-offs can result in reduced patient safety by leading to wrong treatment, delayed diagnoses or other outcomes that can negatively affect the healthcare system. The objectives of this study were to uncover the structure of the information conveyed during patient hand-offs and look for principles characterising the organisation of the information. With an observational study approach, data was gathered during the morning and evening nursing change of shift hand-offs in a Paediatric Intensive Care Unit. Content analysis identified a common meta-structure used for information transfer that contained categories with varying degrees of information integration and the repetition of high consequence information. Differences were found in the organisation of the hand-off structures, and these varied as a function of nursing experience. The findings are discussed in terms of the potential benefits of computerised tools which utilise standardised structure for information transfer and the implications for future education and critical care skill acquisition.