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Article ; Online: Steroid Use for Management of Vasoactive Resistant Shock in Pediatric Cardiac Intensive Care Patients: Experience of the Consortium of Congenital Cardiac Care-Measurement of Nursing Practice.

Diller, Christin N / Hartwell, Lauren / Connor, Jean A

Dimensions of critical care nursing : DCCN

2023 Volume 41, Issue 3, Page(s) 151–156

Abstract: Background: Although a variety of doses and duration of hydrocortisone have been reported as a treatment modality for congenital heart surgery patients with refractory hypotension, there remains a lack of understanding of the clinical use in pediatric ... ...

Abstract	Background: Although a variety of doses and duration of hydrocortisone have been reported as a treatment modality for congenital heart surgery patients with refractory hypotension, there remains a lack of understanding of the clinical use in pediatric cardiac programs. Objectives: The aim of this study was to describe the current practice of steroid use for refractory hypotension in postoperative congenital heart surgery patients. Method: Survey participants were recruited from the Consortium of Congenital Cardiac Care-Measurement of Nursing Practice. The survey focused on 4 areas: diagnosis, intervention, duration of therapy, and clinical decision making. Data were summarized using descriptive statistics. Results: Among the programs, 24 of 31 (77%) responded, with 21 (95%) using hydrocortisone as a treatment modality. Most, 20 (83%), reported no written clinical guideline for the use of hydrocortisone. Variation in dosing existed as 3 centers (14%) use 50 mg/m2/d, 6 (29%) use 100 mg/m2/d, and 8 (38%) indicated that dosing varies by provider. Discussion: Nearly all centers reported using hydrocortisone for the treatment of hypotension refractory to fluid resuscitation and vasoactive medications. Substantial variation in practice exists in areas of diagnosis, dosing, and duration of hydrocortisone. More research is needed to develop a clinical practice guideline to standardize practice.
MeSH term(s)	Child ; Humans ; Hydrocortisone/therapeutic use ; Shock, Septic ; Heart Defects, Congenital ; Critical Care ; Hypotension
Chemical Substances	Hydrocortisone (WI4X0X7BPJ)
Language	English
Publishing date	2023-02-07
Publishing country	United States
Document type	Journal Article
ZDB-ID	632780-1
ISSN	1538-8646 ; 0730-4625
ISSN (online)	1538-8646
ISSN	0730-4625
DOI	10.1097/DCC.0000000000000520
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Article ; Online: Refinement of the Intensive Care Unit Complexity Assessment and Monitoring to Ensure Optimal Outcomes III Acuity Tool.

Connor, Jean A / LaGrasta, Christine / Hickey, Patricia A

Dimensions of critical care nursing : DCCN

2023 Volume 41, Issue 3, Page(s) 144–150

Abstract: Background: The Intensive Care Unit (ICU) Complexity Assessment and Monitoring to Ensure Optimal Outcomes (CAMEO) acuity tool quantifies patient acuity in terms of nursing cognitive workload complexity.: Objectives: The aim of this study was to ... ...

Abstract	Background: The Intensive Care Unit (ICU) Complexity Assessment and Monitoring to Ensure Optimal Outcomes (CAMEO) acuity tool quantifies patient acuity in terms of nursing cognitive workload complexity. Objectives: The aim of this study was to refine the ICU CAMEO II acuity tool. An expert panel of nursing staff from 4 pediatric ICUs convened to refine the CAMEO II across a large, freestanding children's hospital in the United States. Method: This study used a modified Delphi technique. Results: Through a series of 4 Delphi rounds, the expert panel identified Domains of Care and nursing care items that were suitable to be collapsed or bundled. The number of Domains of Care decreased from 18 to 10. Each of the expert panel members then completed the ICU CAMEO II tool and the newly revised tool, ICU CAMEO III, on 5 to 10 patients. Sixty completed ICU CAMEO II tools, and ICU CAMEO III tools were available for comparison. The average difference of the 2 tools' total scores was 5 points (minimum, 4; maximum, 7). The level of agreement between the 2 tools by CAMEO Complexity Classification level (I-V) was 90%. Discussion: The ICU CAMEO III acuity tool is a streamlined measure to describe and quantify the acuity of pediatric critical care nursing. Use of this acuity measure will support projection of staffing models, staffing assignments, and benchmarking across pediatric ICUs. Further research is underway to validate the CAMEO III for multisite use.
MeSH term(s)	Child ; Humans ; United States ; Personnel Staffing and Scheduling ; Intensive Care Units ; Workload ; Intensive Care Units, Pediatric ; Patient Acuity ; Critical Care Nursing ; Nursing Staff, Hospital
Language	English
Publishing date	2023-02-07
Publishing country	United States
Document type	Journal Article
ZDB-ID	632780-1
ISSN	1538-8646 ; 0730-4625
ISSN (online)	1538-8646
ISSN	0730-4625
DOI	10.1097/DCC.0000000000000523
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Article ; Online: Use of Music for Newborns After Cardiac Surgery: A Pilot Study.

Sorensen, Angela / Engstrand, Shannon / Connor, Jean A

American journal of critical care : an official publication, American Association of Critical-Care Nurses

2022 Volume 31, Issue 4, Page(s) 315–318

Abstract: Background: Music can benefit the neurodevelopmental and clinical care of newborns in the neonatal intensive care unit. Newborns in the cardiac intensive care unit experience similar stressors to those in the neonatal intensive care unit, but music ... ...

Abstract	Background: Music can benefit the neurodevelopmental and clinical care of newborns in the neonatal intensive care unit. Newborns in the cardiac intensive care unit experience similar stressors to those in the neonatal intensive care unit, but music therapy has not been widely studied in the cardiac intensive care unit population. Objective: To explore the feasibility of implementing nurse-led music therapy in a cohort of newborns recovering from cardiac surgery in the cardiac intensive care unit. Methods: Lullabies were prerecorded and played for 20 minutes, 2 times per day. Bedside nurses recorded several metrics at designated times during the 1 hour surrounding the music therapy and were asked about the ease of initiating the therapy and their perception of any benefit to the newborns. Parents were invited to complete a 9-question Likert survey exploring their perception of and satisfaction with the music therapy. Results: Nurse-led music therapy was initiated in 44 of 50 eligible shifts (88%) for the 8 newborns who successfully completed the study. The newborns' physiological status remained stable throughout the music therapy sessions. None of the newborns experienced adverse events related to music therapy. All nurses (100%) reported that the music therapy was easy to administer. Parents "agreed" or "strongly agreed" that they were satisfied with the music therapy provided to their newborns. Conclusion: Nurse-led music therapy was highly feasible for hemodynamically stable newborns recovering from cardiac surgery. Parents and nursing staff responded positively to the music therapy.
MeSH term(s)	Cardiac Surgical Procedures ; Humans ; Infant, Newborn ; Intensive Care Units, Neonatal ; Music ; Music Therapy ; Pilot Projects
Language	English
Publishing date	2022-06-26
Publishing country	United States
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	1130987-8
ISSN	1937-710X ; 1062-3264
ISSN (online)	1937-710X
ISSN	1062-3264
DOI	10.4037/ajcc2022604
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Article ; Online: Validation of the withdrawal assessment tool-1 (WAT-1) in pediatric cardiovascular patients on an inpatient unit.

McAlister, Sarah / Connor, Jean A / Engstrand, Shannon / McLellan, Mary C

Journal for specialists in pediatric nursing : JSPN

2023 Volume 28, Issue 2, Page(s) e12404

Abstract: Purpose: Sedation and analgesia are administered to critically ill patients, which may result in physical dependence and subsequent iatrogenic withdrawal. The Withdrawal Assessment Tool-1 (WAT-1) was developed and validated as an objective measurement ... ...

Abstract	Purpose: Sedation and analgesia are administered to critically ill patients, which may result in physical dependence and subsequent iatrogenic withdrawal. The Withdrawal Assessment Tool-1 (WAT-1) was developed and validated as an objective measurement of pediatric iatrogenic withdrawal in intensive care units (ICUs), with a WAT-1 score ≥ 3 indicative of withdrawal. This study's objectives were to test interrater reliability and validity of the WAT-1 in pediatric cardiovascular patients in a non-ICU setting. Design and methods: This prospective observational cohort study was conducted on a pediatric cardiac inpatient unit. WAT-1 assessments were performed by the patient's nurse and a blinded expert nurse rater. Intra-class correlation coefficients were calculated, and Kappa statistics were estimated. A two-sample, one-sided test of proportions of weaning (n = 30) and nonweaning (n = 30) patients with a WAT-1 ≥3 were compared. Results: Interrater reliability was low (K = 0.132). The WAT-1 area under the receiver operating curve was 0.764 (95% confidence interval; ± 0.123). There was a significantly higher proportion (50%, p = 0.009) of weaning patients with WAT-1 scores ≥3 compared to the nonweaning patients (10%). The WAT-1 elements of moderate/severe uncoordinated/repetitive movement and loose, watery stools were significantly higher in the weaning population. Practice implications: Methods to improve interrater reliability warrant further examination. The WAT-1 had good discrimination at identifying withdrawal in cardiovascular patients on an acute cardiac care unit. Frequent nurse re-education may increase accurate tool use. The WAT-1 tool may be used in the management of iatrogenic withdrawal in pediatric cardiovascular patients in a non-ICU setting.
MeSH term(s)	Child ; Humans ; Prospective Studies ; Inpatients ; Reproducibility of Results ; Analgesics, Opioid ; Substance Withdrawal Syndrome/diagnosis ; Substance Withdrawal Syndrome/epidemiology ; Iatrogenic Disease ; Intensive Care Units, Pediatric
Chemical Substances	Analgesics, Opioid
Language	English
Publishing date	2023-02-20
Publishing country	United States
Document type	Observational Study ; Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	2082595-X
ISSN	1744-6155 ; 1539-0136 ; 1088-145X
ISSN (online)	1744-6155
ISSN	1539-0136 ; 1088-145X
DOI	10.1111/jspn.12404
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Article ; Online: Factors Associated With Increased Laboratory Use in the Pediatric Cardiac Intensive Care Unit.

Fisk, Anna C / Gauvreau, Kimberlee / Connor, Jean A

Dimensions of critical care nursing : DCCN

2021 Volume 40, Issue 5, Page(s) 295–300

Abstract: Background: Laboratory testing is frequently used to guide postoperative management and contributes to hospital resource utilization; however, there is little evidence identifying patient or clinical factors to inform the appropriate frequency of ... ...

Abstract	Background: Laboratory testing is frequently used to guide postoperative management and contributes to hospital resource utilization; however, there is little evidence identifying patient or clinical factors to inform the appropriate frequency of laboratory testing in the pediatric cardiac intensive care unit. Objectives: To examine the factors associated with increased laboratory utilization following pediatric congenital heart surgery. Methods: For each patient, the total number of tests and types of laboratory tests were recorded. Patients whose number of tests was greater than the 90th percentile were categorized as increased laboratory use. Results: A sample of 250 unique patients and 909 nursing shifts were obtained for patient- and shift-level analyses. The top 10% of patients identified as the high laboratory utilization group (>128 laboratory tests). High-use group reported significantly younger patients and longer bypass time (P < .001). Patients in the highest Risk Adjustment for Congenital Heart Surgery 1 risk category were 34.7 times more likely to be in high laboratory utilization group (P = .006), independent of age at time of surgery and time on bypass (receiver operating characteristic curve = 0.855). At the shift level, time on bypass (P = .002), age younger than 30 days at surgery (P < .001), 3 to 5 years' registered nurse experience (P < .001), staff precepting (P = .03), and weekday shift status (P = .03) were all independently associated with high laboratory utilization. Conclusions: There are multiple factors associated with increased laboratory utilization. Recognition of specific patient and nursing factors can be used to impact patient management.
MeSH term(s)	Child ; Child, Preschool ; Heart Defects, Congenital/surgery ; Humans ; Intensive Care Units, Pediatric ; Laboratories ; Risk Factors
Language	English
Publishing date	2021-08-16
Publishing country	United States
Document type	Journal Article
ZDB-ID	632780-1
ISSN	1538-8646 ; 0730-4625
ISSN (online)	1538-8646
ISSN	0730-4625
DOI	10.1097/DCC.0000000000000486
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Article ; Online: Expanding Hospital Capacity during the COVID-19 Pandemic: The Family Voice Matters.

Connor, Jean A / Hurtig, Michelle / Ormsby, Jennifer A / Hickey, Patricia A

Pediatric quality & safety

2021 Volume 6, Issue 3, Page(s) e411

Abstract: During the initial COVID-19 response, this children's hospital reduced its inpatient capacity by 52 beds with double rooms' conversion to single patient occupancy, causing significant capacity constraints. To solve this challenge, the family perspective ... ...

Abstract	During the initial COVID-19 response, this children's hospital reduced its inpatient capacity by 52 beds with double rooms' conversion to single patient occupancy, causing significant capacity constraints. To solve this challenge, the family perspective was engaged to safely redouble patient rooms and expand capacity as clinical activity increased during the COVID-19 response. Methods: The team conducted qualitative descriptive interviews with parents of children undergoing congenital heart surgery admitted to the inpatient cardiac unit in a 404-bed free-standing children's hospital. A 2-week pilot study utilizing patient-specific inclusion criteria, newly developed patient room guidelines, universal masking, physical distancing, and inpatient room enhancements with parent COVID-19 testing was conducted. Results: Interviews were conducted [pre (n = 7) and post (n = 6)] regarding patient room redoubling. Participants perceived utilization of double rooms as safe with increased protection, including universal masking, physical distancing, room enhancements, and increased bathroom cleaning. However, some families verbalized anxiety regarding visitation restriction to one parent at a time at the bedside. Additional concerns were voiced around the timing of communication about the need to be placed in a double room. In response, visitation increased to 2 parents at bedside and communication of utilization of double rooms was included in preoperative preparations postpilot. Inclusion criteria were expanded to patients of all ages and included full use of shared in-room bathrooms by parents and patients. Conclusions: Parents perceived patient room redoubling as safe and family centered. Findings from the pilot study were used to scale broad utilization and increase access to care across the institution.
Language	English
Publishing date	2021-05-19
Publishing country	United States
Document type	Journal Article
ISSN	2472-0054
ISSN (online)	2472-0054
DOI	10.1097/pq9.0000000000000411
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Article ; Online: Parent Perception of Their Role in the Pediatric Cardiac Intensive Care Unit.

Fisk, Anna C / Mott, Sandra / Meyer, Shannon / Connor, Jean A

Dimensions of critical care nursing : DCCN

2021 Volume 41, Issue 1, Page(s) 2–9

Abstract: Background/introduction: One way the goal of establishing a partnership with families is accomplished, specific to the pediatric intensive care units, is 24-hour visitation and presence/participation during medical rounds and procedures. Despite the ... ...

Abstract	Background/introduction: One way the goal of establishing a partnership with families is accomplished, specific to the pediatric intensive care units, is 24-hour visitation and presence/participation during medical rounds and procedures. Despite the breadth of literature on the positive effect of parent presence, as well as the nearly nationwide adoption of 24-hour pediatric intensive care unit visitation, there is little to no research about how these changes have affected parents' perception of their role in the pediatric cardiac intensive care unit (PCICU). Objectives/aims: The purpose of this study was to explore and better understand the experience of parents in the PCICU within a patient/family-centered care model. Methods: Using a qualitative descriptive approach, interviews were conducted with parents of children currently admitted as inpatients in the PCICU. Participants were asked broad, open-ended questions and probes to attain qualitative descriptions of their experiences and perceptions of their parental role in the PCICU. The research design for this study was based on naturalistic inquiry and was used to describe rather than interpret parental experiences in their own words. Results: Eleven parents from 7 families were interviewed; parents described their role in terms of 2 main categories, as one who is an advocate and decision maker and one who provides emotional and physical support. Parents valued the expertise of the PCICU team but also shared the significance of the team recognizing their role as parents. Incorporating parents as an integral member of the health care team is a fundamental component to PCICU care. Discussion/conclusion: The role of parents is irreplaceable, particularly in the PCICU. The medical complexity of the intensive care can be a barrier to act as parents resulting in a disruption of family-centered care. Nursing staff avert this disruption through modeling parenting to their child's present circumstances and involvement in normal parenting tasks.
MeSH term(s)	Child ; Critical Care ; Emotions ; Humans ; Intensive Care Units, Pediatric ; Parents ; Perception
Language	English
Publishing date	2021-11-24
Publishing country	United States
Document type	Journal Article
ZDB-ID	632780-1
ISSN	1538-8646 ; 0730-4625
ISSN (online)	1538-8646
ISSN	0730-4625
DOI	10.1097/DCC.0000000000000503
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Article ; Online: Moving from Vaccine Hesitancy to Acceptance: Engaging Underrepresented Employees in a Pediatric Academic Medical Center.

Connor, Jean A / Fynn-Thompson, Francis / Horgan, James J / Luff, Donna / Hickey, Patricia A / Ward, Valerie L

Pediatric quality & safety

2023 Volume 8, Issue 2, Page(s) e643

Abstract: Underrepresented populations historically underserved by the healthcare system and/or marginalized by systematic policies regionally and nationally were particularly vulnerable during the COVID-19 pandemic. While vaccine hesitancy has been described ... ...

Abstract	Underrepresented populations historically underserved by the healthcare system and/or marginalized by systematic policies regionally and nationally were particularly vulnerable during the COVID-19 pandemic. While vaccine hesitancy has been described among hospital employees, the employees' experiences from an underrepresented population cohort have not been reported. We, therefore, sought to understand employees' vaccine experiences, hesitancy, and ways to enhance ongoing COVID-19 vaccine education and communication to build a hospital-wide culture of vaccine acceptance. Methods: We invited interprofessional staff from 5 clinical departments to participate in qualitative focus groups. Guiding questions were used to explore the experiences and perceptions of the staff. Using content analysis, we identified themes and recommendations for improvement. Results: We conducted 5 focus group sessions with over 50 participants. Four themes emerged; "Vaccine Fears Past and Present," "Access to Information," "Worries for Families," and "Our Hospital is a Trusted Name." Participants also provided recommendations for improvement in the messaging around the vaccine rollout. Consideration of how different employees access information, listening to staff needs, and recognizing the role of race and history were critical to engaging and improving the underrepresented employees' vaccine acceptance. Conclusions: Exploring the concerns and fears of the COVID-19 vaccine within groups of underrepresented staff members through qualitative methods was key to understanding their vaccine hesitancy and implementing strategies to move toward vaccine acceptance in the hospital.
Language	English
Publishing date	2023-04-10
Publishing country	United States
Document type	Journal Article
ISSN	2472-0054
ISSN (online)	2472-0054
DOI	10.1097/pq9.0000000000000643
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Article ; Online: The acuity of pediatric neuroscience nursing using the Inpatient Complexity Assessment and Monitoring to Ensure Optimal Outcomes (CAMEO

Atkinson, Carole / Cerrato, Benjamin / Shiers, Deborah / Connor, Jean A

Journal for specialists in pediatric nursing : JSPN

2020 Volume 26, Issue 1, Page(s) e12307

Abstract: Purpose: The neuroscience nurse must possess advanced knowledge and skills to care for a wide range of unique congenital and acquired neurological diagnoses. For each of these clinical scenarios, the measurement of complexity and acuity of patient care ... ...

Abstract	Purpose: The neuroscience nurse must possess advanced knowledge and skills to care for a wide range of unique congenital and acquired neurological diagnoses. For each of these clinical scenarios, the measurement of complexity and acuity of patient care is key to informing staffing models and patient assignments. The Inpatient Complexity Assessment and Monitoring to Ensure Optimal Outcomes (CAMEO Design and methods: Using a quality improvement approach, the Inpatient CAMEO Results: The monthly proportion of Inpatient CAMEO Practice implications: Using the Inpatient CAMEO
MeSH term(s)	Child ; Humans ; Inpatients ; Neuroscience Nursing ; Nursing Staff, Hospital ; Pediatric Nursing ; Personnel Staffing and Scheduling
Language	English
Publishing date	2020-08-27
Publishing country	United States
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	2082595-X
ISSN	1744-6155 ; 1539-0136 ; 1088-145X
ISSN (online)	1744-6155
ISSN	1539-0136 ; 1088-145X
DOI	10.1111/jspn.12307
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Article ; Online: Individualized Family-Centered Developmental Care for Infants With Congenital Heart Disease in the Intensive Care Unit.

LaRonde, Meena P / Connor, Jean A / Cerrato, Benjamin / Chiloyan, Araz / Lisanti, Amy Jo

American journal of critical care : an official publication, American Association of Critical-Care Nurses

2021 Volume 31, Issue 1, Page(s) e10–e19

Abstract: Background: Individualized family-centered developmental care (IFDC) is considered the standard of care for premature/medically fragile newborns and their families in intensive care units (ICUs). Such care for infants with congenital heart disease (CHD) ...

Abstract	Background: Individualized family-centered developmental care (IFDC) is considered the standard of care for premature/medically fragile newborns and their families in intensive care units (ICUs). Such care for infants with congenital heart disease (CHD) varies. Objective: The Consortium for Congenital Cardiac Care- Measurement of Nursing Practice (C4-MNP) was surveyed to determine the state of IFDC for infants younger than 6 months with CHD in ICUs. Methods: An electronic survey was disseminated to 1 nurse at each participating center. The survey included questions on IFDC-related nursing practice, organized in 4 sections: demographics, nursing practice, interdisciplinary practice, and parent support. Data were summarized by using descriptive statistics. Differences in IFDC practices and IFDC-related education were assessed, and practices were compared across 3 clinical scenarios of varying infant acuity by using the χ2 test. Results: The response rate was 66% (25 centers). Most respondents (72%) did not have IFDC guidelines; 63% incorporated IFDC interventions and 67% documented IFDC practices. Only 29% reported that their ICU had a neurodevelopmental team. Significant differences were reported across the 3 clinical scenarios for 11 of 14 IFDC practices. Skin-to-skin holding was provided least often across all levels of acuity. Nurse education related to IFDC was associated with more use of IFDC (P < .05). Conclusion: Practices related to IFDC vary among ICUs. Opportunities exist to develop IFDC guidelines for infants with CHD to inform clinical practice and nurse education. Next steps include convening a C4-MNP group to develop guidelines and implement IFDC initiatives for collaborative evaluation.
MeSH term(s)	Cardiovascular Nursing ; Heart Defects, Congenital/therapy ; Humans ; Infant ; Infant, Newborn ; Intensive Care Units ; Surveys and Questionnaires
Language	English
Publishing date	2021-12-28
Publishing country	United States
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	1130987-8
ISSN	1937-710X ; 1062-3264
ISSN (online)	1937-710X
ISSN	1062-3264
DOI	10.4037/ajcc2022124
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