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Background: Near‐infrared spectroscopy (NIRS) is a non‐invasive technology that estimates regional oxygen saturation. Literature demonstrates that NIRS can provide valuable data for clinical staff. However, little research has addressed the nursing care and management of NIRS in the critical care environment. Aims: To assess nurses' perception around the use of NIRS and current NIRS practice within paediatric cardiac intensive care unit (PCICUs). Study Design: A 53‐item cross‐sectional electronic survey was developed to assess indications for NIRS, critical value thresholds and interventions, barriers to use, policies and procedures, and nursing perceptions. Descriptive statistics were used to summarize and aggregate data. Results: Among the 28 responding sites (63.6% response rate), usage of NIRS was variable and patient‐dependent. Most nurses reported using NIRS in patients with unstable physiology such as post‐operative single ventricle (n = 25, 89.3%) and concern for shock (n = 21, 75.0%). Critically low cerebral values varied among respondents from less than 40 (n = 3, 10.7%) to less than 60 (n = 4, 14.3%), with lower critical values permitted for single ventricle physiology: less than 40 (n = 8, 28.6%) to less than 50 (n = 6, 21.4%). Reported barriers to using NIRS included skin breakdown (n = 9, 32.1%), lack of consistency in decision‐making among physicians (n = 13, 46.4%), and not using NIRS data when developing a plan of care (n = 11, 39.3%). Most (n = 24, 85.7%) nurses reported that NIRS provided valuable information and was perceived to be beneficial for patients. Conclusions: NIRS monitoring is a common technology in the care of complex congenital heart disease patients. Most nurses valued this technology, but inconsistencies and practicalities around its use in guiding patient management were found to be problematic. Relevance to Clinical Practice: NIRS is commonly used in the PCICU and although nurses perceived NIRS to be useful for their practice, the variability in the interpretation of values and inconsistent protocols and decision‐making by physicians was challenging. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Background: The Intensive Care Unit Complexity Assessment and Monitoring to Ensure Optimal Outcomes (ICU CAMEO III) acuity tool measures patient acuity in terms of the complexity of nursing cognitive workload. Objective: To validate the ICU CAMEO III acuity tool in US children's hospitals. Methods: Using a convenience sample, 9 sites enrolled children admitted to pediatric intensive care units (ICUs). Descriptive statistics were used to summarize patient, nursing, and unit characteristics. Concurrent validity was evaluated by correlating the ICU CAMEO III with the Therapeutic Intervention Scoring System-Children (TISS-C) and the Pediatric Risk of Mortality III (PRISM III). Results: Patients (N = 840) were enrolled from 15 units (7 cardiac and 8 mixed pediatric ICUs). The mean number of ICU beds was 23 (range, 12-34). Among the patients, 512 (61%) were diagnosed with cardiac and 328 (39%) with noncardiac conditions; 463 patients (55.1%) were admitted for medical reasons, and 377 patients (44.9%) were surgical. The ICU CAMEO III median score was 99 (range, 59-163). The ICU CAMEO complexity classification was determined for all 840 patients: 60 (7.1%) with level I complexity; 183 (21.8%) with level II; 201 (23.9%), level III; 267 (31.8%), level IV; and 129 (15.4%), level V. Strong correlation was found between ICU CAMEO III and both TISS-C (ρ =.822, P <.001) and PRISM III (ρ =.607, P <.001) scores, and between the CAMEO complexity classifications and the PRISM III categories (ρ =.575, P =.001). Conclusion: The ICU CAMEO III acuity tool and CAMEO complexity classifications are valid measures of patient acuity and nursing cognitive workload compared with PRISM III and TISS-C in academic children's hospitals. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

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©) acuity tool measures patient acuity in terms of nursing cognitive workload complexity. We describe the implementation and evaluation of the Inpatient CAMEO© in a pediatric neuroscience unit in a large free‐standing children's hospital in the northeast United States. Design and Methods: Using a quality improvement approach, the Inpatient CAMEO© was implemented and evaluated over a 12‐month period by a neuroscience clinical lead and unit‐based ambassadors. Monthly data reports evaluating unit‐level completion and the level of acuity (I–V) were generated for unit leadership. Data were further stratified by type of admission to the neuroscience unit. Five categories of patients included neurology medical, epilepsy, neurosurgical, neurooncology, and other, which is defined as nonneurology patients, admitted to unit. Results: The monthly proportion of Inpatient CAMEO©s Classified as III–V ranged from 62.3% to 83.3% with a median of 78.2%. The type of neuroscience admissions varied in level of acuity. Patients identified as neurology (68.7%) and epilepsy (67.5%) had the lowest acuity, patients identified as neurosurgery (82.8%) and other (80.2%) had moderate acuity, and neurooncology (94.5%) had the highest acuity. Practice Implications: Using the Inpatient CAMEO©, the acuity of neuroscience pediatric care was demonstrated to be increased and variable across disease categories. Neurooncology patients were identified as having the highest acuity as compared to other pediatric neuroscience admissions. [ABSTRACT FROM AUTHOR]

Background: The Complexity Assessment and Monitoring to Ensure Optimal Outcomes (CAMEO) acuity tool was developed to quantify patient acuity in terms of nursing cognitive workload complexity. An expert panel including representatives from 4 intensive care units (ICUs) convened to scale and implement the CAMEO II across the ICUs in a large, freestanding children's hospital in the United States. Objectives: The aims of this study were to scale and implement a standardized acuity measure of pediatric critical care nursing. Method: This study used a modified Delphi technique. Results: Through a series of 3 Delphi rounds, the expert panel identified care items not characterized in the original CAMEO and assigned each of these items a cognitive workload scale of 1 to 5. The expert panel identified 4 additional Domains of Care while confirming the original 14 Domains of Care in the first CAMEO version. The panel agreed that a number of care items could be classified as "Standard of Care," reducing items in the CAMEO and generating a baseline score. The panel, serving as ambassadors and unit-based experts, then implemented the refined CAMEO II in each of the 4 ICUs. Discussion: Utilization of the CAMEO II across ICUs provides a standardized measure to describe and quantify the acuity of pediatric critical care nursing. Use of this acuity measure informs projection of staffing models and benchmarking across pediatric ICUs. Further research is needed to validate the CAMEO II formultisite use. [ABSTRACT FROM AUTHOR]

Background: The Complexity Assessment and Monitoring to Ensure Optimal Outcomes (CAMEO II) acuity tool was developed to quantify patient acuity in terms of nursing cognitive workload complexity in a large, freestanding children's hospital in the United States. Objectives: To describe the acuity and complexity of pediatric critical care nursing at a large children's hospital and correlate the CAMEO II with pediatric physiologic measures. Methods: Construct validation was conducted correlating the CAMEO II to a pediatric classification system and 2 physiologic acuity tools. Descriptive statistics summarized patient characteristics. Construct validity across tools was evaluated using the Spearman correlation coefficient. Results: CAMEO II was described both continuously and as ordinal complexity levels (I-V). Among 235 patients who completed CAMEO II across 4 intensive care units (ICUs), the mean total score was 99.06 (median, 97; range, 59-204). The CAMEO II complexity classification for 235 patients was as follows: I: 22 (9.4%), II: 53 (22.6%), III: 56 (23.8%), IV: 66 (28.1%), and V: 38 (16.2%). Findings from the 235 patients across the 4 ICUs revealed a significant correlation between the CAMEO II and the Therapeutic Intervention Scoring System--Children (ρ = 0.567, P < .001), CAMEO II and Pediatric Risk of Mortality III (ρ = 0.446, P < .001), and the CAMEO II and Score for Neonatal Acute Physiology Perinatal Extension II (ρ = 0.359, P = .013). Discussion: Utilization of CAMEO II across ICUs provides an opportunity to validate the current complexity of pediatric critical care nursing in a large children's hospital. [ABSTRACT FROM AUTHOR]

Background Health care work environments affect patient outcomes, staff satisfaction and retention, and organizational financial viability. The American Association of Critical-Care Nurses (AACN) Healthy Work Environment Assessment Tool (HWEAT) is a resource for patient care units and organizations to assess the work environment and track progress on their journey to excellence. Objective To validate interprofessional use of the AACN HWEAT across a large free-standing children's hospital. Methods The AACN HWEAT was administered to staff members across professional categories. Responses were averaged to achieve an overall score and a score for each standard included in the instrument. Nurses' and physicians' scores were further stratified. Test-retest reliability and internal consistency were assessed. Construct validity was measured by correlating the AACN HWEAT and the Agency for Healthcare Research and Quality (AHRQ) Hospital Survey on Patient Safety Culture (H-SOPS). Results Of 2621 AACN HWEAT surveys, 1030 (39.3%) were returned for review. The organization-wide HWEAT mean overall score was 3.58 (3.87 for physicians vs 3.54 for nurses, P = .02). Test-retest reliability was indicated by Spearman correlation coefficients of 0.50 to 0.68. Internal consistency was shown by a Cronbach α of 0.77 overall (range for standards, 0.77-0.81). Convergent validity be tween AACN HWEAT standards and AHRQ H-SOPS items was shown by correlation coefficients of 0.30 to 0.52. Conclusion The AACN HWEAT was both reliable and valid, supporting its interprofessional use as an organizational measure. Active evaluation of health care environments is critical to achieving optimal patient outcomes. [ABSTRACT FROM AUTHOR]

The article discusses a study that examined differences in tobacco taxes and related messaging among Southeasterners versus non-Southeasterners, given the lag in control policies in Southeastern U.S. Topics discussed include the conclusions that other factors must contribute to lagging policy and must be addressed, given that Southeasterners are receptive to increased taxation. Also mentioned are study methods and regression analysis indicating correlations of opposition to increased taxes.

Background Historically, nursing productivity has been measured in adult settings and based on time, intensity, and resource allocation. Objective To develop a comprehensive measure of pediatric critical care nursing workload. Methods An expert panel of pediatric critical care nurses used a modified Delphi method to identify 14 domains of nursing care with a number of corresponding care items in each domain. By consensus, they assigned each care item a cognitive complexity rating from 1 to 5. The panel next developed a classification system (classes I-V) to support interpretation of the patient's total score. The Complexity Assessment and Monitoring to Ensure Optimal Outcomes (CAMEO) tool was initiated with a cohort of 75 pediatric cardiac critical care patients to verify comprehensive capture of nursing care. Results of completed CAMEO tools were summarized by using descriptive statistics. Results The cognitive workload across 14 domains of care was described, and each care item in the domain was scored. The range of CAMEO total scores was 25 to 230 (median, 124). For the initial cohort of patients, the cognitive complexity of care classifications were 13% as class I or II, 80% as class III or IV, and 7% as class V. Conclusions The CAMEO tool was comprehensive in describing and quantifying the cognitive workload of pediatric critical care nurses. The CAMEO classification process informs staffing needs that support synergy between the needs of patients and their families and nurses' knowledge and skill. Articulation of nursing care focused on informed clinical decision making is needed to justify the value of skilled nurses. [ABSTRACT FROM AUTHOR]

Background: A major postoperative problem for infants undergoing cardiopulmonary bypass surgery is hypothermia. Objective: To determine the safety and feasibility of a newly designed Heat Retention Head Wrap on infants during the rewarming period of cardiopulmonary bypass surgery. Methods: A sample of 10 infants was recruited into this descriptive pilot study. The health care providers completed ease-of-use questionnaires to describe the feasibility of the head wrap. Interval body temperatures were recorded to characterize temperature progression from onset of rewarming to arrival in the cardiac intensive care unit (ICU) and were compared with the temperature progression of a similar group of non-participant. Adverse events were recorded on the basis of perioperative body temperatures and skin assessments. Results: The head wrap was easily applied to the infant’s head and was removed without difficulty. A steady increase in median body temperature from (1) the onset of rewarming (28ºC), to (2) removal of bypass cannulas (28.9ºC), to (3) removal of the rectal temperature probe before transfer from the operating room to the cardiac ICU (34.5ºC), and (4) upon arrival in the cardiac ICU (36.0ºC) was observed. No skin lesions or temperature-related adverse events were observed. Conclusions: The newly designed Heat Retention Head Wrap was associated with a gradual normalization of temperature during rewarming and did not interfere with routine perioperative care of infants undergoing bypass surgery. This pilot study indicates that the head wrap is both safe and feasible for use in infants undergoing cardiopulmonary bypass surgery. [ABSTRACT FROM AUTHOR]

evangelista j.-a.k., connor j.a., pintz c., saia t., o'connell c., fulton d.r. & hickey p. (2012) Paediatric nurse practitioner managed cardiology clinics: patient satisfaction and appointment access. Journal of Advanced Nursing 68(10), 2165-2174. Abstract Aim. This article summarizes a comparative study of patient/family satisfaction and appointment wait times in physician managed vs. paediatric nurse practitioner managed cardiology clinics. Background. Appointment wait times exceeded 40 days in the outpatient cardiology department at a children's hospital. To address the gap in available appointments, paediatric nurse practitioner managed cardiology clinics were implemented. Methods. A sample of 128 patients who presented concurrently in physician or paediatric nurse practitioner managed cardiology clinics from December 2009 through February 2010 was recruited for participation. The hospital's ambulatory patient satisfaction survey was utilized to measure level of patient satisfaction with care. Survey responses were evaluated using Fisher's exact test. Appointment wait times were compared pre and post implementation of paediatric nurse practitioner managed clinics. Results. Sixty-five physician families and 63 paediatric nurse practitioner families completed the satisfaction survey. There was no statistically significant difference in patient satisfaction between clinic types. Appointment wait time decreased from 46 to 43 days, which was not statistically significant. Paediatric nurse practitioner clinics included a statistically higher percentage total of urgent appointments compared to that in physician clinics. Conclusions. Paediatric nurse practitioner managed cardiology clinics are a strategic solution for improving patient access and facilitating high quality patient care while earning high levels of patient satisfaction. This healthcare delivery model illustrates the potential for expanded utilization of advanced practice nurses. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Purpose: To use an acuity tool that comprehensively measures the complex care and cognitive workload performed by pediatric cardiovascular nurses in a global setting. The objective of this study was to describe and evaluate use of the Complexity Assessment and Monitoring to Ensure Optimal Outcomes (CAMEO) acuity tool, which measures the nursing cognitive workload, in a pediatric global intensive care unit. Background/Significance: The CAMEO acuity tool quantifies the cognitive workload of pediatric nursing care and the complexity (ie, skill, concentration, and surveillance) required to provide care. The CAMEO acuity tool has been implemented in the intensive care units (ICUs) and acute care areas at our institution. Since 2006, we have conducted missions to establish a pediatric cardiac surgery program at Komfo Anokye Teaching Hospital (KATH; Kumasi, Ghana). More than 1000 children have been evaluated and 112 children have undergone pediatric cardiac surgery. A pilot study of the CAMEO acuity tool was conducted in this setting. Method: The CAMEO acuity tool was used to document and describe the unique experience and the complexity of the nursing workload at KATH. Ten domains measured direct and indirect care items. A CAMEO tool was completed for each patient each shift on admission to the cardiac ICU. A daily log of observations was recorded for each patient to capture work that was not accounted for. Total scores for each tool were calculated and measured by using a classification scoring system (score range: I-V, where I represents stable patients requiring minimal intervention and V represents patients with clinical instability and/or complex care coordination needs). Specific activities were analyzed descriptively using counts and frequencies. Results: Among the 12 patients who underwent cardiac surgical intervention, a total of 63 CAMEO forms were completed. Use of the CAMEO tool revealed a high level of cognitive workload. Approximately 76.2% of CAMEOs were classified as III, IV, or V, and 71.9% of the forms indicated that at least 1 procedure took place in the ICU during that shift. Sixty-seven percent of shifts required more than 6 activities for care coordination, discharge planning, and education. More than 3 professional/environmental management activities were performed during 96.5% of shifts. Conclusion: Overall the CAMEO tool was able to capture the cognitive workload and describe the complexity of nursing during the mission at KATH. The CAMEO acuity tool was able to capture the importance of precepting, teaching, education, and acting as a consultant while highlighting how cultural and language barriers added to the cognitive complexity of the nursing workload. [ABSTRACT FROM AUTHOR]

Purpose: To address the need for practical tools that capture multiple domains or attributes of acuity, a facilitator led the development of the Complexity Assessment and Monitoring to Ensure Optimal Outcomes (CAMEO) acuity tool. The CAMEO tool defines acuity in terms of nursing cognitive-workload complexity: the intellectual processing of information about patients that drives critical thinking, decision-making, and the resulting level of surveillance necessary to meet patient needs. Background/ Significance: Nursing productivity has been measured to describe and quantify nursing workload, intensity, and resource allocation. In pediatric critical care, most measurement of patient acuity has focused on physiological status to predict patient outcomes, length of stay, and resource use. Although these tools have demonstrated scientific usefulness, they are not sufficiently comprehensive to inform nurse staffing assignments and, in general, have limited practical application. Method: Validation of the CAMEO acuity tool was undertaken by an expert clinical panel with representation from 4 intensive care units. Given the lack of a gold standard with which to compare the CAMEO acuity tool, construct validation was conducted using a pediatric classification system, the Therapeutic Intervention Scoring System (TISS-C); and 2 pediatric physiological acuity tools, Pediatric Risk of Mortality III (PRISM-III) and, for patients in the neonatal intensive care unit, the Score for Neonatal Acute Physiology with Perinatal Extension (SNAPPE II). Convergent and divergent validities of the CAMEO score versus the TISS-C, PRISM-III, and SNAPPE II scores were assessed using Spearman rank correlation coefficients. A ρ value greater than 0.5 was considered a strong correlation, 0.35 to 0.5 was considered a moderate correlation, and 0.2 to 0.34 was considered a weak correlation. Results: Among the 235 completed CAMEO acuity tools across the intensive care units (ICUs), the mean total score was 99.06 and the median total score was 97.00 (range, 59-204). The number and percentage of patients by CAMEO complexity classification (range, I-V) of the 235 patients was: I, 22 (9.4%); II, 53 (22.6%); III, 56 (23.8%); IV, 66 (28.1%); and V, 38 (16.2%). Histograms of the scores for the CAMEO acuity tool, TISS-C, and PRISM-III were all positively skewed. Findings from 235 patients across the 4 ICUs revealed a significant correlation between the CAMEO and the TISS-C scores (ρ = 0.567; P < .001), CAMEO and PRISM-III scores (ρ = 0.446; P < .001), and the CAMEO and SNAPPE II scores (ρ = 0.359, P = .01). Conclusion: Information from this examination revealed a moderate to strong significant correlation in the 4 pediatric ICUs. The CAMEO acuity tool provides a comprehensive description and quantification of how nurses assess direct and indirect patient and family needs and then match personal skill sets to provide optimal nursing care. These findings have supported the initiation of a multisite validation of the CAMEO acuity tool in pediatric hospitals. [ABSTRACT FROM AUTHOR]

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 [ABSTRACT FROM AUTHOR]

Background: Neonatal intensive care units (NICUs) located in freestanding children's hospitals may exhibit significant variation in nursing and organizational characteristics, which can serve as opportunities for collaboration to understand optimal staffing models and linkages to patient outcomes. Objectives: Adopting methods used by Hickey et al in pediatric cardiovascular critical care, the purpose of this study was to provide a foundational description of the nursing and organizational characteristics for NICUs located in freestanding children's hospitals in the United States. Methods: Clinical nurse leaders in NICUs located in freestanding children's hospitals were invited to participate in an electronic cross-sectional survey. Descriptive analyses were used to summarize nursing and organizational characteristics. Results: The response rate was 30% (13/43), with 69.2% of NICUs classified as level III/IV and 30.8% classified as level II/III. Licensed bed capacity varied significantly (range, 24-167), as did the proportion of full-time equivalent nurses (range, 71.78-252.3). Approximately three-quarters of staff nurses held baccalaureate degrees or higher. A quarter of nurses had 16 or more years (26.3%) of experience, and 36.9% of nurses had 11 or more years of nursing experience. Nearly one-third (29.2%) had 5 or less years of total nursing experience. Few nurses (10.6%) held neonatal specialty certification. All units had nurse educators, national and unit-based quality metrics, and procedural checklists. Conclusion: This study identified (1) variation in staffing models signaling an opportunity for collaboration, (2) the need to establish ongoing processes for sites to participate in future collaborative efforts, and (3) survey modifications necessary to ensure a more comprehensive understanding of nursing and organizational characteristics in freestanding children's hospital NICUs. [ABSTRACT FROM AUTHOR]

Background/Introduction: Although social media is becoming a primary resource for information and support in all aspects of life, including health care, limited information is available describing social media use in parents whose child undergoes surgical care. Objectives/Aims: The aims of this study were to describe how patients/families use social media to address health care needs and understand their perceptions of social media privacy and reliability. Methods : A descriptive survey of 39 questions, both fixed choice and open ended, was distributed to a convenience sample of parents during their child's preoperative visit. Descriptive statistics were used to summarize fixed-choice responses. Content analysis was used to assess open-ended responses and comments. Results : A total of 205 completed surveys were available for review. Overall, 195 (95.6%) reported using social media, with 70 (35%) using social media up to 5 times a day and another 61 (30.5%) using it 6 to 40 times a day. Respondents used social media for medical information (122/60.1%), to make health care decisions (53/26.5%), after a diagnosis (104/52%), after a medical visit (88/44%), and to update friends and family (129/65.5%). Most respondents were undecided (111/58.1%) when asked how reliable medical information was on social media sites, with 33 (17.3%) believing medical information to be "reliable to very reliable" on social media sites. Among the 61 comments received, 4 themes emerged: Spectrum of Social Media Use, Social Media and Health Care Interaction, Social Media as a Source of Support and Peer Experience, and Reliability of Social Media. Discussion : Most respondents utilized social media for health care information while reporting feeling undecided on the reliability of the information. Understanding the multiple ways patients and families utilize social media provides health care members opportunities to discuss medical information, inform health care decision making, and support patient and family needs. [ABSTRACT FROM AUTHOR]

Background: Opioid and sedative medications are commonly used to treat pediatric patients with congenital heart disease; however, their use is not without adverse effects. Symptoms of withdrawal can occur if the medications are discontinued abruptly or weaned too quickly. Objective: The aim of this study was to understand and describe the current management of opioid and sedative weaning in pediatric congenital heart disease patients in freestanding children's hospitals across the United States. Methods: A Web-based survey of pediatric congenital heart centers was conducted. Survey participants were recruited from the Consortium of Congenital Cardiac Care--Measurement of Nursing Practice. Quantitative data were summarized using frequency and proportions. Qualitative data were summarized using content analysis. Results: Twelve sites participated in the survey (44% response rate). Methadone was used as a weaning medication at 100% of participating sites, lorazepam at 83% of sites, and clonidine at 75% of sites. Seventy-five percent of sites reported using a clinical assessment tool to monitor withdrawal symptoms. Twenty-five percent of sites used a standardized clinical pathway when weaning opioid and sedative medications. Eighty-three percent of sites will consider discharging a patient to complete the medication wean at home. Discussion: Weaning practices varied across sites. While some similarities were observed among sites, substantial practice variation exists. The majority of sites used a clinical assessment tool to assess for withdrawal symptoms. Few sites reported using a standardized approach to weaning patients. Discharging patients to complete an opioid or sedative wean at home was common practice. Opportunities exist for the development of weaning practice guidelines. [ABSTRACT FROM AUTHOR]

OBJECTIVE: This study explored pediatric critical care nursing and organizational factors that impact in-hospital mortality for cardiac surgery patients across children's hospitals in the United States. BACKGROUND: Congenital heart disease is the most common birth defect and the no. 1 cause of death for infants with a congenital defect. Little is known about the impact of pediatric critical care nursing and organizational factors on pediatric mortality. METHODS: Nursing leaders from 38 children's hospitals that contribute data to the Pediatric Health Information System data set completed an organizational assessment for years 2009 and 2010. These data were linked with patient-level data. The Risk Adjustment for Congenital Heart Surgery method was used to adjust for baseline patient differences in patients younger than 18 years. RESULTS: The odds of death increased as the institutional percentage of pediatric critical care unit nurses with 2 years' clinical experience or less increased. The odds of mortality were highest when the percentage of RNs with 2 years' clinical experience or less was 20% or greater. The odds of death decreased as the institutional percentage of critical care nurses with 11 years' clinical experience or more increased and for hospitals participating in national quality metric benchmarking. Clinical experience was independently associated with in-hospital mortality. CONCLUSIONS: These data are the 1st to link clinical nursing experience with pediatric patient outcomes. A cut point of 20% RNs or greater with 2 years' clinical experience or less was determined to significantly affect inpatient mortality. Participation in national quality metric benchmarking programs was significantly associated with improved mortality. [ABSTRACT FROM AUTHOR]