Mobilization practices in critically ill children: a European point prevalence study (EU PARK-PICU)

Early mobilization of adults receiving intensive care improves health outcomes, yet little is known about mobilization practices in paediatric intensive care units (PICUs). We aimed to determine the prevalence of and factors associated with physical rehabilitation in PICUs across Europe. A 2-day, cross-sectional, multicentre point prevalence study was conducted in May and November 2018. The primary outcome was the prevalence of physical therapy (PT)- or occupational therapy (OT)-provided mobility. Clinical data and data on patient mobility, potential mobility safety events, and mobilization barriers were prospectively collected in patients admitted for ≥72 h. Data of 456 children admitted to one of 38 participating PICUs from 15 European countries were collected (456 patient days); 70% were under 3 years of age. The point prevalence of PT- and/or OT-provided mobility activities was 39% (179/456) (95% CI 34.7-43.9%) during the patient days, with significant differences between European regions. Nurses were involved in 72% (924/1283) of the mobility events; in the remaining 28%, PT/OT, physicians, family members, or other professionals were involved. Of the factors studied, family presence was most strongly positively associated with out-of-bed mobilization (aOR 7.83, 95% CI 3.09-19.79). Invasive mechanical ventilation with an endotracheal tube was negatively associated with out-of-bed mobility (aOR 0.28, 95% CI 0.12-0.68). Patients were completely immobile on 25% (115/456) of patient days. Barriers to mobilization were reported on 38% of patient days. The most common reported patient-related barriers were cardiovascular instability (n = 47, 10%), oversedation (n = 39, 9%), and medical contraindication (n = 37, 8%). Potential safety events occurred in 6% of all documented mobilization events. Therapists are infrequently consulted for mobilization of critically ill children in European PICUs. This study highlights the need for a systematic and interdisciplinary mobilization approach for critically ill children

Self-care in children and young people with complex chronic conditions: a qualitative study using Emotional Text Mining

Objectives: To explore: (1) self-care behaviors in children and young people (range: 6 months-24 years) with complex chronic conditions, characterized by the diagnosis of a severe chronic condition, substantial family-identified needs, functional limitations associated with technology dependence, and intensive use of healthcare services; (2) the contribution to self-care of family members and other persons involved in the child's health and daily life context (e.g., health professionals and teachers), and (3) the principal factors that might have influenced the self-care process associated with developmental age. Methods: A qualitative descriptive study was conducted in an Italian academic tertiary pediatric hospital between September 2020 and May 2021. Overall, 25 focus groups and 7 online interviews were conducted via videoconferencing. Textual data were analyzed using Emotional Text Mining to identify three levels of communication: the factors, the main themes (clusters), and the sub-themes. Results: A total of 104 participants were enrolled, including 27 patients with complex chronic conditions (12 males, mean age = 11.1 ± 4.40), 33 parents, 6 siblings, 33 health professionals, and 5 teachers. Participants described the process of self-care through four main factors: "self-care", "external settings", "family", and "management". Five clusters (themes) were identified: (1) Self-care management (device; consulting); (2) Shift of agency (influencing factors; parents; school); (3) Self-care support (normal life and personal development; multidisciplinary support); (4) Daily self-care maintenance/monitoring; (5) Treatment adherence. Self-care management was mostly relevant for parents of children aged between 6 months and 3 years. Conclusion: The self-care process varies according to the needs related to the specific developmental age and the evolution of the clinical condition over time. The contribution of the family, health professionals, and social networks is fundamental for adequate self-care. To help families manage the unstable condition of their children at home, it is necessary to strengthen support networks implement home care, and ensure continuity of care

The LiberAction Project: Implementation of a Pediatric Liberation Bundle to Screen Delirium, Reduce Benzodiazepine Sedation, and Provide Early Mobilization in a Human Resource-Limited Pediatric Intensive Care Unit

Background: Delirium, bed immobilization, and heavy sedation are among the major contributors of pediatric post-intensive care syndrome. Recently, the Society of Critical Care Medicine has proposed the implementation of daily interventions to minimize the incidence of these morbidities and optimize children functional outcomes and quality of life. Unfortunately, these interventions require important clinical and economical efforts which prevent their use in many pediatric intensive care units (PICU). Aim: First, to evaluate the feasibility and safety of a PICU bundle implementation prioritizing delirium screening and treatment, early mobilization (<72 h from PICU admission) and benzodiazepine-limited sedation in a human resource-limited PICU. Second, to evaluate the incidence of delirium and describe the early mobilization practices and sedative drugs used during the pre- and post-implementation periods. Third, to describe the barriers and adverse events encountered during early mobilization. Methods: This observational study was structured in a pre- (15th November 2019-30th June 2020) and post-implementation period (1st July 2020-31st December 2020). All patients admitted in PICU for more than 72 h during the pre and post-implementation period were included in the study. Patients were excluded if early mobilization was contraindicated. During the pre-implementation period, a rehabilitation program including delirium screening and treatment, early mobilization and benzodiazepine-sparing sedation guidelines was developed and all PICU staff trained. During the post-implementation period, delirium screening with the Connell Assessment of Pediatric Delirium scale was implemented at bedside. Early mobilization was performed using a structured tiered protocol and a new sedation protocol, limiting the use of benzodiazepine, was adopted. Results: Two hundred and twenty-five children were enrolled in the study, 137 in the pre-implementation period and 88 in the post-implementation period. Adherence to delirium screening, benzodiazepine-limited sedation and early mobilization was 90.9, 81.1, and 70.4%, respectively. Incidence of delirium was 23% in the post-implementation period. The median cumulative dose of benzodiazepines corrected for the total number of sedation days (mg/kg/sedation days) was significantly lower in the post-implementation period compared with the pre-implementation period: [0.83 (IQR: 0.53-1.31) vs. 0.74 (IQR: 0.55-1.16), p = 0.0001]. The median cumulative doses of fentanyl, remifentanil, and morphine corrected for the total number of sedation days were lower in the post-implementation period, but these differences were not significant. The median number of mobilizations per patient and the duration of each mobilization significantly increased in the post-implementation period [3.00 (IQR: 2.0-4.0) vs. 7.00 (IQR: 3.0-12.0); p = 0.004 and 4 min (IQR: 3.50-4.50) vs. 5.50 min (IQR: 5.25-6.5); p < 0.0001, respectively]. Barriers to early mobilization were: disease severity and bed rest orders (55%), lack of physicians' order (20%), lack of human resources (20%), and lack of adequate devices for patient mobilization (5%). No adverse events related to early mobilization were reported in both periods. Duration of mechanical ventilation and PICU length of stay was significantly lower in the post-implementation period as well as the occurrence of iatrogenic withdrawal syndrome. Conclusion: This study showed that the implementation of a PICU liberation bundle prioritizing delirium screening and treatment, benzodiazepine-limited sedation and early mobilization was feasible and safe even in a human resource-limited PICU. Further pediatric studies are needed to evaluate the clinical impact of delirium, benzodiazepine-limited sedation and early mobilization protocols on patients' long-term functional outcomes and on hospital finances

Staff perceptions of Family-Centered Care in Italian Neonatal Intensive Care Units: A multicenter cross-sectional study

Family Centered Care (FCC) in Neonatal Intensive Care Units (NICUs) included family involvement in the care process of newborns and infants. Staff perceptions of FCC may influence clinical practice and management strategies in NICUs, with an impact on quality and humanization of the care. The Family-Centred Care Questionnaire-Revised (FCCQ-R) was adapted for the NICU setting, therefore the FCCQ-R@it-NICU was developed and used for the present study in 32 Italian NICUs. We calculated internal consistency using Cronbach's alpha correlation between Current and Necessary dimensions of the scale using the Pearson correlation coefficient. Furthermore, we investigated which characteristics could influence staff perceptions of FCC in NICUs. 921 NICU professionals participated in the study. The FCCQ-R@it-NICU revealed good internal consistency (0.96) and good correlation between dimensions (p < 0.05). Statistical and significant differences in Current and Necessary dimensions were found and some demographic characteristics were found predictable on FCC practice. The FCCQ-R@it-NICU is a valid tool to investigate staff perceptions about FCC in NICU settings. Profession, education level and work experience seem to positively influence the perception of what is required for FCC practice within NICUs

Neonatal intensive care parent satisfaction: a multicenter study translating and validating the Italian EMPATHIC-N questionnaire

Background: In Neonatal Intensive Care Units (NICUs), parent satisfaction and their experiences are fundamental to assess clinical practice and improve the quality of care delivered to infants and parents. Recently, a specific instrument, the EMpowerment of PArents in THe Intensive Care-Neonatology (EMPATHIC-N), has been developed in the Netherlands. This instrument investigated different domains of care in NICUs from a family-centered care perspective. In Italy, no rigorous instruments are available to evaluate parent satisfaction and experiences in NICU with family-centered care. The aim of this study was to translate and validate the EMPATHIC-N instrument into Italian language measuring parent satisfaction. Methods: A psychometric study was conducted in nine Italian NICUs. The hospitals were allocated across Italy: four in the North, four in Central region, one in the South. Parents whose infants were discharged from the Units were enrolled. Parents whose infants died were excluded. Results: Back-forward translation was conducted. Twelve parents reviewed the instrument to assess the cultural adaptation; none of the items fell below the cut-off of 80% agreement. A total of 186 parents of infants who were discharged from nine NICUs were invited to participate and 162 parents responded and returned the questionnaire (87%). The mean scores of the individual items varied between 4.3 and 5.9. Confirmatory factor analysis was performed and all factor loadings were statistically significant with the exception of item ‘Our cultural background was taken into account’. The items related to overall satisfaction showed a higher trend with mean values of 5.8 and 5.9. The Cronbach’s alpha’s (at domain level 0.73-0.92) and corrected item-total scale correlations revealed high reliability estimates. Conclusions: The Italian EMPATHIC-N showed to be a valid and reliable instrument measuring parent satisfaction in NICUs from a family-centered care perspective. Indeed, it had good psychometric properties, validity, and reliability. Furthermore, this instrument is fundamental for further research and internationally benchmarking

Psychometric properties of the Turkish version of the vital signs monitoring on pediatric wards scale (Ped-V scale)

Purpose: The aim of this study should be to adopt the Turkish version of the vital signs monitoring on pediatric wards scale (Ped-V scale). Design and method: This methodological study was carried out with 331 pediatric nurses aged 18–65 between September 2022 and November 2022. The data were collected using an online questionnaire including a Descriptive Information Form and the Ped-V scale. Before starting the implementation of the study, the language adaptation of the scale was made, then expert opinion was taken and a pilot application was made. Then the main sampling was applied and evaluated. Explanatory and confirmatory factor analysis, Cronbach's alpha, and item-total score analysis were used for data analysis. Results: It was determined that the scale consisted of 30 items and four sub-dimensions and that four sub-dimensions explained 42.91% of the total variance. Both exploratory and confirmatory factor analyses indicated that all factor loads were >0.30. According to the confirmatory factor analysis, all of the fit indices were >0.80, and the RMSEA was 0.60 for all sub-dimensions. Conclusion: As a result of the analyses, it was determined that the Ped-V scale was a valid and reliable measurement tool for the Turkish sample. Practice implications: Using the Ped-V scale, it can help to determine the attitudes of nurses working in pediatric clinics toward monitoring vital signs and to plan in-service training if there is a problem

The EPICENTRE (ESPNIC Covid pEdiatric Neonatal Registry) initiative: background and protocol for the international SARS-CoV-2 infections registry

The outbreak of SARS-CoV-2 is the worst healthcare emergency of this century, and its impact on pediatrics and neonatology is still largely unknown. The European Society for Pediatric and Neonatal Intensive Care (ESPNIC) launched the EPICENTRE (ESPNIC Covid pEdiatric Neonatal Registry) international, multicenter, and multidisciplinary initiative to study the epidemiology, clinical course, and outcomes of pediatric and neonatal SARS-CoV-2 infections. EPICENTRE background and aims are presented together with protocol details. EPICENTRE is open to centers all over the world, and this will allow to provide a pragmatic picture of the epidemic, with a particular attention to pediatric and neonatal critical care issues

Counseling for pediatric patients undergoing hematopoietic stem cell transplantation and their parents: A pilot descriptive study

Purpose: This study aimed to: (1) to assess the Quality of Life (QoL) of pediatric patients who had undergone Hematopoietic Stem Cell Transplantation (HSCT) and their parents; (2) to explore how patients and parents perceived a nurse counseling intervention; and (3) to explore how health professionals consider the nurse counselor's role.Methods: This was a pilot descriptive study using quantitative and qualitative data.Results: Parents' QoL was compromised in the domains of Social Functioning, Physical and Emotional roles. Patients' QoL was poor in all the domains except in Behavior and Family Cohesion. Patients and their parents considered the counseling as an effective help. Seven categories emerged from the analysis of qualitative data: support and taking charge, empathy, active communication and listening, evasion, sharing, awareness, and organizational availability. Regarding health professionals, five categories emerged from the analysis of the interviews and a focus group: support and taking charge, recovery in self-expression, support in relationship with patients and family, connecting role, and difficult integration within the team.Conclusions: The nurse counselor could empower patients and parents to improve their attitudes towards care pathway. The nurse counselor can be an important resource in the context of HSCT, even if greater integration within the team is required.Keywords: Bone marrow transplantation; Counseling; Quality of Life; Pediatric nursing. Counseling per pazienti pediatrici sottoposti a trapianto di cellule staminali ematopoietiche e loro genitori: uno studio mixed methodsObiettivi: Questo studio è stato condotto allo scopo di: (1) valutare la Qualití  di Vita (QdV) dei pazienti pediatrici che sono stati sottoposti a trapianto di cellule staminali ematopoietiche e dei loro genitori; (2) esplorare come i pazienti ed i loro genitori hanno vissuto un intervento infermieristico di counselling; e (3) esplorare come i professionisti sanitari considerano il ruolo dell'infermiere counselor.Metodi: Questo è uno studio pilota a scopo descrittivo che utilizza dati qualitativi e quantitativi.Risultati: La QdV dei genitori è risultata compromessa nei domini relativi al Funzionamento Sociale ed i ruoli Fisico ed Emotivo. La QdV dei pazienti è risultata scarsa in tutti i domini ad eccezione del Comportamento e della Coesione familiare. I pazienti ed i loro genitori hanno ritenuto che l'intervento di counseling fosse un aiuto concreto. Dall'analisi dei dati qualitativi sono emerse sette categorie: supporto e presa in carico, empatia, comunicazione e ascolto attivo, evasione, condivisione, consapevolezza, e disponibilití  organizzativa. Per quanto riguarda i professionisti sanitari, sono emerse cinque categorie dall'analisi delle interviste e del focus group: supporto e presa in carico, guarigione attraverso l'espressione del sé, supporto nella relazione con i pazienti e la famiglia, ruolo di connessione ed integrazione difficile nell'equipe.Conclusioni: L'infermiere counselor potrebbe consentire a pazienti e genitori di migliorare il loro atteggiamento nei confronti del percorso assistenziale. L'infermiere counselor può essere una importante risorsa nel contesto trapiantologico. È necessaria una maggiore integrazione di questa figura all'interno dell'equipe.Keywords: Counseling; Infermieristica pediatrica; Qualití  di vita; Trapianto di cellule staminali ematopoietiche