The Changing Face of Critical Care Medicine

Molitor-Kirsch, Shirley; Thompson, Lisa; Milonovich, Lisa M.

doi:10.1097/00044067-200504000-00008

Cited by 19 publications

(4 citation statements)

References 11 publications

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“…Nurse practitioners in adult critical care environments are well established 28 however in paediatrics there remains a notable absence of advance practice role opportunities despite collaborative practice serving as a foundation for a multidisciplinary approach to patient care 29 . In children, adoption of more advanced practice roles across ANZ 30 , could support a more collaborative, standardised approach to mechanical ventilation weaning across the 24hour continuum. While randomised clinical trials have demonstrated that the implementation of nurse enabled ventilation weaning can significantly reduce ventilation hours 24 our results demonstrate ANZ units have yet to adopt a more collaborative approach, with limited nursing advance practice role support infrastructure.…”

Section: Discussionmentioning

confidence: 99%

Ventilator weaning and extubation practices in critically ill children: An Australian and New Zealand survey of practice

Schults

Charles

Harnischfeger

et al. 2023

Australian Critical Care

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Section: Discussionmentioning

confidence: 99%

Ventilator weaning and extubation practices in critically ill children: An Australian and New Zealand survey of practice

Schults

Charles

Harnischfeger

et al. 2023

Australian Critical Care

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“…This provides an overall focus on staff education, teaching to patients, families and caretakers, which in turn positively impact patient outcomes and patient satisfaction [1,2]. The ARNPs/PA have been instrumental in developing clinical pathways, inpatient orders, nursing protocols, guidelines for interventions and various procedures [3,4]. …”

Section: Discussionmentioning

confidence: 99%

Advanced Registered Nurse Practitioners and Physician Assistants in the Practice of Pediatric Neurosurgery: A Clinical Report

James¹,

MacGregor²,

Postlethwait³

et al. 2011

Pediatr Neurosurg

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Objective: This report addresses the clinical experience of the Division of Pediatric Neurosurgery with dedicated nurse practitioners and a physician assistant (PA) in outpatient and inpatient health care delivery, including surgical activities, as well as participation with the neurosurgery call schedule, quality improvement, teaching, and clinical research activities. Methods: We report on the activities of allied health personnel in the Division of Pediatric Neurosurgery for the purpose of identifying the current and future role for health care delivery, related to the care of the child with a neurosurgical condition. This addresses the participation of 2 advanced registered nurse practitioners (ARNPs) and a PA in the outpatient and inpatient setting, call schedule, interventions in and out of the operating room, quality improvement sessions, continuing medical education, clinical research, clinical databases, presentations in meetings, teaching, and scientific publications. Results: This report covers the period from September 2003 (when the division was initiated) to February 2011. The division currently consists of 3 pediatric neurosurgeons, 2 ARNPs and 1 PA. The ARNPs/PA have participated in the pediatric neurosurgery clinic held 5 half-days per week, the monthly multidisciplinary clinics (Spinal Defects Clinic, Pediatric Neurosciences Clinic, and the Fetal Diagnosis and Therapy Center working group), and inpatient care, as well as assisting in operative interventions. They participated in the on-call schedule and attended the monthly quality improvement sessions of the division in addition to presenting papers and topics in the monthly continuing medical education session. The PA maintained a computerized database of operative interventions, coding, morbidities, and outcomes. All were involved in teaching activities. They prepared preoperative and postoperative orders and practice guidelines, and they were also involved in the preparation of the database of institutional clinical research projects. They have presented posters in a total of 9 national and 2 international meetings, and have co-authored 8 manuscripts published in peer review journals. Conclusion: The ARNP/PA members have been active participants in all functions of the Division of Pediatric Neurosurgery. They have facilitated the work of the faculty in day-to-day activities and enhanced the scope of divisional activities, providing a team approach for the care of the patients, families, and caretakers.

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“…The APN can provide in-depth problem solving, formal educational periods and impromptu bedside education sessions as opportunities arise, because of his/her relative availability compared to residents. The APN is instrumental in the development of nursing protocols and clinical pathways, being intimately aware of disease process, patients’ adaptation, the natural course of a particular disease, and the appropriate interventions necessary from the medical and nursing staff [9,10]. …”

Section: Discussionmentioning

confidence: 99%

The Impact of a ‘Resident Replacement’ Nurse Practitioner on an Academic Pediatric Neurosurgical Service

Holleman

Johnson²,

Frim³

2010

Pediatr Neurosurg

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Introduction: The introduction of 80-hour workweek limitations has challenged resident training programs with creative scheduling while maintaining comprehensive training experiences. The work hour restrictions may be more adaptable to a medical service, but have been very challenging to an academic surgical program. The particular challenges include maximizing academic learning opportunities, operating room experiences and direct bedside patient care while adhering to the 80-hour restriction. This paper examines the addition of a pediatric nurse practitioner (NP) to a pediatric neurosurgical academic program in response to the resident work hour restrictions. Method: A survey questionnaire asking for responses to questions on a 1–10 rating scale was distributed to physicians, nurses and allied care providers approximately 1 year after addition of the NP. Participants were asked to rate satisfaction with the service’s availability, responsiveness and assessment of patient clinical satisfaction prior to the addition of the NP and at the time of questionnaire distribution. In addition, the hospital paging log was reviewed over a several-month epoch before and after addition of the NP. Finally, the number of quality assurance sentinel events was reviewed for the year prior to and the year after the initiation of the NP program. Results: The satisfaction scores in all categories, including overall satisfaction, significantly improved (p < 0.001) after the addition of the NP to the neurosurgery service. Also, during the NP on-duty coverage hours, the number of paging calls received by the residents was reduced commensurate to the large number of calls received by the NP. This change was presumed to be due to the confidence of other services in obtaining a timely and appropriate response. Finally, the number of sentinel event reports remained stable. Discussion: The addition of an NP in response to resident training changes has been a positive influence on satisfaction with the pediatric neurosurgical service while reducing the reliance on residents for bedside clinical care. Patient safety appears not to have been affected. Presumably, this response to resident work hour limitations will provide the needed time to enhance resident didactic and intraoperative training experiences.

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The Changing Face of Critical Care Medicine

Cited by 19 publications

References 11 publications

Ventilator weaning and extubation practices in critically ill children: An Australian and New Zealand survey of practice

Ventilator weaning and extubation practices in critically ill children: An Australian and New Zealand survey of practice

Advanced Registered Nurse Practitioners and Physician Assistants in the Practice of Pediatric Neurosurgery: A Clinical Report

The Impact of a ‘Resident Replacement’ Nurse Practitioner on an Academic Pediatric Neurosurgical Service

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