The Pediatric Intensive Care Unit

Introduction

The pediatric intensive care unit is an extremely diverse group of interprofessional teams. Pediatric critical care has transitioned to function based on the input of interprofessional team management. Some patients are seen by more than 20 health professionals across 10 disciplines in order to receive highly effective care (Stocker, Pilgirm, Burmester, Allen, & Gijselaers, 2016). Pediatric critical care has physicians, therapists, specialists, surgeons, anesthesiologists, and nursing staff, among others, as part of its interprofessional composition.

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A team function that severely needs improvement is cohesiveness and closer inter-cooperation which could be enhanced by better communication and respect. The workplace felt disorganized at times as a high level of specialization and autonomy amongst all disciplines meant that medical professionals in the pediatric intensive care unit maintained a culture of disrespect. Each had an independent mental model and method of treatment with a mindset of individual accountability that translated poorly into achieving optimal interprofessional care or empowering patients in this psychologically frail environment.

Compassion

While compassion and interprofessional practice are independently associated with improving the quality of care, the potential of their combination is important in helping strengthen health care provision. A new framework has emerged in recent years known as compassionate, collaborative care, which focuses on improved interprofessional collaboration to respond to patient concerns and promote positive outcomes for everyone, including team and organization across all health care settings (Pfaff & Markaki, 2017).

A nurse can demonstrate compassion and empathy by applying active listening skills in the interaction with other members of the interprofessional team. Demonstrating respect through example could have profound implications. Employing the compassionate, collaborative care framework across the care spectrum requires an inherent transformation within an organizational structure such as increased empathy, respect, and partnership. In turn, it leads to value changes within the interprofessional team and has been linked to improvement in patient outcomes and satisfaction.

Advocacy

Patient advocacy is a critical role of nurses, commonly associated with the principle of social justice and actions to address social inequities. When applied to pediatrics, there are evident disparities in healthcare care utilization and access among children and their families. Poverty and lack of resources may make it challenging to afford healthcare, particularly in pediatric critical care, where children are often seriously ill. Interprofessional teams who offer in-depth assessments and treatments of a child have a deeper understanding of their chronic and serious conditions.

Therefore, a nurse can use the support of the interprofessional team to advocate for the client, ensuring that families are offered appropriate funding, subsidies, accommodations at school or work, and other aspects to improve quality of life (Selekman & Calamaro, 2014). More direct action could be something like calling a school nurse of the child to discuss a medication plan and accommodations that the student may need with their illness. Meanwhile, a collaborative approach for the common good and social justice of patients can have a positive impact on the morale of the unit and organization cohesiveness.

Resilience

Resilience is a vital aspect of healthcare teams as defined by health psychology, particularly in regard to patient safety. Team cohesion and cooperation are vital to preventing adverse events. In pediatric critical care, this is very important as children are inherently more vulnerable. Furthermore, the emotional difficulty of the experience of working with chronically and seriously ill children significantly raises the need for resilience among the interprofessional team. A nurse can improve resilience by developing an intervention that will focus on improved education, self-care, mentoring programs, and improved dialogue on a personal level.

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By building understanding and respect for each other, an appropriate social work environment can be created, which is a primary factor in promoting psychological resistance (Cusack et al., 2016). Such mindfulness-based techniques may gradually help the unit to become less autonomous and bind people together, which will reflect positively on the overall organizational structure and patient outcomes.

Evidence-Based Practice

Research demonstrates that nurses practicing an evidence-based approach demonstrate better patient outcomes. Evidence-based practice inherently implies using a problem-solving attitude to clinical healthcare delivery by incorporating the best methods and forms available based on research, expertise, and patient values. Nurses should effectively promote EBP in practice, even in highly specialized interprofessional settings. This helps to seek answers on how to improve collaborative practice and effectiveness of procedures, as well as raising awareness of the interconnection between research evidence and competent clinical practice (Black, Balneaves, Garossino, Puyat, & Qian, 2015).

For example, a nurse can promote a better collaborative approach in pediatric care that would allow for a team to communicate with the patient and their families. This would increase patient satisfaction while allowing the interprofessional unit to cooperate more closely, improving cohesiveness and mutual understanding of the treatment process.

Summary

Pediatric critical care is an example of interprofessional collaboration, which includes a group of various expert physicians and nurses. Many of them are autonomous in their practice, leading to issues of poor cohesiveness, communication, and lack of mutual respect within the interdisciplinary context. Using the iCARE model, a nurse can improve aspects of communication, respect, collaboration, mutual resilience, and growth as a team by demonstrating empathy, establishing a common advocacy goal, and providing interventions to improve resiliency and evidence-based practice. Both, through and in support of interprofessional collaboration, these nursing actions can have a significant impact on organizational and patient outcomes.

References

Black, A. T., Balneaves, L. G., Garossino, C., Puyat, J. H., & Qian, H. (2014). Promoting evidence-based practice through a research training program for point-of-care clinicians. The Journal of Nursing Administration, 45(1), 14-20.

Cusack, L., Smith, M., Hegney, D., Rees, C. S., Breen, L. J., Witt, R. R., Rogers, C., Williams, A., Cross, W., … Cheung, K. (2016). Exploring environmental factors in nursing workplaces that promote psychological resilience: Constructing a unified theoretical model. Frontiers in Psychology, 7, 600. Web.

Pfaff, K., & Markaki, A. (2017). Compassionate collaborative care: An integrative review of quality indicators in end-of-life care. BMC Palliative Care, 16(1), 65. Web.

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Selekman, J., & Calamaro, C. J. (2014). Comprehensive pediatric care includes communication with the school nurse. The Journal for Nurse Practitioners, 10(1), 36–41. Web.

Stocker, M., Pilgrim, S. B., Burmester, M., Allen, M. L., & Gijselaers, W. H. (2016). Interprofessional team management in pediatric critical care: Some challenges and possible solutions. Journal of Multidisciplinary Healthcare, 9, 47-58. Web.

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