Hemorrhagic Shock Recognition

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Service Orientation Helps Nurses Care for Kids
with Broken Hearts
New Cardiovascular Surgery
Mary Frances D. Pate DSN, RN Sharon Nelson,
RN Pediatric Intensive Care Unit Doernbecher
Childrens Hospital at the Oregon Health
Sciences University, Portland, Oregon
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Purpose

• Preparing Pediatric Intensive Care Unit (PICU)
  nurses to care for an entirely new patient
  population requires a multifaceted approach.
  When a pediatric cardiovascular surgeon was hired
  by the hospital it became clear that the nursing
  staff would need considerable educational
  preparation before caring for this special
  surgical population for the first time.

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Description

• Staff education was initiated eighteen months
  prior to the arrival of the first cardiovascular
  surgery patient. A cadre of 20 nurses was
  initially selected and trained for these
  patients. This group was provided with an
  overview of congenital heart defects, surgical
  repairs, and nursing care. Following the
  classes, the core groups critical thinking
  skills were assessed. This was done in
  one-to-one sessions with nurse educators through
  the use of patient scenarios.

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Description

• A few staff members were selected to visit
  hospitals with established pediatric
  cardiovascular surgery programs where they were
  precepted by nurses experienced in working with
  this patient population. Travel also included a
  site visit to the PICU where the newly hired
  cardiovascular surgeon still worked. This allowed
  our nurses to care for actual patients, watch
  surgeries, and talk with staff about the
  surgeons practice preferences.

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Description

• After the site visits, the entire core group met
  to discuss their findings and
• participate in mock thoracotomy drills.

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Description

• Additionally, when the first patient rolled
  through our PICU doors, nurses from nationally
  recognized pediatric cardiovascular surgery
  programs were present to assist staff members at
  the bedside. These preceptors signed off core
  group members on various competencies that
  progressed from simple skills to complex patient
  situations.

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Evaluation/Outcome

• The training program has proven to be very
  successful. Recently our unit admitted its 100th
  cardiovascular surgery patient and we had a
  celebratory reception. All PICU nurses are now
  being oriented to this new patient population.

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