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Children's Intensive Care - Principles of
Practice - 6KNIF318 Level: 6
Credits: 15
Module leader: Matthew Norridge
Tel: 020 7848 3753
Email: [email protected]
Module deputy: Sheryl Gettings
Tel: 020 7848 3569
Email: [email protected]
____________________________________________________________________
This handbook must be read in conjunction with module information provided on KEATS, the King’s E-Learning And Teaching Service. You will be given access to KEATS on enrolment. Important information relating to assessment and related regulations can be found in the Undergraduate Programme Handbook, available on KEATS and via the Student Services Centre. This handbook can also be provided in alternative formats (such as large print) upon request to [email protected].
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Contents
Module overview .......................................................................................................... 3
Module aim ............................................................................................................... 3
Learning outcomes ................................................................................................... 4
Teaching arrangements ............................................................................................ 4
Submitting coursework ............................................................................................ 5
Assessment criteria ................................................................................................... 5
Formative assessment .............................................................................................. 5
Summative assessment............................................................................................. 5
Results and resubmissions for coursework .............................................................. 7
Resubmission dates are: ........................................................................................... 8
Learning resources ....................................................................................................... 9
Session 1a: Ventilation .............................................................................................. 9
Session 1b: Assisted Ventilation ............................................................................... 9
Session 2 – Arterial Blood Gases .............................................................................. 10
Session 3 – Heamodynamics .................................................................................... 10
Session 4a: Cardiovascular Therapies & Shock ........................................................ 11
Session 4b: ECGs & Arrhythmias ............................................................................. 11
Session 5 –Liver Disorders ....................................................................................... 12
Session 6 – Renal failure .......................................................................................... 12
Session 7 – Thermoregulation .................................................................................. 13
Session 8 – Sedation and analgesia .......................................................................... 13
Session 9 – Neurological Disorders ......................................................................... 14
Session 10 – Ethical Issues ....................................................................................... 14
Module evaluation ........................................................................................................ 15
Timetable...................................................................................................................... 16
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Module overview This module forms part of the BSc Nursing Practice. The module can also be taken as a freestanding module.
Module aim Skills gained through a blend of education and experience. These skills are required in PICU’s in lead centres providing level 2 & 3 care as well as by nurses delivering level 1 care in DGH who may also be required to deliver level 2 care prior to retrieval of the child. This module is designed to equip these nurses to recognise critical changes in the clinical condition of a child and take appropriate action.
The main emphasis of this module is to critically analyse and evaluate the practice of the intensive care nursing of children. The critically ill child requiring level 2 intensive care nursing may require advanced respiratory support and support of one or more failing organ systems. This module focuses upon the child with primarily single system failure, for example requiring ventilatory support.
The aims of this module are to enable the student to:
Develop their understanding of the pathophysiology of critical illness in order to facilitate the appropriate selection and usage of assessment tools,
Critically interpret findings/results in the context of the child’s critical illness in relation to personal philosophies and beliefs.
Students will have the opportunity to:
Take control for their own learning and professional development based upon individual learning needs
Develop and evaluate specialist skills
Critique their developing role
Examine contextual issues
Review current research in depth enabling evaluation and synthesis in practice
Students will be required to undertake pre-session preparation and work for the taught sessions of this module to enable them to revise and develop their knowledge to assist with achieving the learning outcomes for this module.
Students who successfully complete the module will be awarded 15 credits at level 6.
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Learning outcomes Overall the learning outcomes for this module will contribute to the NHS Knowledge and Skills Framework (DoH 2004) dimensions.
During the module students will explore:
Pathophysiology of common critical illnesses in children,
the physiological basis for assessment,
the knowledge base to enable skilled, appropriate and timely assessment of the child in intensive care requiring level 2 care,
appropriate evidence based interventions for the critically ill child based on his / her assessment findings,
the knowledge base and specialist skills required to effectively assess and meet the changing needs of the critically ill child and their family,
the impact of personal philosophies and beliefs in relation to paediatric high technology nursing.
At the end of this module students will be able to:
Demonstrate competency in assessing and caring for the child with compromised respiratory function.
Demonstrate an analytical approach to assessment and interpretation of the multisystem assessment of the child requiring intensive care.
Utilise an analytical approach to integrate an understanding of complex ethical issues with family and child support and communication skills.
Evaluate own actions and professional limitations in relation to professional accountability.
Teaching arrangements
Lectures & discussions
Directed reading
Seminars
Critical review and critique of research literature
Critical incident analysis
Case studies and discussion
Reflection
Personal and group tutorials
E-learning activities
Practice placements It is strongly recommended that practitioners have access to a current anatomy and physiology text and critical care nursing text throughout the module.
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Submitting coursework For this module you are assessed by Matthew Norridge and Sheryl Gettings.
For this module you are assessed by an essay and practice assessment document.
The essay must be submitted electronically through TurnItIn, information about how to submit late will be provided on KEATS module sites under assessment information. The Practice Assessment Document must be submitted as a hard copy please ensure you date stamp it and submit it to the submission room G15 JCMB.
Assessment criteria There is one theoretical assignment for this module and an assessment of practice. The Practice Assessment Document can details for completion can be found on the KEATS site for the module.
Both elements of the strategy must be passed in order to successfully complete the module.
Formative assessment Students will undertake a seminar looking into an aspect of the techniques utilised in the reduction of ventilator associated pneumonia. This will be a group activity allocated in the first week of the course.
Summative assessment Title: A critical analysis of a critical care nursing intervention.
Purpose: To enable you to explore analytically the physiological basis and rationale for a specific nursing intervention on a specific patient.
Guidelines for the Summative Essay
Select a patient who has an Intensive Care Acuity Level 2. Undertake a holistic assessment on your patient of choice having sought consent.
Select one nursing intervention from the criteria in the Practice Assessment section you have implemented on this patient based on the assessment. This intervention will be the focus of your essay.
Critically analyse the physiological basis and relevance of this nursing intervention on your chosen patient.
Evaluate the outcome of this nursing intervention in relation to your chosen patient.
Your essay must include:
A brief introduction to the patient and the context of care explained.
Context and justification of the critical care nursing intervention.
Review of the assessment findings that informed the nursing intervention.
Evidence base for the intervention.
Interaction with other body system(s) and / or other care issues must be discussed.
The potential risks of the intervention or non-intervention must be discussed.
Review of the outcome.
Significance and implications of findings and the interrelationships of these to your patient.
Implications for practice.
The holistic assessment must be included in the appendix (this is not included in your word limit)
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The work should:
Demonstrate critical thinking and analysis.
Demonstrate theory–practice link.
Strongly relate to the selected patient.
Follow a structured essay format i.e. must include an introduction, a focused discussion with logical lines of argument and a conclusion. Headings may be used if desired.
Confidentiality must be maintained, specific care areas, trusts, clients or staff must not be named in the main body of the assignment or in appendices.
The work should be supported throughout with up to date, relevant literature, which justifies and supports your discussion. Throughout the essay literature sources must be cited correctly and the Journal of Advanced Nursing system of referencing used accurately.
The assignment should be legible and grammatically correct, with accurate spelling.
Charts, tables and other raw data may be placed in the appendix, but must be referred to in the main text. The appendix must not exceed the size of the main essay and must be referenced correctly. There must be no features that could identify a trust or a ward on any appendix material.
Details of this assignment are contained within the Portfolio document, found on the e-learning site.
Please note any breach of confidentiality may result in a fail grade for the assignment.
Please note that any issue regarded as unsafe practice will constitute an automatic fail.
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Coursework submission are provided on the modules KEATS site. It is essential that you use your candidate number on all assignments/examinations. Your candidate number, which will begin with X for the academic year 2016/17, will be available via Student Records on the King’s Intranet approximately one month after you enrol. If you are unable to submit your work by the deadline please refer to the information in your programme handbook on “mitigating circumstances”. If you require further support in these circumstances you are advised to contact KCLSU. Submission date for coursework: Essay: Tuesday 10 January 2017 PAD: Tuesday 17 January 2017 Late submissions will be accepted for 24 hours following the submission date. All work submitted late will be marked as normal but will be capped at the pass mark for the module. If your assignment is a hard copy please ensure you date stamp it and submit it to the submission room G15 James Clerk Maxwell Building. If your assignment is submitted electronically through TurnItIn, information about how to submit late will be provided on KEATS module sites under assessment information. Please label the file with your candidate number and double-check you have submitted the correct file. The external examiner for this module is Sian Bill. Students are not to make direct contact with external examiners, in particular regarding their individual performance in assessments. The College and its Examination Boards in the ten Faculties (Institutes/Schools, King's Learning Institute and the Association of King's College (AKC), work with over 500 external examiners to ensure the quality and standard of our taught awards. Find the latest report on the External Examiners Report page, navigate to the Faculty of Nursing and Midwifery section.
Results and resubmissions for coursework Students will receive a provisional (unratified) mark for their coursework 4 weeks following submission. According to the method of submission as detailed on your KEATS site, if your work was submitted online you will be able to download marked coursework from KEATS; alternatively, if you completed a hard copy submission you can collect your coursework and feedback from the Student Services Centre. To collect a hard copy assignment, you must provide your candidate number. Alternatively, you may send a stamped addressed envelope to the Student Services Centre ensuring that this is large enough to accommodate your assignments and that you have applied sufficient postage. Hard copy assignments will be retained for four weeks; if you have not collected your assignment by then, it will be destroyed. Feedback will include the award of a numerical grade which remains provisional until ratified by the examination boards. The dates for the examination boards are available on KEATS. Ratified marks can be viewed via Student Records on the King’s Intranet, the Monday following the relevant examination board. The marking criteria by which your work is judged are provided in full in your programme handbook. Please also refer to the section in your programme handbook on plagiarism and how to avoid it. If you have a query about how to refer to a specific piece of work please ask your module leader, your group leader or a member of library staff for guidance or please use King’s Libguides site.
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The feedback you receive on your assignment will guide you towards how to do better next time or how to maintain your existing high standard! If you do not understand your mark or the feedback you receive please contact Matthew Norridge. If you are unsuccessful, it is recommended that you contact the module leader before submitting your second attempt. This will enable the module leader to provide you with an appropriate level of support as you prepare to resubmit your work.
Resubmission dates are: Essay: Tuesday 11 April 2017
PAD: Tuesday 11 April 2017
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Learning resources
Session 1a: Ventilation Pre-session work required
By the end of this session and on completion of the pre-session work practitioners should be able to:
Critically analyse effects of artificial ventilation on patient’s cardiovascular and respiratory system.
Reflect upon the effects of changes in resistance and compliance associated with critical illness or caused by artificial ventilation.
Understand the implications of ventilation/perfusion mismatching for gas exchange.
Understand the causes and implications and initial management of respiratory failure.
Indicative Reading:
Bekos V. & Marini J.J., (2007) Monitoring the Mechanically Ventilated Patient. Critical Care Clinics, Monitoring in the Intensive Care Unit 23, 575–611.
Khemani R.G., Bart R.D. & Newth C.J.L. (2007) Respiratory monitoring during mechanical ventilation. Paediatrics and Child Health 17(5), 193-201.
Levy M.M. (2005) Pathophysiology of oxygen delivery in respiratory failure. Chest. 128(5), 547S-553S.
Milner A.D. & Greenough A. (2006) Applied respiratory physiology. Current Paediatrics 16, 406-412.
Smyth M. (2005) Acute Respiratory Failure: Part 1: Failure of Oxygenation. American Journal of Nursing. 105(5), 72GG-7200.
Smyth M. (2005) Acute Respiratory Failure: Part 2: Failure of Ventilation. American Journal of Nursing. 105(6), 72AA-72DD.
Session 1b: Assisted Ventilation Pre-session work required
By the end of this session practitioners should be able to:
Critically analyse effects of artificial ventilation on patient’s respiratory system and cardiovascular system.
Analyse the effects of changes in resistance and compliance on artificial ventilation.
Critically analyse complications associated with mechanical ventilation
Critically analyse rationale for weaning ventilation.
Indicative Reading:
Couchman B.A. (2007) Nursing care of the mechanically ventilated patient: What does the evidence say? Part one. Intensive & Critical Care Nursing. 23(1), 4-14.
Coyer F.M. (2007) Nursing care of the mechanically ventilated patient: what does the evidence say? Part two. Intensive & Critical Care Nursing. 23(2), 71-80.
Turner D.A. & Arnold J.H. (2007) Insights in pediatric ventilation: timing of intubation, ventilatory strategies, and weaning. Current Opinion in Critical Care. 13(1), 57-63.
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Session 2 – Arterial Blood Gases Pre-session work required
By the end of this session and on completion of the pre-session work practitioners should be able to:
Understand and interpret arterial blood gas assessments for patients with alterations in metabolic or respiratory parameters
Critically evaluate the role of blood gases in the assessment of a patient
Indicative Reading:
Berend K., de Vries A.P.J. & Gans R.O.B., (2014). Physiological Approach to Assessment of Acid–Base Disturbances. New England Journal of Medicine 371, 1434–1445.
Edwards S.L. (2007) Pathophysiology of acid base balance: The theory practice relationship. Intensive and Critical Care Nursing. 23.
Lynch F. (2009) Arterial blood gas analysis: implications for nursing. Paediatric Nursing. 21(1), 41-44.
Session 3 – Haemodynamics Pre-session work required
By the end of this session and on completion of the pre-session work practitioners should be able to:
Understand physiology of normal blood pressure, heart rate and cardiac output regulation.
Critically analyse effects of artificial ventilation on patient’s cardiovascular system.
Critically analyse use of and contra-indications for non-invasive and invasive tools for haemodynamic monitoring.
Critically evaluate cardiac output assessment tools.
Indicative Reading:
Alhashemi J., Cecconi M. & Hofer C. (2011): Cardiac output monitoring: an integrative perspective. Critical Care 15, 214.
Howlin F. & Brenner M. (2009) Cardiovascular assessment in children: assessing pulse and blood pressure. Paediatric Nursing. 22(1), 25-35.
Tibby S.M. (2009) Haemodynamic Monitoring. Cardiovascular Pediatric Critical Illness and Injury. 2, 1-20.
Vincent J-L., Rhodes A., Perel A., Martin G., Rocca G., Vallet B., Pinsky M., Hofer C., Teboul J-L., de Boode W-P., Scolletta S., Vieillard-Baron A., De Backer D., Walley K., Maggiorini M. & Singer M. (2011): Clinical review: Update on hemodynamic monitoring - a consensus of 16. Critical Care 15, 229.
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Session 4a: Cardiovascular Therapies & Shock Pre-session work required
By the end of this session and on completion of the pre-session work practitioners should be able to:
Critically analyse the indications for administration of inotropes considering receptor action and clinical gain.
Understand aetiology of shock.
Critically evaluate the fluid interventions in the treatment of shock.
Indicative reading:
Deho A. & Nadel S. (2008) Understanding shock. Paediatrics and Child Health. 19(3), 97-102.
Holliday M.A., Ray P.E. & Friedman A.L. (2007) Fluid therapy for children: facts, fashions and questions. Archives of Diseases in Childhood. 92, 546-550.
Morrison G. (2006) Applied physiology: Understanding Shock. Current Paediatrics 16, 420-424.
Mecham N. & Vanore M. (2006) Early recognition and treatment of shock in the pediatric patient. Journal of Trauma Nursing 13(1), 17-21.
Paise F. & Playfor S.D. (2008) Which Inotrope? Paediatrics and Child Health 19(3), 142-144.
Session 4b: ECGs & Arrhythmias Pre-session work required
By the end of this session and on completion of the pre-session work practitioners should be able to:
Understand the normal ECG.
Analyse the relationship of the ECG to the components of the cardiac cycle.
Interpret common dysrhythmias: sinus bradycardia, sinus tachycardia, atrial flutter and fibrillation, ventricular tachycardia, ventricular fibrillation, SVT, heart blocks.
Understand the rationale for introducing pacing.
Indicative Reading:
Chan T.C., Sharieff G.Q. & Brady W.J. (2008): Electrocardiographic Manifestations: Pediatric ECG. The Journal of Emergency Medicine 35, 421-430.
Doniger S.J. (2006) Pediatric dysrhythmias. Pediatric Clinics of North America. 53(1), 85-105.
Ladusans E.J. (2008) Diagnosis, evaluation and treatment of cardiac arrhythmias. Paediatrics and Child Health 19(1), 30-36.
Park M.K. & Guntheroth W.G. (2006) How to Read Pediatric ECGs. 4th ed. Mosby, St. Louis.
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Session 5 –Liver Disorders Pre-session work required
By the end of this session & completion of pre-session work / reading you should be able to:
Analyse the effects of acute hepatic failure.
Critically analyse the presentation of hepatic encephalopathy.
Examine the management principles following liver transplantation
Indicative reading
Dong Q. (2006) Pediatric liver transplantation. Seminars in Roentgenology. 41(1), 61-70.
Cochran J.B. (2007) Acute liver failure in children. Pediatric Emergency Care. 23(2), 129-135.
McGuinness A. (2007) Hepatic nursing. Role of the nurse in managing patients with hepatic cerebral oedema. British Journal of Nursing. 16(6), 340-343.
Session 6 – Renal failure Pre-session work required
By the end of this session and on completion of the pre-session work practitioners should be able to:
Understand aetiology of acute renal failure.
Analyse the effects of renal failure for the child with respiratory and or cardiac failure.
Analyse the indications for management strategies for the child with renal failure.
Indicative reading:
Akcan-Arikan A., Zappitelli M., Loftis L.L., Washburn K.K., Jefferson L.S. & Goldstein S.L (2007): Modified RIFLE criteria in critically ill children with acute kidney injury. Kidney Int 71, 1028-1035.
Alkandari O., Eddington K., Hyder A., Gauvin F, Ducruet T., Gottesman R., Phan V. & Zappitelli M. (2011): Acute kidney injury is an independent risk factor for pediatric intensive care unit mortality, longer length of stay and prolonged mechanical ventilation in critically ill children: a two-center retrospective cohort study. Critical Care 15, 1-12.
Fortenberry J.D., Paden M.L. & Goldstein S.L. (2013): Acute Kidney Injury in Children: An Update on Diagnosis and Treatment. Pediatric Clinics of North America 60, 669-688.
Srisawat N., Hoste E.E.A. & Kellum J.A. (2010): Modern Classification of Acute Kidney Injury. Blood Purification 29, 300-307.
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Session 7 – Thermoregulation Pre-session work required
By the end of this session and on completion of the pre-session work practitioners should be able to:
Review the regulation of normal body temperature.
Understand the difference between core and shell temperature and their respective regulatory mechanism.
Understand the difference between pyrexia and hyperthermia.
Analyse the advantages and disadvantages of available treatment methods for pyrexia and hyperthermia.
Understand the metabolic consequences of pyrexia and hyperthermia.
Indicative reading:
Batra P. & Goyal S. (2013). Comparison of Rectal, Axillary, Tympanic, and Temporal Artery Thermometry in the Pediatric Emergency Room: Pediatric Emergency Care 29, 63–66.
Broom M. (2007) Physiology of Fever. Paediatric Nursing. 19(6), 40-45.
El-Radhi A.S. & Barry W. (2006) Thermometry in paediatric practice. Archives of Diseases in Childhood. 91, 351-356.
Henker R. (2007) Fever: applying research to bedside practice. AACN Advanced Critical Care. 18(1), 76-87.
Session 8 – Sedation and analgesia Pre-session work required
By the end of this session practitioners should be able to:
Review the anatomy & physiology of paediatric pain
Review the importance and necessity of adequate sedation and analgesia in the child in intensive care
Critically evaluate the use of pain assessment tools in PICU
Critically analyse the use of analgesia in PICU
Critically evaluate the use of non-pharmacological interventions and potential benefits in PICU
Understand the mechanism of action of muscle relaxants
Indicative reading:
Razmus I. (2006) Current trends in the development of sedation/analgesia scales for the pediatric critical care patient. Pediatric Nursing. 32(5), 435-41, 452-4
Srouji R., Ratnapalan S. & Schneeweiss S. (2010): Pain in Children: Assessment and Nonpharmacological Management. International Journal of Pediatrics 2010.
RCN (2009) The Recognition and assessment of acute pain in children [online] UK http://www.rcn.org.uk/__data/assets/pdf_file/0004/269185/003542.pdf [Accessed 2/11/09]
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Session 9 – Neurological Disorders Pre-session work required
By the end of this session and on completion of the pre-session work practitioners should be able to:
Critically evaluate the purpose, use and limitations of neurological assessment scales in paediatric critical care.
Critically analyse the pathophysiology of seizure activity.
Critically analyse the management of the child with seizures in critical care.
Indicative reading:
Cohen J. (2009) Interrater Reliability and Predictive Validity of Four Score Coma Scale in a Pediatric Population. Journal of Neuroscience Nursing. 41(5), 261-267.
Floweer D. (2009) Epilepsy part 1: Recognizing seizure types and diagnosis. British Journal of School Nursing. 4(3), 113-118.
Leung A.K.C (2007) Febrile Seizures. Journal of Pediatric Healthcare. 21(4), 250-255.
Martland T. & Harris C.S. (2009) Management of Seizures. Paediatrics and Child Health. 19(5), 225-231.
Session 10 – Ethical Issues Pre-session work required
By the end of this session and on completion of the pre-session reading practitioners should be able to:
Critically analyse the complexities of ethical issues in critical care.
Indicative reading:
Austin W., Kelecevic J., Goble E. & Mekechuk J. (2009) An Overview of Moral Distress & the Paediatric Intensive Care Team. Nursing Ethics. 16(1), 57-68.
Laddie J., Craig F., Brierley J., Kelly P. & Bluebond-Langner M. (2014): Withdrawal of ventilatory support outside the intensive care unit: guidance for practice. Archives of Disease in Childhood 99, 812-816.
Longden J.V. (2011): Parental perceptions of end-of-life care on paediatric intensive care units: a literature review. Nursing in Critical Care 16, 131-139.
Vince T. & Petros A. (2006) Should children’s autonomy be respected by telling them of their imminent death? Journal of Medical Ethics. 32, 21-23.
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Module evaluation At the end of the module you are requested to complete the short online evaluation which will be available on your module KEATS site. Student evaluations are very important to us and are required by Health Education England and the regional London Local Education and Training Boards.
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Timetable Subject to possible changes. An updated timetable will be available on the module KEATS site should any changes be made.
Timetable – 6KNIF318 Term 1
Date Session Time Venue
6 Oct 2016
Introduction 9:00 - 10:00
G80 FWB Respiratory Assessment 10:00 - 11:00 Ventilation 11:00 - 13:00
Lunch 13:00 - 14:00
Ventilation 14:00 - 15:00 TBC
ABGs & Scenarios 15:00 - 17:00
20 Oct 2016
Cardiovascular Assessment 10:00 - 12:00 2.80 FWB
ECGs & Arrhythmias 12:00 - 13:00
Lunch 13:00 - 14:00
CVS Therapies 14:00 - 15:30 1.17 FWB
Journal Task 15:30- 16:30
Assignment Tutorial 16:30- 17:00
3 Nov 2016
Acute Liver Failure 10:00 - 11:30 2.80 FWB
Acute Kidney Injury 11:30 - 13:00
Lunch 13:00 - 14:00 Pain & Sedation 14:00- 15:00
1.17 FWB Formative – VAP 15:00- 17:00
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8 Dec 2016
Neuro 10:00 - 11:00
2.80 FWB Thermoregulation 11:00 - 12:00
Psychosocial Issues of PICU 12:00 - 13:00
Lunch 13:00 - 14:00
Psychosocial Issues of PICU 14:00 - 15:00
G8 WBW Ethics 15:00 - 16:30
Evaluation 16:30 - 17:00
Location key:
FWB – Franklin-Wilkins building, Waterloo campus
JCMB – James Clerk Maxwell building, Waterloo campus
WBW – Waterloo Bridge Wing, Waterloo campus
