Measuring the Interprofessional Health of the Pediatric Cardiovascular Operating Room Work Environment.

Introduction: Pediatric cardiac surgery is complex and has significant risk, requiring interprofessional teamwork for optimal outcomes. Unhealthy work environments have been linked to poor patient outcomes, staff dissatisfaction, and intention to leave. We describe the interprofessional health of pediatric cardiovascular operating room (CVOR) work environments in the United States and the establishment of a healthy work environment (HWE) benchmark score.

The Voice of Travel Nurses: Facilitating Effective Staffing During Pandemic and Expansion-Related Demands in a Children's Hospital.

Objective: The aim of this study was to explore the experience and perceived value of travel nurses in a children's hospital.

Background: Children's hospitals face unique challenges related to highly specialized care requirements and workforce expansion limitations. Travel nurses can augment nurse staffing capacity during times of intense demand and may offer insights as organizations seek to strengthen work environments.

No Place Like Home: Improving the Transition From NICU to Home Through the NICU to Nursery Program.

Background: Boston Children's Hospital's Level IV Neonatal Intensive Care Unit (NICU) discharges about a third of its medically complex infants home. Parental feedback indicated a need for more education and training in discharge preparation.

Purpose: The NICU to Nursery (N2N) program was created to better prepare parents to care for their medically complex infants following Level IV NICU discharge.

Moving from Vaccine Hesitancy to Acceptance: Engaging Underrepresented Employees in a Pediatric Academic Medical Center.

Unlabelled: Underrepresented populations historically underserved by the healthcare system and/or marginalized by systematic policies regionally and nationally were particularly vulnerable during the COVID-19 pandemic. While vaccine hesitancy has been described among hospital employees, the employees' experiences from an underrepresented population cohort have not been reported. We, therefore, sought to understand employees' vaccine experiences, hesitancy, and ways to enhance ongoing COVID-19 vaccine education and communication to build a hospital-wide culture of vaccine acceptance.

Refinement of the Intensive Care Unit Complexity Assessment and Monitoring to Ensure Optimal Outcomes III Acuity Tool.

Background: The Intensive Care Unit (ICU) Complexity Assessment and Monitoring to Ensure Optimal Outcomes (CAMEO) acuity tool quantifies patient acuity in terms of nursing cognitive workload complexity.

Objectives: The aim of this study was to refine the ICU CAMEO II acuity tool. An expert panel of nursing staff from 4 pediatric ICUs convened to refine the CAMEO II across a large, freestanding children's hospital in the United States.

Measuring Acuity and Pediatric Critical Care Nursing Workload by Using ICU CAMEO III.

Background: The Intensive Care Unit Complexity Assessment and Monitoring to Ensure Optimal Outcomes (ICU CAMEO III) acuity tool measures patient acuity in terms of the complexity of nursing cognitive workload.

Objective: To validate the ICU CAMEO III acuity tool in US children's hospitals.

Methods: Using a convenience sample, 9 sites enrolled children admitted to pediatric intensive care units (ICUs).

Utilizing high-fidelity simulation to improve newly licensed pediatric intensive care unit nurses' experiences with end-of-life care.

Purpose: New pediatric intensive care unit (PICU) nurses face distinct challenges in transitioning from the protected world of academia to postlicensure clinical practice; one of their greatest challenges is how to support children and their caregivers at the end-of-life (EOL). The purpose of this quality improvement project was to create, implement, and assess the efficacy of a high-fidelity EOL simulation, utilizing the "Debriefing with Good Judgment" debriefing model.

Design And Methods: Participants were nurses with 4 years or less of PICU experience from a 404-bed quaternary care, free-standing children's hospital in the northeastern United States.

Expanding Hospital Capacity during the COVID-19 Pandemic: The Family Voice Matters.

Unlabelled: During the initial COVID-19 response, this children's hospital reduced its inpatient capacity by 52 beds with double rooms' conversion to single patient occupancy, causing significant capacity constraints. To solve this challenge, the family perspective was engaged to safely redouble patient rooms and expand capacity as clinical activity increased during the COVID-19 response.

Methods: The team conducted qualitative descriptive interviews with parents of children undergoing congenital heart surgery admitted to the inpatient cardiac unit in a 404-bed free-standing children's hospital.

Nursing science fellowship at Boston Children's Hospital.

Introduction: Clinical inquiry is vital to safeguard nursing practice and ensure optimal outcomes for our patients and families. The innovative Nursing Science Fellowship (NSF) was developed to provide structured mentorship for pediatric nurses by nurse scientists to design and conduct clinical inquiry generated from their practice.

Methods: Each fellow is paired with a nurse scientist mentor to receive support for timely project completion.

Nurse-Implemented Goal-Directed Strategy to Improve Pain and Sedation Management in a Pediatric Cardiac ICU.

Objectives: To assess the impact of a nurse-implemented goal-directed sedation strategy on patient care and nursing practice in a pediatric cardiac ICU.

Design: Quality improvement project with a pre-post interval measurement plan.

Setting: Thirty-one bed pediatric cardiac ICU in a freestanding tertiary care children's hospital.

Pediatric nurses' perceptions of preparedness for global health fieldwork.

Objectives: The purpose of this qualitative descriptive research study was to understand the current state, perceived content, and experiential needs of pediatric nurses preparing for global health (GH) fieldwork experience. This study aimed to inform stakeholders about the standard and unique preparation needs of pediatric GH nurses.

Study Design And Methods: One group and five individual interviews were held with nurses from a large pediatric quaternary care facility in the Northeast United States.

The Measurement of Pediatric Inpatient Nursing Using the Complexity Assessment and Monitoring to Ensure Optimal Outcomes (CAMEO©) Tool.

Purpose: Physiologic measurement of patient acuity has been used to predict patient outcomes, length of stay, and resource utilization. To date, these tools are not sufficiently comprehensive to inform nurse staffing assignments and have limited practical application. The Complexity Assessment and Monitoring to Ensure Optimal Outcomes (CAMEO©) acuity tool was initially developed and validated to quantify patient acuity in terms of complexity of nursing cognitive workload in pediatric intensive care units (ICU).

A Vision for Excellence by Design.

Generating evidence for care improvement has characterized my program of research spanning 20 years. Six domains are highlighted to advance the science and practice of critical care nursing in today's complex health care systems. Employee well-being and taking care of team members are key priorities for successful leaders.

Linking world bank development indicators and outcomes of congenital heart surgery in low-income and middle-income countries: retrospective analysis of quality improvement data.

Objective: Many low-income and middle-income countries (LMICs) struggle to provide the health services investment required for life-saving congenital heart disease (CHD) surgery. We explored associations between risk-adjusted CHD surgical mortality from 17 LMICs and global development indices to identify patterns that might inform investment strategies.

Design: Retrospective analysis: country-specific standardised mortality ratios were graphed against global development indices reflective of wealth and healthcare investment.

Validation of the Complexity Assessment and Monitoring to Ensure Optimal Outcomes (CAMEO II) Acuity Tool for Pediatric Critical Care Nursing.

Background: The Complexity Assessment and Monitoring to Ensure Optimal Outcomes (CAMEO II) acuity tool was developed to quantify patient acuity in terms of nursing cognitive workload complexity in a large, freestanding children's hospital in the United States.

Objectives: To describe the acuity and complexity of pediatric critical care nursing at a large children's hospital and correlate the CAMEO II with pediatric physiologic measures.

Methods: Construct validation was conducted correlating the CAMEO II to a pediatric classification system and 2 physiologic acuity tools.

Scaling the Measurement of Pediatric Acuity Using the Complexity Assessment and Monitoring to Ensure Optimal Outcomes (CAMEO II) Tool.

Background: The Complexity Assessment and Monitoring to Ensure Optimal Outcomes (CAMEO) acuity tool was developed to quantify patient acuity in terms of nursing cognitive workload complexity. An expert panel including representatives from 4 intensive care units (ICUs) convened to scale and implement the CAMEO II across the ICUs in a large, freestanding children's hospital in the United States.

Objectives: The aims of this study were to scale and implement a standardized acuity measure of pediatric critical care nursing.

Building and Sustaining a Culture of Clinical Inquiry in a Pediatric Quaternary Hospital.

The Nurse Executive Committee for Research and Inquiry (NECRI) was established to align clinical inquiry with nursing clinical operations to advance nursing science and improve patient care and outcomes for patients and their families. The authors describe the development, structure, and function of NECRI, outcomes to date, and infrastructure necessary to support a sustainable model.

Interprofessional Use and Validation of the AACN Healthy Work Environment Assessment Tool.

Background: Health care work environments affect patient outcomes, staff satisfaction and retention, and organizational financial viability. The American Association of Critical-Care Nurses (AACN) Healthy Work Environment Assessment Tool (HWEAT) is a resource for patient care units and organizations to assess the work environment and track progress on their journey to excellence.

Objective: To validate interprofessional use of the AACN HWEAT across a large free-standing children's hospital.

Pressure injury prevention for paediatric cardiac surgical patients using a nurse-driven standardized clinical assessment and management plan.

Background: The description of pressure injury development is limited in children with CHD. Children who develop pressure injuries experience pain and suffering and are at risk for additional morbidity.

Objectives: The objective of this study was to develop a standardized clinical assessment and management plan to describe the development of pressure injury in paediatric cardiac surgical patients and evaluate prevention strategies.

The Impact of Critical Care Nursing Certification on Pediatric Patient Outcomes.

Objectives: To examine the relationship of nursing and unit characteristics including Critical Care Registered Nurse certification on patient complications for children undergoing congenital heart surgery in free-standing children's hospitals in the United States.

Design: A cross-sectional descriptive survey of nursing and organizational characteristics was sent electronically.

Setting: Free-standing children's hospitals in the United States.

Informing Leadership Models: Nursing and Organizational Characteristics of Neonatal Intensive Care Units in Freestanding Children's Hospitals.

Background: Neonatal intensive care units (NICUs) located in freestanding children's hospitals may exhibit significant variation in nursing and organizational characteristics, which can serve as opportunities for collaboration to understand optimal staffing models and linkages to patient outcomes.

Objectives: Adopting methods used by Hickey et al in pediatric cardiovascular critical care, the purpose of this study was to provide a foundational description of the nursing and organizational characteristics for NICUs located in freestanding children's hospitals in the United States.

Methods: Clinical nurse leaders in NICUs located in freestanding children's hospitals were invited to participate in an electronic cross-sectional survey.

Measuring Care Coordination in the Pediatric Cardiology Ambulatory Setting.

The role of ambulatory nursing is diverse, and the impact on patient outcomes is difficult to measure. The concept of care coordination is an important focus for the ambulatory nurse. We describe the efforts to implement the Cardiac Care Coordination Measurement Tool to document and quantify care coordination activities in a pediatric cardiac ambulatory setting.

Parental perceptions of disease-severity and health-related quality of life in school-age children with congenital heart disease.

Purpose: Understanding parents' perceptions of their child's health status is important as parents are drivers of healthcare utilization in the pediatric setting. Understanding parent-perceived disease-severity and its effects on a child's health-related quality of life (HRQOL) in children with congenital heart disease (CHD) is necessary to evaluate outcomes of care, improve care coordination, and inform policies focused on advancing family-centered care for pediatric cardiac patients. The impact of CHDs and disease-severity on the child's HRQOL has been investigated with inconsistent results.

International quality improvement initiatives.

Across the globe, the implementation of quality improvement science and collaborative learning has positively affected the care and outcomes for children born with CHD. These efforts have advanced the collective expertise and performance of inter-professional healthcare teams. In this review, we highlight selected quality improvement initiatives and strategies impacting the field of cardiovascular care and describe implications for future practice and research.