STANDARDS FOR EDUCATION IN PAEDIATRIC CRITICAL CARE SPECIALIST NURSING

Background

TheseStandardsareadditionaltoCareofCriticallyIllChildren(PaediatricIntensiveCareSociety,2015)and relatedirectlytotherecommendationsfornationallyconsistentLevel3PaediatricCriticalCareUnit(PCCU) specialistnurseeducation(PaediatricIntensiveCareSocietyUK–NurseEducatorsSubgroup(PICS-E), 2015).Thisisthirditerationofthiswork.

Whenusedforself-assessmentorpeerreview,theStandardsinthissectionshouldbereviewedforeach areathatisseparatelymanagedorstaffed.

Thelearningenvironmentandculturemeetsthelearner’sneedsandensurestheyhaveanexcellent experience.Multi-professionaleducationshouldbeencouraged.

Measuring compliance coding (PICS, 2015)

BI / Background information for the review team
Visit / Visiting facilities
MP&S / Meeting patients, carers and staff
CNR / Case note review or clinical observation
Doc / Documentation may be in
the form of a website or other social media

[Type text]

Ref. / Quality Standard
LEARNING OUTCOMES
code / At the end of the programme the student is expected to:
BeanexpertPICnurseabletomanagepatientsinalevel3PCCU(RCPCH,2014;PICS, 2015),withtheabilityandinsighttoseekappropriatesupport
Leadanddeliversafe,evidence-basedcaretothechildandtheirfamilyincriticalcare
Communicateeffectivelywiththepatient,familyandwiderhealthcareteam
Understandtheorganisationalandpoliticalcontextofpaediatriccriticalcare
BI
Visit
MP&S
CNR
Doc
ENTRY REQUIREMENTS
code / Havecurrentclinicalexperienceworkinginanappropriatelevelpaediatriccriticalcare unit(PCCU),forexampleaLevel3unitforalevel3course.
HavesuccessfullycompletedaLevel3PCCUnursingorientation/development programme[PICS-EStandardsforPICUNursingOrientationProgrammes].
BeworkinginaclinicalcapacityonaLevel3PCCUforthedurationoftheprogramme.
BI
Visit MP&S CNR
Doc
Ref. / Quality Standard
PROGRAMME STRUCTURE
code
BI
Visit MP&S CNR
Doc / Educationshouldbedeliveredinasafeandopenenvironmentforpatients,staffandlearners toensureprovisionofhighqualitycareandexperienceforserviceusers(DH,2013;HEEQuality Framework, 2016/2017; NHSHEE)
Content and assessment at a minimum academic level 6, with a level 7 option if accredited throughHEI
Canbecreditbearingandqualitycontrolledthroughahighereducationinstitution and/orvalidatedthroughPICS-EEQAGroup
Haveclearlinks/opportunitiestoprogressontorelevantpathwayssuchasleadership, research,advancedpractice,thuslinkingeducationtosuccessionplanning.
Thecoursemust:
MeettherelevantPICSstandards(forNurseOrientation/FoundationProgrammesor SpecialistNurseEducationProgrammes)
BemappedagainstBloom’sReviewedTaxonomyofLearningDomains(Andersonetal, 2001)
ComplywiththeQualityStandardswithintheHeathEducationEngland(HEE)Quality Framework2016/17
ComplywiththeHEEQualityStrategy2016–2020
MeetthestandardsoftheHigherEducationAcademyUKProfessionalFrameworkfor TeachingandSupportingLearninginHigherEducation
Educationprogrammemustbeinclusive,particularlyforlearnerswithdisabilitiesoralearning difficultyandarrangementstosupportsuchlearnersmuchbeinplace,evidencedbyan Equality ImpactAssessment.
Leanersmustbesupportedinpracticebyuseofsuchmethodsasmentorship,bysomeonewho hassuccessfullycompletedarecognisedcriticalcareeducationprogrammeandwhohas completedamentorshipinpracticeprogrammeasrecommendedbytheNursingand MidwiferyCouncil.
code / Theoretical Content
Should encompass the following areas - physiology and care and management:
BI
Visit
MP&S
CNR
Doc
code / Assessment of the child:
Advanced clinical assessment of the critically ill infant/child (CYP)
BI
Visit
MP&S
CNR
Doc
Ref. / Quality Standard
code / Respiratory:
  • Basicairwaycareclearance,manoeuvresandmanagement
  • Advancedairwaymanagement,includingIntubation
  • TracheostomycareandemergencyTracheostomyAlgorithm
  • Difficult airwaymanagement
  • Respiratoryanatomyalteredphysiologyleadingtocriticalillness
  • Respiratorydistressleadingtorespiratoryfailure
  • Principlesandmanagementstrategiesformechanicalventilationandweaning
  • Arterialbloodgas(ABG)analysis
  • Handventilationandthetheoryofmanualventilationdevices
  • CommonrespiratorypathologyseeninthePICU
  • Advanced respiratorytherapies,
e.g. High Frequency Oscillatory Ventilation (HFOV), Extracorporeal membrane oxygenation (ECMO) and nitric oxide
CXRinterpretation
Non-invasive ventilation(NIV)
Long termventilation
Careofpleuraldrainsandassociatedconditions
BI
Visit
MP&S
CNR
Doc
code / Cardiovascular monitoring and therapies:
  • Cardiovascularanatomyandphysiology
  • Haemodynamicmonitoring
  • Non-invasiveandinvasivepressuremonitoring
  • Careofchildrenfollowingcardiacsurgery,includingcardiactamponade,careofdrains
  • ECGinterpretation
  • Arrhythmia, dysrhythmia andpacing
  • Congenitalheartdisease,includingductdependantlesions
  • Shock,lowcardiacoutputstate
  • DIC
Ifworkinginacardiacsurgicalcentreallshouldbecoveredinmoredetailincludingpost- operativesurgicalmanagementandECPR/ECLS
BI
Visit MP&S CNR
Doc
code / Pharmacology:
  • PICU relatedpharmacology
oIncludinginotropes,vasodilators,analgesics,sedativesandmusclerelaxants
  • Theimpactofageandcriticalillnessonpharmacodynamicsandpharmacokinetics, includingtheeffectsofrenalreplacementtherapies

BI
Visit
MP&S
CNR
Doc

Ref.QualityStandard

code

Infection & Sepsis:

  • InfectionandSepsis(PaediatricSepsis6)
  • Septicshock
  • SystemicInflammatoryResponseSyndrome(SIRS)
  • Includingpathology,therapies,nursingcareandinfectioncontrol.
  • Antimicrobialstewardship

Gastrointestinal aspects:

  • Gastrointestinalconditions
  • Hepaticfailure
  • Nutritionandfeedingstrategies,toincludeenteralandparenteralroutes,EBMand breastfeeding.

Livercentres:careofacuteliverfailure,chronichepaticconditionsandpost-operative transplantmanagement

Trauma:

  • Traumatic braininjury
  • Burns
  • Poisoning
  • Drowning
  • Non-accidentalinjuries
  • MassiveHaemorrhage
  • C Spineinjury
  • TARN, TraumaRehabilitation
  • Mass Casualtyprocedures

Neurological aspects:

  • Neurologicalanatomyandphysiology
  • Neurologicalassessmentandcomascoring
  • Commonpathology
  • RaisedICP

oMonitoring, management andtreatment

  • Paediatricbrainstemdeathandtesting
  • Organ donormanagement
  • Statusepilepticus
  • Careofexternalventriculardrains
  • CFAM

code

BI

Visit MP&S CNR

Doc

Advanced Life Support Skills:

  • AdvancedLifesupportifindividualsdonotholdaformalcertificate
Ref. / Quality Standard
code / Renal:
  • AcuteKidneyInjuryandRenalfailure
  • Fluid and electrolytephysiology
  • Fluidmanagement
  • Renalpathology,
  • Renal replacementtherapies
  • See alsopharmacology

BI
Visit
MP&S
CNR
Doc
code / Retrieval and transport of the critically ill child:
  • In-hospitaltransfer
oE.g.transferstoMRI,CTandbetweenwardareas,ED
  • Stabilisationofthecriticallyillchild
  • Principles ofRetrieval

BI
Visit
MP&S
CNR
Doc
code / Pain & sedation management:
  • Utilisation oftools
  • Drugwithdrawaltreatmentandmanagement
  • Evidence base fortreatments
  • Deliriumprevention,recognitionandmanagement

BI
Visit
MP&S
CNR
Doc
code / Evidence based practice in paediatric critical care:
  • ReviewingandanalysingtheevidencebaseforPICUnursingcareandmulti-disciplinary therapies.
  • Useofresearchandaudit
  • PICANet

BI
Visit
MP&S
CNR
Doc
Ref. / Quality Standard
code / Professional, ethical & psychosocial issues:
  • Communicationwithprofessionalsandserviceusers
  • Communicationwithfamiliesunderstress
  • Non-technicalskills,teamworkingandleadingateam
  • Legal and clinicalgovernance
  • Professionaldevelopment,toincludeadvancedpractice,extendingroles,research.
  • Organisation(centralisationandfunding),leadershipandmanagerialawareness
oTimemanagement,reflection,self-awareness
  • Safeguarding
  • Ethics
  • Safety andquality
  • Careofchildwithlearningdisabilities,communicationwithnon-verbalpatients
  • End of lifecare
  • Spiritualcare
  • Compassionfatigue
  • HumanFactors,SituationAwareness,RiskManagement
  • Thepoliticalcontextofcriticalcaredelivery

BI
Visit
MP&S
CNR
Doc
code / Other key topics to be addressed:
  • Revisionofallaspectsofessentialnursingcare
  • Metabolicandendocrineemergencies,forexampleinbornerrorsofmetabolism, adrenal insufficiency andDKA
  • Specialistneedsofthepretermneonateandtheneonateinpaediatricintensivecare
  • Oncology andHaematology
  • Long-termventilationandtransitionalcare
  • Quality Improvement andresearch

BI
Visit
MP&S
CNR
Doc
Ref. / Quality Standard
TEACHING AND LEARNING STRATEGIES
code
BI
Visit MP&S CNR
Doc / Curriculaandprogrammesaredevelopedandimplementedsothatlearnersareenabledto demonstrate and achieve the learning outcomes required for course completion and professional standards. The content should be responsive to changes in treatments, technologiesandcaredeliverymodelsandarereflectiveofstrategictransformationplans acrosshealthandcaresystems.Theprovidersandlearnersshouldproactivelyengagewith patients,serviceusers,carers,citizenstoshapecurricula,assessmentsandcoursecontentto supportanethosofpatientpartnershipwithinthelearningenvironment(DH,2013;HEE QualityFramework2016/2017;NHSHEE).
Arangeofteachinglearningstrategiesisencouragedtomeetvaryinglearningneeds. TeachingLearningstrategiesmustreflectcurrentclinicalpractice,berealisticandemphasise reflectionuponandlearningfromthepracticeenvironment.
Moduleleadersshouldholdorbeworkingtowardsaqualificationineducationwhichshould allowthemoduleleadertoregisterasaNurseTeacherwiththeNursingMidwiferyCouncil (NMC).Educationqualificationsgainedpriortopublicationofthesestandardsareacceptable. Onewholetimeequivalenteducatorto50nurseswithinPICUisarecommendedstandard (AustralianCollegeofCriticalCareNursesAdvisoryPanel,2003;PICS,2015).Educatorsshould receivesupport,resourcesandtimetomeettheireducationalandresearchresponsibilities (HEEQualityFramework2016/2017,NHSHEE).
Organisationsmustbesupportivetofacilitatemodulesandstudentstoattendlearningevents. Thisenablestherightcaretobeprovidedtopatientsbythosewiththerightknowledgeand skillsandevidencedbasedknowledgewhichunderpinssafetyandhighqualitycare.
Clinical Exposure
Mostactivelearningwillbeintheclinicalenvironment.ThisshouldbeinthehomePICUor throughvisitsorplacementsatthediscretionofthehomePICU,dependingonthespecialities offeredinthehomeunitandtheindividuallearningneeds.
Ref. / Quality Standard
code
BI
Visit MP&S CNR
Doc / ASSESSMENT STRATEGIES
Assessmentstrategiesshouldreflectboththeoreticalandpracticelearninginrelationto paediatricintensivecareandbedirectlylinkedtothelearningoutcomes.
Assessments must be:
  • Fair,reliableandvalidpermittingeducatorstojudgethatlearnershaveachievedthe necessary learningoutcomes.
  • Mappedtothecurriculumortrainingprogrammeandappropriatelysequencedto matchprogressionthroughtheeducationandtrainingpathway.
  • Leadbysomeonewithappropriateexpertiseintheareabeingassessed,andwhohas beenappropriatelyselected,supportedandappraised.Theyareresponsiblefor honestlyandeffectivelyassessingthelearner’sperformanceandbeingabletojustify decisions.
Assessmentscouldbebothsummativeandformativeandincludethefollowingexamples:
  • Competencies
  • LearningPackages
  • Skillspassport
  • Essays /written work/Reflections
  • Viva/OSCE
  • Presentations
Learners should have two attempts permitted to meet the criteria for a pass.
Ref. / Quality Standard
EVALUATION OF THE PROGRAMMES
code
BI / Thereshouldbeanevaluationstrategytoensuretheprogrammeremainsresponsivetoquality
Visit / assurance and workforce succession planning. If required the strategy will meet higher
MP&S / education benchmarks.
CNR
Doc /
  • 75%ofstudentswillpasstheprogramme
  • Participantfeedbackandmonitoringchange
  • Positivestaffretentionthroughdevelopment
  • Localworkforcesuccessionplanningsuccesses
  • NursingCareQualityIndicatorsorequivalent
  • Safety thermometer orequivalent
  • MeetingPICSstandardsforstaffingandstaffeducation,monitoredbyannualPICANet

returns
  • Learningfromclinicalincidentsandnearmisses

*HEE Quality Framework: Quality 6- Developing a Suitable Workforce)
GOVERNANCE
QUALITY ASSURANCE
code / Onceapprovedacourseshouldbereapprovedeveryfiveyearsormorefrequentlyifrequired. Please see partner document Standard Operating Procedure for Quality Assurance of Post RegistrationEducationinPaediatricCriticalCareUnits
BI
Visit
MP&S
CNR
Doc
DOCUMENTS
code / AllcoursevalidationanddocumentationarehousedonthePICSwebsiteformembersonly. Thereissharingagreementbetweenallcentres.IntellectualProperty(IP)wouldbeownedby the localorganisations.
InstitutionsareencouragedtohousetheirdocumentsonthePICSwebsiteforsharingwith othercentres.
BI
Visit MP&S CNR
Doc

References

Anderson,L.W.,Krathwohl,D.R.,Airasian,P.W.,Cruikshank,K.A.,Mayer,R.E.,Pintrich,P.R.,Rathe,J., Wittrock,M.C.,(2001)ATaxonomyforLearning,Teaching,andAssessing:ARevisionofBloom’sTaxonomyofEducationalObjectives.NewYork:Pearson,AllynBacon

DepartmentofHealth(2013)EducationOutcomesFrameworkRetrieved 10th November 2013 from

HealthEducationEngland(2016)HEEQualityFramework2016/17.Retrieved18thNovember,2016from

HealthEducationEngland(2016)HEEQualityStrategy2016–2020.Retrieved16thNovember2016from

TheHigherEducationAcademy(2011)TheUKProfessionalStandardsFrameworkforTeachingandSupporting Learning in Higher Education.Retrieved 11th November 2016 from

PaediatricIntensiveCareSociety(2015)QualityStandardsfortheCareofCriticallyIllChildren.PICS,London