1 Education in the Pediatric Intensive Care Unit at American Family Children’s HospitalClaude Rochon MSN, RN, CPN Edgewood College American Family Children’s Hospital Masaryk University Faculty of Nursing March 15, 2016

2 EDGEWOOD COLLEGE Madison, Wisconsin U.S.A.

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5 Edgewood College is a community of learners that affirms both its Catholic heritage and its respect for other religious traditions.

6 We foster open, caring, thoughtful engagement with one another and an enduring commitment to service.

7 Education in the Pediatric Intensive Care UnitThe Hospital The Patient The Family The Medical Staff – All Disciplines The Nursing Staff The Transfer of Education to the Clinical Area

8 American Family Children’s Hospital

9 University of Wisconsin – Madison Hospital and Clinics

10 Research and Grant SpendingUniversity of Wisconsin – Madison American Family Children’s Hospital We are rated from number two to number nine of rankings for the most money spent of research and development

11 Facts and Figures – Fiscal Year 2015Inpatient discharges: 4,200 Surgical procedures: 5,789 Clinic visits: 144,879 UW pediatric specialists/surgeons: 235 Average hospital stay: 5.1 days Case Mix Index: 1.6

12 Pediatric Heart Program – Ultra-safe ImagingFirst in world with Artis Q.zen imaging equipment. Up to 60 percent less radiation exposure than conventional machines Primary uses: Interventional cardiology Cardiac electrophysiology Interventional radiology Neuro-interventional radiology Complex surgery

13 Nursing / Medical TrainingGraduate from High School years old Associate Degree Nurse 2-21/2 years Technical College 4 year Baccalaureate Nursing Degree Masters of Science – Nursing Education Administration Doctor of Nursing Practice Practical Doctor of Philosophy Graduate from High School years old 4 year Bachelor Degree 4 Year Medical School 3-8 Year Residency 3-6 Year Fellowship Attending DNP Nurse functions at the same level as a Fellow on most units

14 Hospital Where Does Education Begin? Open Policy at the Bedside!Planned Admission Clinical Nurse – Nurse Practitioner / Nurse Clinician Emergent / Unplanned Admission Emergency Department Child Life Nursing Staff in the Pediatric Intensive Care Unit Open Policy at the Bedside! Parents Allowed Discharge Planning Begins Upon Admission

15 Parent and Family Advisory Council Patient Relations Patient and Family Support Services American Family Children's Hospital is a comprehensive pediatric medical and surgical center featuring nationally recognized pediatric specialists in fields from Cardiology to Cancer, including faculty from the University of Wisconsin School of Medicine and Public Health's Department of Pediatrics.   The Patient and Family Support Services section of the Children's Hospital Patient Guide includes the following information and resources: Parent and Family Advisory Council Patient Relations Pediatric Palliative Care Pet Therapy Playrooms and Teen Lounges Positive Image Center SAFE KIDS Coalition Social Work Staff Special Events and Visitors Spiritual Care Services Support Groups Tyler's Place and Sibling Services Volunteering at the Children's Hospital Advance Directives Child Health Advocacy and Safety Child Life Flad Family Chapel Flashes of Hope Hospital School and School Re-Entry Interpreter Services Kids as Partners (KAP) and Teen Advisory Board (TAB) Kohl's Safety Center Nutrition and Kids Oral Health and Dental Care

18 Ability to Learn in a Stressful EnvironmentNursing Students Medical Students Family Patient

21 So How do we Teach Austin and his Family?

22 American Family Children’s Hospital: A Clinical Innovator

25 Family Acute Nurse dedicated to family Open policy Child Life

26 Patient and Family-Centered CareWe are a leader in making patient- and family-centered care a core principle Rooted in the belief that family members know their child best

28 Advanced Pediatric Care – It Takes a VillagePediatric Intensivists Nutritionists Surgeons Families Subspecialists Case Management Nurse Practitioners Social Work Hospitalists Health Psychology Pharmacists Child Life PICU RN’s Respiratory Therapists

29 Medical Faculty – All DisciplinesWho is Involved In Patient Education Complexity of the Disease Process Physicians Fellows / Nurse Practitioners Residents Medical Students Pharmacy Pharmacy Students Nutrition Respiratory Therapists Occupational Therapists Physical Therapists Speech Mutual Respect Collaboration

30 Nursing How do I teach? Little Children 2-3 years old Older ChildrenDown on their level! Keep it simple Pill Case Study Older Children Ask them how much they want to be involved?

31 Nurse Led Care Rounds: Originated in our Neonatal Intensive care UnitPediatric Bone Marrow Transplant Unit Pediatric Hematology / Oncology Unit

32 10 Elements of Competence for Using Teach-back Effectively1. Use a caring tone of voice and attitude. 2. Display comfortable body language and make eye contact. 3. Use plain language. 4. Ask the patient to explain back, using their own words. 5. Use non-shaming, open-ended questions. 6. Avoid asking questions that can be answered with a simple yes or no. 7. Emphasize that the responsibility to explain clearly is on you, the provider. 8. If the patient is not able to teach back correctly, explain again and re-check. 9. Use reader-friendly print materials to support learning. 10. Document use of and patient response to teach-back. What is Teach-back? A way to make sure you—the health care provider—explained information clearly. It is not a test or quiz of patients. Asking a patient (or family member) to explain in their own words what they need to know or do, in a caring way. A way to check for understanding and, if needed, re-explain and check again. A research-based health literacy intervention that improves patient-provider communication and patient health outcomes1 .

33 Diabetic Education Diagram Intensive Care EducationAge of the child Previous Understanding of the Disease Process Bedside Nurse Initiating Re-enforcement Clinical Nurse Educator 2 to 3 Short Education Sessions Medical Floor Education Clinical Setting

35 As a Nurse What Would you Teach?Paper and write everything that you can think of to teach parents and Patient before Discharge.

37 What Did We Forget? School Nurse Child Health PsychRe-introduction into the classroom. CPR Training Nose Speaking Valve Cuff or Un-cuffed

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40 Nurse Education in the Pediatric Intensive Care UnitNurse Residency Programs New Graduate 3 to 6 month Orientation Residency to last 1 year Over 1 year in Pediatrics in another hospital Short orientation period designed to meet the nurse Springboard to Pediatrics Have nursing experience greater than one year in adult population Shadow Classroom Studies

42 Thank You! Madison, Wisconsin U.S.A.