Publications by authors named "Amy Jo Lisanti"

15 Publications

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Assessment of an Educational Tool for Pediatric Cardiac Nurses on Individualized Family-Centered Developmental Care.

Crit Care Nurse 2021 Apr;41(2):e17-e27

Amy Jo Lisanti is a nurse scientist-clinical nurse specialist, Cardiac Nursing, Center for Pediatric Nursing Research and Evidence-Based Practice, Children's Hospital of Philadelphia, and an adjunct assistant professor, University of Pennsylvania School of Nursing, Philadelphia.

Background: Prevention of neurodevelopmental sequelae is a high priority in the care of infants with congenital heart defects. Individualized family-centered developmental care has been identified as a promising approach to promote infant neurodevelopment during hospitalization.

Objective: To educate nurses on the concept of individualized family-centered developmental care and its application to nursing practice and to reduce perceived barriers to its implementation.

Methods: Two evidence-based visual educational tools called "developmental care flowers" were created and implemented in the inpatient and procedural units of a cardiac center. Each flower petal represented a core component of individualized family-centered developmental care: cue-based care, patient positioning, supportive environment, and parent engagement. Surveys were administered before and after the educational intervention to assess changes in nurses' knowledge and perceptions of individualized family-centered developmental care.

Results: Nurses reported that the developmental care flowers improved their understanding of individualized family-centered developmental care. The educational tools reduced some perceived barriers to implementation of this care model and increased nurse-reported inclusion of parents in care. Qualitative feedback from staff members regarding the tools was positive and acknowledged that individualized family-centered developmental care should be an ongoing priority.

Conclusions: The inpatient and procedural developmental care flowers are useful tools for educating nurses about individualized family-centered developmental care. They could be revised into more interactive tools that might be used to educate parents and further support the integration of this care concept into nursing practice.
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http://dx.doi.org/10.4037/ccn2021213DOI Listing
April 2021

Standardized Feeding Approach Mitigates Weight Loss in Infants with Congenital Heart Disease.

J Pediatr 2021 Apr 23;231:124-130.e1. Epub 2020 Dec 23.

Children's Hospital of Philadelphia, Nursing and Clinical Care Services, Philadelphia, PA; University of Pennsylvania, School of Nursing, Philadelphia, PA.

Objective: To evaluate the effect of a standardized feeding approach using a clinical nutrition pathway on weight-for-age Z score (WAZ) over hospital length of stay (HLOS) for infants with congenital heart disease (CHD).

Study Design: A 10-year retrospective cohort study examined eligible infants who underwent neonatal cardiac surgery between July 2009 and December 2018 (n = 987). Eligibility criteria included infants born at least 37 weeks of gestation and a minimum birth weight of 2 kg who underwent cardiac surgery for CHD within the first 30 days of life. Using the best linear unbiased predictions from a linear mixed effects model, WAZ change over HLOS was estimated before and after January 2013, when the standardized feeding approach was initiated. The best linear unbiased predictions model included adjustment for patient characteristics including sex, race, HLOS, and class of cardiac defect.

Results: The change in WAZ over HLOS was significantly higher from 2013 to 2018 than from 2009 to 2012 (β = 0.16; SE = 0.02; P < .001), after controlling for sex, race, HLOS, and CHD category, indicating that infants experienced a decreased WAZ loss over HLOS after the standardized feeding approach was initiated. Additionally, differences were found in WAZ loss over HLOS between infants with single ventricle CHD (β = 0.26; SE = 0.04; P < .001) and 2 ventricle CHD (β = 0.04; SE = 0.02; P = .04).

Conclusions: These data suggest that an organized, focused approach for nutrition therapy using a standardized pathway improves weight change outcomes before hospital discharge for infants with single and 2 ventricle CHD who require neonatal cardiac surgery.
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http://dx.doi.org/10.1016/j.jpeds.2020.12.047DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8005454PMC
April 2021

Evidence in Hand: Optimizing the Unique Skill Set of a Hospital-Based Center for Nursing Research and Evidence-Based Practice.

J Pediatr Nurs 2021 Jan-Feb;56:60-63. Epub 2020 Nov 10.

Children's Hospital of Philadelphia, Department of Nursing & Clinical Care Services, PA 19104, United States of America; University of Pennsylvania, School of Nursing. PA 19104, United States of America.

This paper describes how, as the COVID-19 pandemic emerged, one hospital-based center for nursing research and evidence-based practice capitalized on its unique skill mix to quickly pivot to provide hospital administrators and staff with timely, relevant evidence regarding the care of patients and families, as well as the protection of direct care providers and all support staff. The products produced by this center, both proactive and in direct response, contributed to clinical operations decision-making and thus, tangibly impacted practice. The positive outcomes described speak not only to the clinical environment, but also to the presence and specialized contributions of a multiprofessional center for nursing research and evidence-based practice in such a way that was not possible prior to COVID-19.
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http://dx.doi.org/10.1016/j.pedn.2020.09.011DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7655024PMC
February 2021

Prevalence of ICU Delirium in Postoperative Pediatric Cardiac Surgery Patients.

Pediatr Crit Care Med 2021 Jan;22(1):68-78

University of California San Francisco, School of Nursing, San Francisco, CA.

Objectives: The objective of this study was to determine the prevalence of ICU delirium in children less than 18 years old that underwent cardiac surgery within the last 30 days. The secondary aim of the study was to identify risk factors associated with ICU delirium in postoperative pediatric cardiac surgical patients.

Design: A 1-day, multicenter point-prevalence study of delirium in pediatric postoperative cardiac surgery patients.

Setting: Twenty-seven pediatric cardiac and general critical care units caring for postoperative pediatric cardiac surgery patients in North America.

Patients: All children less than 18 years old hospitalized in the cardiac critical care units at 06:00 on a randomly selected, study day.

Interventions: Eligible children were screened for delirium using the Cornell Assessment of Pediatric Delirium by the study team in collaboration with the bedside nurse.

Measurement And Main Results: Overall, 181 patients were enrolled and 40% (n = 73) screened positive for delirium. There were no statistically significant differences in patient demographic information, severity of defect or surgical procedure, past medical history, or postoperative day between patients screening positive or negative for delirium. Our bivariate analysis found those patients screening positive had a longer duration of mechanical ventilation (12.8 vs 5.1 d; p = 0.02); required more vasoactive support (55% vs 26%; p = 0.0009); and had a higher number of invasive catheters (4 vs 3 catheters; p = 0.001). Delirium-positive patients received more total opioid exposure (1.80 vs 0.36 mg/kg/d of morphine equivalents; p < 0.001), did not have an ambulation or physical therapy schedule (p = 0.02), had not been out of bed in the previous 24 hours (p < 0.0002), and parents were not at the bedside at time of data collection (p = 0.008). In the mixed-effects logistic regression analysis of modifiable risk factors, the following variables were associated with a positive delirium screen: 1) pain score, per point increase (odds ratio, 1.3; 1.06-1.60); 2) total opioid exposure, per mg/kg/d increase (odds ratio, 1.35; 1.06-1.73); 3) SBS less than 0 (odds ratio, 4.01; 1.21-13.27); 4) pain medication or sedative administered in the previous 4 hours (odds ratio, 3.49; 1.32-9.28); 5) no progressive physical therapy or ambulation schedule in their medical record (odds ratio, 4.40; 1.41-13.68); and 6) parents not at bedside at time of data collection (odds ratio, 2.31; 1.01-5.31).

Conclusions: We found delirium to be a common problem after cardiac surgery with several important modifiable risk factors.
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http://dx.doi.org/10.1097/PCC.0000000000002591DOI Listing
January 2021

Telehealth Home Monitoring and Postcardiac Surgery for Congenital Heart Disease.

Pediatrics 2020 09;146(3)

Department of Anesthesia and Critical Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.

Objectives: To test the effect of a 4-month telehealth home monitoring program (REACH), layered on usual care, on postdischarge outcomes in parents of infants recovering from cardiac surgery and their infants.

Methods: Randomized trial of infants discharged from the hospital after cardiac surgery for congenital heart disease. Consecutive infants with complex congenital heart disease undergoing cardiac surgery within 21 days of life were enrolled at 3 university-affiliated pediatric cardiac centers.

Results: From 2012 to 2016, 219 parent-infant dyads were enrolled; 109 were randomly assigned to the intervention group and 110 to the control group. At 4 months postdischarge, parenting stress was not significantly different between groups (total Parenting Stress Index in the intervention group was 220 and in the control group was 215; = .61). The percentages of parents who met posttraumatic stress disorder (PTSD) criteria and parent quality of life inventory scores were also not significantly different between the 2 groups (PTSD in the intervention group was 18% and was 18% in the control group; =.56; the mean Ulm Quality of Life Inventory for Parents in the intervention group was 71 andwas 70 in the control group; = .88). Infant growth in both groups was suboptimal (the mean weight-for-age scores were -1.1 in the intervention group and -1.2 in the control group; = .56), and more infants in the intervention group were readmitted to the hospital (66% in the intervention group versus 57% in the control group; < .001).

Conclusions: When added to usual care, the REACH intervention was not associated with an improvement in parent or infant outcomes. Four months after neonatal heart surgery, ∼20% of parents demonstrate PTSD symptoms. Suboptimal infant growth and hospital readmissions were common.
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http://dx.doi.org/10.1542/peds.2020-0531DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7461139PMC
September 2020

Holding and Mobility of Pediatric Patients With Transthoracic Intracardiac Catheters.

Crit Care Nurse 2020 Aug;40(4):16-24

Andrea Sorbello is a nurse practitioner in the cardiac intensive care unit, Jamie Fitzgerald and Annemarie D'Amato are quality improvement advisors, Xuemei Zhang is a biostatistician in the Cardiac Center Research Core, and J. William Gaynor is a professor of surgery in the Division of Pediatric Cardiothoracic Surgery, Children's Hospital of Philadelphia.

Background: Nursing care of pediatric patients after cardiac surgery consists of close hemodynamic monitoring, often through transthoracic intracardiac catheters, requiring patients to remain on bed rest and limiting holding and mobility.

Objectives: The primary aim of this quality improvement project was to determine the feasibility of safely mobilizing pediatric patients with transthoracic intracardiac catheters out of bed. Once feasibility was established, the secondary aim was to increase the number of days such patients were out of bed.

Methods And Interventions: New standards and procedures were implemented in July 2015 for pediatric patients with transthoracic intracardiac catheters. After initiation of the new policies, complications were tracked prospectively. Nursing documentation of activity and positioning for all patients with transthoracic intracardiac catheters was extracted from electronic health records for 2 fiscal years before and 3 fiscal years after the new policies were implemented. The Cochran-Armitage test for trend was used to determine whether patterns of out-of-bed documentation changed over time.

Results: A total of 1358 patients (approximately 250 to 300 patients each fiscal year) had activity and positioning documented while transthoracic intracardiac catheters were in place. The Cochran-Armitage test for trend revealed that out-of-bed documentation significantly increased after the new policies and procedures were initiated (P < .001). No major complications were noted resulting from patient mobility with transthoracic intracardiac catheters.

Conclusion: Pediatric patients with transthoracic intracardiac catheters can be safely held and mobilized out of bed.
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http://dx.doi.org/10.4037/ccn2020260DOI Listing
August 2020

Kangaroo Care for Hospitalized Infants with Congenital Heart Disease.

MCN Am J Matern Child Nurs 2020 May/Jun;45(3):163-168

Dr. Amy Jo Lisanti is a Nurse Scientist-Clinical Nurse Specialist, Cardiac Nursing and the Center for Pediatric Nursing Research and Evidence-Based Practice, Children's Hospital of Philadelphia, Philadelphia, PA. Dr. Lisanti can be reached via e-mail at Alessandra Buoni is a Clinical Nurse, Neonatal Intensive Care Unit, Nemours/Alfred I. duPont Hospital for Children, Wilmington, DE. Megan Steigerwalt is a Clinical Nurse Expert, Cardiac Intensive Care Unit, Children's Hospital of Philadelphia, Philadelphia, PA. Michelle Daly is a Clinical Nurse, Cardiac Intensive Care Unit, Children's Hospital of Philadelphia, Philadelphia, PA. Stephanie McNelis is a Cardiac Center Outreach and Referral Nurse Manager, Children's Hospital of Philadelphia, Philadelphia, PA. Dr. Diane L. Spatz is a Professor of Perinatal Nursing & The Helen M. Shearer Professor of Nutrition, University of Pennsylvania School of Nursing; and Nurse Scientist, Center for Pediatric Nursing Research and Evidence-Based Practice, Children's Hospital of Philadelphia, Philadelphia, PA.

Background: Kangaroo care (KC), or skin-to-skin care, occurs when an infant is dressed in a diaper and held to a parent's bare chest. This form of holding has been shown to have many benefits for hospitalized infants and has been shown to be a safe and feasible intervention to support infants with congenital heart disease. Despite known benefits, KC was not implemented routinely and consistently in our cardiac center for infants with congenital heart disease. The purpose of this project was to support use of KC as a nursing intervention for hospitalized infants with congenital heart disease and their parents.

Methods: A KC quality improvement committee formed to develop strategies to increase frequency of KC, including the creation of a new nursing policy and procedure on KC for infants, adaptation of the electronic health record to facilitate KC documentation, education, and supporting translation of KC into practice through the cardiac center's first Kangaroo-A-Thon.

Results: Twenty-six nurses initiated KC 43 times with 14 patients over the 8-week period for the Kangaroo-A-Thon. No adverse events were reported as a result of infants being held by their parents in KC.

Conclusion: Our local initiative provided preliminary evidence that KC can be safely integrated into standard care for hospitalized infants with congenital heart disease. Formal standards and procedures, along with creative initiatives such as a Kangaroo-A-Thon, can be a first step toward fostering the translation of KC into practice.
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http://dx.doi.org/10.1097/NMC.0000000000000612DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7190454PMC
December 2020

Neurodevelopmental Outcomes Among Children With Congenital Heart Disease: At-Risk Populations and Modifiable Risk Factors.

World J Pediatr Congenit Heart Surg 2019 11 28;10(6):750-758. Epub 2019 Oct 28.

Department of Cardiac Nursing and the Center for Pediatric Nursing Research and Evidence-based Practice, Children's Hospital of Philadelphia, PA, USA.

As survivable outcomes among patients with complex congenital heart disease (cCHD) have continued to improve over the last several decades, more attention is being dedicated to interventions that impact not just survival but quality of life among patients with cCHD. In particular, patients with cCHD are at risk for impaired neurodevelopmental outcomes. In this review summarizing select presentations given at the 14th Annual Pediatric Cardiac Intensive Care Society's Annual Meeting in 2019, we discuss the neurodevelopmental phenotype of patients with cCHD, patients at greatest risk of impaired development, and three specific modifiable risk factors impacting development.
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http://dx.doi.org/10.1177/2150135119878702DOI Listing
November 2019

Nursing Practice With Transthoracic Intracardiac Catheters in Children: International Benchmarking Study.

Am J Crit Care 2019 05;28(3):174-181

Amy Jo Lisanti is a Ruth L. Kirschstein NRSA Postdoctoral Fellow at the University of Pennsylvania School of Nursing in Philadelphia and a clinical nurse specialist/nurse researcher at Children's Hospital of Philadelphia, Philadelphia, Pennsylvania. Jamie Fitzgerald is a safety and quality specialist at Children's Hospital of Philadelphia. Stephanie Helman was a clinical nurse specialist at Children's Hospital of Philadelphia when the study was done. She is now a doctoral student at the University of Pittsburgh, Pittsburgh, Pennsylvania. Spencer Dean is a staff nurse in the cardiac intensive care unit at Children's Hospital of Philadelphia. Andrea Sorbello is a nurse practitioner and advanced practice provider team lead at Children's Hospital of Philadelphia. Heather Griffis is director of the Health Care Analytics Unit at Children's Hospital of Philadelphia.

Background: Transthoracic intracardiac catheters are central catheters placed in the operating room at the conclusion of cardiac surgery for infants and children. Complications associated with these catheters (eg, bleeding, migration, premature removal, infection, leakage, and lack of function) have been described. However, no researchers have addressed the nursing management of these catheters in the intensive care unit, including catheter dressing and securement, mobilization of patients, and flushing the catheters, or the impact of these interventions on patients' outcomes.

Objectives: To internationally benchmark current nursing practice associated with care of infants and children with transthoracic intracardiac catheters.

Methods: In a cross-sectional, descriptive study of nursing practice in infants and children with transthoracic intracardiac catheters, a convenience sample of bedside and advanced practice nurses was recruited to complete an online survey to benchmark current practice. The survey included questions on criteria for catheter insertion and removal, dressing care, flushing practice, securement, and mobilization of patients.

Results: Transthoracic intracardiac catheters are used by most centers that provide care for infants and children after open heart surgery. A wide range of practices was reported.

Conclusions: Standardizing the use and care of transthoracic intracardiac catheters can improve the safety and efficacy of their use in infants and children and promote safe and early postoperative mobilization of patients.
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http://dx.doi.org/10.4037/ajcc2019350DOI Listing
May 2019

Individualized Family-Centered Developmental Care: An Essential Model to Address the Unique Needs of Infants With Congenital Heart Disease.

J Cardiovasc Nurs 2019 Jan/Feb;34(1):85-93

Amy Lisanti, PhD, RN, CCNS, CCRN-K NRSA Postdoctoral Fellow, University of Pennsylvania School of Nursing; and Clinical Nurse Specialist/Nurse Scientist, Cardiac Nursing at Children's Hospital of Philadelphia, Pennsylvania. Dorothy Vittner, PhD, RN Nurse Scientist, Connecticut Children's Medical Center, Hartford; and Faculty, School of Nursing and an Assistant Professor, University of Connecticut School of Nursing, Storrs. Barbara Medoff-Cooper, PhD, RN Professor, Univeristy of Pennsylvania School of Nursing, Philadelphia. Jennifer Fogel, M.S.CCC-SLP/L Pediatric Speech Language Pathologist, Advocate Children's Hospital, Oak Lawn, Illinois. Gil Wernovsky, MD Senior Consultant in Cardiac Critical Care and Pediatric Cardiology, Children's National Health System, Washington, District of Columbia. Samantha Butler, PhD Developmental and Clinical Psychologist Director, Boston Children's; and Assistant Professor in Psychiatry, Harvard Medical School, Boston, Massachusetts.

Background: Infants born with critical congenital heart disease (cCHD) who require surgical intervention in the newborn period are often hospitalized in a cardiac intensive care unit (CICU). Cardiac surgery and the CICU environment are traumatic to infants and their families. Infants are exposed to overwhelming stress, which can result in increased pain, physiologic instability, behavioral disorganization, disrupted attachment, and altered brain development. Individualized Family-centered Developmental Care (IFDC) is a model that can address the unique needs and developmental challenges of infants with cCHD.

Purpose: The purpose of this article is to (1) clearly describe the uniqueness of the infant with cCHD, including the medical, neurological, and parental challenges, and (2) propose methods to apply IFDC to support recovery of infants with cCHD in the CICU.

Conclusions: The experiences in the CICU shape the developing brain and alter recovery and healing, thus adversely impacting development. Individualized Family-centered Developmental Care is a promising model of care that nurses can integrate into the CICU to promote neuroprotection and development. Nurses can effectively integrate IFDC into the CICU by understanding the unique characteristics of infants with cCHD and applying IFDC interventions that include both maturity and recovery perspectives.

Clinical Implications: The incorporation of IFDC interventions is essential for the infant with cCHD and should be a standard of care. Applying IFDC with a recovery perspective in all aspects of caregiving will provide opportunities for individualization of care and parent engagement, allowing infants in the CICU to recover from surgery while supporting both short- and long-term neurodevelopment.
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http://dx.doi.org/10.1097/JCN.0000000000000546DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6283700PMC
March 2020

The Pediatric Cardiac Intensive Care Unit Parental Stress Model: Refinement Using Directed Content Analysis.

ANS Adv Nurs Sci 2017 Oct/Dec;40(4):319-336

University of Pennsylvania School of Nursing, Philadelphia (Drs Lisanti, Golfenshtein, and Medoff-Cooper); and Children's Hospital of Philadelphia, Philadelphia, Pennsylvania (Drs Lisanti and Medoff-Cooper).

This descriptive, qualitative study used directed content analysis to explore and clarify specific foci of parental stress for mothers of infants with complex congenital heart disease in the pediatric cardiac intensive care unit (PCICU). The PCICU Parental Stress Model was used as the guiding theoretical framework. Three focus groups were conducted with 14 mothers of infants who were being cared for in a PCICU at a large mid-Atlantic children's hospital. Data provided themes to support and refine the PCICU Parental Stress Model that can be used to guide practice, education, and future research in this unique population and setting.
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http://dx.doi.org/10.1097/ANS.0000000000000184DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5664220PMC
June 2018

Maternal Stress and Anxiety in the Pediatric Cardiac Intensive Care Unit.

Am J Crit Care 2017 Mar;26(2):118-125

Amy Jo Lisanti is a postdoctoral fellow at the University of Pennsylvania School of Nursing, and a clinical nurse specialist/nurse researcher at Children's Hospital of Philadelphia, Philadelphia, Pennsylvania. Lois Ryan Allen and Lynn Kelly are professors emeritus of nursing, Widener University School of Nursing, Chester, Pennsylvania. Barbara Medoff-Cooper is a professor, University of Pennsylvania School of Nursing, and a nurse scientist at Children's Hospital of Philadelphia.

Background: Mothers whose infants are born with complex congenital heart disease (CCHD) experience stress during their infant's hospitalization in a pediatric cardiac intensive care unit (PCICU).

Objectives: This study addressed 2 research questions: (1) What are the parental stressors for mothers whose infants with CCHD are in the PCICU? And (2) What are the relationships of trait anxiety and 3 parental stressors to the parental stress response of state anxiety in mothers whose infants with CCHD are in the PCICU?

Methods: This descriptive correlational study included 62 biological mothers of infants admitted to a PCICU within 1 month of birth who had undergone cardiac surgery for CCHD. Maternal and infant demographics and responses to the Parental Stressor Scale: Infant Hospitalization and the State-Trait Anxiety Inventory were collected at 3 major PCICUs across the United States.

Results: Mothers' scores revealed that infant appearance and behavior was the greatest stressor, followed by parental role alteration, then sights and sounds. The combination of trait anxiety and parental role alteration explained 26% of the variance in maternal state anxiety. Mothers with other children at home had significantly higher state anxiety than did mothers with only the hospitalized infant.

Conclusions: Results from this study revealed factors that contribute to the stress of mothers whose infants are born with CCHD and are hospitalized in a PCICU. Nurses are in a critical position to provide education and influence care to reduce maternal stressors in the PCICU, enhance mothers' parental role, and mitigate maternal state anxiety.
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http://dx.doi.org/10.4037/ajcc2017266DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5426478PMC
March 2017

Developmental Care Rounds: An Interdisciplinary Approach to Support Developmentally Appropriate Care of Infants Born with Complex Congenital Heart Disease.

Clin Perinatol 2016 Mar;43(1):147-56

University of Pennsylvania, School of Nursing, 418 Curie Boulevard, Claire Fagin Hall, Philadelphia, PA 19104, USA. Electronic address:

Newborn infants with complex congenital heart disease are at risk for developmental delay. Developmental care practices benefit prematurely born infants in neonatal intensive care units. Cardiac intensive care units until recently had not integrated developmental care practices into their care framework. Interdisciplinary developmental care rounds in our center have helped in the promotion of developmentally supportive care for infants before and after cardiac surgery. This article discusses basic principles of developmental care, the role of each member of the interdisciplinary team on rounds, common developmental care practices integrated into care from rounds, and impacts to patients, families, and staff.
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http://dx.doi.org/10.1016/j.clp.2015.11.010DOI Listing
March 2016

Just-in-Time Training for High-Risk Low-Volume Therapies: An Approach to Ensure Patient Safety.

J Nurs Care Qual 2016 Jan-Mar;31(1):33-9

Department of Nursing, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.

High-risk low-volume therapies are those therapies that are practiced infrequently and yet carry an increased risk to patients because of their complexity. Staff nurses are required to competently manage these therapies to treat patients' unique needs and optimize outcomes; however, maintaining competence is challenging. This article describes implementation of Just-in-Time Training, which requires validation of minimum competency of bedside nurses managing high-risk low-volume therapies through direct observation of a return-demonstration competency checklist.
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http://dx.doi.org/10.1097/NCQ.0000000000000131DOI Listing
November 2016

A developmental care framework for a cardiac intensive care unit: a paradigm shift.

Adv Neonatal Care 2012 Oct;12 Suppl 5:S28-32

Children's Hospital of Philadelphia, Pennsylvania, USA.

Within the past several decades, medical and surgical advancements have dramatically decreased mortality rates in neonates and infants with congenital heart disease. Although patients are surviving in greater numbers, little research is reported on issues related to newborn care for these at-risk infants. A developmental care model was introduced to the nursing staff at the Children's Hospital of Philadelphia, which included 5 core measures to support evidence-based developmental care practices: (1) sleep, pain, and stress assessment; (2) management of daily living; (3) positioning, feeding, and skin care; (4) family-centered care; and (5) a healing environment. The care practices were adapted to the specific issues of the late preterm and full-term infant who has experienced neonatal cardiac surgery. The purpose of this article is to review the process of implementing a development model of care in a cardiac intensive care unit.
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http://dx.doi.org/10.1097/ANC.0b013e318265aeefDOI Listing
October 2012