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Related Concept Videos

Nursing Implementation01:15

Nursing Implementation

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Implementation is the execution of the nursing care plan developed during the planning phase.
The five steps to implementing effective nursing care include reassessing the patient, reviewing and revising the existing nursing care plan, organizing the resources and care delivery, anticipating and preventing complications, and implementing nursing interventions.
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The Nurse-Implemented Chronotherapeutic Bundle in Critically Ill Children, RESTORE Resilience (R 2 ): Pilot Testing

Martha A Q Curley1,2,3, Onella S Dawkins-Henry4, Laura Beth Kalvas1

  • 1Department of Family and Community Health, University of Pennsylvania School of Nursing, Philadelphia, PA.

Pediatric Critical Care Medicine : a Journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies
|August 12, 2024
PubMed
Summary
This summary is machine-generated.

This pilot study shows that a nurse-led chronotherapeutic bundle (RESTORE Resilience or R 2 ) is feasible in the pediatric intensive care unit (PICU). Critically ill children receiving the R 2 bundle demonstrated improved daytime activity consolidation before extubation.

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Area of Science:

  • Critical Care Medicine
  • Pediatric Nursing
  • Sleep Science

Background:

  • Critically ill children in the pediatric intensive care unit (PICU) often experience disrupted sleep-wake cycles and daily routines.
  • This disruption can negatively impact recovery and long-term outcomes.
  • Chronotherapy, the application of timed treatments, offers a potential strategy to mitigate these effects.

Purpose of the Study:

  • To pilot test the feasibility and preliminary efficacy of the nurse-led RESTORE Resilience (R 2) chronotherapeutic bundle in critically ill children.
  • To assess the impact of the R 2 bundle on daytime activity consolidation in mechanically ventilated children.

Main Methods:

  • A two-phase cohort study conducted in two US PICUs from 2017 to 2021.
  • The R 2 bundle included replicating pre-hospital routines, light/sound modulation, minimal sedation, specific feeding schedules, early mobility, nursing continuity, and parent diaries.
  • Outcomes included environmental and patient monitoring, parent surveys, and the Daytime Activity Ratio Estimate (DARE) for post-extubation activity consolidation.

Main Results:

  • Compliance with key R 2 elements significantly increased from baseline (18%) to the intervention phase (63%).
  • Intervention participants experienced more days with adherence to their routine, light/sound modulation, and early mobility.
  • The Daytime Activity Ratio Estimate (DARE) improved pre-extubation in the intervention group (62% vs. 53%).

Conclusions:

  • The nurse-led R 2 chronotherapeutic bundle is feasible for implementation in the PICU setting.
  • The R 2 bundle led to increased pre-extubation daytime activity consolidation in critically ill children.
  • Future research should focus on interprofessional collaboration and pragmatic trial designs to optimize protocol adherence.