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Critical Care Medicine

Cardiac Critical Care Nurse

Cardiac Critical Care Nursing Orientation

“Learning is finding out what you already know. Doing is demonstrating that you know it. Teaching is reminding others that they know just as well as you. You are all learners, doers, and teachers.” Bach, (1977) in Illusions: The adventures of a reluctant messiah

Having a clinically competent and confident nursing staff caring for critically ill cardiac children and their families is essential and is dependent upon offering a comprehensive educational program in the Paediatric Cardiac Critical Care Unit.  

The Labatt Family Heart Centre, through its Avenues to Excellence, is committed to quality education and training. Initial and ongoing education is both valued and supported in Cardiac Critical Care.  The nursing orientation program and ongoing training efforts are designed using adult learning principles and varied methods of teaching and learning.  There is a wealth of knowledge shared and a collaborative approach to educational opportunities helps in achieving the goal of service excellence bringing us ever closer to the vision of Healthier Children. A Better World.  Our quality educational program aims toward continuous quality improvement, optimizing patient safety, facilitating skill growth and leadership development, enhancing communication effectiveness and accountability.  The critical care education is aimed at  developing and retaining highly skilled and engaged nurses.

The Cardiac Critical Care orientation program for new learners exposes them to an expert Interprofessional team who teaches the care and management of critically ill children.  The layout of the Cardiac Critical Care orientation is designed to gradually prepare the newly hired nurse for this highly complex and technological environment.  

The goal is to prepare the new nurse for collaborative practice, partnering with other healthcare providers to deliver excellence in patient and family centred care. The duration of orientation is dependent on the orientees years of experience and considers their individual learning needs and styles. 

Orientation

Orientation for “experienced” nurses consists of a three month 'core' orientation program, comprised of clinical and theoretical components.  This is followed by eight weeks supported by a preceptor, role modeling the way. 

Orientation for “new graduate nurses” is a 12 month program.  It consists of the same three month 'core' orientation program, followed by a six month clinical period spent with a preceptor (in a shared assignment) guiding their development.  In the final three months, the learner is more independent in their practice and is coached as needed by their preceptor.  

Multimodal Approach to Learning 

The multimodal approach to education facilitates learners at all levels, to understand the evidenced-based management of critically ill children and their families.  

The program includes: 

  • Didactic sessions
  • Case studies
  • Self-directed learning
  • On-line learning
  • Rounds
  • Chapter reviews
  • Objective Structured Clinical Evaluations (OSCE’s)
  • Simulation training

Clinical time throughout the first three months is interspersed between theoretical content, which enhances the integration and translation of knowledge.  Examples of theoretical content are: 

  • Congenital heart disease
  • Advanced ECG interpretation
  • Cardiac physiology
  • Blood gas analysis
  • Respiratory physiology
  • Artificial airways
  • Ventilators and a great deal more

Ongoing Training

Ongoing training of all nursing staff includes cardiac mandatory study days, OSCE evaluation, PALS training, “30 Minute Work-Out” skill based education, and support of conference attendance.  Attendance and participation at bedside patient care rounds, back rounds, ethics, research, and safety rounds, offer interprofessional health care providers with an excellent opportunity for collaborative practice by sharing their knowledge and experience.

The increased use of simulation provides students with a more realistic environment to enhance critical thinking and problem solving skills.  Insitu mock codes using high fidelity simulators in the unit, enhances retention of guidelines. E-CPR (ExtraCorporeal CPR) training exists, supporting resuscitation onto ECMO (extracorporeal membrane oxygenator).  This type of in the moment, insitu training helps prepare nurses and interprofessional team members for these critical and sudden events, hopefully enhancing patient outcomes.

The Cardiac Critical Care Unit sees a broad spectrum of patients such as those with congenital and acquired heart disease, heart transplantation and those requiring advanced technology and life support – (eg. ECMO, Berlin Heart, Novalung and Continuous Renal Replacement Therapy). Subspecialty training in these areas is offered to experienced Cardiac Critical Care nurses; including competency assessment to help them provide the best possible care.

Cardiac Critical Care has focused efforts on enhancing communication and leadership between all health-care team members.  Using the Crucial Confrontations framework by VitalSmarts, caregivers are encouraged to engage in communication that is respectful and at the same time holds people accountable for broken promises, violated expectations and bad behavior.  A program for training, and mentoring has been developed for interprofessional staff.

Interprofessional Acute Care Paediatric Cardiology Certificate - Coming soon! 

SickKids in collaboration with George-Brown College is planning to provide a two-module program (Pediatric Cardiology Level 1 – Theory & Clinical; Pediatric Cardiology Level 2 – Theory & Clinical).  

This course is designed to provide interprofessional health-care team members with the knowledge, skills and competencies to care for the child and family with congenital and acquired heart disease across the lifespan. Each module consists of 125 hours theory and 120 hours clinical. Clinical hours can be completed concurrently with theory or up to three months post theoretical component completion. Learners will actively integrate theoretical knowledge with observational and hands on practice in a variety of paediatric cardiac settings, including:

  • inpatient and critical care unit
  • operating room
  • diagnostic interventional catheterization
  • cadaver laboratories
  • outpatient clinics

In summary, enabling our people through the provision of quality cardiac critical care education, supports our goal of leadership in world class quality and service excellence.  Every effort in education is aimed at Healthier Children. A Better World.  

For more information, please contact:

Cecilia Hyslop
Cardiac Advanced Practice Nurse
Critical Care Medicine
The Hospital for Sick Children (SickKids)
555 University Ave
RM 2849
Toronto, ON
M5G 1X8
Canada
Phone: 416-813-6499
Fax: 416-813-7299
email: cecilia.hyslop@sickkids.ca