Doctor of Philosophy, The Ohio State University, 2022, Nursing

Delirium is a serious but under-studied complication of pediatric critical illness. Sleep disruption is frequently observed in children with delirium, and circadian rhythm dysregulation is one proposed pathway to delirium. Children admitted to the pediatric intensive care unit (PICU) experience multiple environmental exposures with the potential to disrupt sleep, including excessive light and sound and frequent caregiving. The scientific premise of this dissertation study is that these modifiable characteristics of the PICU environment contribute to sleep disruption and thus have a neurophysiological effect that may lead to delirium. The purpose of this observational, repeated measures pilot study is to develop a measurement framework that illustrates the relationship between modifiable characteristics of the PICU environment, sleep disruption, and delirium in a young, critically ill pediatric sample. This measurement framework will inform future, large scale studies as well as the development of nurse-driven sleep promotion interventions to prevent delirium and improve outcomes in survivors of pediatric critical illness.

Committee: Mary Beth Happ (Committee Chair); Alai Tan (Committee Member); Judith Tate (Committee Member); Tondi Harrison (Committee Member) Subjects: Health Care; Medicine; Nursing

Master of Arts, The Ohio State University, 2021, Educational Studies

Background: Working in the pediatric intensive care unit (PICU) exposes nurses to intense and recurrent experiences with loss. Such experiences may result in unresolved grief or despair among nurses. Although previous studies have explored grief within the nursing profession, few have focused on grief following the death of children in the PICU, where sudden or traumatic deaths are more frequent. Aim: To examine how pediatric critical care nurses experience symptoms of grief or distress following the suffering or death of a patient in the PICU. Methods: An email invited PICU nurses to complete an online survey with demographic questions and an open-ended, qualitative question about grief experiences. Research team members coded open-ended responses, using thematic content analysis. Final themes were further validated via member checking with 10 participants. Findings: Of the 104 participants, most were Caucasian (96.3%), female (97%), bedside (83.5%) nurses with a bachelor's degree (85.4%). Participants had variable years of experience and included both day (59.6%) and night (40.4%) shift nurses. Four themes emerged when pediatric critical care (PCC) nurses were asked about grief symptoms and distress following the suffering or death of a patient in the PICU: (1) continuum of emotional responses (2) emotional moderators, (3) coping, and (4) resilience. Conclusion: This qualitative study provides a rich, contextualized understanding of PCC nurses' grief experiences. The 4 themes and underlying subthemes unveiled areas of need in nurse support programs, such as the necessity to know and recognize maladaptive grief responses, the importance of institutional peer support programs, and the value of teaching resilience amongst PCC nurses.

Committee: David Stein (Advisor) Subjects: Medicine; Nursing

PhD, University of Cincinnati, 2017, Nursing: Nursing - Doctoral Program

Background: In 2013, over 39,000 children in the United States died, with approximately 80 percent of deaths occurring in a pediatric critical care unit. The death rate for critically ill children treated in pediatric critical care units decreased by half in the last two decades, yet remains at 2.39 percent. There is a small body of current knowledge which examines the lived experience of nurses who care for dying children, the grief they experience, and how they individually or with the aid of organizational interventions resolve their grief. No current studies have examined the culture nurses create that helps them collectively manage work-related grief. Purpose: The purpose of this study was to explore how nurses in two pediatric critical care units use shared behaviors to help manage work-related grief and continue providing care in the stressful pediatric critical care environment. Method: Focused ethnography was the method used to examine the shared culture nurses create that helps them manage work-related grief. Thirty-three informants were interviewed, 20 from the pediatric intensive care unit (PICU) and 13 from the cardiac intensive care unit (CICU). Data were comprised of interviews, and researcher reflections, with themes and domains abstracted from the data. Findings: Study findings demonstrated that PICU and CICU nurses had very different strategies for grief management. These differences were explicated in the five domains abstracted from the research data. The five domains were further broken down into themes. Domain I: Values and Beliefs reviewed shared values and beliefs held by critical care nurses in both units. Themes which comprised this Domain are: Always Learning – Always New, Dignity in Life – Dignity in Death, Bringing Comfort, and Meaning in Work. Domain II: Causes of Grief, was comprised of the themes: Hyper-Responsibility, Prevented from Bringing Comfort, Bonding, Alive One Day, Dead the Next, and Acuity of the Unit. (open full item for complete abstract)

Committee: Donna Shambley-Ebron Ph.D. (Committee Chair); Erynn Casanova Ph.D. (Committee Member); Carolyn Smith Ph.D. (Committee Member) Subjects: Nursing

MS, University of Cincinnati, 2009, Medicine : Environmental Health

Objective: A significant number of children require long-term sedation and mechanical ventilation, which leads to significant morbidity and mortality. Propofol use decreases time to extubation and extubation failure in adults. However, there are safety concerns with long-term use of propofol, particularly in children. The purpose of this study is to report the safety and efficacy of propofol used as a bridge to extubation in children who have received long-term mechanical ventilation and sedation.Methods: After querying the pharmacy database, charts were reviewed to screen for propofol infusion use in pediatric and cardiac intensive care units at a single large children's hospital. A total of 152 uses of propofol (representing 141 unique patients) were analyzed in this case series. We measured exposure to propofol by total dose, average dose, maximum dose, and duration of propofol use. We assessed safety of propofol use in this limited setting by evaluating the incidence of bradycardia, hypotension, acidosis, and mortality. Efficacy is measured by time to extubation and extubation success. Results: Median time to extubation was 30 minutes and the extubation failure rate was 20%. Bradycardia (42%) and hypotension (28%) are common, but typically self-limited. Inotrope requirement prior to initiation of propofol predicted hypotension and acidosis. There were no cases of propofol infusion syndrome. Conclusions: The short-term use of propofol as a bridge to extubation in pediatric patients after longterm ventilation is a safe and effective strategy if used in carefully selected hemodynamically stable patients.

Committee: Kim Dietrich Ph.D. (Committee Chair); M.B. Rao Ph.D. (Committee Member); Derek Wheeler M.D. (Committee Member); Lesley Doughty M.D. (Committee Member) Subjects: Health Care; Pharmaceuticals; Pharmacology