Enhancing the Neuro Critical Care program in CHEO's NICU: Staff Education
Summary
Therapeutic Hypothermia (TH) is a therapy delivered to neonates that experience hypoxic ischemic encephalopathy (HIE). TH consists of whole-body cooling, neurological assessment, and seizure monitoring and management. Registered nurses in the neonatal intensive care unit (NICU) receive education on policy rationale and equipment, but there are persistent knowledge gaps between the physiological experience of HIE and the modifications to nursing care necessary for this diagnosis.
This is particularly relevant for novice NICU nurses, which make up a significant portion of the nurses in CHEO’s NICU. The unit experienced a demographic change, causing a loss of nursing professional skill and experience. Educational efforts to succeed this change are in place, however the infrequency of HIE patients and the brevity of orientation periods means that exposure to HIE patients and opportunities to learn are limited. Furthermore, there are nuances to nursing care that
This project will establish an online learning platform for the education and professional development in HIE, TH and seizure management for nurses in the NICU. Additionally, this project began working to educate nurses on more technical equipment to improve care provided to future patients, based on the most recent research evidence. Specifically, the use of video electroencephalography (VEEG) in lieu of amplitude integrated electroencephalography can detect seizures more accurately, which in turn reduces brain injury caused by untreated seizures, reduced medication usage, and decreased length of stay in hospital. Despite its merits, the use of VEEG as a first line treatment remains difficult due to technologist availability. At a comparable hospital in another Canadian province, this challenge has been overcome by educating NICU nurses to apply VEEG when technologists are not available.
While securing a video electroencephalography machine for use in the NICU remains an eventual goal, fiscal limitations prevented this from occurring during the ACP fellowship as initially planned. Until that time, the fellowship has established a core education to improve neurological care provided by all NICU nurses, and allowed for recruitment of a smaller subset of nurse experts who will be trained to apply and interpret VEEG once it is available.
The overall objective of this fellowship project was to develop expert-level knowledge in a subject area (neonatal encephalopathy and seizures) and apply it broadly as a clinical leader in my unit. This fundamental objective involved many underlying “micro-objectives” and opportunities for reflection and development. Throughout the fellowship, I developed a profound knowledge of encephalopathy, seizures, and pedagogy.
To increase my knowledge of encephalopathy, I conducted a literature review of the topic and catalogued articles in a digital library. These articles were then used to create educational slide decks/modules that curated the Google Classroom and SharePoint page shared by the NICU team. Additionally, I attended a symposium hosted by Sick Kids Hospital on Neonatal Neurology which covered a broader view of neonatal neurological critical care (inclusive of encephalopathy).
In the process of this fellowship, I learned about seizure recognition and treatment advances for my target population. While we experience and deliver care that is reflective of the latest research evidence, I often perceive that this information is introduced by my experience rather than research done outside of work. The ACP fellowship was a great opportunity to more deeply delve into research and integrate it into advocacy with my colleagues rather than the passive learning approach I had prior to my project. I also felt validated the research-to-practice lag but reinforced nurses as change agents to incorporating the latest evidence into patient care.
During my ongoing graduate studies, I was introduced to pedagogy as a concept. While seemingly inherent for some, the action of teaching is actually a very active, deliberate process. I learned to evaluate lesson materials, prioritize lessons, and order concepts to build upon one another. Further, I learned about learning and teaching styles in the process of developing my own. The RNAO ACPF provided me the opportunity to elaborate and apply my understanding of how people learn. Further, I developed as an expert and leader due to the experience. All adults learn differently, so I attempted to cater to the majority in creating the modules and reference materials.
Outcomes
There are two main outcomes for this fellowship. The first being an opportunity for professional engagement and development for nursing staff in the NICU at CHEO. The other outcome is better neurological critical care for neonates.
By creating an easily accessible online database of educational resources, nurses in the unit have one place to improve their nursing practice for a vulnerable subset of the patient population. It is also a communication tool to ensure staff are kept up to date on changes in policy. Additionally, it sets an example for other education within the unit to improve our offerings for new staff members. In addition to the online platform, there are visually pleasing environmental supports (bulletin board within the unit) which can increase job satisfaction and staff engagement.
Prior to this fellowship, the staff education for neurological pathophysiology covered important fundamentals. However, in order to gain a comprehensive understanding, we rely on orientation at the bedside to provide contextual experience that can be rare or non-existent during an orientation period. By providing a comprehensive platform with numerous elements of neurological critical care, this bridges some of the gaps seen between orientation and independent practice.
As a result, it is anticipated that the organization will observe lower incidence of safety reports related to lack of knowledge.
Overall experience
The fellowship experience was phenomenal. It bridged interests that were otherwise difficult to incorporate given time constraints. I was able to expand my knowledge on a pathophysiology that is complex, multifactorial, and incredibly stressful for families to navigate. With that knowledge, I was able to empower my colleagues in caring for these infants and assisting their families through the experience.
I, like many of my colleagues, have experienced professional burnout. This fellowship was an opportunity to reinvigorate and refocus my practice from that mental space. It has helped me to find my “why” again, why I love this profession and the families I provide care to.
My favourite moment that was a culmination of these feelings was presenting my seizure recognition module and working one on one with some of my colleagues. I got to see an “aha moment” on their faces after the presentation, which was such a reward after all of my hard work!
