Specialized pediatric simulation opportunities for healthcare staff are incredibly important for anyone involved in the clinical care of pediatric patients. Critically unwell pediatric patients are in general a rare occurrence. However when a pediatric patient does become critically unwell, timely and quality clinical care from high functioning teams can greatly reduce risks of morbidity and mortality. This article by Erin Carn-Bennett, RN, MSN, will discuss the importance and potential impact that specialized pediatric simulation based education can have on pediatric clinical care as well as healthcare staff confidence and competence in their care.
Pediatric Patients Are Not Little Adults
Pediatric anatomy has notable differences that are also minor to identify at all pediatric age brackets. These differences in pediatric anatomy also require often subtle alterations to clinical practice. These subtle clinical care provisions are ideally practiced in clinical simulation based education alongside a specialized yet psychologically safe pediatric faculty. For example: the positioning to manage the pediatric airway effectively for a baby should be in a neutral position and not with the chin lifted as to occlude the trachea. This clinical skill alongside additional extra expertise such as a shoulder roll to optimise an airway are best taught by pediatric specialists in a clinical simulation experience that encourages participants and increases their confidence to undertake this clinical care to unwell children.
The pathophysiology of pediatric illness, injury and associated risk factors also alters at each age bracket for pediatric patients. The signs and symptoms of injury, disease and deterioration of pediatric patients are often subtle and require specialist training and clinical experience to recognize and respond accordingly. A deteriorating pediatric patient requires specialized clinical care often in extremely critical timeframes. For many healthcare professionals this causes a lot of anxiety, especially as an unwell pediatric patient often rapidly deteriorates due a lack of reserves in comparison to an adult patient. When inexperienced in pediatric clinical care, to make a call to escalate care for a pediatric patient can seem an incredibly scary concept. Clinical simulation based education is the ideal environment for participants to practice going through the motions to make such calls and do so in a simulated environment.
Family Centered Care is Essential But is A Skill That Needs Practice
Care of an unwell pediatric patient’s parents, caregivers, siblings and family who are usually present in resuscitation or clinical care is an additional stress on healthcare staff. There can be layers of aggression, fear, anxiety and terror from families in the clinical space to manage and not add to as well as provision of care to the pediatric patient with these distractions present. For many healthcare professionals attempts to communicate with distressed family members can be an incredibly daunting task and also can cause overwhelm for staff members.
For example: To say that a pediatric patient will be ok when this information is not certain can seem like the right thing to do in the moment, but can cause trauma to families if this is not necessarily true or known. Clinical simulation scenarios with simulated persons as a patient has ethical issues for pediatric patients. However, a simulated person in the role of a parent in a pediatric resuscitation clinical simulation scenario can add to fidelity and complexity greatly. This is a layer of complexity that can be difficult to get right in pediatric simulation yet is incredibly important to be considered.
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Clear communication and effective teamwork is incredibly essential for the care of a critically ill pediatric patient. Healthcare simulation scenarios with a highly trained specialized pediatric specialist faculty can be highly effective to increase confidence of healthcare staff and improve future clinical care of pediatric patients and their families. Communication and team work skills require experiential learning through healthcare simulation in realistic scenarios with highly trained faculty who can gauge how much to challenge participants to maximise learning.
Healthcare simulation based education to care for adult patients is not the same as healthcare simulation based education for pediatric patients. For example: high quality CPR as with adult patients is incredibly important with pediatric patients. Yet many healthcare staff from pre-hospital to primary and specialist pediatric teams often struggle to be able to provide critically unwell pediatric patients with high quality CPR for a number of complex factors.
Pediatric manikins alongside specialized pediatric faculty allows healthcare staff the opportunity to practice through experiential learning in a clinical simulation environment. Pediatric CPR depth, rate of compressions and ventilation skills decay quickly without regular practice. Not only is pediatric high quality CPR a difficult clinical skill to excel as an isolated clinical skill, but within a team environment challenges are greatly increased.
Pediatric Simulation Needs to be Debriefed with Care and Psychological Safety
Debriefing of pediatric simulation scenarios is a highly specialized skillset. Psychological safety of clinical simulation participants should be one of the most important factors in pediatric simulation. Many pediatric simulation participants feel incredibly anxious as the care of unwell pediatric patients is complex, and under stress overwhelm and mistakes can happen.
Healthcare simulation participants often report that mistakes occur that deviate from their usual practice due to being observed by clinical simulation faculty. Respect and trust in the clinical simulation faculty to provide a psychologically safe pediatric simulation experience is vital. Clinical simulation participant trauma can easily occur without these factors carefully considered.
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Due to the nature of what is at stake with traumatic debrief experiences, particularly in pediatric simulation, experienced faculty with a focus foremostly on psychological safety should be paramount. This investment into the presence of such faculty will pay dividends in regards to improvement of team culture and confidence to provide high quality clinical care to pediatric patients.
This article has discussed why specialized pediatric healthcare simulation opportunities are so important for healthcare staff that care for pediatric patients. There are many highly specialized and complex skills required for teams in the clinical care of critically ill pediatric patients. Experienced pediatric simulation faculty who are skilled in psychological safety and clinical care are incredibly important to ensure maximal learning of participants and reduce risk of healthcare simulation participant trauma.
