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A Descriptive Assessment of Comfort Levels of Inpatient Nurses Caring for Pediatric Pulmonary Hypertension Patients Receiving Prostacyclin Therapy

Anna Brown

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Conference: 2015 PH Professional Network Symposium

Release Date: 09.17.2015

Presentation Type: Abstracts

File Download: 2015 Symposium Abstract - 1003

File Size: (243 kb)

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Purpose

The specific aims of this project were to 1) identify the comfort levels of the inpatient nursing staff that came in direct contact with pediatric pulmonary hypertension patients receiving invasive prostacyclin therapy as well as 2) identify the barriers to feeling comfortable taking care of these patients.

Background

Pulmonary hypertension (PH) is a rare pulmonary vascular disease causing increased pulmonary artery pressures leading to right sided heart failure. Current therapies are targeted at vasodilation of the pulmonary arteries, thereby relieving stress on the right ventricle. Prostacyclins are the most complex and invasive form of therapy for PH and are delivered continuously either intravenously or subcutaneously. The delivery of these medications is a complicated process that requires specific training for clinical personnel. Due to its low prevalence and high acuity, bedside nurses may feel uncomfortable taking care of these patients when they are admitted to the hospital despite ongoing educational initiatives.

Methods

Twenty-five registered nurses on 7A, the cardiac ward at Vanderbilt Children’s Hospital, were given a 22 question survey assessing their comfort level from 0-100 regarding various aspects of caring for patients receiving prostacyclin therapy and queried their perceived barriers in caring for these patients through multiple choice and free response. Surveys were voluntary and anonymous. Information was collected and analyzed using the Redcap database. Approval was obtained from the IRB at Vanderbilt University. Based upon the results of this survey, an educational program was designed to improve nursing education and comfort with PAH patients.

Results

Twenty-five nurses from 7A completed the survey. While the overall mean (standard deviation) comfort level with the management of a central venous lines (CVL) was reported as 87% (21.9), the comfort with the care for prostacyclin-based delivery was low with epoprostenol at 38% (23.9) and treprostinil at 47% (23.9); comfort with subcutaneous delivery of treprostinil was low at 35% (23.5). While nurses cited numerous reasons for deficiency of comfort with prostacyclins, areas of particular concern included lack of understanding of the nurse’s role in the device care (48%) and deficiency of expertise in the pathophysiology of PAH (44%). To address these concerns, formal and informal educational programs were designed, including active education via: shift change seminars; PAH & Pump Management added to the annual nursing check offs; monthly lectures at new hire orientation; and, formal resources including: PAH Unit Resource Binder; distribution of educational PowerPoint files; resource website; and bedside RN checklist. In addition, an inpatient Super User Team for prostacyclins was created.

Conclusion

Inpatient Pediatric Nurses caring for PH patients report insufficient comfort levels with patients who require continuously infused prostacyclin therapy due to a variety of reasons. To address these concerns, multiple educational approaches have been implemented. Future directions include pre- and post- educational program surveys to evaluate the utility of educational programs and continued refinement of educational programs.