560 - Advancing Pediatric Critical Care Nursing Practice Through High-Fidelity Simulation and Clinical Coaching: A Curriculum-Based Intervention

Publication Number: 1539.560

Rachel Adleta, Cincinnati Children's Hospital Medical Center, Batavia, OH, United States; Natalie Mitchell, Cincinnati Children's Hospital Medical Center, Erlanger, KY, United States; Kara McGuire, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States; Kelly Ely, Cincinnati Children's Hospital Medical Center, Loveland, OH, United States

Background: Pediatric intensive care units (PICUs) require advanced clinical expertise to manage complex, low-frequency, high-risk scenarios, complications, advanced ventilator modalities and escalation protocols. A needs assessment in our 48-bed PICU revealed significant gaps in competence and confidence among nurses 1–2 years post-orientation. Limited exposure to high-risk cases and inconsistent access to clinical coaching contributed to feelings of unpreparedness.

Objective: To design, implement, and evaluate a targeted educational intervention using high-fidelity simulation, structured debriefing, and clinical coaching to enhance nursing competence in managing complex pediatric critical care scenarios.

Design/Methods: Grounded in adult learning theory and simulation-based education, the curriculum addressed identified gaps through three components:
High-Fidelity Simulation:
Scenarios replicated real-world challenges, including transplant-related complications (e.g., multi-organ failure, VST therapy, sepsis) and advanced ventilator management. Each scenario included “Watcher Plans”—individualized escalation strategies to prevent cardiac arrest via early recognition of deterioration.
Structured Debriefing:
Led by experienced nurses and simulation educators, debriefings emphasized clinical reasoning, early identification of decompensation, and escalation protocols. Reflective practice was encouraged to support retention and behavior change.
Clinical Coaching:
Nurses 1–2 years post-orientation were paired with senior nurses for two dedicated bedside shifts aligned with simulation content, reinforcing learning and fostering mentorship.

Results: A mixed-methods approach assessed impact. Knowledge scores improved from 47% (n=59) pre-test to 72% (n=60) post-test. Follow-up scores at 3 months (n=7) averaged 67%; one 6-month respondent scored 90%. Surveys showed increased self-reported competence in recognizing deterioration (4.4 to 5.8/7), prioritizing interventions (4.2 to 5.8/7), and communication (4.2 to 5.6/7).
Qualitative feedback highlighted the value of realistic scenarios and safe learning environments. Participants reported enhanced critical thinking and preparedness for complex clinical situations.

Conclusion(s): This curriculum offers a replicable model for advancing pediatric critical care nursing through simulation and coaching. Success factors included alignment with unit-specific needs, realistic scenario design, and longitudinal evaluation. Institutions can adopt this framework to improve staff readiness, promote safety culture, and support professional growth in high-acuity settings.