像孩子一样对待孩子

儿童不仅是成年人。显而易见，对吧？但是，如果您要问那些儿科的人，他们可能会说，显然会错过很多。

在过去的二十年中，全国急诊科（EDS）的患者有所增加，其中近25％是儿童。¹专家担心，由于儿童主要被带到不专门从事儿科护理的设施，因此儿童可能无法接受应有的专业治疗。²儿童，尤其是不到一岁的婴儿，与成年人有明显的解剖学和生理差异，诊断和治疗所需的护理是独一无二的，而且经常错过。

In an emergency, a child's condition can deteriorate quickly, parents on scene can panic, and the care team at the bedside is likely to experience degrees of stress. Because of this,there is an urgent need to improve pediatric training—to ensure that when we say “children are not just small adults” we are not missing something.

专家们将重点放在确定适当的临床途径，管理药物和在跨学科团队中工作的培训。研究表明，这三个领域的培训可以对儿科患者的结局产生积极影响。

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在本文中，我们讨论了如何使用小儿模拟来训练：

During physical assessments, infants are not able to articulate what hurts, explain what happened, or raise concerns about prior procedures or complications. In these cases, it's critically important to listen to the parent, guardian, or social worker, because they will know the child's baseline. This is the start of the clinical pathway, or what some call the "blueprint for a plan of care".³

Many organizations have begun implementing full-scale pediatric simulation efforts, according to the American Academy of Pediatrics (AAP). One example is the Pediatric BASE Camp, an immersive simulation event supported by Laerdal and hosted by Weill Cornell Medical College, that focuses on fine-tuning and strengthening the clinical-pathway skills that providers use when faced with a pediatric emergency.⁴

Other organizations are using sequential simulation (SqS) to prepare front-line staff to participate in integrated, or person-centered, care at various points on the patient journey.⁵This form of simulation focuses on important moments, such as hand-offs (i.e. from parent to physician, from ambulance to ED, etc.), information sharing, role assignments, and individual tasks.

能够评估症状，衡量生理差异和改善并进行干预措施将使学习者暂停怀疑并在没有障碍的情况下通过模拟。

在儿科中，用药物错误的发生率每6个订单中高达1个。⁷这可能部分是由于儿童的体重，身体表面积和器官系统成熟度差异很大，这会影响他们代谢和排泄药物的能力。⁸

在一项研究的研究中，使用模拟来观察护理学生来解决复杂的儿科患者病例，只有22％的学生在培训前提供了正确的药物管理。训练后，96％的稀释技术成功，而百分之八十八能够提供准确的IV泵率。¹⁰

仿真培训为护士和医生做好了不可避免的压力，噪音和混乱，这些压力，噪音和混乱将带有危急状况的婴儿。

当将婴儿带到急诊室时，很有可能会形成几乎不熟悉的团队，但必须像上油一样表现出色。那么，为什么不给他们训练机会呢？

辛辛那提儿童医院医学中心的研究主张高保真模拟是在儿科创伤患者的背景下增强和评估跨学科团队培训的有效方法。¹¹这项研究得出的结论是，改善团队绩效直接与更有效的护理和更少的错误相关。

紧急医疗服务（EMS）是一种动态，因为所有EMS呼叫中约有7％-13％涉及儿科患者。¹²Training to incorporate all possible caregivers can lead to a more effective team dynamic, and certainly a more accurate clinical pathway.

此外，在模拟中强调闭环通信技术不仅可以帮助降低错误风险，而且还可以提高治疗危机儿科患者时的速度和效率。

在每年五岁以下的900万儿童中，据估计，其中70％是由于正确诊断出可以预防或治疗的情况所致。¹⁴Experts recommend concentrating pediatric training efforts on the decision-making process in a clinical pathway, practicing administering medication in small doses required for children, and training with interdisciplinary teams to improve overall communication.

模拟是一种有效的训练方法can incorporate each of these skills. Following a patient case from start to end, with the many ups and downs that a real patient would experience, can enhance existing pediatric training curricula by increasing skills and clinical expertise.¹⁵