Medical Overview

Several types of specialized pediatric critical care units exist. Many children's hospitals house a general pediatric intensive care unit (PICU), known alternatively as a medical intensive care unit (MICU)

or medical-surgical intensive care unit (MSICU), depending on the patient population. Similarly, many obstetrical, pediatric, and general hospital settings have dedicated neonatal intensive care units (NICUs). Also, some hospitals have specialized pediatric cardiovascular intensive care units (CICUs), of which there are substantially fewer.

These various types of critical care settings share some common features. Each is characterized by a low staff-to-patient ratio. In a national survey of pe-diatric critical care resources across the United States, 81% (204 units total) of participating PICUs had a 1:2 nurse-to-patient ratio (Odetola et al. 2005). In some instances, as in complex and unstable surgical and acute medical presentations, a single patient is cared for by one or more than one nurse.

Given the high medical acuity of the patient population, the critical care environment is dominated by advanced technological monitoring and intrusive, often intimidating life support equipment as the care approaches "technological brinksmanship" (Ferrell and Coyle 2008). A high level of "traffic" is common, with hosts of urgently busy interdisciplinary staff members tending to various aspects of patient care. In addition to these practitioners is the continual presence of patients' family members, friends, and other visitors, as well as the frequent bustle of transport team and support staff. Given the nature of pediatric settings, children's toys, clowns, pets, photographs, and artwork make for a startling juxta position against the backdrop of technology and critical care medicine. Such effects can be potent reminders of the children's daily lives and their place in the world and can serve as a rich starting point for introduction and conversation (Macnab et al. 1997).

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