Nursing Management in Pediatric Intensive Care in South Asia
Abstract
:1. Introduction
2. Methods
3. Overview of Pediatric Intensive Care in South Asia
4. Nursing Management in PICUs: Core Responsibilities
5. Workforce Challenges and Solutions
6. Cultural and Ethical Considerations in Nursing Care
7. Technological and Policy Advancements
8. Implications for Practice and Policy
9. Future Research Directions
10. Discussion
11. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
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Country | First PICU | Current PICU Availability | Key Institutions & Statistics | Challenges |
---|---|---|---|---|
India [9,10,11] | 1991 (Chennai, KKCTH) [9] | >100 PICUs (public + private) [11] | 7-bed PICU at KKCT Hospital (first organized unit); led by a pediatric anesthesiologist; teaching institutes crucial [9] | Earlier units lacked support; maintaining a 1:1 nurse-patient ratio remains challenging; training more professionals is crucial |
Bangladesh [12,13,14,15,16] | 1994 (Dhaka Shishu Hospital) [12] | 11–12 PICUs (public + private) [15] | First ICU in the 1980s at NICVD; 27 government ICUs (22%); 80% of ICUs in Dhaka. [14] | Urban-rural disparity; lack of protocols; private PICUs unaffordable; nurse staffing is inadequate (often ~1:4 nurse: patient) |
Nepal [17,18] | 1986 (Kanti Children’s Hospital) [17] | 18 independent PICUs [18] | Started with 4 beds; ~2000 annual PICU patients; high critical care burden [18] | Shortage of trained staff; skill gaps in care; staffing often falls short of recommended levels |
Pakistan [19] | N/A (first survey 2023) [19] | 53 PICUs (of 114 hospitals) [19] | 667 beds, 217 ventilators (nationwide); 38 govt + 15 private PICUs; 16 units with 20 trained intensivists; nurse:patient ~1:3 [19] | Resource shortages; lack of skilled nurses limits infrastructure development |
Criteria | Assessment | Procedures/Equipment | Access and Line |
---|---|---|---|
Cardiovascular | Head-to-Toe | Cardiac Monitor | Care of Central Venous Catheter |
Heart Sounds | CPR of Infant | Care of Subclavian Lines | |
Pulses | CPR of Child | Care of Arterial Catheter | |
Wolf-Parkinson White Syndrome | Preparation of Emergency Drugs | ECMO therapy | |
Perfusion | Defibrillation | Autotransfusion system | |
Acyanotic and Cyanotic Heart Disease | Rhythmic recognition | Care of Swanz Ganz Catheter |
Criteria | Assessment/Equipment/Skills |
---|---|
Endocrine Disease | Diabetes/Ketoacidosis |
Glucose Monitoring Devices | |
Insulin Drip |
Criteria | Assessment and Treatment | Procedures and Equipment | Care of Patient on Oxygen Treatment |
---|---|---|---|
Respiratory Disease | Asthma | Intubation/Extubation | Mask/Cannula |
Cystic Fibrosis | Tracheotomy Care | Ambu Bag | |
Pneumonia | Capillary Blood Gas | Ventilator | |
Epiglotitis | Arterial Blood Gas | Apnea Monitor | |
Chest Tubes | Interpretation of Blood Gas | Endo/Naso Tracheal Tube | |
N/A | O2 Analyzer | ||
Pulse Oximeter | |||
Nasal tracheal suctioning | |||
Endo tracheal suctioning |
Criteria | Experience and Skill |
---|---|
Intravenous (IV) Therapy | Peripheral IV Insertion (Angio/Intracath) |
Administration of Blood/Blood Products | |
Care of Implanted Vascular Access | |
Insertion of Scalp Veins | |
PICC Lines |
Criteria | Assessment/Equipment/Skills |
---|---|
Renal Disease | Foley Catheter Disease |
Hemodialysis | |
Renal Transplant | |
Peritoneal Dialysis |
Criteria | Assessment/Treatment Disease |
---|---|
Hematology/Oncology Disease | Anemia |
Hemophilia | |
Administration of Chemotherapy | |
Immunocompromised patients | |
Post Bone Marrow Treatments |
Research Focus Area | Key Questions |
---|---|
Workforce Outcome | Impact of nurse-patient ratio on mortality [11,19] |
Infection Control | Minimizing infection rate by sustainable means [5,29] |
Wellbeing of Nurses | Longitudinal burnout trajectories [31,39,40] |
Liberation Bundle Implementation | Effectiveness of Liberation Bundle in LMICs in South Asia [21,23,52] |
Issue | Scenario in Multiple Countries |
---|---|
Limited resources & infrastructure | Disparities exist across South Asia. For instance, India has ~100 fully functional PICUs, whereas Bangladesh struggles with only 11–12 although the exact number of PICUs cannot be stated here concretely due to ethical issues, privacy, and confidentiality of the information originating from the various tiers from governmental to private hospitals. Nepal and Pakistan similarly lack sufficient units and skilled personnel. |
Nurse–patient ratio & burnout | The ratio is about 1:3 in many Pakistani PICUs, making it difficult for nurses to simultaneously care for multiple critically ill children, leading to burnout and high turnover. Similar staffing shortfalls are seen across the region (e.g., ~1:4 in Bangladeshi PICUs), exacerbating nurse fatigue and compromising patient care. |
Hospital-acquired infections (HAIs) | PICUs encounter frequent HAIs (e.g., ventilator-associated pneumonia and central line-associated bloodstream infections (CLABSI)). Nurses must rigorously implement infection control to keep infection rates in check given patients’ critical conditions. |
Lack of evidence-based protocols | Evidence-based protocols like the Liberation Bundle are rarely implemented in South Asian PICUs, reflecting gaps in translating knowledge into practice. |
Limited family involvement | Parental presence in PICUs is often restricted due to space or policy constraints. By contrast, ~63% of Latin American PICUs permit 24-h parent visitation. Limited family engagement can heighten children’s anxiety, whereas involving parents in care (when feasible) helps reduce stress and improve coping. |
Patient safety and quality gaps | Many units lack robust patient safety monitoring. Medication errors and ICU infections (VAP, CLABSI) are prevalent concerns, yet safety indicators are not systematically tracked. Inconsistent infection control compliance and limited medication safety training for nurses highlight the need for stronger quality assurance programs. |
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Hirao, D.; Jesmin, S.; Sugasawa, T.; Maqbool, A.; Shimojo, N. Nursing Management in Pediatric Intensive Care in South Asia. Children 2025, 12, 726. https://doi.org/10.3390/children12060726
Hirao D, Jesmin S, Sugasawa T, Maqbool A, Shimojo N. Nursing Management in Pediatric Intensive Care in South Asia. Children. 2025; 12(6):726. https://doi.org/10.3390/children12060726
Chicago/Turabian StyleHirao, Daigo, Subrina Jesmin, Takehito Sugasawa, Adil Maqbool, and Nobutake Shimojo. 2025. "Nursing Management in Pediatric Intensive Care in South Asia" Children 12, no. 6: 726. https://doi.org/10.3390/children12060726
APA StyleHirao, D., Jesmin, S., Sugasawa, T., Maqbool, A., & Shimojo, N. (2025). Nursing Management in Pediatric Intensive Care in South Asia. Children, 12(6), 726. https://doi.org/10.3390/children12060726