The control framework reveals that ensuring adherence to the specific requirements for specialized nursing certifications is paramount for maintaining professional standards and patient safety within the Critical Mediterranean Pediatric Acute Care Nursing Specialist Certification. This scenario is professionally challenging because it requires a nuanced understanding of the certification body’s mandate, balancing the desire for professional advancement with the strict criteria established for specialized practice. Misinterpreting or circumventing these criteria can lead to unqualified individuals practicing in critical pediatric acute care, jeopardizing patient outcomes and undermining the integrity of the certification. The best approach involves a thorough and direct engagement with the official documentation provided by the certifying body. This entails meticulously reviewing the stated purpose of the Critical Mediterranean Pediatric Acute Care Nursing Specialist Certification, which is to establish a benchmark of advanced knowledge and skills for nurses providing acute care to critically ill pediatric patients in the Mediterranean region. Crucially, it also requires a precise examination of the eligibility criteria, which are designed to ensure that candidates possess the requisite education, specialized experience in pediatric critical care, and potentially regional-specific competencies. By directly consulting these official sources, a nurse can accurately ascertain their qualifications and the steps necessary to pursue certification, ensuring all requirements are met without ambiguity. This aligns with ethical obligations to practice within one’s scope and to uphold the standards of specialized care. An incorrect approach would be to rely on informal discussions or anecdotal evidence from colleagues regarding the certification’s purpose and eligibility. While peer advice can be helpful, it is not a substitute for official guidelines. This approach fails because it introduces the risk of misinformation, outdated information, or subjective interpretations that may not align with the certifying body’s official stance. This can lead to a nurse investing time and resources into an application process based on flawed assumptions, ultimately resulting in disqualification and a failure to meet the established professional standards. Another incorrect approach would be to assume that general pediatric acute care experience is sufficient without verifying if it meets the specific duration and nature of experience mandated by the Critical Mediterranean Pediatric Acute Care Nursing Specialist Certification. The certification likely specifies a minimum number of years and a particular type of experience (e.g., direct care in a pediatric intensive care unit) that is distinct from broader pediatric acute care roles. Relying on this assumption bypasses the critical step of confirming specialized experience, which is a cornerstone of advanced certification and directly impacts patient safety in high-acuity settings. A further incorrect approach would be to focus solely on the perceived prestige of the certification without a thorough understanding of its underlying purpose and the specific competencies it aims to validate. This perspective prioritizes personal career advancement over the commitment to specialized patient care that the certification represents. It fails to acknowledge that the purpose of the certification is to ensure a high standard of care for a vulnerable population, and eligibility is a mechanism to guarantee that standard. Professionals should adopt a systematic decision-making process that begins with identifying the specific certification of interest. This is followed by actively seeking out and thoroughly reviewing the official documentation from the certifying body, including its mission statement, purpose, and detailed eligibility requirements. Any discrepancies or ambiguities should be clarified directly with the certifying body. This ensures that professional development efforts are aligned with established standards and contribute meaningfully to specialized patient care.

Scenario Analysis: This scenario is professionally challenging due to the inherent complexity of pediatric acute care, where rapid deterioration can occur, and the need for continuous, accurate assessment and monitoring is paramount. The lifespan approach requires adapting diagnostic and monitoring strategies to the unique physiological and developmental stages of pediatric patients, from neonates to adolescents. Ensuring timely and appropriate interventions relies heavily on the nurse’s ability to synthesize assessment data, interpret diagnostic findings, and proactively monitor for subtle changes, all while navigating potential communication barriers with young patients and their families. Correct Approach Analysis: The best professional practice involves a systematic, age-appropriate, and continuous multi-system assessment integrated with real-time interpretation of diagnostic data and proactive monitoring for subtle changes. This approach prioritizes early identification of deviations from baseline, allowing for prompt and targeted interventions. It aligns with ethical principles of beneficence and non-maleficence by ensuring the patient receives the highest standard of care and minimizing potential harm through vigilant observation and timely response. Regulatory frameworks governing pediatric nursing emphasize the importance of comprehensive assessment, accurate documentation, and timely communication of findings to the healthcare team. Incorrect Approaches Analysis: One incorrect approach involves relying solely on scheduled vital sign checks without integrating other assessment data or considering the patient’s developmental stage. This fails to capture subtle but critical changes that may precede overt deterioration, potentially violating the duty of care and leading to delayed interventions. It also neglects the dynamic nature of pediatric acute illness. Another incorrect approach is to focus exclusively on one body system based on the initial complaint, ignoring other potential areas of concern. This narrow focus can lead to missed diagnoses or overlooked complications in other systems, which is contrary to the comprehensive assessment required in acute pediatric care and may breach professional standards of care. A third incorrect approach is to delay the interpretation of diagnostic results until a physician reviews them, without the nurse actively correlating these findings with the patient’s clinical presentation. This passive approach can lead to significant delays in recognizing critical trends or abnormalities, potentially compromising patient outcomes and failing to meet the expectations of proactive nursing practice in acute care settings. Professional Reasoning: Professionals should employ a structured decision-making process that begins with a thorough understanding of the patient’s baseline status and the expected trajectory of their condition. This involves continuous assessment, integrating subjective and objective data, and critically analyzing diagnostic results in the context of the patient’s age, developmental stage, and clinical presentation. Proactive monitoring for subtle changes, anticipating potential complications, and timely, clear communication with the interdisciplinary team are essential components of effective pediatric acute care nursing.

This scenario is professionally challenging because it requires balancing immediate patient needs with the complexities of inter-facility transfers, particularly in a pediatric acute care setting where patient vulnerability is high. Ensuring continuity of care while adhering to strict regulatory and ethical standards for patient safety and information privacy is paramount. Careful judgment is required to navigate potential communication breakdowns, differing facility protocols, and the critical nature of the patient’s condition. The best approach involves a comprehensive, documented handover process that prioritizes patient safety and regulatory compliance. This includes a thorough review of the patient’s current status, treatment plan, and any specific care requirements by the sending nurse, followed by a direct, real-time verbal report to the receiving nurse. Crucially, this process must include the transfer of all relevant medical records and documentation, ensuring the receiving facility has complete information for ongoing care. This aligns with ethical principles of beneficence and non-maleficence by ensuring the patient receives appropriate and uninterrupted care, and with regulatory guidelines that mandate accurate and complete patient information transfer to facilitate continuity of care and prevent medical errors. An approach that relies solely on a brief verbal summary without comprehensive documentation fails to meet regulatory requirements for complete patient record transfer. This omission can lead to gaps in understanding the patient’s history, allergies, or specific treatment nuances, potentially jeopardizing patient safety and violating principles of good medical practice. Another incorrect approach, focusing only on the physical transfer of the patient without ensuring a detailed, real-time handover of clinical information, creates a significant risk of care disruption. This neglects the critical need for the receiving team to be fully informed about the patient’s condition, recent interventions, and ongoing needs, which is a cornerstone of safe patient care and regulatory expectations for continuity. Finally, an approach that delays the transfer of essential medical records until after the patient has arrived at the receiving facility introduces an unacceptable delay in information access. This can lead to delayed or inappropriate treatment decisions, contravening the ethical duty to provide timely and effective care and potentially violating regulations concerning the prompt and accurate transfer of patient health information. Professionals should employ a structured decision-making process that begins with identifying the core objective: safe and effective patient transfer. This involves consulting relevant facility policies and regulatory guidelines regarding patient transfers and information exchange. Next, assess the specific patient’s needs and the resources available at both facilities. Prioritize communication and documentation, ensuring all necessary information is accurately conveyed and recorded. Finally, engage in critical reflection post-transfer to identify any areas for improvement in future transfer processes.

This scenario is professionally challenging because it requires the pediatric acute care nurse to integrate complex pathophysiological knowledge with immediate clinical observations to optimize patient care, all while navigating the ethical imperative of patient advocacy and resource stewardship within a specific healthcare context. The pressure to make timely, evidence-based decisions for a critically ill child necessitates a systematic and informed approach. The best professional practice involves a comprehensive assessment that directly links observed clinical signs and symptoms to underlying pathophysiological processes, then uses this understanding to anticipate potential complications and guide immediate interventions. This approach prioritizes the child’s immediate needs by leveraging the nurse’s advanced knowledge to predict and prevent deterioration. This aligns with the ethical principles of beneficence (acting in the patient’s best interest) and non-maleficence (avoiding harm) by ensuring interventions are targeted and effective. Furthermore, it supports the professional responsibility to practice at the highest level of one’s scope, utilizing specialized knowledge for optimal patient outcomes. An approach that focuses solely on treating isolated symptoms without a deep understanding of the underlying pathophysiology risks misdiagnosis, delayed or inappropriate treatment, and potential harm to the child. This fails to uphold the ethical duty of competence and can lead to adverse events, violating the principle of non-maleficence. It also neglects the professional responsibility to provide holistic and evidence-based care. Another incorrect approach would be to rely primarily on established protocols without critically evaluating the child’s unique presentation against the pathophysiology. While protocols are essential, rigid adherence without considering individual variations in disease progression or response to treatment can be detrimental. This approach may overlook subtle but critical changes that deviate from the typical protocol pathway, potentially delaying necessary adjustments and failing to advocate effectively for the child’s specific needs. This can be seen as a failure in professional judgment and patient advocacy. Finally, an approach that prioritizes resource availability over immediate clinical need, even if the child’s condition appears stable at that moment, is ethically problematic. While resource management is important, the primary ethical obligation in acute care is to the patient’s well-being. Delaying necessary interventions based on potential future resource constraints, without a clear and immediate indication of such constraints impacting current care, can lead to preventable deterioration and harm. Professionals should employ a decision-making framework that begins with a thorough, pathophysiology-informed assessment. This involves actively questioning observed signs and symptoms, hypothesizing underlying mechanisms, and then using this understanding to guide the selection of diagnostic tests and therapeutic interventions. Continuous re-evaluation of the patient’s response in light of the evolving pathophysiology is crucial for adapting care plans and ensuring optimal outcomes.

The control framework reveals a critical juncture in pediatric acute care nursing where process optimization directly impacts patient outcomes and adherence to professional standards. This scenario is professionally challenging due to the inherent vulnerability of pediatric patients, the complexity of acute care environments, and the need for seamless, evidence-based interventions. Careful judgment is required to balance efficiency with the paramount principle of patient safety and the ethical imperative to provide the highest standard of care. The best approach involves a systematic, data-driven review of the existing medication administration process, focusing on identifying bottlenecks and potential error points through direct observation and staff feedback. This method aligns with the principles of continuous quality improvement mandated by nursing professional bodies and regulatory agencies that emphasize evidence-based practice and patient safety. By analyzing the current state, identifying deviations from best practices, and implementing targeted, evidence-based interventions, nurses can optimize the process to reduce errors, improve efficiency, and enhance patient outcomes. This proactive and analytical strategy is ethically sound as it prioritizes patient well-being and adheres to the professional responsibility of maintaining and improving care standards. An approach that relies solely on anecdotal evidence or assumes the current process is optimal without objective evaluation is professionally unacceptable. This failure stems from a lack of due diligence and a disregard for the systematic identification of risks. It neglects the ethical obligation to actively seek and implement improvements that safeguard patients. Furthermore, implementing changes based on a single incident without a broader process review risks addressing a symptom rather than the root cause, potentially leading to recurring issues and a failure to meet regulatory expectations for quality assurance. Another professionally unacceptable approach is to implement changes without involving the nursing staff directly responsible for medication administration. This oversight creates a disconnect between policy and practice, potentially leading to resistance, non-compliance, and the introduction of new, unforeseen problems. Ethically, it undermines the professional autonomy and expertise of the nursing team, failing to leverage their invaluable frontline knowledge. Regulatory frameworks often require stakeholder engagement in process changes to ensure feasibility and effectiveness. Finally, adopting a reactive approach that only addresses process issues after a significant adverse event occurs is a failure to uphold the proactive standards of acute care nursing. While learning from errors is crucial, the primary ethical and professional responsibility is to prevent harm through robust process design and continuous monitoring. This reactive stance can be seen as a dereliction of duty, as it implies a lack of commitment to ongoing risk mitigation and quality improvement, which are fundamental to pediatric acute care. The professional reasoning process for similar situations should involve a cyclical approach: assess the current state, identify areas for improvement using objective data and staff input, develop evidence-based interventions, implement these changes, and then monitor their effectiveness. This iterative process ensures that optimizations are data-driven, practical, and ultimately beneficial to patient care, while adhering to ethical principles and regulatory requirements.

The control framework reveals a scenario where a pediatric acute care nurse specialist, preparing for the Critical Mediterranean Pediatric Acute Care Nursing Specialist Certification, is grappling with the examination’s blueprint, scoring, and retake policies. This situation is professionally challenging because understanding these policies is crucial for effective test preparation, managing expectations, and potentially mitigating financial and emotional costs associated with retakes. Accurate interpretation of the blueprint directly impacts study focus, while understanding scoring and retake policies informs strategic test-taking and future planning. Careful judgment is required to navigate the information provided by the examination board and apply it to personal preparation and potential outcomes. The best professional approach involves meticulously reviewing the official examination handbook and any supplementary documentation provided by the Mediterranean Pediatric Acute Care Nursing Certification Board. This handbook is the definitive source for all policies, including the detailed blueprint weighting, scoring methodology, and the specific conditions, timelines, and fees associated with retaking the examination. Adhering to these official guidelines ensures that preparation is aligned with the examination’s actual requirements and that the candidate is fully aware of the consequences and procedures for any necessary retakes. This approach is correct because it is grounded in the official regulatory framework governing the certification, ensuring compliance and informed decision-making. It prioritizes accuracy and official guidance, which are paramount in professional certification processes. An incorrect approach would be to rely solely on anecdotal information from colleagues or online forums regarding the examination’s policies. While peer experiences can offer insights, they are not official pronouncements and may be outdated, misinterpreted, or inaccurate. This failure to consult the primary source constitutes a regulatory and ethical lapse, as it risks basing critical preparation and decision-making on unreliable data, potentially leading to misaligned study efforts or unexpected financial penalties if retake policies are misunderstood. Another incorrect approach would be to assume that the scoring and retake policies are standardized across all professional nursing certifications and therefore do not require specific review for this particular Mediterranean examination. This assumption is a significant ethical and professional failure. Each certification body establishes its own unique policies, and assuming universality ignores the specific regulatory framework of the Mediterranean Pediatric Acute Care Nursing Certification Board. This can lead to critical misunderstandings about eligibility for retakes, required waiting periods, or additional examination fees, all of which are governed by the specific board’s regulations. Finally, an incorrect approach would be to disregard the retake policy entirely, believing that a single attempt will suffice and that planning for a retake is unnecessary. This demonstrates a lack of comprehensive preparation and foresight. Professionally, it is prudent to understand all potential pathways to certification, including contingency plans. Ignoring retake policies, even with the intention of passing on the first attempt, is a failure to fully engage with the examination’s governance and can lead to significant stress and logistical challenges if a retake becomes necessary. Professionals should adopt a decision-making process that begins with identifying the authoritative source of information for any certification or regulatory requirement. This involves actively seeking out official documentation, such as handbooks, guidelines, and official websites. Subsequently, information should be critically evaluated for its relevance and accuracy, prioritizing official statements over informal sources. Finally, decisions regarding preparation, application, and examination strategy should be made based on a thorough understanding of these official policies, ensuring compliance and informed action.

The control framework reveals that preparing for a specialized nursing certification requires a structured and resource-informed approach. This scenario is professionally challenging because candidates often face time constraints, competing professional responsibilities, and varying levels of prior knowledge. Effective preparation hinges on accurately assessing personal learning needs and aligning them with available, high-quality resources within a realistic timeframe. Careful judgment is required to avoid superficial study or burnout. The best approach involves a comprehensive self-assessment of knowledge gaps against the certification’s domain outline, followed by the strategic selection of a diverse range of reputable preparation materials, including official study guides, peer-reviewed literature, and accredited online courses. This should be integrated into a personalized study schedule that allows for regular review and practice testing, prioritizing areas of weakness. This method is correct because it directly addresses the individual candidate’s needs, ensuring efficient use of time and resources. It aligns with ethical principles of professional development and competence, emphasizing a thorough understanding of the subject matter rather than rote memorization. Regulatory guidelines for professional nursing certifications generally advocate for evidence-based preparation and continuous learning, which this approach embodies. An incorrect approach would be to rely solely on a single, generic review book without assessing its alignment with the specific certification’s content or the candidate’s existing knowledge. This fails to address individual learning needs and may lead to gaps in understanding or inefficient study. It could also be ethically questionable if it results in a candidate presenting for certification without adequate preparation, potentially compromising patient care. Another incorrect approach is to attempt to cram all material in the final weeks before the exam, without a structured study plan or regular review. This is detrimental to long-term retention and deep understanding, increasing the likelihood of errors and anxiety. It disregards the principles of adult learning, which favor spaced repetition and consistent engagement. Finally, an approach that prioritizes attending every available seminar or webinar without evaluating their relevance or quality, or without integrating the information into a personal study plan, is also flawed. This can lead to information overload and a lack of focused learning, making it difficult to synthesize knowledge effectively. It represents a passive rather than active learning strategy, which is less effective for certification preparation. Professionals should employ a decision-making framework that begins with understanding the certification’s objectives and scope. This is followed by a realistic self-appraisal of strengths and weaknesses. Next, they should identify and vet credible preparation resources, considering their alignment with the certification’s content and their own learning style. Finally, they must develop and adhere to a flexible yet disciplined study schedule that incorporates active learning techniques and regular self-assessment.

The audit findings indicate a potential breach in clinical documentation standards, specifically concerning the electronic health record (EHR) system used within a pediatric acute care setting. This scenario is professionally challenging because it requires immediate and accurate assessment of documentation practices against established regulatory frameworks and ethical obligations to patient safety and privacy. The pressure to maintain efficient patient care while ensuring meticulous record-keeping necessitates careful judgment. The approach that represents best professional practice involves a comprehensive review of the EHR system’s audit logs and individual clinician access records to identify the specific nature and extent of the documentation discrepancies. This includes verifying that all entries are timely, accurate, complete, and reflect the patient’s condition and interventions as per the established nursing scope of practice and institutional policies. Furthermore, it requires cross-referencing these findings with relevant regulatory guidelines, such as those pertaining to patient rights, data integrity, and the legal defensibility of medical records. Adherence to these principles ensures that patient care is accurately represented, facilitates continuity of care, and protects both the patient and the healthcare provider from legal and ethical repercussions. This approach directly addresses the audit’s concerns by systematically investigating the root cause and scope of any identified issues. An incorrect approach would be to dismiss the audit findings without thorough investigation, assuming minor errors that do not warrant further attention. This fails to acknowledge the potential for systemic issues or significant deviations from best practices, thereby neglecting the regulatory requirement for accurate and complete patient records. Such an oversight could lead to compromised patient care, misinterpretation of a patient’s history, and potential legal liabilities. Another incorrect approach would be to implement broad, punitive measures against all staff without a specific understanding of the audit’s findings or individual contributions. This reactive strategy can damage staff morale and does not address the underlying causes of any documentation deficiencies. It also fails to meet the regulatory expectation of fair and evidence-based disciplinary or corrective actions. A further incorrect approach would be to focus solely on the technical aspects of the EHR system, such as software glitches, without considering the human element of documentation practices. While technical issues can contribute, the primary responsibility for accurate documentation lies with the clinician. Ignoring the clinical workflow and user practices overlooks a critical component of regulatory compliance and patient safety. Professionals should employ a systematic decision-making process that begins with understanding the specific nature of the audit findings. This involves gathering all relevant data, consulting institutional policies and procedures, and referencing applicable regulatory guidelines. A collaborative approach, involving relevant stakeholders such as nursing leadership, IT, and quality improvement teams, is crucial. The process should prioritize patient safety and data integrity, leading to targeted interventions and ongoing monitoring to ensure sustained compliance.

Scenario Analysis: This scenario presents a professional challenge rooted in the ethical imperative to advocate for a vulnerable patient population while navigating the complexities of resource allocation and interdisciplinary collaboration within a critical care setting. The nurse specialist must balance immediate patient needs with broader systemic considerations, requiring astute clinical judgment, strong communication skills, and a deep understanding of pediatric acute care best practices. The urgency of the situation, coupled with the potential for differing opinions among team members, necessitates a decisive yet collaborative approach. Correct Approach Analysis: The most appropriate approach involves the pediatric acute care nurse specialist immediately initiating a structured discussion with the multidisciplinary team, including the attending physician, to present the evidence supporting the need for continuous cardiac monitoring for the infant. This approach is correct because it prioritizes patient safety and evidence-based practice, aligning with the core knowledge domains of pediatric acute care nursing, which emphasize continuous assessment and timely intervention. Regulatory frameworks governing pediatric care and nursing practice universally mandate that healthcare professionals act in the best interest of the child, utilizing available evidence to guide clinical decisions. This proactive communication ensures that all team members are informed and can collectively make a decision that optimizes the infant’s outcome, fostering a culture of shared responsibility and patient advocacy. Incorrect Approaches Analysis: Initiating a formal grievance process against the attending physician without first attempting direct communication and collaborative problem-solving is professionally unacceptable. This approach bypasses essential interdisciplinary communication channels and can create unnecessary conflict, potentially delaying critical care decisions and undermining team cohesion. It fails to uphold the principle of collaborative practice, which is fundamental in acute care settings. Escalating the situation directly to hospital administration without first engaging the immediate care team, including the attending physician, is also professionally inappropriate. This action circumvents the established chain of command and fails to provide the attending physician with an opportunity to address the clinical concerns. It demonstrates a lack of respect for the interdisciplinary team dynamic and can be perceived as an overreaction, potentially damaging professional relationships. Accepting the attending physician’s decision without further discussion or seeking clarification, despite having evidence to the contrary, is ethically and professionally deficient. This approach fails to uphold the nurse specialist’s role as a patient advocate and neglects the core knowledge domain of critical assessment and intervention. It prioritizes compliance over the patient’s well-being and the application of evidence-based practice, potentially leading to suboptimal care. Professional Reasoning: Professionals should employ a decision-making framework that begins with a thorough assessment of the patient’s needs and relevant evidence. This should be followed by open and respectful communication with the immediate care team, presenting concerns and supporting evidence clearly. If consensus cannot be reached, a structured escalation process, involving appropriate channels within the healthcare institution, should be considered, always prioritizing patient safety and advocating for evidence-based care.

Scenario Analysis: This scenario presents a professional challenge due to the inherent risks associated with pediatric medication administration, particularly in acute care settings where patient conditions can rapidly change. The critical need for accurate dosing, appropriate drug selection, and vigilant monitoring for adverse effects, coupled with the vulnerability of pediatric patients, necessitates a rigorous and systematic approach to prescribing support and medication safety. The complexity is amplified by the potential for drug interactions, allergies, and the need for individualized treatment plans based on age, weight, and clinical status. Correct Approach Analysis: The best professional practice involves a comprehensive, multi-faceted approach that prioritizes patient safety through a combination of evidence-based protocols, interdisciplinary collaboration, and robust technological safeguards. This includes utilizing a validated pediatric dosing reference guide, cross-referencing potential drug interactions with the patient’s current medication list, and confirming the order with the prescribing physician, especially for high-alert medications or novel prescriptions. This approach directly addresses the core principles of medication safety by ensuring accuracy, minimizing errors, and promoting open communication to prevent adverse events. It aligns with ethical obligations to provide competent and safe care, and implicitly with regulatory frameworks that mandate patient safety standards in healthcare. Incorrect Approaches Analysis: One incorrect approach involves solely relying on the prescriber’s verbal order without independent verification or consultation of a pediatric-specific reference. This fails to acknowledge the potential for human error in prescribing and bypasses crucial safety checks designed to protect vulnerable pediatric patients. It represents a significant ethical lapse by not exercising due diligence in ensuring the appropriateness and safety of the medication. Another incorrect approach is to administer the medication based on a previous similar case without re-verifying current patient parameters and the specific order. This ignores the dynamic nature of pediatric care and the importance of individualized assessment. It is a failure to adhere to best practices in medication safety, which demand that each prescription be evaluated anew in the context of the current patient presentation and clinical guidelines. A third incorrect approach is to delegate the entire responsibility of medication verification to a junior nurse without adequate supervision or a clear protocol for complex pediatric prescriptions. While delegation can be appropriate, it must be done within the scope of practice and with appropriate oversight. This approach risks overlooking critical safety checks and fails to ensure that the most experienced and knowledgeable personnel are involved in high-risk medication decisions for children. Professional Reasoning: Professionals should adopt a systematic decision-making process that begins with a thorough review of the medication order against the patient’s chart, including allergies, current medications, and relevant clinical data. This should be followed by consulting reliable, up-to-date pediatric pharmacology resources. If any ambiguity, potential for interaction, or deviation from standard practice exists, immediate consultation with the prescribing physician or a clinical pharmacist is paramount. This iterative process of verification, consultation, and documentation forms the bedrock of safe medication practice in pediatric acute care.