Pediatric heart failure (HF) is a complicated clinical illness that has several causes as well as 
common disease development pathways. The developing evidence clinical pathway will most 
certainly enhance the outcomes of children with HF in the future. Purpose: effects of application of 
a nurse driven clinical pathway guidelines on selected health outcomes in children with congestive 
heart failure. Design: Quasi-experimental research design. Setting: pediatric intensive care unit 
(PICU) at Menoufia University Hospital, Shebine Elkom city, Menoufia Governorate. Subjects: a 
purposive sample of sixty children with congestive heart failure who divided into study & control 
groups and a convenient sample of 50 care providers including nursing staff, pediatricians, 
pharmacist, dietitian and physiotherapist. Tools: four tools were used; I: congestive heart failure 
children's assessment, II: congestive heart failure complications, III: modified clinical pathway 
guidelines variances checklists and IV: Nurse driven clinical pathway guidelines competency 
evaluation tool. Results: there was statistical significant difference between study and control 
groups as regards hemodynamic state, chest sound, edema, dyspnea, chest pain, systemic 
complications, length of stay in PICU, and variance deviations. In addition, there was statistical 
significant difference between competency score at pre and post clinical pathway guidelines 
sessions among multidisciplinary team. Conclusion: Children with congestive heart failure in study 
group reported a more hemodynamic stability, lower mean scores of chest pain, episodes of dyspnea 
and edema. Also, it contributed to no systemic complications in the majority of these children with 
higher positive variation than children in control group. Recommendations: replication of the study 
on large probability sampling