Journal of Pediatric Nursing

A Time of Change

Cecily L. Betz — 2010-04-01

Periodically, over the past 25 years since the first issue of the Journal of Pediatric Nursing (JPN) was published, the team of editors associated with the journal changes as members have determined that it is time to pursue other professional opportunities or seek respite from the very intense demands associated with an editorship. With the departure of long-standing professional associates comes the advent of partnerships with new team members of committed and outstanding professionals who are eager to share their expertise and fresh perspectives. I would like to announce the range of changes—the departures and the addition of new members of the JPN editorial team.

Cultural Sensitivity Removes Barriers to Better Care. A Letter to the Editor on Article “Parental Preference or Child Well-Being: An Ethical Dilemma”

Shiho Murayama — 2010-04-01

I recently read the article “Parental preference or child well-being: An ethical dilemma” in the Journal of Pediatric Nursing. The analysis and resolution for the ethically complicated case reported by was very impressive. I am grateful to the author for sharing the case study that encourages nurses working with children and families to actively contribute to the coordination of care for children with diverse cultural backgrounds.

A Descriptive Study of Complications of Gastrostomy Tubes in Children

2009-06-01

Objectives: The purpose of this study was to determine the number and types of complications experienced by children with gastrostomy tubes.Methods: This is a prospective study of children with gastrostomy tube complications. Enrollment occurred on the first 24 months of the study. Data were collected for 4 years, beginning at the enrollment of the first participant. Demographic data and information on infections, granulation tissue formation, and major complications were recorded.Results: Infections occurred in 37% of patients, with most experiencing a single infection that occurred within the first 15 days after tube placement. Granulation tissue developed in 68% of patients, with 17% experiencing recurrent granulation tissue despite treatment. There was no difference in infection rates or granulation tissue formation between subgroups based on gender, ethnicity, or parents' education level. Major complications occurred in 4% of the patients.Conclusion: Complications of infection and granulation tissue occur frequently and likely are a cause of stress and increased burden of care for these children and families. Improved strategies for care are needed.

The Foundations for the Development of Intimacy

Sharyl Eve Toscano — 2009-04-09

In this article, the concept of intimacy is presented as developing concurrent with identity as the basis for exploring the foundations of intimate relationships in adolescents. Researchers explore intimacy as perceived by female adolescents aged 15–18 years regarding heterosexual dating relationships. Both the process toward intimate relationships and various forms are reported.

Staff Perception One Year After Implementation of the The Newborn Individualized Developmental Care and Assessment Program (NIDCAP)

Marit Solhaug, Ida Torunn Bjørk, Hege Pettersen Sandtrø — 2010-04-01

The Newborn Individualized Developmental Care and Assessment Program (NIDCAP) was piloted at one NICU. Staff perception of impact and the feasibility of applying the program was explored in a survey and a focus group interview. NIDCAP was perceived to impact positively on infant well-being and parents' way of caring. Although the influence of NIDCAP on staff working conditions and job perfomance was overall positive, their perceptions varied. Presence of the NIDCAP observer and empowerment of parents was challenging to some nurses, especially in terms of decision making in care. Conflicts of interest occurred between staff member need of light and infant need of light reduction.

Pediatric Safe Patient Handling

Kristi Haglund, Jennifer Kyle, Marsha Finkelstein — 2009-04-20

Patient-handling tasks have historically been recognized as the primary cause for musculoskeletal disorders among the nursing workforce. Children's Hospitals and Clinics of Minnesota (Children's) implemented an innovative and industry-leading pediatric safe patient-handling program to minimize the frequency of occupational injuries associated with patient-handling tasks. An analysis of workers' compensation claims revealed that the rate of postimplementation incidents was reduced by 71.4% when compared with Children's preimplementation incidence rate. A review of risk perception surveys illustrated that most patient-handling tasks at Children's were perceived to be significantly less risky after implementation.

Impact of Computerized Orders for Pediatric Continuous Drug Infusions on Detecting Infusion Pump Programming Errors: A Simulated Study

2009-04-09

Continuous infusion medications are associated with fatal adverse events in pediatric intensive care units. The effect of computerized orders on detecting infusion pumps programming errors has never been studied. Using a crossover design, we examined the effect of using computerized orders for continuous infusions as compared with that of using handwritten orders on nurse ability to detect infusion pump programming errors, time required to verify pump settings, and user satisfaction. The computerized orders saved nurses time but did not improve their ability to detect infusion pumps programming errors. Nurses preferred computerized orders. High error rate was related to manual calculations and inconsistent use of computerized orders.

Overweight and Central Adiposity in School-Age Children and Links With Hypertension

2009-04-08

The purpose of this study of school-age children was to estimate prevalence and interrelationships of overweight, central adiposity, and hypertension. It included 1,070 children in kindergarten through sixth grade (67% Hispanic, 26% African American, mean age = 8.9 years). Measures included body mass index (BMI), waist circumference (WC), systolic and/or diastolic hypertension identified by measurements on three separate occasions. Percentage overweight (BMI ≥95th percentile) was 28.7%, 17.9% were at risk of overweight, 28.8% had WC ≥90th percentile, and 9.4% had elevated (≥90th percentile) systolic and/or diastolic blood pressure (BP). If we had screened only for BMI and examined those with BMI ≥85th percentile or underweight for hypertension, we would have missed 26% of the children with persistently elevated BP. WC explained variance in elevated BP not explained by BMI (p < .001). Measurement of WC is easily incorporated in a school-based screening protocol.

An Integrative Model of Adolescent Health Risk Behavior

Heidi J. Keeler, Margaret M. Kaiser — 2009-04-13

Nursing research in adolescent health risk behavior is lacking because there are few comprehensive nursing models to guide it. Nurses need to understand what influences adolescents to engage in health risk behavior or to refrain from it. The Integrative Model of Adolescent Health Risk Behavior was developed to guide adolescent nursing research using existing theoretical and empirical data. Components include protective/escalatory factors, risk stimulus, maturity of judgment (as a meditational influence), and the risk decision (dichotomized into risk avoidance and taking). The model will facilitate development of nursing interventions to increase health protection by discouraging adolescents from making unhealthy choices.

Children's Health Insurance Program and Pediatric Nurses

Betty Smith-Campbell, Debra Pile — 2010-04-01

Over the past decade, health coverage for millions of low-income children and their families has been impacted by publicly funded programs such as the Children's Health Insurance Program and Medicaid. There are more than six million children currently eligible for coverage. The Obama administration increased funding for the program that allows coverage for additional enrollees. This comes at a critical time with economic downturn. Participation in professional organizations and attention to legislative reports by pediatric nurses are imperative to support legislation that continues to provide adequate funding for this program.

A New Horizon for Newborn Screening

Rita Black Monsen — 2009-08-07

MANY OF US remember a time when mental retardation (MR) affected significant numbers of children and adults. Before the 1960s, phenylketonuria (PKU) and several other preventable causes of developmental delay severely disabled thousands of children each year. reported that between 1950 and 2000, detection and treatment programs for seven conditions associated with MR (congenital syphilis, Rh hemolytic disease of newborns, measles, Haemophilus influenzae B meningitis, congenital hypothyroidism, PKU, and congenital rubella syndrome) reduced their prevalence from 16.5% to 0.005% as causes of MR in the United States. Although this is an impressive drop, Brosco et al. noted that these conditions represent only a small part of the overall prevalence of MR today. Nevertheless, this valuable review affirms the direction taken in the 1960s, led by President Kennedy with the establishment of federal programs using the findings of scientific research to ameliorate disease and disability.

Improving Family-Centered Care Through Research

2009-10-19

The need for change toward more family centered care involved focusing on issues identified by families and staff on a medical-surgical infant and toddler unit of a pediatric hospital. The research process was used to identify issues of concern and to develop and evaluate interventions to improve family centered care. This article presents the research process, the interventions employed, and family and staff perceptions of family and centered care pre and post intervention.

Society of Pediatric Nurses 2009 Election

2010-04-01

The results of the 2009 Society of Pediatric Nurses (SPN) election are as follows. VICE-PRESIDENT

List of SPN 2010 Poster Abstracts

2010-04-01

PENS 2010 Convention

2010-04-01

Increasing Job Satisfaction: Changing the Work Environment Through Evidence

2010-04-01

Increasing staff satisfaction is a common issue among nurse managers. The management team of a 40-bed pediatric medical unit noticed that staff morale began to decline. Management felt the mandatory on-call shifts and budget constraints with regard to staffing contributed to the low morale. The institution's nurse manager council submitted baseline data proving a significant number of mandatory on-call shifts were used to maintain staffing. Collection of the data led to the elimination of mandatory on-call shifts and increased FTEs. However, staff believed patient acuities were on a continuous rise, and these acuity levels were not reflected in staffing. As a result of these concerns, the management team felt it was time to change the working environment allowing for increased job satisfaction and retention.

Self-Scheduling: Evaluating an Evidence-Based Change

Barbara Giambra, Pam Laramie, Stefanie Newman — 2010-04-01

Self-scheduling is one way to provide nurses greater control over their work/life balance. Self-scheduling may have other benefits as well. Therefore, the clinical question asked was, “Among hospital staff nurses, does self-scheduling increase autonomy, job satisfaction and retention, enhance patient outcomes and/or reduce cost?”

Pediatric IV Evaluation (PIE) Tool for Assessing Pediatric IV Complications

Julie Bartoy, Simone Ebbinghaus — 2010-04-01

Pediatric patients are more vulnerable to tissue and vein injury when receiving peripheral IV fluids than adult patients. A search of the literature revealed a lack of pediatric-specific assessment tools. To improve pediatric IV assessment, identification, and scoring of IV-related injuries, a pediatric specific instrument (PIE Tool) was developed. An investigation has been initiated to determine the validity, reliability, clinical utility, and responsiveness of the developed tool. The two-part investigation will occur on select acute care units of a freestanding pediatric hospital where care is provided to children of all ages. Part 1 involves a pre- and posttest administered to staff nurses. The tests will identify the clinical utility and responsiveness to the PIE Tool in comparison to the existing code site check used to identify signs of peripheral IV injury. The second part of the investigation is a pilot study to determine the validity and reliability of the PIE Tool. Acute care staff nurses will complete IV assessments using the PIE Tool for various patients to identify the type and severity of injury. Data from the investigation will be used to determine if the PIE Tool is easy to use and consistently identifies the signs, type, and severity of injury related to a peripheral IV. The benefits of using an improved assessment tool in management of pediatric peripheral IVs are improved peripheral IV injury nursing documentation, reduced severity of infiltrate and phlebitis injury, and decreased incidence of legal action related to IV complications.

Tools for Organizing Medical Information Created for Family Support

Ashley Breaux, Joanne Hyatt, Alisha Farris, Kathy Molina — 2010-04-01

Registered nurses, APNs, and student nurses. A total of 5.6 million children in the United States have health conditions associated with moderate to severe limitations in self-care. Historically, care was provided by hospitals and institutions, but nursing shortages, scarce resources, and in-home technology have shifted care to parents.

Every Last Drop: Implementation of Medication Calendars to Improve Home Medication Adherence on an Inpatient Pediatric Observation Unit

2010-04-01

Medication noncompliance can be directly linked to a lack of understanding of medication usage. Because of the increasing population diversity, language barriers, and that most health information is written at a 12th grade reading level, many people may not understand the health information and medication regimen provided to them. Consequently, caregivers return to the emergency department for care because of a lack of understanding of how to take the medications. Thus, the purpose of this project was to implement interventions to increase medication adherence following discharge from an in-patient observational unit.

Is Tympanic Thermometry an Accurate Method Compared to Axillary Thermometry for Recording Temperatures in Infants Less than 6 Months of Age?

Elizabeth Carbone, Carol Flanagan, Sara Gibbons, Karin Pennie, Kelly Sanborn — 2010-04-01

Temperature monitoring is an essential component of vital signs in the hospitalized infant. Nurses are responsible for instituting an intervention when a temperature is not in appropriate thermal range. The purpose of our evidence-based review was to gather and critically appraise current literature on the use of tympanic thermometry in infants less than 6 months in order to make recommendations for practice.

A Multidisciplinary, Focused Approach to Eliminating CLABSI

Suzanne Durning — 2010-04-01

The cost associated with central line associated blood stream infection (CLABSI) is reported as $39,000–$46,000 per episode. Despite valiant efforts by clinicians across the hospital, CLABSI continues to present challenges. In October 2008, Children's Hospital of Philadelphia (CHOP) formed the BSI Advisory, with a goal to eliminate CLABSI and improve patient outcomes. This unique group includes senior leadership physicians and nurses as well as bedside clinicians from each unit: respiratory, infection control, supply chain, nursing education/practice, quality patient safety, radiology.

Covering All Bases: LEADing Pediatric Surgical Nursing Care

Danielle Flynn, Cara Rakow — 2010-04-01

The LEAD (Liaison for Extra Admissions and Discharges) initiative was designed to facilitate the care of pediatric surgical/trauma patients throughout all nursing units at The Children's Hospital of Philadelphia.

It's All In The Training: Improving Clinical Decision Making and Customer Service in Telephone Triage

Kelly Galloway, MaryBeth Cooper — 2010-04-01

Evaluating the effectiveness of training to monitor both clinical decisions and customer service behaviors is essential. This evaluation process is used initially as a teaching tool to reinforce orientation information. Telephone triage orientation is accomplished using a resource and training manual created with screen shots of step-by-step procedures developed to standardize documentation. Current technology was developed to capture and mine data for each nurse, which is reviewed during monthly rounding sessions led by the clinical coordinator. Evaluation is ongoing for all telephone triage nurses for the purpose of quality assurance and improvement. Calls are evaluated by a customer service agent and by a registered nurse to evaluate clinical decision making, documentation, and utilization of approved telephone triage guidelines as appropriate. Objectivity of the evaluations is reviewed monthly by the Ambulatory Clinical Coordinator group during call calibration sessions.

Strength in Numbers: Identification of Pediatric Hypertension in a Primary Care Setting

Kelly Galloway, Marguerite Swietlik — 2010-04-01

The estimated prevalence of hypertension in children is 2%–3% and is likely increasing with the growing obesity epidemic. Prompt detection and evaluation are important in order to decrease morbidity and properly diagnose the etiology of hypertension. Elevated blood pressure readings in childhood and adolescence can correlate to the development of adult hypertension.

What's All The Buzz? The Role of Distraction During Medication Preparation in a Primary Care Outpatient Setting

Kelly Galloway — 2010-04-01

Medication Preparation Distractions Data for First Floor Ambulatory The following baseline data were obtained initially for this project:

Incontinence-Associated Diaper Dermatitis (IDD): Prevention and Management

Erika Guidry, Jasmin Westcott — 2010-04-01

Educating medical and nursing staff on the proper methods to assess and care for the pediatric skin associated with diaper dermatitis. Several nurses have questioned the Wound, Ostomy, and Continence Nurse (WOCN) on when, why, how, and what could they do to better assess their patients' incontinence-associated diaper dermatitis (IDD). After participating in an Evidence-Based Scholars program, we came up with guidelines for nurses as well as for parents to follow and to learn the proper method to caring for a child with IDD.

J Pouch—An Overview

Patricia Hagarman, Cindy Petro, Judith J. Stellar — 2010-04-01

J pouch surgery has been a widely accepted surgical treatment for patients with ulcerative colitis as well as those who have been diagnosed with familial polyposis. Recent advances in surgical technique and minimally invasive technology have had a positive impact on the postoperative course of pediatric patients undergoing this procedure.

Managing the Postoperative Nuss Patient

Patricia Hagarman, Rebecca Ehling, Judith J. Stellar — 2010-04-01

Pectus Excavatum is an abnormal condition that occurs in 1 out of every 1,000 children, more so in males than females. This condition is corrected with either the minimally invasive Nuss procedure or the open technique of the Ravitch procedure. Focusing on the Nuss procedure, this poster will include an overview of the procedure, indications for surgery, postoperative nursing care, complications, and patient/family education. Pain management, often a challenge in these patients, will be highlighted.

EDIT

Tricia Hayes, Tricia Marie Crowley — 2010-04-01

The emergency department to Inpatient Transition Task Force is an institution-wide initiative. This task force receives significant support and collaboration from many disciplines including but not limited to administration, physicians, nursing, bed management, respiratory therapy, and environmental services. Improving patient flow from the emergency department to the inpatient unit is a significant issue in today's health care environment. Safe handoff of patient information is critical to this process while ensuring institutional quality and efficiency. The goal of the task force is to improve overall patient flow through the institution. With the support and collaboration of this task force, we were able to successfully implement “Fax and Go.” Fax and Go is the title of the nurse-to-nurse handoff communication from the emergency department to the inpatient units at The Children's Hospital of Philadelphia. This program supports consistency and clarity of information. Patient report is completed via electronic records using an ISBARQ format; report is printed and faxed to the inpatient unit. The plan was developed, implemented, and continues to be evaluated using quality improvement processes and data collection. As a result of new initiatives from EDIT; safety, efficiency, and timeliness of patient flow have been improved.

Reframing the Picture of Nursing Quality: Moving from PI to WOW!

Angela Jones — 2010-04-01

The shift in our organizational culture surrounding nursing quality was ignited by increased focus on evidence-based nursing practice throughout the country, recent changes in the ANCC's Magnet Recognition Program emphasizing empirical outcomes, and a robust commitment from leaders within our organization to enhance the quality and safety programs. The potential for transitioning the nursing quality improvement model from one that emphasized data collection with minimal analysis to one that actively engaged clinical nurses and promoted sound action planning in response to data was viewed as an exciting opportunity for our staff.

“Wash Your Paws” Handwashing Campaign

2010-04-01

Handwashing has been shown to be the single most effective barrier to reducing the transmission of infections to patients and others in any setting. CDC guidelines for hand hygiene in health care settings (2002) state that based on extensive evidence, improved adherence to hand hygiene (i.e., handwashing or the use of alcohol-based hand rubs) has been shown to terminate infectious disease outbreaks in health care facilities, reduce transmission of antimicrobial resistant organisms, and reduce overall infection rates.

Aiming for 90%: An Interdisciplinary Project Improving Immunization Record Keeping

Karalyn Kerby, Lisa Spikes, Lissa Symancyk — 2010-04-01

Children often receive vaccines in multiple places: clinic visits, inpatient, health department, or “open vaccine” events. This may result in lost or scattered immunization records. As a result, using records from a single site may underestimate immunization rates.

Pain Free Times Three

Kerry Kovar, Jennifer Hudnall, Becky Wolfe — 2010-04-01

Results from a hospital wide pain prevalence study indicated that patients were experiencing moderate to severe pain without adequate intervention. This motivated a group of nurses to develop a program to improve staff performance and compliance with pain management.

Reviving Resuscitation in the Pediatric ICU and Pediatric Inpatient Units

Yvette Laboy — 2010-04-01

In small pediatric inpatient units and PICUs, despite high acuity, there is often a lack of frequency of patients experiencing deterioration. Concerns from PICU and pediatric nursing staff include a lack of experience in participation in patient codes and in their confidence levels in responding when patients are doing poorly. A review of the literature on both simulation and resuscitation reveals that the opportunity to practice in rapidly changing situations has been shown to improve performance at the “real” patient's bedside. In many institutions, code teams are already assembled, and staff participate in an identified position at each and every resuscitation. Based on this evidence and the formal code team experience, a description of roles during resuscitation was developed. Multidisciplinary educational sessions were presented within the PICU and pediatric units. Quick reference pocket cards were also completed with information regarding drugs and dosing on one side and staff roles on the other. Surprise mock resuscitation drills are being implemented on a regular basis and will be followed by debriefing.

Mentoring Health Care Providers Through the Maze of EBP

Lisa English Long, Barbara Giambra, Susan McGee, Mary Meier — 2010-04-01

In a unique role developed at a large pediatric hospital, Evidence-Based Practice Mentors guide staff in implementation of the evidence-based practice (EBP) process. Mentors use a systems-wide approach to integrating evidence into practice. Development of processes, resources, and tools was essential to complete this work. Mentors work closely with staff engaged in EBP to disseminate findings through the development of evidence summaries, poster and podium presentations, and publications. In working with staff, mentors identify strengths and areas for growth as a way to advance staff personally and professionally. A formal program for immersing staff in EBP has also been developed.

Drug Endangered Children and Methamphetamine: A Provider Tool for Identification

2010-04-01

Rising methamphetamine use in the United States contributes substantially to the dangers faced every day by drug endangered children (DEC). Methamphetamine exposure is associated with clusters of documented physical and behavioral cues. Symptom clusters may mimic other illnesses. Health care provider pattern recognition of symptom clusters is lacking.

Development of a Multidisciplinary Evidence-Based Framework for Sustaining Change in Pediatric Nursing Practice

Shirley Martin, Suzanne Frey, Andrea Smith — 2010-04-01

Up to two decades may pass before the findings of original research become part of routine clinical practice. There are many strong EBP models available for initiating change in pediatric nursing practice, but the challenge remains how to sustain the change over time. The purpose of this EBP project was to identify the most effective concepts and strategies to sustain change from a variety of different disciplines and develop them into a framework for changing practice.

Get Going With Go-Bags

Carol Murray, Abigail Riedel — 2010-04-01

Patients with tracheostomies are at risk for mucus plugging and accidental decannulation, thus requiring emergency suction and/or changing of the tracheostomy tube. These children are seen in many inpatient and outpatient areas of the hospital. The hospital implemented a standardized Go-Bag to ensure that patients with tracheostomies have the necessary emergency supplies with them at all times. We require the caregivers of patients with tracheostomy tubes to carry supplies that allow them to perform a tracheostomy tube change or suction should the child become distressed. We noticed caregivers carrying these supplies in plastic bags and having only some of the necessary supplies with them. Through a grant from the hospital, we were able to purchase bags and supplies. These Go-Bags are bright red so they are easily identified and highly visible. The bags have clear compartments that allow the supplies to be organized and easily visualized when needed. The Go-Bag remains at the bedside and is used for all out-of-unit transports. When the child is discharged, the Go-Bag is sent home with the caregiver to be kept with the child at all times. The caregivers and home nurses report positive feedback on the style, organization, and quality of the Go-Bags. With the adoption of the Go-Bags, we have seen increased compliance with caregivers using the Go-Bags on all social and medical adventures. The Go-Bags have improved care and safety for tracheostomy patients throughout the hospital.

It's a Little Nosey, Isn't It? Screening for Risk Behaviors in Adolescents

Allison Nisbet, Barbara Harrison — 2010-04-01

The purpose of the poster is to describe the quality improvement processes used to create and implement an evidence-based risk behaviors screening tool for adolescents aged 12–18 years admitted to the hospital and to report on pilot test outcomes relating to follow-up assessments, education, and referrals. In addition, the dimensions of inpatient risk assessments as guided by the literature review are presented, and the prevalence in the population overall for each area screened, as indicated by the literature search. Illness and injury associated with risk-taking behaviors comprise the area of highest mortality and morbidity for adolescents (CDC, 2006, 2008). In 2009, The Joint Commission (JCAHO, 2009) has identified a National Patient Safety Goal (#15), which requires health care organizations to identify risks inherent in their population.

Work Redesign for Today's Surgical Patients: The Short Stay Surgical Program

Cindy Petro, Sonja Jones, Judith J. Stellar — 2010-04-01

As surgical care advanced to include more minimally invasive techniques, the surgical population at The Children's Hospital of Philadelphia (CHOP) has evolved from a traditional inpatient length of stay (LOS) of 3 to 7 days, to a significantly shorter LOS—23 hours or less. Data regarding surgical patients were analyzed from FY 2006 through FY 2008. Over this 3-year period, the short stay (SS) surgical population increased nearly 50%. Staffing and work design changes were indicated to keep up with this trend. In order to meet the needs of this changing surgical population, a work redesign project was developed.

To Heparinize or Not to Heparinize

Wanda Rodriguez — 2010-04-01

The use of normal saline or dilute heparin as a flush to maintain the patency of peripheral intermittent infusion devices (PIID) has been a controversy in medicine since the 1980s. Most children admitted to an acute health care facility require a PIID. Maintaining patency of the PIID is important to continue administration of intermittent IV medications, minimize number of IV catheter placements, and decrease number of supplies. Because of the side effects related to heparin use, it is important to evaluate the use of normal saline flushes as an alternative to heparin to maintain PIID patency in the pediatric population.

The More We Know the Less We Cancel

Theresa Schultz, Denise Coan — 2010-04-01

Pediatric patients often require sedation or anesthesia for radiology imaging and intervention. At The Children's Hospital of Philadelphia, over 200,000 examinations are performed annually. The goal of the nurse triage role is to call scheduled pediatric patients to obtain accurate history and educate patients and families about what they could expect on the day of service. Planning care according to unique needs minimizes day of service delays and cancellations. Our experiences were such that patients were being cancelled because of npo violations, medical issues requiring anesthesia when sedation was scheduled, and consent issues.

Taking Sedation Assessment on the Road

Theresa Schultz, Marianne Briggs, Susan Maeder-Chieffo — 2010-04-01

A hospital-based sedation service has become a standard of care in many settings. In our outpatient pediatric radiology and painful procedure setting, patients are evaluated by the nurse practitioner (NP). The appropriateness of sedation is determined through assessment of the patient's medical condition, test to be completed, duration, and pain associated. A plan of care is developed and executed on the day of service by the sedation team. In our current practice model, the NP is the primary provider. In select cases, consultation with the collaborating sedation attending occurs. Care is provided by the sedation nurse with intervention as needed from the NP.

Procedural Sedation

Audrey Scully, Juanda Pryor — 2010-04-01

In pursuit of Nursing Excellence, CNMC nurses are seeking Magnet Recognition through the American Nurses Credentialing Center (ANCC). As part of the Magnet process, nurses strive to improve performance related to Nurse Sensitive Indicators (NSIs). NSIs reflect the structure, process, and outcomes of nursing care (ANA, 2003). The purpose of this project was to increase patient compliance with preprocedure preparation and to improve family satisfaction with the overall experience. Collectively, the ambulatory nurse selected procedural sedation in the neurology clinic as the NSI. This involves implementing preprocedural education via telephone interaction 24 hours prior to the scheduled appointment for anxiolysis. Historically, the neurology nurse noticed an increased trend in patients arriving unprepared or ineligible for their Brainstem Auditory Evoked Response (BAERS) appointment. The registered nurse wanted to increase family compliance, decrease test failure, decrease wait times, and increase patient family satisfaction. Above all, the neurology clinic nurse wanted to maximize patient safety. The first step in assessing patient safety includes assessing whether the procedure and the patient are appropriate for the setting. To date, minimal published evidence related to anxiolysis in the outpatient pediatric arena exists. Beginning in February 2007, the neurology RN implemented calling all patients scheduled for the BAERs test 24 hours prior to the appointment. A pre-appointment assessment is conducted over the phone by the RN. Currently, there are 13 slots per week, 3 per day, Monday through Thursday. Since the RN initiated preassessment calls, the rate of successfully completed BAERs has increased from 55% to 90%. In addition, there have been no adverse events related to anxiolysis in the neurology clinic. The implementation of preprocedural screening is now a standard of nursing practice in the neurology clinic.

Transforming Care at the Bedside (TCAB): Lessons Learned at one Children's Hospital

Laura Shroyer, Susan Widener — 2010-04-01

Transforming Care at the Bedside (TCAB) is a 2-year project funded by the Robert Wood Johnson Foundation and led by the American Organization of Nurse Executives. It was initiated to engage frontline care providers in implementing and evaluating changes intended to improve care delivery and patient outcomes. From simple implementations such as discharge follow-up telephone calls to more complex changes such as bedside report, TCAB has been an important mechanism to allow staff members the freedom and creativity to make changes that truly affect patient care.

Sneak Peak to Peak Stream—Performance Excellence Acquired Through Knowledge

Julie Vaandrager, Kirsten Schroeder Campbell — 2010-04-01

At British Columbia Children's Hospital it is a high priority to focus on pediatric nursing professional development to support a quality practice environment. A professional development plan was created through a competency-based education approach and implemented within a personal accountability framework.

The Art of Comfort Care

Elizabeth Voyles — 2010-04-01

Nursing care is an art that is multidimensional, complex, and essential. Nurses provide a magnitude of interventions for patients, ranging from caring for the intubated patient on a multitude of medications to caring for the patient receiving immunizations. Comfort should be our first and last consideration when caring for patients. It is an important aspect of care and provides strength and allows for optimal function, therefore increasing the quality of life. Comfort care should be delivered at all phases of illness but becomes especially important at end of life. This presentation will discuss Swanson's Structure of Caring and how this model applies not only to nursing care but can also be used by other disciplines. The many dimensions of caring will be identified, including the utilization of child life, music therapy, social work, and chaplains to deliver care. The common final pathway of dying, the types of comfort interventions, and comfort measures that can be used to relieve distress associated with the symptoms will be addressed. Several case studies will be illustrated.

Create a Safe Day, Patient Safety Behaviors for Staff at Helen DeVos Children's Hospital

Kellie Waller — 2010-04-01

Can Helen DeVos Children's Hospital reduce serious safety events by 2010? Helen DeVos Children's Hospital (HDVCH) hired a consultant to look at employee safety behaviors via a survey and interviews. The consultant came up with Scorecard Safety Metrics: Leading Measures, Real-Time Measures, and Lagging.

Improving Patient Safety Utilizing a Peer Risk Management Liasion: Improving IV Safety

Sharon Wilson, Rebecca Pehovic — 2010-04-01

Literature review shows using checklists can help reduce negative patient outcomes. A paper safety checklist at the time of bedside nursing report is currently used. A Peer Risk Management Liaison, a staff RN, reviews all safety reports on unit and follows up with the nurses from a peer perspective versus a supervisory perspective. In reviewing reports, the liaison noticed an increase in incorrect IV fluids, rates, and peripheral IV infiltrates. Fifty-two percent of patients on unit have some type of venous access device, 31% with peripheral IVs, and 20% with central access.

On a Roll With Pediatric Health and Safety

Karen Cochrane, Marilyn Prier, Ginger Parsons — 2010-04-01

A partnership with Blue Cross and Blue Shield of Alabama and The Comprehensive Health Education Center for Kids (CHECK Center) at Children's Hospital support a health education and injury prevention exhibit called Body Trek. Body Trek is an interactive mobile unit designed for children in kindergarten through fifth grade. The program began in 1993 and has been visited by more than 96,000 children. The students learn about safety, healthy choices, and how the body works through interactive hands-on stations.

“Education Days”: An Innovative Approach to Teaching and Managing Staffing Resources

Laura DeBenedictis, Diane Tubman — 2010-04-01

A large pediatric surgical/orthopedic unit recognized the need for a continuing education program specific to its highly specialized patient population. Having a large portion of staff attend education sessions disrupted staffing schedules. A program was conceived, developed, and presented by the staff working on the unit and presented on the unit.

An Innovative Performance Improvement Plan to Increase Medication Safety Software Compliance

Carrie Gavriloff — 2010-04-01

An estimated 54% of pediatric adverse drug events are associated with pediatric IV infusions (Kaushal, Bates, & Landrigan, 2001). Literature supports that use of “smart pump” technology with medication safety software programs. The Institute for Safe Medication Practices adopted the term smart pumps for their ability to reduce medication errors and to gather quality improvement data from the pump or a database server. The Education Coordinator Nursing Products identified the need to increase direct care nurses' consistent utilization of large volume infusion pump medication safety programs in a Midwest freestanding pediatric facility.

Nursing Resource Guide (NRG): A Pragmatic Multimedia Demonstration of Patient Care Policy/Procedure

Jennifer Kindred — 2010-04-01

Applying patient care policy and procedure can be consistent in theory; however, access to resources and interpretation of procedure practice is as individual as the patient and challenges of health care staff in providing effective, uniform care. As technology improves, an increasing number of hospitals are making use of standardized media resources to educate staff and improve consistency. However, patient care policies and procedures differ from institution to institution, challenging even the most experienced nurse. One Midwestern pediatric Magnet facility addressed these concerns by implementing a Nursing Resource Guide (NRG): a pragmatic multimedia demonstration of patient care policy/procedure.

The Best Practice Templates

Angelina Koehler, Elizabeth Colbeth — 2010-04-01

A series of best practice templates that provide a brief description of the pathology, procedure performed, nursing care needs, possible complications, discharge criteria, and contact information for orders. The purpose was to provide quick and direct access to pertinent information, thereby increasing the comfort level and significant/specific knowledge for nurses unfamiliar with the diverse patient population or diagnoses. This inherently increases the nurse's confidence in her or his ability to provide patient care effectively and safely to the unit patient population and reinforces the physicians' confidence that patients were being well cared for by knowledgeable and capable staff.

Pediatric Nursing: Exploring the Next Decade Without Horizontal Hostility

Cherie McCann, Jeannine Roth, Sheri Shull — 2010-04-01

Horizontal hostility must not be tolerated, especially in pediatrics. Hostile work environments are not conducive for nurses, whether in a hospital, a community setting, or even in a university setting. Come and learn why horizontal hostility is ubiquitous, how it effects all of us, and most importantly, how to stop it.

Using Scenario Simulation in an Undergraduate Pediatric Nursing Course

Nancy Wagner, Kimberly Serroka — 2010-04-01

Scenario simulation is becoming widely used as an effective teaching–learning strategy in undergraduate nursing education. This approach replicates real-life situations in a safe environment to provide consistent clinical experiences for all students. The purpose of this descriptive study was to evaluate the effect of scenario simulation on pediatric nursing students' knowledge of sickle cell disease. A pediatric scenario was developed to provide an opportunity for nursing students to enhance assessment skills, increase cultural awareness, and identify the need for developmentally appropriate interventions related to pain. A convenience sample of senior level baccalaureate nursing students (N = 40) participated in the pediatric scenario simulation. The data were collected using a pretest–posttest 10-item questionnaire related to knowledge of nursing care of the child with sickle cell disease. Following the scenario simulation experience, a structured debriefing session was conducted by the faculty to facilitate the guided reflection of the simulation experience. Positive responses from students following this culturally enhanced pediatric scenario simulation included overall satisfaction, a better understanding of assessment skills, medication administration, communication, and decision making in a safe environment.

Are You Smarter Than a Fifth Grader?

Jennifer Wilson, Rica Kendrick, Leah Martin, Renay Johnson, Daniel Petrie — 2010-04-01

Senior Nursing Students, during their child health rotation, researched and planned a field trip for fifth graders visiting the TWU Nursing campus. The purposes of the field trip were (a) to promote the profession of nursing as a viable career choice in the future, (b) to demonstrate how math is incorporated into nursing/medicine on a daily basis, and (c) to demonstrate the importance of accuracy when performing math operations, particularly in the medical field.

Peds Post—Educational Newsletter for Staff

Sherri Woody, Karla Abela, Kathleen Little — 2010-04-01

With varied work shifts, longer days, and shorter weeks, nursing staff expressed feeling overwhelmed with e-mail. With regular e-mail updates about the latest educational offering, standard changes, and regulatory requirements, many staff complained that compliance was impossible with so many pieces of information coming from many different areas that it was difficult to prioritize.

Wiki, Wiki, Wiki

Sherri Woody, Karla Abela, Kathleen Little, Mary Anne Bosher — 2010-04-01

Providing consistent preceptors for orientees is difficult at best. Common issues include the following: Preceptors believe that they have to restart at the preceptor transition. This restart creates frustration and delays progression. Educators found that preceptors were reluctant to express when a orientee was struggling to transition into the role. Novice preceptors often did not recognize that the orientee was not on target. Despite education and training for preceptors, it was a struggle to identify issues early. The delay in early detection created a difficult situation for educators to be able to provide opportunities for improvement.

Reducing Heparin Volume in Pediatric Vascular Devices

Kathrina Boldt-MacDonald, Richard McLenon — 2010-04-01

Advancement in pediatric access device (VAD) technology has allowed for customization of catheter length from access site to tip placement. Consequently, not all catheters have the same fill volume. The need to standardize appropriate heparin dosing volume relative to catheter type, luminal volume, and purpose was identified.

Children With Cancer: Should You be Concerned About Their Sleep?

Mei Lin Chen-Lim, Katherine Finn Davis — 2010-04-01

Clinicians report that children with cancer experience sleep disturbances; however, empirical data are scarce. Optimal sleep is crucial for normal growth and development and emotional and physical health. Therefore, an understanding of the sleep patterns and disturbances experienced by this population as compared to the general pediatric population is necessary.

Procedural Sedation for Children With Cancer: How Do Clinicians Decide?

Danielle Clericos, Catherine Timko — 2010-04-01

Pediatric oncology patients often require painful procedures during the course of their therapy. These procedures can be the source of great anxiety and stress for patients and families. Because of the painful nature of the procedures, most patients will receive either moderate sedation (MS) or general anesthesia (GA) for lumbar punctures, bone marrow aspirates, and bone marrow biopsies. The selection of MS or GA depends on several factors, decided on primarily by the patient's primary oncologist. To better understand the factors involved in decision making, clinicians were asked to participate in individual scripted interviews exploring their decision-making process leading to their sedation choices.

Coping Strategies Used by Adolescents With Diabetes Mellitus Type 1

Elaine Damiao — 2010-04-01

This study aimed to identify the coping strategies used by adolescents in their experience of having diabetes mellitus type 1. The research is a qualitative, exploratory–descriptive study. The Symbolic Interactionism and Ways of Coping Questionnaire by Folkman and Lazarus (1985) was chosen as the theoretical frameworks and the Grounded Theory as the methodological one. Data were collected by semistructured interviews, with 10 adolescents, 12 to 18 years old, with diabetes mellitus type 1, diagnosed at least a year before. The coping strategies are part of two phenomena that explain the adolescent illness experience: “being normal having diabetes” and “not being normal having diabetes.” The strategies identified belong to the following scales of the Ways of Coping Questionnaire: Distancing, Escape–Avoidance, Social Support, Accepting Responsibility, Solving Problem, and Positive Reappraisal. The identification of the adolescent's coping strategies will enable nurses to propose interventions that really help the adolescent to live better with the illness.

The Smoking Cessation Counseling Intervention for Parents of Hospitalized Pediatric Patients (SCCIP) Study: Phase I

Meredith DeMaina Kells — 2010-04-01

Secondhand smoke (SHS) exposure puts children at risk for asthma, infectious illness, and premature death (1–3), and results in an estimated 7,500 to 15,000 children being hospitalized per year (4–5). Among children 2 months to 2 years of age exposed to SHS, 40% to 60% of the cases of asthma, chronic bronchitis, and three or more episodes of wheezing were attributable to SHS exposure (6). Parents who smoke endanger themselves, put their children and spouses at risk for adverse health outcomes, and increase the chance that their children will become smokers (1).

Associations Among Distinct Behaviors of Children With Autism, Community Support for the Family, and Family Adaptation

Heather Hall — 2010-04-01

This study examined the distinct behaviors of children with autism, community support for the family, and family adaptation and the relationships among these variables. Children with an autistic disorder present more socially unacceptable behaviors than other children their age including children with intellectual disabilities. Parents of children with autism have reported how they search for encouragement from friends, seek advice from other families with children diagnosed with autism, pursue support from agencies and programs, and place little emphasis on spiritual support.

Magnet From the Frontline: Using Focus Groups to Realize the Possibilities

Amy Huett, Pamela Trevino — 2010-04-01

The ANCC Magnet Recognition Program recognizes nursing excellence. Early in the journey toward Magnet recognition, a freestanding children's hospital developed a staff advisory council to advise the senior nursing leadership team. The council suggested focus groups to learn from nurses with work experience in a Magnet organization.

Risk Factors and Interventions for Ventilator Associated Pneumonia Among Ventilated Pediatric Intensive Care Unit Patients

Jacalyn Iacoboni — 2010-04-01

Ventilator-associated pneumonia (VAP) is a leading nosocomial infection in pediatric intensive care units, affecting patient outcomes and hospital costs. Implementation of all or nothing evidence-based interventions (VAP bundle) has reduced VAP among ventilated adult patients. However, little research has investigated these VAP bundles in pediatric patients. Baseline data on the presence of VAP risk factors and current practices among ventilated pediatric patients is needed.

Standardized Bronchiolitis Education

Joanne Kaye, Emma Elizabeth Scotter — 2010-04-01

Bronchiolitis is the leading cause of hospitalization of infants and toddlers up to age 15 months. The American Academy of Pediatrics has well-defined evidence-based recommendations for providing optimum care for this patient population, which is reflected in a care pathway developed and used at our hospital. Treatment for bronchiolitis is most often supportive care only. The bulk of care for bronchiolitis is done by parents after discharge as symptoms can continue for 3 to 4 weeks after hospitalization. Parents must feel confident in caring for their children at home. Little literature is available regarding best practice for family education and ongoing documentation of the education.

Adult and Child Weight Perception in Wendover, UT

Karen Lundberg, James E. Kohl — 2010-04-01

Childhood obesity is a prevalent and significant problem in the United States demonstrated across all age groups, ethnicities, and educations levels. Childhood obesity puts children at greater risk for associated comorbidites such as heart disease, hypertension, diabetes, and cancer (). Management of childhood obesity continues to be problematic and challenging for both parents and health care providers. Self-perception of correct BMI should be considered when developing obesity treatment programs.

Responding to Verbal Abuse: Exploring Successful Nursing

Huong Mai, Mary Dominiak, Candace Hale — 2010-04-01

Verbal abuse (VA) is the most common form of workplace violence that nurses experience (Cameron) and can result in psychological trauma, decreased morale, and decreased job satisfaction in nurses; can affect staff retention; and can negatively impact quality patient care. Research findings suggest that VA is a problem for nurses in all areas, including the pediatric setting (Pejic). No studies have been found that describe successful nurse interventions and strategies to prevent or reduce VA.

Incremental Research for Developing a Questionnaire on Child Autonomy Toward Minor Surgery—By Way of the Parent and the 3- to 6-Year-Old Child Undergoing Minor Surgery for Inguinal Hernia

Satomi Ono, Yukiki Manabe — 2010-04-01

The objective of this research is to inquire into the intrinsic appropriateness of questions as part of an incremental process developing a questionnaire regarding child autonomy toward minor surgery.

At Camp and Caring for Special Needs Children: The Lived Experience of Student Nurses

Brenda Pavill, Roberta Allred, Nancy Jackson — 2010-04-01

The study uses a phenomenological qualitative approach to better understand the experiences of student nurses in a pediatric rotation attending an overnight camp respite program to care for special needs children of military families. The findings can have an impact on pediatric clinical practice in several ways. First, depending on the responses of the students attending the experience, faculty may choose to include or not include similar pediatric experiences in their curricula. If nursing faculty includes such experiences in clinical rotations the frequency that respite care can be offered to parents of special needs children increases. Additionally, the feedback obtained from student responses can be used to make modifications and improvements for future students attending similar programs. Also, utilizing similar community pediatric experiences may provide another avenue for faculty and students trying to find clinical placement in communities where inpatient pediatric census is low. Lastly, if students perceive their lived experience as a constructive one, they would be more likely to consider working with this population in the future; an outcome that can positively impact care of special needs children and their families.

Measuring the Pediatric Nurses' Knowledge, Perception, and Behaviors Concerning Clinical Alarms

Simmy Randhawa, Sarah Weeks, Meghan Yowell — 2010-04-01

Clinical monitoring is a key tool for patient safety as it alerts clinicians to patient deviations from a predetermined “normal” status. However, when alerted excessively for clinically insignificant events, clinicians may ignore or silence the alarms. Results from an online survey for hospitals and clinicians, sponsored by the American College of Clinical Engineers, found that 77% of respondents felt that clinical alarms to disrupt patient care and 78% reported that the frequency of alarms can reduce trust in alarms and cause clinicians to disable them. Preliminary data collection at our organization in August 2007 indicated that a total of 8732 alarms occurred over a 10 day period; 51.25% of these alarms were heart rate alarms, 17.58% were pulse oximetry alarms, and 31.17% were arrhythmia alarms. Only 17% of the alarms were deemed clinically significant. Because these data indicate a high risk of excessive care disruptions for clinically non-significant events, our proposed study, using the Nursing Role Effectiveness Model (NREM), will focus on the preventive role of the nurse in relationship to the process of clinical monitoring and patient outcomes. Our study is designed to implement and assess the outcomes of a structured training protocol aimed at (a) improving the nurse's knowledge of the clinical alarm system and (b) improving the nurse's ability to customize alarm limits based on the patient's status. Findings from this study will be used to increase understanding of the nurse's role in clinical alarm management, and patient safety and to glean future training recommendations.

Providing Medication Information Across Practice Settings

Kathy Riley-Lawless — 2010-04-01

There is a paucity of literature that addresses the challenges associated with the medication reconciliation process and children. Family ability to participate in the process by providing complete and accurate medication information needs to be addressed across all points of entry into health care.

Application of the Brazilian Pain Quality Cards in Children and Adolescents in Pain

Lisabelle Rossato — 2010-04-01

This pilot, descriptive, and exploratory study aimed to verify the representative of the quality of pain, applying the Pain Quality Cards to 50 Brazilian children and adolescents in pain and hospitalized, after being approved by the Ethic Commission. The interviewees were stimulated to talk about each of the cards. The Pain Quality Cards had been elaborated from McGill Pain Questionnaire were applied in 263 adults with chronic pain and had been selected the 18 describers of pain more chosen, which had been directed to the famous Brazilian cartoonist Maurício de Souza to create illustrations using the personage “Cebolinha.” The illustrations of the pain describers had been evaluated by four judges to verify the adequacy between the drawing and the describer of pain to 45 Brazilian children without pain. However, the results this study have shown that there is no relationship between the age group and the number of positive answers. The identification of the cards was different to each group: 61.1% of the cards were identified for the prescholar; 77.8% for the scholar, and 27.8% for the adolescents. Conclusions have shown that the use of the Pain Quality Cards has revealed itself successful and able to evaluate, discriminate, and measure the different dimensions of pain. Its use should be encouraged and accessible to health professionals, with a view to the qualitative evolution of care to children and adolescents in pain. This requires the insertion of the pain theme in the curricula of all medical, nursing, and paramedical schools.

The Meaning of the Experience of the Pain and the Hospitalization for the Brazilian Child

Lisabelle Rossato — 2010-04-01

The aims of this study were to understand the meaning that the hospitalized Brazilian child attributes to pain and hospitalization. Because methodological and theoretical framework were used the Grounded Theory and the Symbolic Interactionism, respectively. For the collection of data five interviews half-structuralized with Brazilian children in a pediatric unit of a public hospital of the city of Sao Paulo, Brazil had been conducted through, after the approval of the committee of ethics of the institution. The results showed three categories: having to be separate from family and friends during hospitalization; having to submit to the painful procedures and attributing two sides for hospitalization. It concluded that the arrival of an event in the life of the child causes a series of changes. The Brazilian child attributes to this new reality meanings that are of extreme importance for the knowledge of the nurse to increase the quality of the nursing assistance.

The Meaning of the Experience of Brazilian Families Having a Child in Pain Due to Juvenile Idiopathic Arthritis

Lisabelle Rossato — 2010-04-01

The aims of this study were to understand the meaning of the experience of Brazilian families having a child experiencing pain due to juvenile idiopathic arthritis and to construct a theoretical model representing this experience. Grounded Theory and Symbolic Interactionism were used as methodological framework and theoretical framework, respectively. Data were collected by semistructured interviews with 12 families. Data analysis allowed for the construction of the theoretical model Caring for the child to grow despite the pain, which describes an experience based on motivational elements: wanting to see the child without pain and wanting to see the child live a normal life, reviewing how the family lives the transition in its development cycles, retaking and integrating them in the family dynamic with the appearance of the disease, and pain in the child. This theoretical model provides a framework for teaching, research, and care, permitting advances in terms of theoretical nursing knowledge.

Age-Appropriate Health Promotion Education: Roots Firmly Established in Baccalaureate Pediatric Rotation

Zepure Samawi, Mary S. Haras, Teresa L. Miller — 2010-04-01

Chronic illnesses in the pediatric population are a growing problem and significantly impact quality of life. The Essentials of Baccalaureate Education for Professional Nursing Practice (The American Association of Colleges of Nursing, 2008) addresses the importance of health promotion at the individual level accross the lifespan to effect optimal population health. This qualitative study explores senior baccalaureate nursing students' perceptions (N = 85) of the teaching and learning experience related to health promotion during their pediatric clinical rotation. Several themes emerged. Knowledge was enhanced related to patient and family understanding of basic issues as well as self-reflection of the student's perceptions, teaching styles, and understanding of essential concepts learned in the classroom. Tailoring material appropriate to the developmental stage of the individual was considered very important. Students identified that adapting the teaching style and method to the appropriate age and education level ensured engagement by the child or family. Students identified that the children and families had a desire to learn and were more likely to be an active participant if the material was presented in multiple sessions over time and in an interesting manner. Students' perception of the importance of patient and family teaching evolved over the course of the semester and highlights the importance of providing students with the tools necessary to be effective teachers and change agents to promote healthy behaviors across the lifespan. Fink's Taxonomy of Significant Learning can be applied to facilitate integrated course design for a pediatric baccalaureate nursing curriculum.

Defining Care Models to Achieve Excellence in Patient and Family Centered Care

Angela Scott, Sharon Johnson, Mary Salassi-Scotter, Tammy Webb — 2010-04-01

Professional models of care define the framework for nursing practice whereas professional practice models define how nursing practice, policies, and procedures are developed and implemented. Defining such care models is key to achieving excellent nursing practice outcomes. The purpose of this project was to define the professional model of care and practice model for a large children's hospital.

Adolescent Sleep: Implications for Nursing

Shirley Wiggins, Jackie Freeman — 2010-04-01

Adolescents report changes in sleep that include less night time sleep, later bedtimes, and day time sleepiness. These developmental changes in sleep have been reported to contribute to difficulty with morning waking, altered school performance, depression, obesity, and other aspects of well-being. There is a need to understand how developmental changes in sleep influence the health of this age group. Adolescents who recover at home following ambulatory surgery report sleep alterations related to pain, nausea, and vomiting. Parents may not awaken adolescents postoperatively to administer oral analgesics because of concerns about sleep interruption. With a limited knowledge about the health effects of developmental sleep changes during adolescence, it is unclear how pain and care interventions that interrupt sleep may contribute to postoperative recovery outcomes.