Journal of Pediatric Nursing - Articles in Press

Technology and the Illusion of Saving Time - Uncorrected Proof

Michael Grossman — 2012-05-10

In these tough economic times, everyone is looking for ways to be more efficient and cost-effective. Unfortunately, efficiency often comes at a cost, a cost that may destroy the essence of what you are trying to achieve. The greatest lesson in life is learning to do what you need to do, when you need to do it, whether you want to or not (). I recently presented at a conference in Las Vegas where they had kiosks, similar to the ones that you find in the airport, where you could self-register for a room at the hotel. It was certainly efficient. After registering, I asked the one live registration clerk how this system was working. She said it saved money by eliminating a lot of front desk jobs, yet was impacting on good customer service, which eventually could impact on the number of customers coming to the hotel. Thus, an initial improvement in efficiency and cost savings could eventually prove destructive to business. Technology often offers the promise of improved efficiency and cost savings. However, without careful attention to the implementation, technology can actually have harmful long-term outcomes.

The Broselow Tape as an Effective Medication Dosing Instrument: A Review of the Literature - Corrected Proof

Michael J. Meguerdichian, Timothy C. Clapper — 2012-05-10

The Broselow tape provides clinical providers with a method of quickly estimating medications and airway adjuncts for pediatric patients. However, since the development of the Broselow tape, there has remained a controversy over the accuracy of the tape for estimating weight to determine pediatric resuscitation needs. Using multiple search engines, this review of the literature examined the potential of the Broselow tape to be an effective guide for emergency medicine teams. The evidence suggests that when compared with other methods of estimating medication dosing and airway equipment size, it is the most reliable predictor in most situations, especially in younger pediatric patients. Ultimately, the Broselow tape is only a guide that should be considered, whereas the final determination of drug dosage and equipment sizes will be determined by the patient situation and the clinical provider's experience and training.Objective: Pediatric emergency medicine departments can be overwhelmed with conflicting literature on the accuracy of the Broselow tape. The Broselow tape provides clinical providers with a method of quickly estimating medications and airway adjuncts for pediatric patients. We present an analysis of literature and research of the Broselow tape as a means of estimating weight in pediatric patients to address medication dosing.Methods: A systematic review was conducted using three primary search engines, including PubMed, Ebscohost, and ProQuest. Inclusion criteria included (a) peer-reviewed literature and (b) original research articles. Literature related to or appearing to have a commercial interest was not included in this review. The initial search showed 84 publications, 24 with relevance to this review.Results: Although the Broselow tape may underestimate the weight of outlier pediatric patients, it is still the most accurate tool available. In addition, it appears to be more accurate for use with younger patients.Conclusion: The evidence suggests that when compared with other methods of estimating medication dosing and airway equipment size, the Broselow tape is the most reliable predictor in most situations, especially in younger pediatric patients.

Children and Outdoor Play - Uncorrected Proof

Deborah L. McBride — 2012-05-07

AS A RESULT of the current focus on the obesity epidemic, the benefits of physical activity are being more widely discussed. A new study reveals that approximately half of all preschool-aged children are not being taken outside to play each day (). Clinicians are advised by the American Academy of Pediatrics (AAP) to encourage a healthy and active lifestyle, which includes playing outdoors frequently, and according to the AAP, participating in physical activities by playing and playing outdoors is beneficial for mental health, vitamin D levels, motor development, vision, and cognition. The researchers examined data of 8,950 preschool-aged children from the Early Child Longitudinal Study–Birth Cohort, a nationally representative study that tracks children born in 2001. The researchers used parent's reports on how many physical activities their children had. They found that 51% of children went outside to walk or play at least one time per day with either parent, whereas 58% of children who were not in child care went outside on a daily basis. The researchers found that being a boy, having physically active parents, and having more regular playmates were linked to going outdoors at least one time per day. Girls were 16% less likely than boys their age to be taken outside by their parents to play. Asian, Black, and Hispanic mothers were less likely to take their children outside on a daily basis than White mothers (49%, 41%, and 20%, respectively). No significant connection was found between the mother's marital status, child's television viewing, parent perceptions of neighborhood safety, and household income with the frequency of outdoor play. Overall, 60% of mothers worked outside the home, and 79% exercised less than 4 days a week. Most of the children (80%) spent time in nonparental daycare—an average of 28.5 hours a week. Only 44% of mothers and 24% of fathers reported taking their child outside to play at least once a day. Children who were not in any type of child care were slightly more likely to have a parent take them outside to play (58% vs. 51%). Mothers who worked either part time or full time were 18% to 30% less likely to take their child out to play on a daily basis, which points to logistical barriers and time constraints standing in the way of outdoor play. Although it is possible that children are getting outside to play each day at child care, according to the researchers, the activity levels at child care are low, and preschoolers rarely achieve 60 minutes of recommended moderate-to-vigorous physical activity during the child care day. On the other hand, children were more likely to get outside every day if they had regular playmates and if they had a parent who exercised at least 4 days a week. The researchers acknowledged that the study was limited by the lack of information on season or climate and the assessment of outdoor playtime.

Tough Times for Children - Uncorrected Proof

Cecily L. Betz — 2012-05-07

The past several years have been financially difficult for many families not only in the United States but also worldwide. Most often, the focus of attention during these turbulent and trying economic times has been directed to the barometers that reflect the economic “health” of the nation and our world. These barometers include tracking the filings for unemployment insurance, the monthly payrolls, and the indices of manufacturing and nonmanufacturing activities. One of the unfortunate consequences of the economic downturn is the effect that it has upon children. Times of national economic hardship intensify and exacerbate the struggles that poor and low-income families have.

“It's No Big Deal”: Adolescents With Congenital Heart Disease - Corrected Proof

Kathleen Shearer, Gwen R. Rempel, Colleen M. Norris, Joyce Magill-Evans — 2012-04-26

Improved survival rates for congenital heart disease (CHD) have increasing numbers requiring lifelong specialized health care. In this interpretive description, interview data were analyzed to understand how adolescents with CHD describe everyday life and relate to questions about quality of life. Most viewed themselves as normal, their CHD something that they situated into the foreground or background of their lives as it suited their needs. They spoke of quality-of-life issues in a concrete manner focusing on physical activity limitations and their need to fit in. These findings can direct interventions for adolescents with CHD for transition to adulthood.

Nurses' Uniform Color and Feelings/Emotions in School-Aged Children Receiving Health Care - Corrected Proof

2012-04-26

Children may fear nurses wearing white uniforms. When emotions and uniform color were studied in 233 children, many positive emotions were most often associated with blue, bold pink-patterned, or yellow-patterned tops (all p ≤ .002). Negative emotions were not associated with uniform top colors (all p < .001). However, after excluding “uniform color does not matter,” 8 negative emotions were most often associated with white uniform color (p < .001–.04), and 2 others were most often associated with the yellow-patterned top. Bold pink-patterned and solid blue uniform tops were preferred. In conclusion, children's emotions were associated with nurse uniform color.

Uncertain Link Between Loneliness and Companion Animals in Rural Adolescents - Corrected Proof

Laura Nist, L. Lee Glenn — 2012-04-25

The study by Black (2011) concluded that pets may be valuable in reducing loneliness among adolescents based on the finding that pet owners had lower loneliness scores. As appealing and logical as this conclusion may appear, there are a number of shortcomings in the study that prevent it from actually supporting this conclusion.

Empower U: Effectiveness of an Adolescent Outreach and Prevention Program With Sixth-Grade Boys and Girls: A Pilot Study - Corrected Proof

2012-04-20

Sixth graders are at a prime age to modify behaviors and beliefs regarding exercise, nutrition, body image, and smoking. Empower U was created to change knowledge, beliefs, and behaviors regarding these topics. This pilot study utilized pre/post assessments of 58 sixth graders from a private middle school in the midsouth. Results showed a significant increase in self-esteem as well as in exercise and nutrition knowledge and beliefs at posttest and a significant increase in body image as well as in self-reported exercise and nutrition behaviors at the 1-month follow-up. Empower U provides nurses with an effective educational program that may be useful in positively impacting health behaviors.

Here Today, Gone Tomorrow: Diagnostic and Treatment Challenges Created by Medication Shortages and Discontinuations - Corrected Proof

Mary S. Burr — 2012-04-12

Drug shortages and discontinuations can present a dangerous if not deadly scenario for our pediatric patients. The inability of a provider to prescribe the indicated and approved drug for an illness often can adversely affect therapy, compromise or delay medical procedures, and result in medication errors and less than therapeutic treatment outcome (). A survey of 311 pharmacy experts representing 228 hospitals and other health care sites over a 6-month period showed that 89% experienced shortages that could have caused a medication safety issue or error in patient care, and 80% experienced shortages resulting in a delay or cancellation of a patient care intervention. In addition, 98% experienced shortages resulting in increased costs. Providers pay an average of 11% more for shortage products. If these products cannot be obtained, providers can turn to generic medications (if available) or more costly therapeutic substitutes. This could result in at least $200 million annually, not including indirect costs, such as the added labor needed to manage shortages and secure alternative supplies ().

Optimizing the Assessment of Pain in Children Who Are Cognitively Impaired Through the Quality Improvement Process - Corrected Proof

2012-04-11

Pain assessment in children with cognitive impairment (CI) is challenging. A quality improvement (QI) project involving evidence-based review of pain assessment tools, feedback from the Family Advisory Council, trialing of selected tools within clinical settings including obtaining feedback from nurses, and parents caring for nonverbal children with developmental delay was reported. Synthesized evidence supported the adoption of revised Faces, Legs, Activity, Cry, and Consolability pain assessment tool into clinical practice. Results of postimplementation audit and challenges of staff nurse involvement in the QI process were also discussed. The 24-month-long QI process and its impact on changing practice were described in detail.

The Effects of Oral Motor Stimulation on Feeding Behaviors of Infants Born With Univentricle Anatomy - Corrected Proof

Patty Coker-Bolt, Courtney Jarrard, Francis Woodard, Paige Merrill — 2012-04-11

The purpose of this pilot study was to determine the effects of oral motor stimulation on infants born with complex univentricle anatomy who required surgery shortly after birth. A quasi-experimental group design was used to compare 18 infants receiving an oral motor stimulation program with 10 infants who did not receive any oral motor intervention. Infants in the treatment group received the oral motor treatment prior to cardiac surgery and immediately following surgery, one time a day, 6 days a week. Outcomes data were collected for length of time to reach full bottle-feeds and length of hospital stay. A statistically significant difference was seen in the overall length of hospital stay between the two groups (p = .04). Infants in the experimental group were hospitalized for a mean of 28.6 days and infants in the comparison group for a mean of 35.3 days. Infants in the treatment group achieved full bottle-feeds 2 days earlier than infants in the comparison group, although this was not statistically significant. There is positive support for the use of oral motor stimulation for infants born with univentricle anatomy, but further study is needed to determine the long-lasting effects of this intervention.

Biological Correlates and Predictors of Insulin Resistance Among Early Adolescents - Corrected Proof

Ross J. Bindler, Ruth C. Bindler, Kenneth B. Daratha — 2012-04-09

Abnormal glucose metabolism is associated with obesity, insulin resistance (IR), and Type 2 diabetes mellitus. The purposes of this study were to describe anthropometric and laboratory markers of adolescents, examine correlates of IR, and test ability of anthropometric and laboratory markers to predict risk of exhibiting IR. A total of 150 early adolescents participated. Participants with obesity had increased IR, high-sensitivity C-reactive protein, triglycerides, and blood pressure. Waist circumference and triglycerides were predictive of IR. Multiple risk factors compound and lead to long-term health consequences among youth. Nurses can evaluate these factors to identify IR.

Response to Letter - Corrected Proof

Keri Black — 2012-04-05

I appreciate the opportunity to respond to Nist and Glenn's (2012) letter to the editor regarding my article, The Relationship between Companion Animals and Loneliness among Rural Adolescents (Black, 2012). Nist and Glenn raised questions about the validity of my finding that adolescents who reported a companion animal bond (CAB) reported less loneliness than adolescents without a CAB. I agree with their stated limitations of this study and addressed those within the article's survey limitations and recommendations areas. These include a small sample size of non-pet owners, limited to Southwestern geographic locations, and other potentially confounding factors.

Children With Developmental Disabilities at a Pediatric Hospital: Staff Education to Prevent and Manage Challenging Behaviors - Corrected Proof

Norah L. Johnson, Joel Lashley, Alice V. Stonek, Annette Bonjour — 2012-03-29

Children with developmental disabilities may get frustrated in unpredictable hospital environments. Frustration may escalate to challenging behaviors, which are a safety concern and may contribute to staff and patient injuries, use of restraints, and procedure delay or cancelations. The purpose of this article was to describe a pilot staff education program on preventing and managing challenging behaviors of children with developmental disabilities at a pediatric hospital. The 2-hour-long education (1 hour on-line and 1 hour instructor led) content focused on family-centered care and communication skills, including verbal judo™ modified for use in the health care setting. Participants in the instructor-led sessions reported improved knowledge and decreased fear about caring for children with developmental disabilities. Relationships of the education and fewer staff injuries, fewer canceled procedures, and decreased use of restraints merit further study.

After the Storm: Personal Experiences Following an EF4 Tornado - Corrected Proof

Olivia W. May, Amy B. Bigham — 2012-03-26

In April of 2011, an EF4 tornado ripped through the city of Tuscaloosa, AL, leaving in its wake thousands of destroyed homes and businesses. In the hours and days that followed, the health care community of this city, as well as the entire state of Alabama and the southeastern United States, came together to provide care to hundreds of victims, recovery workers, and volunteers.

Risk Factors and Interventions for Ventilator-Associated Pneumonia in Pediatric Patients - Corrected Proof

Jill Morinec, Jacalyn Iacaboni, Molly McNett — 2012-03-26

Ventilator-associated pneumonia (VAP) is a leading nosocomial infection in pediatrics. Little research has investigated the risk factors or effectiveness of interventions for pediatric VAP prevention. The purposes of this study were to identify the risk factors associated with VAP in pediatric patients and describe current VAP prevention practices. Data were gathered retrospectively on ventilated patients admitted to the pediatric intensive care unit over 12 months. No variables were found to be predictive of VAP. Review of practices indicates that better documentation is needed of all interventions. Findings provide information to guide the implementation of VAP bundles. Implementation should focus on adequate documentation of VAP prevention efforts.

Telephone Follow-up for Pediatric Ambulatory Surgery: Parent and Provider Satisfaction - Corrected Proof

2012-03-12

Traditional 4- to 6-week clinic follow-up after pediatric ambulatory surgery does not rapidly identify complications and is often a burden for parents. Telephone follow-up offers support and is preferred in a variety of adult populations, but there is little research in pediatrics to support this practice. This article describes a practice change involving a standardized telephone follow-up protocol by a pediatric nurse practitioner to parents within 1 week of their child's ambulatory surgery. An interview survey method was used to evaluate parent satisfaction with telephone follow-up and desire for a clinic visit. Staff satisfaction and resource utilization are also described.

Student Nurses as School Nurse Extenders - Corrected Proof

Carol L. Rossman, Florence V. Dood, Darcy A. Squires — 2012-03-12

The severe underuse of school nurses leaves students with unaddressed health needs that impact their safety and learning ability. An undergraduate pediatric clinical focusing on nursing students and the role of a school nurse in an elementary school setting can be a unique approach to combining the needs of school children and educating student nurses. One school of nursing created such a project to help address these needs and collect data on the activities student nurses performed in school nurse role and their impact on student health. This project serves as both a practice improvement project and an innovation in pediatric clinical education. The purposes of this project were to quantify baccalaureate nursing student activities related to the school nurse role and to evaluate the results that have the potential to impact on student health in an urban elementary school.

The Use of Nonnutritive Sucking to Facilitate Oral Feeding in a Term Infant: A Single Case Study - Corrected Proof

Celia Harding, Lindsay Frank, Carol Dungu, Nuala Colton — 2012-02-24

Abstract: This individual case study presents an evaluation of and reflection on the use of nonnutritive sucking as a technique to facilitate nutritive sucking with an infant with feeding difficulties. Nonnutritive sucking is used in a variable way with mainly premature or sick infants. However, the rationale underpinning use of such an approach is not clear. The infant participant in this study, Baby H, was born at 37 weeks. This case illustrates the use of nonnutritive sucking as an approach with supported rationales for promoting transition toward oral feeding with infants who have complex needs and who are term infants. The literature focuses on using nonnutritive sucking with premature infants who have no additional difficulties such as hypoxic neonatal encephalopathy, meconium aspiration, sepsis, or severe perinatal asphyxia. The intervention carried out with Baby H demonstrates that nonnutritive sucking can contribute toward the management of an infant's feeding development. Baby H took 23 days to develop a sequential nonnutritive sucking pattern, but her ability to transfer this to nutritive sucking and safe feeding took the first 17 months of this infant's life. This study is unique in that it explored the issues involved with a term infant who had complex needs that impacted on feeding development. It is important because many practitioners use nonnutritive sucking with infants who have complex needs.

A Comprehensive Review of Evidence and Current Recommendations Related to Pacifier Usage - Corrected Proof

Antonia M. Nelson — 2012-02-17

Pacifier usage is controversial, and published recommendations are contradictory. The purposes of this literature review were to provide a comprehensive summary of risks and benefits of pacifier usage based upon the highest levels of evidence available and to provide a reference for nurses to utilize while assisting mothers in making an informed decision. Results indicated that benefits include reported ability to soothe/comfort, decreased risk of sudden infant death syndrome, and a probable synergistic role in adjunctive pain relief. Greatest risks are an increased incidence of acute otitis media, possible negative impact on breast-feeding, and dental malocclusion particularly if usage is greater than 2–3 years. The frequency, intensity, and duration of pacifier use are related to type and extent of all risks.

Quality Improvement Project to Reduce Infiltration and Extravasation Events in a Pediatric Hospital - Corrected Proof

2012-02-17

A safety event response team at Cincinnati Children's Hospital Medical Center developed and tested improvement strategies to reduce peripheral intravenous (PIV) infiltration and extravasation injuries. Improvement activities included development of the touch–look–compare method for hourly PIV site assessment, staff education and mandatory demonstration of PIV site assessment, and performance monitoring and sharing of compliance results. We observed a significant reduction in the injury rate immediately following implementation of the interventions that corresponded with monitoring compliance in performing hourly assessments on patients with a PIV, but this was not sustained. The team is currently examining other strategies to reduce PIV injuries.

Alcohol Use: From Childhood Through Adolescence - Corrected Proof

Travis “Pete” Lewis, Carol Hession — 2012-02-13

Alcohol use is often overlooked and more importantly unsuspected in young children 3–11 years of age. Alcohol use in preteens is commonly overlooked when there is growing evidence to suggest that the age at which one begins drinking can be predictive of future problem drinking and other substance abuse. There is a need for health care professionals and elementary school educators to be aware of the real and growing problem of alcohol use from childhood through adolescence. It is sometimes difficult to recognize because many of the effects of alcohol mimic routine presentations seen in children. This article focuses on the significance, contributing factors, effects on the body, comorbidities, and social and psychological effects of alcohol use on children through adolescence. It also examines diagnostic screening for alcohol use in adolescence and the detrimental role of the nurse in assisting with identifying and preventing the problem of alcohol use in childhood through adolescence.

Administration Burden Associated With Recombinant Human Growth Hormone Treatment: Perspectives of Patients and Caregivers - Corrected Proof

2012-02-10

Patients treated with recombinant human growth hormone (rhGH) for growth hormone disorders follow a challenging treatment schedule. This study assessed patient and caregiver experiences with rhGH therapy treatment regimens. Patients 13 years or older with growth hormone deficiency and caregivers completed Web-based surveys. A total of 61 patients and 239 caregivers participated. Storage of rhGH was considered burdensome by more than a third. More than 51% considered storage “somewhat more” to “much more of a burden” relative to the burden while not traveling. “Away from home or traveling” was the most frequently endorsed reason for missing a dose. rhGH treatment while traveling is challenging because of rhGH storage burden.

Identifying Changes in Comfort and Worry Among Pediatric Nursing Students Following Clinical Rotations - Corrected Proof

Madeline Lassche, Sharifa Al-Qaaydeh, Christopher I. Macintosh, Melissa Black — 2012-02-10

Pediatric nursing clinicals often cause feelings of worry, thus hindering students' discovery. This study sought to identify worry-provoking elements before and after pediatric clinical rotations. Participants included 100 pediatric nursing students. A descriptive, exploratory, quantitative design was used to explore student worry using the Pediatric Student Comfort and Worry Assessment Tool. Pre- and post-test scores were calculated to evaluate changes in worry and comfort. The item that changed the most was comfort in assessment, whereas worry regarding causing a child pain changed the least. These data suggest the significant need in identifying worries to improve confidence in performance for pediatric clinical.

Promoting Physical Activity in Preschoolers to Prevent Obesity: A Review of the Literature - Corrected Proof

Eric A. Hodges, Cecily Smith, Stacy Tidwell, Diane Berry — 2012-02-10

This literature review summarizes clinical recommendations for adequate physical activity and reviews recently published studies that focus on identifying common factors associated with physical activity levels among preschoolers in the United States and Canada. Currently, there is inconsistency in both the definition of and recommendations for physical activity. In addition, there is relatively little research in this area. Common factors and contexts associated with physical activity levels in preschoolers in this review included (a) child characteristics; (b) interpersonal dynamics between preschoolers and their families, childcare providers, and health care providers; (c) childcare setting; and (d) neighborhood environment.

Discussing Death With Pediatric Patients: Implications for Nurses - Corrected Proof

Danelle Nielson — 2012-01-16

Communicating about end-of-life issues with a pediatric patient and their families can be difficult and uncomfortable for many nurses. The purposes of this article are to provide nurses a foundational overview of the child's understanding of death through the lens of awareness, development, and experience and to provide effective ways for nurses to implement this knowledge as they approach the topic of death with patients and their families.

An Exemplar for Evidence-Based Nursing Practice Using the Magnet® Model as the Framework for Change: Oral Feeding Practice in the Neonatal Intensive Care Unit - Corrected Proof

Sharon Sables-Baus, Jeannie Zuk — 2012-01-09

Implementation of research evidence into practice can be challenging in areas such as the neonatal intensive care unit (NICU), where the environment is complex and rapidly changing and caregiving goals have shifted from simply infant survival to supporting positive long-term neurodevelopmental outcomes. Clinical nurse specialists (CNS) are ideally positioned to use research to obtain new knowledge, innovations, and improvements in care as part of an interdisciplinary team. The authors describe the role of the CNS in changing NICU culture around feeding infants, an important and frequent nursing activity, with the Magnet® model as the framework for change.

Implementing a Pediatric Obesity Care Guideline in a Freestanding Children's Hospital to Improve Child Safety and Hospital Preparedness - Corrected Proof

Renee M. Porter, Jodi Thrasher, Nancy F. Krebs — 2012-01-04

Medical and surgical care of children with severe obesity is complicated and requires recognition of the problem, appropriate equipment, and safe management. There is little literature describing patient, provider, and institutional needs for the severely obese pediatric patient. Nonetheless, the limited data suggest 3 broad categories of needs unique to this population: (a) airway management, (b) drug dosing and pharmacology, and (c) equipment and infrastructure. We describe an opportunity at the Children's Hospital Colorado to better prepare and optimize care for this patient population by creation of a Pediatric Obesity Care Guideline that focused on key areas of quality and safety.

Tough-Skinned Kids: Identifying Psychosocial Effects of Psoriasis and Helping Pediatric Patients and Families Cope - Corrected Proof

Virginia W. Lin — 2011-12-15

Outward appearance is exquisitely and undeniably tied to self-perception. Pediatric patients with psoriasis face the challenge of coping with psychosocial issues because of the visibility of their skin lesions. The burden of psoriasis also affects the quality of life of family members. This article discusses pediatric psoriasis, current literature on psychosocial impact, role of the nurse to help patients and families cope, and recommendations for further research. Through clinical intervention, patient education, and referral to resources, the nurse can hope to relieve some stress and help the child, adolescent, and family maintain their improved quality of life.

The Quality Caring Nursing Model: A Journey to Selection and Implementation - Corrected Proof

Elizabeth Edmundson — 2011-11-14

A nursing model selection team was created to evaluate the theoretical framework of the professional practice model for the department of nursing. The team's mission was to assess whether the present nursing model was congruent with the culture of contemporary practice of nursing within the organization. After a year of in-depth readings, meetings, and communications with other hospitals, the committee adopted the Quality Caring Model© (QCM) developed by Joanne Duffy, RN, PhD. The implementation team used focus groups, Web-based tutorials, and interactive media as educational tools. Quality caring advocates (unit-based direct care nurses) were selected to assist with the sustainability of the QCM©.

Body Mass Index and Injury Severity in Adolescent Males - Corrected Proof

Kathleen Burns, Carolyn J. Murrock, Christine Heifner Graor — 2011-11-14

Childhood obesity's relationship to injury severity has not been determined. This study examined the relationship between obesity and injury severity, differences in injury severity between weight groups, and injury predictors. The sample included 611 adolescent males treated for injury at a 10-day camping event in Virginia. Findings indicate a significant relationship between body mass index percentile and injury severity (r = .08, p = .04) and less injury severity in normal-weight adolescents, F(2, 608) = 5.27, p < .01. Predictors of injury severity were cause, place injury occurred and injury type, R2 change = .07, F(5, 601) = 6.52, p < .01. Implications are that overweight/obese adolescents may have increased risk of serious injuries. Examining predictors may decrease incidence of injuries at future events.

Greater Saphenous Vein Location in a Pediatric Population - Corrected Proof

Kevin W. Germino, James M. Gerard, Robert G. Flood — 2011-11-10

The purpose of this study was to assess the accuracy of a landmark technique for cannulation of the greater saphenous vein (GSV) near the medial malleolus. We performed bedside ultrasound in a convenience sample of 100 children, ages 3 to 16 years, to evaluate the anatomy of the GSV at the ankle. Despite the proposed constancy of the landmark technique regardless of patient age, the GSV location varied significantly with increasing patient age and weight. In children less than 10 years old or weighing less than 40 kg, the traditional landmark rarely predicted the precise location of the GSV.

Testing a Model for Parental Acceptance of Human Papillomavirus Vaccine in 9- to 18-Year-Old Girls: A Theory-Guided Study - Corrected Proof

Diane Reynolds, Kathleen A. O'Connell — 2011-11-04

Gardasil is the first vaccine developed to prevent cervical cancer and other diseases caused by certain types of genital human papillomavirus in females, but little is known about parental acceptance of this vaccine. The purpose of this study was to test a model that predicts intention to vaccinate that includes constructs from the health belief model and the theory of reasoned action.

Distraction Techniques for Children Undergoing Procedures: A Critical Review of Pediatric Research - Corrected Proof

Donna Koller, Ran D. Goldman — 2011-10-14

Pediatric patients are often subjected to procedures that can cause pain and anxiety. Although pharmacologic interventions can be used, distraction is a simple and effective technique that directs children's attention away from noxious stimuli. However, there is a multitude of techniques and technologies associated with distraction. Given the range of distraction techniques, the purpose of this article was to provide a critical assessment of the evidence-based literature that can inform clinical practice and future research. Recommendations include greater attention to child preferences and temperament as a means of optimizing outcomes and heightening awareness around child participation in health care decision making.

Pediatric Medical Line Safety: The Prevalence and Severity of Medical Line Entanglements - Corrected Proof

Heather Janiszewski Goodin, Nancy A. Ryan-Wenger, Joyce Mullet — 2011-10-14

The purpose of this cross-sectional study was to describe the prevalence and severity of medical line entanglements among pediatric patients (N = 486). Most patients, with ages from birth to 6 years, had at least 1 medical line (n = 444, 91%), and 294 children (60%) had 2 to 11 medical lines. Observed entanglements included lines around body parts (n = 31), lines under the body (n = 71), and lines tangled with other lines (n = 50). One third of the children were at risk for adverse events due to entanglements, and 1 patient actually experienced real harm.

Maternal–Child Nutrition Practices and Pediatric Overweight/Obesity in the United States and Chile: A Comparative Study - Corrected Proof

2011-10-10

Childhood overweight/obesity is now epidemic in both developed countries and those undergoing economic transition. This study compared maternal and school-age child nutrition practices and body mass index in the United States and in Chile. Children (125 in the United States, 121 in Chile) and their mothers (116 in the United States, 101 in Chile) participated. Findings indicated that child nutrition practices were comparable, but mothers in the U.S. group demonstrated fewer healthy nutrition practices on behalf of their children. Significant associations were found between maternal and child nutrition practices. Substantially more children in the U.S. sample were overweight/obese. Implications for practice are presented.

Increasing the Safety of Blind Gastric Tube Placement in Pediatric Patients: The Design and Testing of a Procedure Using a Carbon Dioxide Detection Device - Corrected Proof

Rebecca T. Gilbert, Suzanne M. Burns — 2011-10-10

The accidental placement of feeding tubes into the airway is a rare but serious complication of blind feeding tube placement in pediatrics. A method using a colorimetric carbon dioxide detector has been tested as a means of decreasing the risk of inadvertent airway placement of gastric tubes in adults, but to date, a similar study has not been accomplished in pediatric patients. This study sought to evaluate the efficacy of a procedure using the colorimetric device during blind gastric tube placement in children. The results demonstrated that the study procedure using the device is effective in detecting inadvertent tube placement into the lung in the pediatric population.

Child With Idiopathic Pulmonary Hemosiderosis: A Case Report From Pakistan With Multiple Ethical and Moral Issues - Corrected Proof

Shela Akbar Ali Hirani, Arshalooz Rahman — 2011-10-10

This report discusses the case of a young Pakistani child diagnosed with idiopathic pulmonary hemosiderosis (IPH). The key features of IPH were iron deficiency anemia and pulmonary symptoms due to recurrent pulmonary hemorrhages. The child showed complications of the disease process because of late diagnosis. Because various ethical and moral issues were associated with the diagnosis and management of IPH, this case provides insights about the care burden of health care professionals and a child's parents in a Pakistani pediatric setting. During the course of the child's treatment at one of the private tertiary care settings of Karachi, Pakistan, the key challenges were as follows: declaring the diagnosis to the parents, dealing with the request of the child's parents for withdrawal of ventilatory support and withholding treatment, deciding the code status of the child, and ensuring the quality of the child's life after discharge from the hospital. It was learned from this case report that shared decision making and open communication with the child's family enabled the pediatric health care professionals to determine what was in the best interest of the child, resulting in provision of effective palliative care to the child. Moreover, it was realized that early detection of the disease and availability of hospice care can facilitate palliative care of children diagnosed with IPH.

Integrative Review: Parent Perspectives on Care of Their Child at the End of Life - Corrected Proof

Ann P. Aschenbrenner, Jill M. Winters, Ruth Ann Belknap — 2011-09-14

This integrative review aims to describe parents' perspectives on end-of-life care for their children. Fifteen publications from a literature search of the Cochrane databases, CINAHL, MEDLINE, and PSYCHinfo were included in the review. Recurring themes included poor communication/lack of information, strained relationships/inadequate emotional support, parental need to maintain parent/child relationships in life and death, quality of care continues after the death of the child, influence of services/planning on parent/child impacts quality of life, and the difficult decision to terminate life support. No studies were identified that focused on parents' perspectives on the care their child received at the end of life. Further research that focuses on the special needs of parents at this difficult time is needed.

Caregiver Perspectives on Unintentional Injury Risk in Children With an Autism Spectrum Disorder - Corrected Proof

Rachel N.S. Cavalari, Raymond G. Romanczyk — 2011-09-14

Unintentional injury risk research for children with an autism spectrum disorder (ASD) is currently limited. This article presents findings from a two-phase investigation of caregiver perspectives regarding unintentional injury risk in children with an ASD. Results indicate that children with an ASD exhibit elevated rates of risk-taking behaviors compared with peers, which increases the likelihood of more frequent and severe injuries. In addition, although ASD symptom severity positively correlated with risk-taking behavior and frequency of injury, children with an ASD were rarely rated as high risks for injury by caregivers. Implications are discussed in the context of pediatric health service provision.

Emancipated Minors: Health Policy and Implications for Nursing - Corrected Proof

Susan H. Lane, Eileen Kohlenberg — 2011-09-14

Emancipation is a process that offers adolescents a solution to serve in the role of an adult in circumstances that warrant the need for more autonomy. The process and definitions of emancipation are often ambiguous for adolescents, nurses, and other health care providers that provide services for these individuals. Emancipation can be additionally perplexing with the lack of overarching federal guidelines and the fragmented definitions among various states. Nursing has a significant and legal role in providing care for emancipated minors and a more global duty to advocate for adolescents in situations that necessitate emancipation. This article explores the emancipation process, the laws of each state that govern emancipation, the facilitators and barriers, and the role of nursing in the emancipation process.

Explicating Caregiving by Mothers of Children With Complex Needs in Ireland: A Phenomenological Study - Corrected Proof

Honor M. Nicholl, Cecily M. Begley — 2011-09-07

This qualitative phenomenological study explored mothers' experiences of caring for a child with complex needs. After ethical approval was obtained, data were collected through 11 diaries and 48 interviews with 17 mothers in Ireland. Caring for a child with complex needs involves the delivery of care in an inside world of the home, the world outside the home, and a “going-between” world. Caregiving, 1 of 8 closely linked dimensions, is presented, including its 4 categories. These are normal mothering, technical caregiving, preemptive caregiving, and individualized caregiving. Professionals require a greater understanding of the experiences of mothers caring for children with complex needs at home.

Environmental Health Advocacy: An Overview of Natural Gas Drilling in Northeast Pennsylvania and Implications for Pediatric Nursing - Corrected Proof

Lori S. Lauver — 2011-09-07

This article presents an overview of the Marcellus Shale gas well drilling project in northeast Pennsylvania and serves as a model for how nurses can evaluate such problems in their own communities. Resources to help nurses become involved in the environmental health advocacy process are made available.

Neurocognitive Functioning in Children with Obstructive Sleep Apnea Syndrome: A Pilot Study of Positive Airway Pressure Therapy - Corrected Proof

2011-09-02

Studies of individuals with obstructive sleep apnea syndrome (OSAS) have shown impairment in neurocognitive function. This study investigated the neurocognitive function in children with OSAS before and after positive airway pressure (PAP) therapy. Twenty-one participants with suspected/documented OSAS were recruited, completing the Epworth Sleepiness Scale (ESS), the Child Sleep Habit Questionnaire (CSHQ), and/or the Pittsburgh Sleep Quality Index. Participants were administered sections of the Wechsler Intelligence Scale for Children-IV, the Delis Kaplan Executive Functioning Scales, the Test of Everyday Attention for Children, and the Wide Range Assessment of Memory and Learning—2nd Edition to assess neurocognitive function. The ESS and the CSHQ indicate that many participants had excessive daytime sleepiness and increased sleep-disordered breathing. Participants before therapy reflected neurocognitive deficiencies in all areas. Of the original 21 children, 4 completed the full PAP treatment and were reevaluated, demonstrating improvements in memory and motor speed. Children with OSAS reported sleep-disordered breathing, increased daytime sleepiness, and deficiencies in neurocognitive measures. Correcting these sleep impairments appeared to reduce global neurocognitive deficits while improving memory and processing speed.

Development and Implementation of a Pediatric Palliative Care Program - Corrected Proof

Diane Pelant, Terri McCaffrey, Jean Beckel — 2011-08-26

Palliative care, long-used in the adult setting, is new to the pediatric setting. Research indicates that palliative care reduces length of stay and use of aggressive end-of-life interventions, improves quality of life, and provides hope. It balances provision of coordinated care with building of family memories and preparation for the child's death with celebration of the child's life. We advocate implementation of pediatric palliative care in any hospital that cares for children. This article provides a model outlining critical steps and considerations for establishing a successful pediatric palliative care program.

Support Needs and Preferences of Young Adolescents With Asthma and Allergies: “Just No One Really Seems to Understand” - Corrected Proof

2011-08-26

The objectives of this study were to identify support needs, support resources, and support barriers for young adolescents with asthma and allergies and to describe preferences for an accessible support intervention. Adolescents (N = 57) completed a survey questionnaire. Eight young adolescents, 10 parents, and 5 older adolescents participated in separate group interviews. Young adolescents' challenges included transition to self-care, balancing restrictions with safety, social isolation, and loneliness. Young teens recommended supportive networks facilitated by older adolescent peers and wanted to meet with other young adolescents living with asthma and allergies online and share information, advice, and encouragement with them.

Is Rural School-Aged Children's Quality of Life Affected by Their Responses to Asthma? - Corrected Proof

Sharon D. Horner, Sharon A. Brown, Veronica García Walker — 2011-08-26

The unpredictable nature of asthma makes it stressful for children and can affect their quality of life (QOL). An exploratory analysis of 183 rural school-aged children's data was conducted to determine relationships among demographic factors, children's responses to asthma (coping and asthma self-management), and their QOL. Coping frequency, asthma severity, and race/ethnicity significantly predicted children's asthma-related QOL. Children reported more frequent coping as asthma-related QOL worsened (higher scores). Children with more asthma severity had worse asthma-related QOL. Post hoc analyses showed that racial/ethnic minorities reported worse asthma-related QOL scores than did non-Hispanic Whites.

Caring for Children With Life-Threatening Illnesses: Impact on White, African American, and Latino Families - Corrected Proof

2011-08-26

We describe the racial and ethnic variation in family impact resulting from caring for a child with a life-threatening illness. Parents of children aged 2–21 years diagnosed with a potentially life-threatening illness and enrolled in Florida's Medicaid and Children's Medical Services Network programs were surveyed. Two hundred sixty-six telephone surveys were conducted in English and Spanish between November 2007 and April 2008. In adjusted models, compared with Whites, Latinos reported that their child's illness resulted in a greater negative impact on the family. Continued study of this group of parents is critical to developing culturally appropriate interventions to reduce strain and burden and improve the quality of life for families.

The Integration of a Specialized Eating Disorders Nurse on a General Inpatient Pediatric Unit - Corrected Proof

Nancy Carter, Cheryl Webb, Sheri Findlay, Christina Grant, Sherry Van Blyderveen — 2011-08-26

Eating disorders (EDs) affect approximately 5% of Canadian adolescents. Patients experiencing acute medical complications of their illness are often treated on a general pediatric ward with mixed populations. Twenty-one health care providers shared their experiences caring for youth with EDs and provided feedback regarding the integration of a specialized ED nurse (ED-RN). Findings suggest that an RN and ED-RN model produces consistent care for ED patients and satisfying therapeutic relationships for nurses. ED-RNs caring for youth with EDs need support from their peers, whereas other nurses need training regarding this population. Suggestions for the integration of specialized RN roles are discussed.

What Level of Knowledge Do Elementary School Teachers Possess Concerning the Care of Children With Asthma? A Pilot Study - Corrected Proof

Tara Lucas, Mary Ann Anderson, Pamela D. Hill — 2011-08-26

A self-report questionnaire was used to assess the level of knowledge among a convenience sample of 34 elementary school teachers in a rural school district in Illinois. The questionnaire addressed general asthma knowledge and management, including signs and symptoms, triggers, and treatment. The results suggest a knowledge deficit among this sample of elementary school teachers; the average score was 75%. Teachers with an increased exposure/experience with asthma scored significantly higher than did those with limited exposure. Implications of these findings for schools in rural areas are discussed.