Journal of Pediatric Nursing - Articles in Press

Updates for the Journal of Pediatric Nursing Readership - Corrected Proof

Cecily L. Betz — 2012-01-19

We wish to inform the readership of several recent developments initiated and about to be implemented at the Journal of Pediatric Nursing (JPN). These new changes reflect the global reach and widespread recognition of the prominence of JPN as a publication resource for not only pediatric nurses and practitioners but also our interdisciplinary colleagues as well.

Homelessness and Health Care Disparities Among Lesbian, Gay, Bisexual, and Transgender Youth - Corrected Proof

Deborah L. McBride — 2012-01-18

A NUMBER OF recent studies on lesbian, gay, bisexual, and transgender (LGBT) youth have come up with some startling statistics. One study reported that somewhere between 30% and 40% of homeless youths identify as LGBT (). Researchers from the Children's Hospital Boston and the Harvard Medical School suggest that this may be because LGBT youths are more often kicked out of their homes than straight youths, or even if they are not kicked out, they may feel so uncomfortable that they leave. The study identified two distinct groups that make up the population of homeless children and youths in the United States: (a) families with children and (b) unaccompanied youths. The first group has been estimated to be more than 1.5 million U.S. children living within families that lacked a permanent home during the period of 2005 and 2006. The second group was estimated to be an additional 575,000 to 1.6 million U.S. youths living without a home and without a family, unaccompanied on the streets or in a shelter (). The researchers used data from the Massachusetts Youth Risk Behavior Survey, which contains information on homeless status and sexual orientation to estimate the prevalence of homelessness in sexual minority adolescents. The researchers defined homelessness as lacking a fixed, regular, and adequate nighttime residence. Several factors associated with greater risk for homelessness were found to occur more frequently in youths with minority sexual orientation than in heterosexual youths. The researchers documented a higher risk of familial maltreatment among LGBT individuals than among heterosexual individuals. This population also faces an increased likelihood of experiencing discrimination and victimization in school and community settings as well as diminished peer support.

Infant Safe Sleep: Efforts to Improve Education and Awareness - Corrected Proof

Donna M. Flook, Durae L. Vincze — 2012-01-18

According to the , more than 4,500 infants die annually in the United States of no apparent cause of death. These deaths are defined as sudden unexplained infant deaths (SUID). Half of these SUIDs are because of sudden infant death syndrome (SIDS). SIDS is defined as the sudden death of an infant less than 1 year of age that remains unexplained after a thorough case investigation, autopsy, examination of the death scene, and review of clinical history (). Despite national programs and public health education, SIDS remains one of the three leading causes of infant death accounting for 8% of all infant deaths () and is the leading cause of deaths among infants 1–12 months of age ().

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.

Management of Vitamin D Deficiency in Children and Adolescents - Corrected Proof

Sarah Al Sawah, Kevin R. Lewis — 2012-01-16

During the past two decades, vitamin D has gained considerable attention among researchers, health policy makers, and the general public within the United States. There is an accumulating body of evidence that supports the link between vitamin D deficiency (defined by the Endocrine Society as serum 25-hydroxyvitamin D less than 20 ng/ml) and important health outcomes including altered calcium homeostasis and the increased risk of developing diabetes, autoimmune diseases, cardiovascular disorders, and cancer ().

Gene Therapy: A Genetic Era of Technological Development to Treat Pediatric Genetic Disorders - Corrected Proof

Cheryl Mele — 2012-01-16

RECOGNITION THAT CERTAIN pediatric hereditary disorders are based upon definite genes and defects in specific proteins led the initial evolution of the concept of gene therapy, which began 50 years ago with the discovery of the double-helix DNA (). For two decades, the active pursuit of gene therapy for inherited single-gene defects such as cystic fibrosis (CF), phenylketonuria (PKU), Duchene muscular dystrophies (DMD), hemophilia IX, severe combined immunodeficiency disorders (SCID-X1 and ADA-SCID), and orthine transcarbamylase deficiency (OTC) have been sought after because of absence of curative treatments available. Moreover, success stories have been reported with the use of gene therapy in most of these disorders when contemporary treatment failed (). SCID -X-linked mutation (bubble boy disease) was the first successful treatment using gene therapy reported by a French team in May 2000 (). This article will review the technology of gene therapy, complications, and clinical relevance in the pediatric realm.

Education of the Pediatric Patient With Asthma: A Literature Review - Corrected Proof

Sharon Lack — 2012-01-16

PEDIATRIC ASTHMA AFFLICTS nearly 9 million children in the United States and is considered one of the most chronic conditions of childhood. According to , children with asthma have 65% more acute care visits, three times as many prescriptions, and double the number of inpatient hospital days than the general pediatric population. In addition, the health care costs for children diagnosed with asthma are 88% higher than for children who do not have asthma. Furthermore, The Pew Environmental Health Commission projects the cost of childhood asthma to reach 18 billion dollars by the year 2020 (). Of concern is that asthma prevalence and hospitalization rates remain high despite improvements in treatments and a greater understanding of the disease. Thus, the best way to educate the pediatric patient with asthma needs to be addressed.

Translating Research Into Everyday Practice—The Essential Role of Pediatric Nurses - Corrected Proof

Becky J. Christian — 2012-01-16

TRANSLATING RESEARCH EVIDENCE into best clinical practices enhances the quality of pediatric nursing practice by improving child and family health outcomes. Given that the role of pediatric nurses is to promote the health and welfare of children and their families through excellent patient care (), pediatric nurses are in a unique position to improve clinical practice. Excellence in pediatric nursing is achieved through the translation of research to guide clinical practice for children and their families (). Evidence-based practice is the integration of best evidence with clinical expertise and patient preferences in clinical decision making () and then translation of clinical research into everyday practice (). Thus, best practices for pediatric nursing improve the quality of care for children and their families (). Moreover, pediatric nurses play an essential role in translating research evidence into clinical practice to improve the quality of care for children 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.

Using Continuous Process Improvement Methodology to Standardize Nursing Handoff Communication - Corrected Proof

Kristi Klee, Linda Latta, Sallie Davis-Kirsch, Maria Pecchia — 2011-11-04

The purpose of this article was to describe the use of continuous performance improvement (CPI) methodology to standardize nurse shift-to-shift handoff communication. The goals of the process were to standardize the content and process of shift handoff, improve patient safety, increase patient and family involvement in the handoff process, and decrease end-of-shift overtime. This article will describe process changes made over a 4-year period as result of application of the plan–do–check–act procedure, which is an integral part of the CPI methodology, and discuss further work needed to continue to refine this critical nursing care process.

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.

New Knowledge, Innovations, and Improvement in a Magnet® Children's Hospital Cardiac Center - Corrected Proof

2011-09-07

Bedside nurses involved in research and evidence-based practice (EBP) have the ability to change policies, patient care, and outcomes. This article describes the journey of a research committee using the Magnet® component of new knowledge, innovation, and improvements. Using several tools, the unit-based committee developed skills in meeting management, nursing research methods, and EBP. Focusing to improve family and nurse communication about the plan of care, the committee recommended changes in the existing Plan of Care tool, including family input and recommendations for families to view and add to the sheet and participate in daily rounds, which was not the standard practice. Since this intervention was implemented, patient satisfaction has increased, as well as nurse engagement and intent to stay. This project exemplifies how nurse-driven innovations and family partnership led to new knowledge, innovations in learning about research, applying it to practice, and improving practice.

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.

Evaluating the Effectiveness of Pediatric Pain Management Guidelines - Corrected Proof

2011-08-16

In response to unit nursing quality and patient satisfaction concerns, the shared governance councils identified opportunities to improve overall assessment and management of pain in hospitalized pediatric patients. Together, the unit-shared governance councils evaluated current practice and reviewed the literature to develop comprehensive Pediatric Pain Assessment and Management Guidelines. The purpose of this study was to evaluate the effectiveness of implementing an evidence-based pain assessment and management guideline on nurses' knowledge, ability to assess and manage the patients' pain, and patient/family satisfaction with staff's management of pain. This intervention study with a pre–post design included three assessment intervals described as baseline and 3 and 6 months after guideline implementation. The sample included pediatric and pediatric intensive care unit (PICU) nursing staff, retrospective chart reviews of pediatric and PICU patients, and patient/parent satisfaction scores. No differences were found between nurses' knowledge and attitudes regarding pain before and after implementation of the guideline. Significant increases in pain assessment, use of correct tool, and reassessment were found following implementation. Although improving, there was no difference in patient/family satisfaction after guideline implementation.

Finding the Evidence to Change Practice for Assessing Pain in Children Who Are Cognitively Impaired - Corrected Proof

2011-08-08

We report on a quality improvement project whose purpose was to systematically review behavioral pain assessment tools for children who are cognitively impaired, with the goal of identifying a valid and reliable tool for clinical practice. In addition, we sought to partner with parents and/or caregivers to expand their role in pain assessment. The project team conducted an extensive synthesis of the literature to examine the availability and quality of published pain assessment tools for use with children with cognitive impairment (CI) or developmental disability. Once completed, we identified 2 of the available 10 tools to test in the clinical setting. Data from this quality improvement project provided evidence to support the adoption of the revised Faces, Legs, Activity, Cry, and Consolability pain assessment tool for children with CI into clinical practice.

Coping While Caring for the Dying Child: Nurses' Experiences in an Acute Care Setting - Corrected Proof

2011-08-08

The aim of this study was to describe and understand behavior and coping strategies used by pediatric nurses caring for dying children on an inpatient acute care cardiology unit. Qualitative descriptive methods consisting of semistructured questions were presented to acute care nurses participating in focus groups. The nurses who participated in the focus groups had cared for an acutely ill child who died. Conventional content analysis was used to analyze data and organize results. The categories that emerged included the following: boundaries, memories, disconnecting, and labeling. Colleague support, institutional resources, and nurses' experience level were critical to the process of coping. Coping and grieving are facilitated by colleague and unit resources. Studies exploring job dissatisfaction, stress, and burnout from an inadequate grieving process are required.

A Performance Improvement Plan to Increase Nurse Adherence to Use of Medication Safety Software - Corrected Proof

Carrie Gavriloff — 2011-08-08

Nurses can protect patients receiving intravenous (IV) medication by using medication safety software to program “smart” pumps to administer IV medications. After a patient safety event identified inconsistent use of medication safety software by nurses, a performance improvement team implemented the Deming Cycle performance improvement methodology. The combined use of improved direct care nurse communication, programming strategies, staff education, medication safety champions, adherence monitoring, and technology acquisition resulted in a statistically significant (p < .001) increase in nurse adherence to using medication safety software from 28% to above 85%, exceeding national benchmark adherence rates (Cohen, Cooke, Husch & Woodley, 2007; ).

Nurses' Expectations of Using Music for Premature Infants in Neonatal Intensive Care Unit - Corrected Proof

Tarja Pölkki, Anne Korhonen, Helena Laukkala — 2011-08-04

This study aimed to describe nurses' expectations of using music for premature infants in the neonatal intensive care unit (NICU) and to find out about the related background factors. The subjects consisted of 210 Finnish nurses who were recruited from the country's five university hospitals providing premature infant care in NICU. The data were collected by validated questionnaire, and the response rate was 82%. Most nurses preferred recorded music to live music in the NICU. They expected that music would have positive effects on premature infants, parents, and staff. Few demographic and many background factors of the respondents' music-related experiences correlated significantly with the expectations concerning their preference. In conclusion, the nurses' expectations were positive regarding the use of music in the NICU, which supports evidence regarding the efficacy of music therapy for premature infants.

Where Do Youth in Foster Care Receive Information About Preventing Unplanned Pregnancy and Sexually Transmitted Infections? - Corrected Proof

Angela L. Hudson — 2011-07-20

Adolescents in foster care are at risk for unplanned pregnancy and sexually transmitted infections, including HIV infection. A study using a qualitative method was conducted to describe how and where foster youth receive reproductive health and risk reduction information to prevent pregnancy and sexually transmitted infections. Participants also were asked to describe their relationship with their primary health care provider while they were in foster care. Nineteen young adults, recently emancipated from foster care, participated in individual interviews. Using grounded theory as the method of analysis, three thematic categories were generated: discomfort visiting and disclosing, receiving and not receiving the bare essentials, and learning prevention from community others. Recommendations include primary health care providers providing a confidential space for foster youth to disclose sexual activity and more opportunities for foster youth to receive reproductive and risk prevention information in the school setting.

Challenges in Treating Oppositional Defiant Disorder in a Pediatric Medical Setting: A Case Study - Corrected Proof

Ann M. Kledzik, Michele C. Thorne, Vivek Prasad, Kathy H. Hayes, Lori Hines — 2011-07-20

The following case study is presented to highlight the importance of consistency in identifying and treating oppositional defiant disorder in a pediatric patient with a life-threatening medical illness. A pediatric transplant patient's oppositional behaviors are described, as well as the educational behavioral training program provided to the patient's caregivers and medical staff. As a result of the training, the patient engaged in less oppositional behavior, was more cooperative and pleasant with staff, and was more compliant with her treatment. Subjective reports from caregivers indicated that the training with its emphasis on consistency effectively reduced the patient's symptoms and enhanced the caregivers' ability to care for the patient.

Nurses' Role in the Prevention of Infant Mortality in 1884–1925: Health Disparities Then and Now - Corrected Proof

Mary E. Thompson, Arlene A. Keeling — 2011-07-15

Nursing has a strong historical precedence in the treatment of health disparities. This article evaluates the public health nurses' (PHNs') role with infant mortality during 1884–1920, specifically how nursing care impacted on conditions of poverty, poor nutrition, poor living conditions, lack of education, and lack of governmental policies that contributed to the poor health of infants a century ago. The historical significance of the early PHNs' role can improve our understanding of nursing practice with childhood health issues today. Suggestions are made for nursing to focus on health disparities in childhood obesity, in areas of environmental and policy changes, and the development of social programs and education for families to support healthier living.

Pediatric Palliative Care: A Conceptual Analysis for Pediatric Nursing Practice - Corrected Proof

Debbie Stayer — 2011-07-11

Although there have been significant advances in medical technology, thousands of children continue to die annually. Pediatric palliative care is a relatively new field and has not been well defined in the literature. Therefore, the purposes of this article were to provide a concept analysis of pediatric palliative care that presents pediatric nurses with fundamental information regarding this concept and to increase their ability to understand, identify, provide, and subsequently meet and enhance the needs of those children with a life-limiting illness and their families. With this enhanced understanding of pediatric palliative care, pediatric nurses will continue to improve and provide quality, safe nursing care for this vulnerable population of children with life-limiting illnesses.

The Health Care Experiences of the Preschool Child With Autism - Corrected Proof

Margaret W. Bultas — 2011-07-11

It is known that children with autism spectrum disorder (ASD) visit health care providers (HCPs) more frequently than typically developing peers, and mothers experience barriers in this process. The purpose of this interpretive phenomenological study was to gain a better understanding of a mother's experiences of taking her child with ASD to the HCP. Two themes related to the health care experience of the child surfaced from the study. These themes included feelings that HCPs do not “get” the complexity of caring for the child and marginalization of mothers by the HCP. The need for creation of child-specific profiles emerged from this study.

Rectal Versus Axillary Temperatures: Is There a Significant Difference in Infants Less Than 1 Year of Age? - Corrected Proof

Chris A. Stine, Donna M. Flook, Durae L. Vincze — 2011-07-04

There are identified gaps regarding the accuracy of axillary temperatures as a means of predicting core temperatures in infants and children. This article discusses the relationship between rectal and axillary temperatures in infants less than 1 year of age. This quality improvement project evaluated 425 paired temperature measurements in 86 infants admitted to an inpatient pediatric unit over a 2-month period. A correlation analysis showed statistically significant differences between the two measurements. The results of this project promoted the development of a standard of care for temperature measurement at the project facility.

Using the Teach-Back Method to Increase Maternal Immunization Literacy Among Low-Income Pregnant Women in Jamaica: A Pilot Study - Corrected Proof

2011-07-04

The purpose of this pilot study was to assess maternal health literacy of pregnant women in Jamaica and evaluate their ability to communicate the benefits, risks, and safety of the Bacillus Calmette-Guerin (BCG) and Hepatitis B (hep B) vaccines after using the teach back method. REALM scores were moderately, positively correlated with identification of the BCG vaccine risks (r = .43, p = .01) and with hep B vaccine benefits (r = .34, p = .05) and risks (r = .42, p = .01). Women who gave incorrect responses about the benefits or risks of the vaccines had lower REALM scores than women who gave completely correct or partially correct responses.

Coping With Autism: A Journey Toward Adaptation - Corrected Proof

Heidi R. Lutz, Barbara J. Patterson, Jean Klein — 2011-06-27

As the number of individuals with autism grows, it is critical for nurses in all settings to understand how autism influences the family unit, as they will likely interact with these children, the adults, and their families. The intent of this descriptive narrative study was to explore the experiences of families of individuals with autism as perceived by the mother. Through personal interviews, 16 mothers' perceptions of the impact of autism on the family unit during different stages of the life cycle were revealed through a constructivist lens. Pediatric nurses employed in acute care settings, community, and schools are poised to assess and support these families following diagnosis and throughout the child's life.

Symptoms of Posttraumatic Stress Disorder Among Pediatric Acute Care Nurses - Corrected Proof

Angela S. Czaja, Marc Moss, Meredith Mealer — 2011-06-27

In their work, pediatric acute care nurses may encounter traumatic events and be at risk for posttraumatic stress disorder (PTSD). This survey-based study examines the potential diagnosis of PTSD among nurses at a tertiary children's hospital with a Level 1 trauma center. Twenty-one percent of respondents had strong PTSD symptoms without significant difference between units. Nurses with potential PTSD had more comorbid symptoms of anxiety, depression, and burnout and were more often considering a career change. Furthermore, symptoms affected not only their work but also their personal lives. Future research should focus upon identifying pediatric nurses with PTSD to provide therapeutic interventions and reducing high-risk events and their potential impact.

Experience of Support for Parents of Adolescents With Heart Defects—Supported to be Supportive - Corrected Proof

Elisabeth Bruce, Karin Sundin — 2011-06-27

The purpose of this study was to illuminate the meanings of the lived experience of support for parents of adolescents with heart defects. Narrative interviews were conducted with four mothers and two fathers of adolescents with heart defects. Interviews were interpreted using a phenomenological–hermeneutic method. The interpretation revealed that parents, themselves, attempt to be very supportive. They support their adolescent children, the rest of their families, the staffs of their children's schools, and others around their children. The sense of gratification and contentment that parents receive from fulfilling supportive functions is, in turn, influenced by the support that they, themselves, receive from care providers.

Clinical Problem-Solving: Three Rare Conditions-One Pediatric Surgical Patient - Corrected Proof

Raquel Pasarón — 2011-06-08

The purpose of this report is to demonstrate a step-by-step process of clinical decision making. A case study is presented in stages to simulate the way such information emerges in clinical practice. The focus is on the diagnostic process of this pediatric surgical patient's presentation, with particular attention to the unusual sequence of events and the diagnostic dilemmas that emerged for the clinicians involved. This case also represents three very rare conditions related to the same patient that have never been presented in the literature occurring in combination or in relationship to one another.