Cigarette smoking is a growing problem among adolescents. This correlational study tested theoretical relationships between the dependent variable (smoking behavior) and the independent variables (depression and smoking...Cigarette smoking is a growing problem among adolescents. This correlational study tested theoretical relationships between the dependent variable (smoking behavior) and the independent variables (depression and smoking resistance self-efficacy) in a convenience sample of 364 college students ages 18 to 21 years recruited from a large urban public college. An a priori mediational model tested the role of smoking resistance self-efficacy as a mediator in the relationship between smoking behavior and depression. Findings showed there was a statistically significant positive relationship between depression and smoking behavior (r = 0.122, p = 0.01). There was a statistically significant negative relationship between smoking resistance self-efficacy and smoking behavior (r = -0.744, p = 0.01). Additionally, smoking resistance self-efficacy was a mediator of the relationship between depression and smoking behavior (beta = -0.757, p = 0.001). This study identifies a need for further theory-driven study of the relation of adolescent depression and smoking behavior. The findings of this study have implications for nursing interventions targeted to both current smokers and smoking initiation prevention programs.
Abusive head trauma, formerly known as shaken baby syndrome, is a condition with physical, psychosocial, and fiscal implications presenting opportunities for nurses to intervene with prevention strategies. This integrati...Abusive head trauma, formerly known as shaken baby syndrome, is a condition with physical, psychosocial, and fiscal implications presenting opportunities for nurses to intervene with prevention strategies. This integrative review of the literature explored the empirical evidence to identify prevention strategies effective in decreasing abusive head trauma. Education, medical, and nursing databases yielded 14 quality research studies providing the basis for the review. Multiple facets of prevention strategies were identified with patterns in the literature of community involvement, early detection and involvement by health professionals, and parental education programming. A five-component model of prevention strategies is proposed to provide nurses with a comprehensive approach to the issue. These components consist of a) completion of personal inventory, b) involvement in multi-modal parental education, c) commitment to a prevention program, d) participation of the family and community, and e) connection to a spiritual element. Through these components, it is hoped there is enhancement of the quality of life for parents and infants, and a discouragement of situations that increase the risk of infant injury.
The purpose of this study was to compare child, hospital course, and discharge characteristics by admitting unit, injury type, head Abbreviated Injury Scale (AIS), and Glasgow Coma Scale (GCS), and test congruence of AIS...The purpose of this study was to compare child, hospital course, and discharge characteristics by admitting unit, injury type, head Abbreviated Injury Scale (AIS), and Glasgow Coma Scale (GCS), and test congruence of AIS and GCS categories. Chart data were collected from seven hospitals on 183 preschool children with head injury (90 admitted to PICU, 93 to general care unit). Injury events included falls (n = 89, 49%), hit by car (n = 35, 19%), motor vehicle crashes (n = 26, 14%), bicycle crashes (n = 12, 7%), and blunt traumas (n = 21, 11%). Most children (68%) had head injuries only, 20% had other fractures, 5% had organ damage, and 7% had all three. Injury severity was measured by head AIS and GCS scores. Treatments and procedures included tubes/lines, blood/blood products, and medications. Children with head injuries only had fewer hospital days, less severe head injuries, and near normal GCS scores. They were less likely to have tubes/lines and medications. Children were discharged with medications (61%) and medical equipment (14%). Five children were discharged to long-term care facilities, and five were discharged to rehabilitation facilities. Concordance of head AIS and GCS categories occurred for only 50 (28%) children. Although the GCS is the gold standard for identifying changes in neurological status, it was not as helpful in representing hospital care. Head AIS injury categories clustered children in more homogeneous groups and better represented hospital care. Head AIS categories are better indicators of injury severity and care provided than GCS. Head injury AIS score may be an important addition to GCS for guiding care.
The care of the pediatric patient with a severe traumatic brain injury (TBI) is an all-encompassing nursing challenge. Nursing vigilance is required to maintain a physiological balance that protects the injured brain. Fr...The care of the pediatric patient with a severe traumatic brain injury (TBI) is an all-encompassing nursing challenge. Nursing vigilance is required to maintain a physiological balance that protects the injured brain. From the time a child and family first enter the hospital, they are met with the risk of potential death and an uncertain future. The family is subjected to an influx of complex medical and nursing terminology and interventions. Nurses need to understand the complexities of TBI and the modalities of treatment, as well as provide patients and families with support throughout all phases of care.
Technologic and pharmacologic advances have improved school attendance for students with chronic neurological conditions. Supporting the special needs of these students presents challenges for parents, school nurses, sch...Technologic and pharmacologic advances have improved school attendance for students with chronic neurological conditions. Supporting the special needs of these students presents challenges for parents, school nurses, school staff, and health care providers. Many school nurses have less confidence in managing some neurological conditions, thus identifying a need for continuing education. Education around a broad spectrum of common child neurology conditions can help school nurses blend educational, medical, and health services action plans. A curriculum was developed based upon the Child Neurology Telephone Encounter Guides (Sprague-McRae, Rosenblum, & Morrison, 2009). The curriculum uses the Child Neurology Process-Oriented Triage conceptual framework (Rosenblum & Sprague-McRae, 2009) and the Healthy Learner Model (Erickson, Splett, Mullett, & Heiman, 2006) to promote and maintain student health. This collection of child neurology educational and assessment content guides school nurses through in-person or telephone interactions with health care providers, students, and parents for selected child neurology issues.
When a child incurs a traumatic brain injury, parents suddenly enter a culture filled with technology, confusion, and uncertainty. An understanding of their perspectives can provide the basis for developing policies and...When a child incurs a traumatic brain injury, parents suddenly enter a culture filled with technology, confusion, and uncertainty. An understanding of their perspectives can provide the basis for developing policies and practices to best meet their needs.
Traumatic brain injuries (TBIs) in childhood, especially those related to participation in sports and recreation activities, are receiving increased public awareness. Research is beginning to show that even mild TBIs (mT...Traumatic brain injuries (TBIs) in childhood, especially those related to participation in sports and recreation activities, are receiving increased public awareness. Research is beginning to show that even mild TBIs (mTBIs) may not be mild at all, and could have serious long-term effects on the health, behavior, and cognitive abilities of children. With the development of the Centers for Disease Control and Prevention's TBI tools for professionals, a more evidenced and systematic way is available to help recognize and manage mTBI. New research on predictor values showing that symptoms may not be the best way to assess the severity of mTBI will help to change how mTBIs are managed in the future.
In 2007, The Joint Commission began requiring health care organizations to develop and implement a standardized approach to clinical handoff. The goal is to improve patient safety across the health care continuum. While...In 2007, The Joint Commission began requiring health care organizations to develop and implement a standardized approach to clinical handoff. The goal is to improve patient safety across the health care continuum. While accurate and complete handoff communication is essential in all areas of patient care, it is of critical importance where patients require the most complex care, such as in the emergency department. This quality improvement study used a focus group to begin to understand the clinical handoff perspective of pediatric emergency nurses. Eight nurses of varying levels of practice who work a variety of shifts participated to explore the clinical handoff process in the emergency department of a pediatric teaching hospital. Perceptions and beliefs regarding the process of clinical handoff (who is involved, what variations exist, where they occur) and barriers to the clinical handoff process were explored. Recurring themes included provider-directed handoff, interruptions--impediment to care, and envisioning the ideal process.
BACKGROUND: Use of opioids and benzodiazepines in critically ill children results in an increased risk of withdrawal syndrome requiring the pediatric nurse to accurately assess the patient's clinical state. A valid and r...BACKGROUND: Use of opioids and benzodiazepines in critically ill children results in an increased risk of withdrawal syndrome requiring the pediatric nurse to accurately assess the patient's clinical state. A valid and reliable pediatric withdrawal assessment tool could be of considerable value to improve nursing care. OBJECTIVE: To evaluate nurses' satisfaction with a new pediatric assessment tool, the Withdrawal Assessment Tool-1 (WAT-1). METHODS: Forty-one Pediatric Intensive Care Unit (PICU) and 27 Pediatric Intermediate Care Unit (PIMC) staff participated in a pre- and post-implementation survey. The survey looked at confidence in assessment skills, perception of communication about withdrawal, and satisfaction with nursing care of the child undergoing withdrawal syndrome. Staff were surveyed, completed online education about the WAT-1, and then repeated the survey after six months of clinical use. RESULTS: Overall confidence in assessment changed very little. There was improvement in the perception of communication (p = 0.005) as well as satisfaction with care provided (p = 0.00002) after implementation of the WAT-1. In particular, satisfaction with nursing documentation of withdrawal syndrome improved significantly (p = 0.00002). CONCLUSIONS: The WAT-1 improves nurses' satisfaction with their care of children undergoing withdrawal syndrome, in particular, their documentation of the level of withdrawal symptoms.
This qualitative study explored the lived experiences of parents parenting a child with autism while living in a rural area. The philosophy of hermeneutic phenomenology was used to guide this inquiry, and interviews of 2...This qualitative study explored the lived experiences of parents parenting a child with autism while living in a rural area. The philosophy of hermeneutic phenomenology was used to guide this inquiry, and interviews of 26 families served as primary data. Thematic statements were isolated using van Manen's (1990) selective highlighting approach. "Making the invisible, visible" emerged as the essence of the parents' experience. Parents shared that although autism was an invisible disability, they in fact made it visible in their constant battles to ensure their child received the best quality of life. The major themes of this essence included a) he's not the Rain Man, b) society's lack of knowledge and understanding, and c) doing it on our own. Findings from this study may be used to guide program development that is concerned with improving the quality of life of families of children with autism living in rural areas.