Type 1 diabetes mellitus has increased in children by 23% from 2001 to 2009. Rural communities additionally have increased disparities related to access barriers and a large minority population with poorer overall health...Type 1 diabetes mellitus has increased in children by 23% from 2001 to 2009. Rural communities additionally have increased disparities related to access barriers and a large minority population with poorer overall health. Research evidence supports telemedicine as an effective alternative to bring preventive diabetes care to remote areas. This article presents an overview of the leadership role of advanced practice registered nurses (APRNs) with the implementation and evaluation of a pediatric diabetes telemedicine program at a rural pediatric outpatient specialty clinic in partnership with a tertiary center telemedicine network. The telemedicine program quality improvement (QI) project explored caregiver satisfaction with a convenience sample of caregivers (N = 14) using a nine-item Telemedicine Diabetes Caregiver Satisfaction Survey (TDCSS), with responses ranging from 1 = strongly disagree to 5 = strongly agree. Findings indicate caregivers were highly satisfied with communication/ privacy (M = 4.8), access to care (M = 4.1), and quality of services (M = 5.0). The multidisciplinary collaborative teamwork, continuous QI, and dependable technology were integral to the quality of the telemedicine clinical initiative. APRNs provided technology expertise, interdisciplinary collaboration leadership, care coordination, and advocacy for policy changes. Results demonstrate that telemedicine and APRN leadership can help implement innovative programs into rural communities to improve access to care, healthcare cost, and outcomes.
The purpose of this project was to determine if a bullying educational program for school nurses and certified nursing assistants/health technicians (CNAs/HTs) would increase knowledge of bullying, probability of reporti...The purpose of this project was to determine if a bullying educational program for school nurses and certified nursing assistants/health technicians (CNAs/HTs) would increase knowledge of bullying, probability of reporting a bully, and probability of assisting a bullied victim. This educational program and evaluation employed a retrospective, post-then-pre-test design. Instruments used included a 17-item demographic questionnaire and the 12-item Reduced Aggression/ Victimization Scale Bullying Assessment Tool (BAT), a 5-point Likert Scale de - signed to assess school nurses’ and CNAs’/HTs’ understanding of bullying, the probability of reporting bullies, and the probability of assisting bullied victims before and after the educational presentation. Findings of this educational evaluation program indicated that the majority of school nurses and CNAs/HTs had an increased understanding of bullying, higher probability of reporting a bully, and assisting a bullied victim after the presentation.
The adolescent and young adult years are a time of growth, change, and challenge. Experiencing the loss of a family member or friend during this period of life can have a profound effect on a young person’s social functi...The adolescent and young adult years are a time of growth, change, and challenge. Experiencing the loss of a family member or friend during this period of life can have a profound effect on a young person’s social functioning, physical and mental health, and development. Research demonstrates that the grief reactions of adolescents and young adults differ from those of adults, and that loss is an individual experience that varies widely throughout each developmental stage. Further, youth who struggle to cope with a significant loss without support and guidance are more likely to experience a greater intensity of grief and distress. When providing support to a grieving adolescent or young adult, it is important to understand normal development, appreciate common grief responses, and identify deviations. It is also important to know about available interventions and supportive strategies, specifically for this age group. With this knowledge, pediatric nurses and other helping professionals can tailor guidance, support, and referrals to suit the specific needs of individual bereaved youth.
Vaccinations are often associated with anxiety, avoidance, and considerable distress for children and parents. These issues can also impair coping during future health care visits. Parents, children, and clinicians can b...Vaccinations are often associated with anxiety, avoidance, and considerable distress for children and parents. These issues can also impair coping during future health care visits. Parents, children, and clinicians can benefit from strategies designed to enhance coping. However, an important barrier to implementation of coping strategy interventions is lack of knowledge among both parents and staff. We produced two sets of tailored handouts designed to enhance education for primary care staff and parents using 41 clinical guidelines, reviews, and randomized controlled trials. Articles were selected from vaccine-specific literature by relevance and practicality for primary care. Handouts provide suggestions for parent and staff interventions before, during, and after vaccinations, focusing on techniques that are effective, cost-efficient, and adaptable. For children of all ages, tailored adult vocabulary and tone can also support coping.
Preventing patient falls begins with an accurate assessment of a patient's risk of falling followed by the initiation and continued evaluation of a fall prevention program based on patient-specific identified risks. Chil...Preventing patient falls begins with an accurate assessment of a patient's risk of falling followed by the initiation and continued evaluation of a fall prevention program based on patient-specific identified risks. Children have a normal tendency to fall based on developmental growth, and each child is different in physical and cognitive abilities. Falls may occur both in and out of the hospital setting. Prevention programs that have revealed the most favorable restuls include the use of a validated fall risk assessment tool. The Humpty Dumpty fall Scale is a screening tool specifically developed for pediatric patients to assess risk for fall. This project developed a pediatric fall prevention policy and implemented an inpatient pediatric fall prevention program. Pediatric staff contributed to the development of this policy and program by providing feedback, support, and cooperation, which was instrumental in the success of this program resulting in no falls after implementation.
Patient and family education is a critical element of diabetes management. Many children with new onset type 1 diabetes present with symptoms of diabetic ketoacidosis (DKA) and are hospitalized at diagnosis. These childr...Patient and family education is a critical element of diabetes management. Many children with new onset type 1 diabetes present with symptoms of diabetic ketoacidosis (DKA) and are hospitalized at diagnosis. These children and their families receive their initial education in the hospital setting. As soon as blood glucose levels are stabilized and the acidosis is corrected. The patient is discharged home, usually within three days (Nettles, 2005). There is little time to provide the skills and education, as well as emotional support, for a smooth transition to home. It is a challenge to achieve these goals if the only resource person for diabetes education is the clinical nurse specialist (CNS). The CNS for a 14-bed pediatric unit sought to expand the role of the bedside nurse to being the primary educator of patients with diabetes through education and support. All nurses attended an eight-hour workshop on diabetes. A DKA protocol was developed through multidisciplinary collaboration, and nurses were educated on this protocol. Additionally, the CNS organized a diabetes resource cart that contains the tools for diabetes education. The protocol and education materials were uploaded in the Pediatric Share Point site to make them accessible to nurses. Most importantly, the CNS developed a structured patient education plan that is outcome-oriented, and based on review of current literature and practices in the unit. This initiative resulted in an increase in nursing confidence and expertise related to diabetes care as demonstrated by competencies met by nurses and anecdotal evidence from nurses and patients' caregivers.
Patient and family education is a critical element of diabetes management. Manychildren with new onset type 1 diabetes present with symptoms of diabeticketoacidosis (DKA) and are hospitalized at diagnosis. These children...Patient and family education is a critical element of diabetes management. Manychildren with new onset type 1 diabetes present with symptoms of diabeticketoacidosis (DKA) and are hospitalized at diagnosis. These children and theirfamilies receive their initial education in the hospital setting. As soon as bloodglucose levels are stabilized and the acidosis is corrected, the patient is dischargedhome, usually within three days (Nettles, 2005). There is little time toprovide the skills and education, as well as emotional support, for a smooth transitionto home. It is a challenge to achieve these goals if the only resource personfor diabetes education is the clinical nurse specialist (CNS). The CNS for a 14-bed pediatric unit sought to expand the role of the bedside nurse to being the primaryeducator of patients with diabetes through education and support. All nursesattended an eight-hour workshop on diabetes. A DKA protocol was developedthrough multidisciplinary collaboration, and nurses were educated on this protocol.Additionally, the CNS organized a diabetes resource cart that contains thetools for diabetes education. The protocol and education materials wereuploaded in the Pediatric SharePoint site to make them accessible to nurses. Most importantly, the CNS developed a structured patient education plan that isoutcome-oriented, and based on review of current literature and practices in theunit. This initiative resulted in an increase in nursing confidence and expertiserelated to diabetes care as demonstrated by competencies met by nurses andanecdotal evidence from nurses and patients’ caregivers.
Well-child visits can be ideal times for health education of children, parents, and caregivers. A trusting relationship with both children and their parents is the foundation for acceptance of any changes in health behav...Well-child visits can be ideal times for health education of children, parents, and caregivers. A trusting relationship with both children and their parents is the foundation for acceptance of any changes in health behaviors. Children grow rapidly, and poor health conditions during this time could be unfavorable or detrimental to their long-term wellbeing. Clinicians play pivotal roles in helping children understand the importance of working toward healthier lifestyles and preventing hypertension and obesity. Hypertension in obese and overweight children continues to increase, but these two conditions are preventable and can also be reversible if managed early. Data from four studies reviewed here indicate that diet and exercise can help reduce the incidence of hypertension in overweight/obese children. Primary care providers can incorporate specifically pointed physical activity and dietary change education into their daily practices, with attention directed toward helping children with hypertension to decrease their blood pressure for life.
Quinn M, Gillooly D, Kelly S
… +3 more, Kolassa J, Davis E, Jankowski S
Pediatr Nurs
· 2016 · PMID 29406642
Super Storm Sandy, one of the largest storms endured by the East Coast of theUnited States, devastated New Jersey and the eastern seaboard. Although naturaldisasters affect individuals of all ages, children are particula...Super Storm Sandy, one of the largest storms endured by the East Coast of theUnited States, devastated New Jersey and the eastern seaboard. Although naturaldisasters affect individuals of all ages, children are particularly vulnerable becausetheir sense of normalcy is altered. The purpose of this study was to explore theeffects that exposure to Super Storm Sandy had on children who resided in NewJersey. This was a non-experimental, quantitative, cross-sectional research study.Study participants were recruited via printed flyers at disaster resource sites and ona dedicated research team’s Facebook site. Each participant completed theHurricane Stressors Assessment Tool for Children and Adolescents as a webbasedsurvey related to their experiences with the hurricane. One hundred andforty-one (141) children participated in this study. Age groups (preschool, child, andadolescent) had varied results based upon developmental level. Age was positivelyassociated with finding it harder to concentrate and pay attention (r = 0.18, p =0.04); feeling sad, down, or depressed (r = 0.17, p < 0.05); being quiet and withdrawn (r = 0.16, p = 0.05); feeling irritable and grouchy (r = 0.26, p < 0.05); and findingit harder to complete schoolwork (r = 0.32, p < 0.001). Certain parental perceptionsof their child’s behavior were negatively associated with the age of the child.Children had varying degrees of experiences after Sandy. Adolescents were shownto be more aware and affected by the storm than younger children. Observationscan be used for intervention initiatives in the post-natural disaster period, encouraginghealthcare providers to acknowledge family and community healing to provideadequate mental health referrals in the post-disaster period.
Long thought to be purely psychological in origin, current research lends credenceto the idea that autism has a medical basis. Patients with autism can be among themost challenging patients that a healthcare provider may...Long thought to be purely psychological in origin, current research lends credenceto the idea that autism has a medical basis. Patients with autism can be among themost challenging patients that a healthcare provider may care for. Often the presentingsymptoms of autism make these patients difficult to examine and may alsomask underlying concurrent conditions. This article reviews some of the more commonconditions found concurrently in the autistic population.
Delirium is a serious neuropsychiatric condition that emerges acutely in all age groups, including infants, children, and adolescents. Delirium serves as an urgent signal of distress that a young child’s brain is in trou...Delirium is a serious neuropsychiatric condition that emerges acutely in all age groups, including infants, children, and adolescents. Delirium serves as an urgent signal of distress that a young child’s brain is in trouble. Prevention, recognition, and management of infants with delirium is often especially challenging due to their pre-verbal status and still immature cognitive development. This article presents an overview of delirium in infants, offers details regarding the presentation of delirium in infants, discusses the challenges to screening and identification of infants with delirium, and provides evidence-based suggestions for pediatric nurses to optimize nursing care for infants at risk for or exhibiting delirium.
Concussions are a form of traumatic brain injury (TBI). Concussion is defined by the American Academy of Neurology as a “trauma-induced alteration in mental status that may or may not involve loss of consciousness” (Kirk...Concussions are a form of traumatic brain injury (TBI). Concussion is defined by the American Academy of Neurology as a “trauma-induced alteration in mental status that may or may not involve loss of consciousness” (Kirkwood, Yeates, & Wilson, 2012, p. 1360). At least 1.7 million TBIs occur annually, with 75% being in the form of concussion. Almost half a million patients ages 14 years and younger visit emergency rooms annually for TBI (Centers for Disease Control and Prevention [CDC], 2011). Diagnosing a concussion can be difficult because symptoms vary among individuals and may be subtle and vague, and neuro-radiologic imaging studies typically reveal no abnormalities. Due to the varying degree of symptomatology and recovery, there are no specific recommendations on when it is safe for patients to resume normal activity. Complications can arise if a second injury occurs prior to complete healing from the initial concussion. This literature review identifies current recommendations on the screening and management of concussion in the pediatric population. A clear, concise definition of concussion is presented, as well as recommendations for concussion management. Return to play and return to learn guidelines are explored. The nursing role in concussion management is discussed, and future implications are explored.