Professional values form the basis for nurse attitudes and behavior, and are cornerstones to guiding nurses' clinical practice decisions. The purpose of this descriptive study of nurses at a large children's hospital is...Professional values form the basis for nurse attitudes and behavior, and are cornerstones to guiding nurses' clinical practice decisions. The purpose of this descriptive study of nurses at a large children's hospital is to describe the professional values of employed registered nurses and describe differences based on demographic characteristics, such as generation, years of experience, education, and professional role. This study is based on Benner's (1984) theoretical framework of novice to expert. The Nurses Professional Values Scale: Revised (NPVS-R) (Weis & Schank, 2004) was administered to working RNs at the children's hospital. The results of this descriptive study indicate that nurses' professional values differed based on characteristics, such as education, generation, job classification, and years of experience.
Disorders of sexual differentiation (DSD) describe a number of genetically influenced congenital anomalies of the genitalia for which the previous standard of care has included emergent sex assignment and early genitopla...Disorders of sexual differentiation (DSD) describe a number of genetically influenced congenital anomalies of the genitalia for which the previous standard of care has included emergent sex assignment and early genitoplasty and gonadectomy. This article provides a brief summary of the most common DSD and their genotypic and phenotypic variations. It presents an overview of the history of and treatment recommendations for individuals with DSD beginning in the 1950s. It provides a historical basis upon which evolving treatment guidelines are beginning to call into question the status quo. The discussion applies the moral principles of autonomy, beneficence, and nonmaleficence for the care of individuals with DSD. In the process, the advantages of early as well as delayed cosmetic genital surgery will be discussed when contemplating the ethical question: Do parents have the moral right to provide informed consent to surgically alter the ambiguous genitalia of their infants born with DSD?
Murray JS, Williams LA, Pignataro S
… +1 more, Volpe D
Pediatr Nurs
· 2015 · PMID 26470465
Increasingly, early warning system scores are being introduced into pediatric clinical practice to support the early recognition of and intervention for clinical deterioration in hospitalized children at risk. This integ...Increasingly, early warning system scores are being introduced into pediatric clinical practice to support the early recognition of and intervention for clinical deterioration in hospitalized children at risk. This integrative review explored what is known about early warning system scores with pediatric patients. Twenty-eight publications, including research, clinical practice articles, and conference abstracts, were identified. Five major concepts emerged from analysis of retrieved documents: overview of pediatric early warning system scores, supplementary benefits, facilitators to successful implementation, barriers to successful implementation, and needed research. Greater psychometric testing of tools is needed before any recommendations can be made regarding extensive implementation with the pediatric population.
Type 1 diabetes is the most commonly seen endocrinopathy in pediatrics. This is an autoimmune condition. Children with type 1 diabetes are at much greater risk for other autoimmune conditions, particularly autoimmune thy...Type 1 diabetes is the most commonly seen endocrinopathy in pediatrics. This is an autoimmune condition. Children with type 1 diabetes are at much greater risk for other autoimmune conditions, particularly autoimmune thyroiditis, most commonly Hashimoto's thyroiditis, and celiac disease. It is important for the primary care practitioner to be aware of subtle symptoms of these conditions and how to screen for them because early treatment of both conditions can lead to better diabetes control and improved health in general.
This third article in a series on the critical issue of the transition from pediatric to adult care for young adults with complex chronic conditions offers resources, including information about exemplary programs, to pe...This third article in a series on the critical issue of the transition from pediatric to adult care for young adults with complex chronic conditions offers resources, including information about exemplary programs, to pediatric nurses. Three hospital-based programs are highlighted, four key Internet resources are identified, and five relevant articles are annotated. This information can support pediatric nurses in considering transition support options for individual teens and their families as well as in developing resources and designing programs in their own settings.
This study explored associations between depressive symptoms, violence exposure, and psychological birth trauma (PBT) among 44 adolescents experiencing cesarean births. Within 72 hours postpartum, symptoms of PBT were me...This study explored associations between depressive symptoms, violence exposure, and psychological birth trauma (PBT) among 44 adolescents experiencing cesarean births. Within 72 hours postpartum, symptoms of PBT were measured via a subjective rating of the birth experience and the Impact of Event Scale (IES). The Edinburgh Postnatal Depression Scale measured depressive symptoms. Single questions assessed violence exposure, including child abuse, partner violence, and traumatic life experiences as attribute variables. Adolescents were typically single with an unplanned first pregnancy. A similar number of adolescents reported a negative or positive birth experience. Correlations between IES scores, parity, depressive symptoms, partner violence, gestational age, and a negative birth appraisal suggested interconnected prenatal vulnerabilities for birth trauma and adverse infant outcomes. Partner violence and depressive symptoms need continuous assessment throughout pregnancy. The potential for continued symptoms and presence of violence beyond discharge requires follow up and education in pediatric settings at well-baby and routine visits.
Self-injection of growth hormone (GH) by children with GH deficiency can be problematic. They may have difficulty manipulating injection devices or preparing medication, and injections can be painful and create anxiety....Self-injection of growth hormone (GH) by children with GH deficiency can be problematic. They may have difficulty manipulating injection devices or preparing medication, and injections can be painful and create anxiety. Adherence to daily GH injections optimizes treatment benefit. Studies indicate that injection pens or needle-free devices enable easy self-injection by children, minimize medication reconstitution and storage requirements, and reduce injection pain. Newer GH delivery devices potentially encourage improved patient adherence. Reviewing features of GH devices will help nurses decide which GH device best fits the needs and abilities of pediatric patients. We searched recent medical literature about GH device development, about device-associated patient preferences and treatment adherence, and comparisons among GH devices. We concluded that improved awareness of the strengths and limitations of GH devices will enable nurses to guide families in selecting and using GH devices, improving adherence and outcomes, and helping children reach full growth potential.
Animal-facilitated therapy (AFT), more specifically known as animal-assisted therapy (AAT) or "pet therapy," has had an increased presence in the literature with a surge of recent research methodologies exploring this co...Animal-facilitated therapy (AFT), more specifically known as animal-assisted therapy (AAT) or "pet therapy," has had an increased presence in the literature with a surge of recent research methodologies exploring this complementary alternative medicine (CAM) intervention. However, limited studies have been conducted in the pediatric population, with many articles anecdotal in nature. A literature review included primary data sources PubMed, PsychINFO, Medline, and CINAHL, and yielded positive and beneficial outcomes to be gained through AAT in the pediatric population. Primary outcome variables of decreased anxiety and pain are the most commonly reported results. Further research studies are indicated to include the effects of AFT with children with different diseases and diagnoses. Exploration of other psychosocial and physical variables, such as self-esteem, would be useful. Interdisciplinary strategies are needed to develop interventions to help reduce patient symptoms and treatment-associated stress, as well as to facilitate healing and wellness beyond traditional medical treatment plans. Complementary therapies are of continued interest to the health care community, especially for pediatric nurses. Effective use of animals to facilitate conversation, lead discussion, or break communication barriers has been demonstrated through both research and anecdotal reports.
Legislation exists regulating adolescents' use of tanning beds; however, the rate at which adolescents use these devices has not been reduced. The purpose of this study was to provide an analysis of indoor tanning bed le...Legislation exists regulating adolescents' use of tanning beds; however, the rate at which adolescents use these devices has not been reduced. The purpose of this study was to provide an analysis of indoor tanning bed legislation in the United States specifically related to legal issues and parental consent along with enforcement of current laws. The investigators collected data via review of state health department websites or telephone interviews of identified contacts for all 50 states. Findings reveal wide variation in legislation related to adolescents' access to tanning devices and enforcement of violation of legal statutes. Nurses and other health care professionals can play key roles in educating families and adolescents to the dangers from the use of tanning beds along with being role models for proper skin protective behaviors. In addition, nurses should become advocates by supporting legislative efforts that ban tanning salons for all minors, with the long-term goal of reducing skin cancer caused by ultraviolet radiation (UVR) exposure from the use of tanning salons today.
Meakins L, Ray L, Hegadoren K
… +2 more, Rogers LG, Rempel GR
Pediatr Nurs
· 2015 · PMID 26281274
Hypoplastic left heart syndrome (HLHS) is a complex heart malformation that requires life-saving treatments. Parents experience numerous challenges as they learn to parent a child with complex care requirements. The foll...Hypoplastic left heart syndrome (HLHS) is a complex heart malformation that requires life-saving treatments. Parents experience numerous challenges as they learn to parent a child with complex care requirements. The following research question guided this qualitative study: Is the parenting process among parents of a child with HLHS characterized by exaggerated vigilant parental action, and if so, how does this influence parental response? Situated within a larger program of pediatric cardiology research, this study included data from two grounded theory studies with parents of children with HLHS. This secondary analysis involved a thematic content analysis using sensitizing concepts of uncertainty, protectiveness, support, and mastery of complex care. Transcribed data from 55 interviews with 24 mothers and 17 fathers of young children with HLHS were analyzed for relevant and recurring themes. In mastering skills required to care for their child with HLHS, parents contrasted what was in their hands with what was out of their hands. Vigilant parental actions were evident as parents became skilled at providing complex care. Parents said they were sometimes excessive in their vigilant actions. In retrospect they viewed this vigilance as appropriate in some situations but exaggerated in other situations. Understanding parents' vigilant actions in response to their child's complex care can guide health care providers' interactions with families. Long-term follow up, both clinically and through research, is needed to assess the long-term consequences of exaggerated vigilant parental action on the child, parent, and family, and to determine and evaluate appropriate and timely intervention.
Blair F, McFarlane J, Nava A
… +2 more, Gilroy H, Maddoux J
Pediatr Nurs
· 2015 · PMID 26281272
Children who witness the abuse of their mother by an intimate partner suffer negative effects on behavioral functioning. In this study, 300 abused women seeking services for abuse were interviewed regarding how often the...Children who witness the abuse of their mother by an intimate partner suffer negative effects on behavioral functioning. In this study, 300 abused women seeking services for abuse were interviewed regarding how often their child had witnessed the abuse. Baseline data for this study found that boys who witnessed abuse had externalizing and internalizing behavioral problems comparable to boys in clinical treatment. Girls did not display clinically significant behaviors. For evidence-based programs to interrupt the effect of witness to violence on children, empirical data that are gender-specific are needed. Findings support the need to screen mothers for abuse during well-child visits and offer education to all mothers on the possible effects of child witness to violence in the home.
Diabetes mellitus is a complex disease that requires significant changes in lifestyle upon diagnosis, which may be difficult for children because of differences in growth and developmental levels. The purpose of this stu...Diabetes mellitus is a complex disease that requires significant changes in lifestyle upon diagnosis, which may be difficult for children because of differences in growth and developmental levels. The purpose of this study was to increase our understanding of "what it is like" to be a child with type 1 diabetes mellitus and explore factors that interfere with disease management. Qualitative interviews using puppets constructed by children 7 to 12 years of age were conducted during clinic visits. The interviewer engaged in conversations to examine thoughts, feelings, and daily experiences with the management of diabetes. Results indicated that the children (N = 19) expressed emotions and psychosocial factors that may interfere with their ability to manage diabetes. These included conflicting desires, insecurity, fear, pain, inadequate knowledge, worry about long-term effects, prejudice, rejection, and shame. Findings suggest that during patient teaching at the time of diagnoses and follow-up clinic visits, clinicians address not only the physical aspects of the disease (blood sugar monitoring, insulin administration, diet and exercise management) but also examine emotional and psychosocial needs, and discuss strategies that will promote positive coping as children live with the complexities of growing up with diabetes.
The diagnosis of autism spectrum disorder is on the rise in the United States. More children with this disorder are requiring hospitalization and have an extended length of stay once hospitalized. The pediatric nurse is...The diagnosis of autism spectrum disorder is on the rise in the United States. More children with this disorder are requiring hospitalization and have an extended length of stay once hospitalized. The pediatric nurse is often unaware of or unprepared to offer the care that this special population requires. Sharing information obtained through repeated encounters with this population may lead to a less stressful and safer hospital stay for the child with autism, the family, and the pediatric nurse. Items about which the nurse should be aware when caring for a child with autism include the symptoms of autism spectrum disorder, the importance of family involvement, identifying the best way to communicate with the child, minimizing change, incorporating the child's home routine into the stay, creating a safe environment, identifying emotional disturbances, involving a multi-disciplinary team of experts on admission, listening to the family, and creating a record of this information to be shared among staff members.