Jamerson PA, Graf E, Messmer PR
… +9 more, Fields HW, Barton S, Berger A, Daraiseh NM, Fix M, Huth M, Latta L, Smith AB, Lunbeck M
Pediatr Nurs
· 2014 · PMID 25134226
Patient falls are considered a significant safety risk, but little evidence regarding the significance of falls in children is available. A multisite, observational study of fall events occurring in pediatric inpatients...Patient falls are considered a significant safety risk, but little evidence regarding the significance of falls in children is available. A multisite, observational study of fall events occurring in pediatric inpatients (younger than 18 years of age) from Child Health Corporation of America member hospitals was conducted to determine the prevalence and significance of falls. Fall prevalence was 0.84 per 1,000 patient days with 48% classified as preventable. Injuries occurred in 32%, but only two falls resulted in an increased length of stay; none resulted in permanent disability or death. Only 47% of the children who fell were identified to be at risk for fall. Alert mechanisms were used in 60% and preventive measures in 23%. These findings suggest that while inpatient pediatric fall rates are lower than those of adults, greater diligence in identification and risk reduction may further reduce the prevalence of falls and the proportion of fall-related injuries.
UNLABELLED: Recent health care legislative acts, federal budget cuts, and changes in health care reimbursement are posing significant challenges for mothers accessing health care for their infants. There is very little r...UNLABELLED: Recent health care legislative acts, federal budget cuts, and changes in health care reimbursement are posing significant challenges for mothers accessing health care for their infants. There is very little reported literature on post-birth newborn morbidity and associated charges for full-term infants within the first two months of life, a time of increased risk for mortality. PURPOSE: To examine infant morbidities, associated health care charges, and access to health care within the first eight weeks in healthy, full-term infants born to low-income, first-time mothers. DESIGN: A secondary analysis of data from a randomized clinical trial that compared infants' health and newborn health care charges. METHODS: Data on infant morbidity and health care charges on 139 first-time mothers and their healthy full-term newborns were collected at one and two months post-hospital discharge. Data were analyzed using descriptive statistics and two-sample t-tests. FINDINGS: The most common infant morbidity was upper respiratory illness. Morbidities occurred as early as day two post-hospital discharge. Total charges were emergency room visits--$24,255, urgent care visits--$2,937, and rehospitalizations--$56,377. Most newborns received a well-baby clinic visit within 48 to 72 hours post-hospital discharge. CONCLUSION: Studies of morbidities, health care charges, and access to care for infants two months and less are very limited. However, such data are important because of increasing health care costs, health care budget cuts, and the lack of an infant morbidity surveillance system.
The importance of successfully transitioning pediatric patients to adult care is increasingly recognized as more children with chronic diseases are living to adulthood. The aim of this study was to investigate the curren...The importance of successfully transitioning pediatric patients to adult care is increasingly recognized as more children with chronic diseases are living to adulthood. The aim of this study was to investigate the current state of provider perceptions across disciplines regarding transition of pediatric patients to adult care. Focus groups made up of providers of various roles and experience levels were conducted. A total of six major themes were identified. We conclude that pediatric providers share common concerns about transitioning pediatric patients to adult care. We reinforce many of the issues raised in the literature and also discuss a sense of professional ego that was identified as a barrier to successful transition, which is not widely reported in other studies.
Adolescents have unique sleep behaviors related to physiological and developmental differences. Research suggests that sleep debt related to these adolescent differences contributes to risk for accidents, behavioral chan...Adolescents have unique sleep behaviors related to physiological and developmental differences. Research suggests that sleep debt related to these adolescent differences contributes to risk for accidents, behavioral changes, and other health concerns. In addition, the impact of pain related to trauma, surgery, and chronic illness can further alter the sleep patterns of this age group. Limited normative parameters describe the sleep of healthy adolescents. A comparative study of 26 adolescents from 12 through 18 years of age was designed to describe the sleep patterns of two groups of adolescents. Sleep parameters, including actual sleep time, sleep efficiency, nighttime awakenings, and other sleep patterns of adolescents following post-operative tonsillectomy and adenoidectomy (T & A), were compared with an age and gender-matched sample of healthy adolescents. All adolescents wore wrist-actigraphy and documented sleep information in a diary for three continuous days. Healthy adolescents had significantly less (p = 0.003) actual hours of night time sleep and significantly less (p = 0.039) sleep efficiency than adolescents in the post-operative sample during the three days. None of the adolescents in this study had sufficient actual hours of nighttime sleep. Findings support the need for nurses to assess adolescent sleep patterns and to educate teens and their families about the importance of adequate sleep. Further research is needed to establish sleep interventions that will improve the sleep hygiene of both healthy adolescents and those who experience sleep disruption due to painful conditions.
Scholarship is an important facet of the nursing profession. There are many components, virtues, and roles and responsibilities of a nursing scholar practicing in today's ever-changing health care environment. Scholarshi...Scholarship is an important facet of the nursing profession. There are many components, virtues, and roles and responsibilities of a nursing scholar practicing in today's ever-changing health care environment. Scholarship was redefined by Boyer to include scholarly activities in addition to research. Boyer's Model of Scholarship includes four interrelated and overlapping domains of discovery, integration, application, and teaching. Each domain is explained with examples for the pediatric nurse scholar, which includes roles in academia as well as in the practice setting. Pediatric nurses are key to scholarship in nursing because they work to improve the care of children.
Childhood obesity has become a topic of interest for the health sciences research community due to the childhood obesity epidemic. Pediatric nurse practitioners are in the frontline of prevention for children who are obe...Childhood obesity has become a topic of interest for the health sciences research community due to the childhood obesity epidemic. Pediatric nurse practitioners are in the frontline of prevention for children who are obese or at risk of becoming obese. Serving in this role requires the nurses' ability to measure parenting practices, parents' inner beliefs, and parental control over their child's eating practices. Questionnaires and other tools are needed to understand parents' thoughts on how satisfied they are as parents, their locus of control in their parent-child relationship, and how competent they feel in the parenting role. Many parenting scales related to self-efficacy, competence, locus of control, and satisfaction have been developed over the past decades, but little research development has occurred in relation to child's eating behaviors within nursing. This article will review the current parent efficacy literature and examine its relationship to childhood obesity.
Tyrosinemia type 1 (TT1) is an inherited metabolic disease that can be fatal when not detected early by newborn screening. In the past, children with TT1 had a poor prognosis due to organ failure and neurologic crisis du...Tyrosinemia type 1 (TT1) is an inherited metabolic disease that can be fatal when not detected early by newborn screening. In the past, children with TT1 had a poor prognosis due to organ failure and neurologic crisis during infancy. Recent improvements in newborn screening have changed the prognosis of affected children. Measurement of succinylacetone by tandem mass spectrometry provides early identification and the opportunity to manage TT1 as a chronic disease. Treatment includes genetic counseling, dietary management, pharmacotherapy, metabolic crisis prevention, and whole organ transplant. Nursing care is critical to successful management when it is based on a clear understanding of the pathophysiology. This overview of nursing care will provide specific recommendations to reduce complications and enhance the quality of life for children with TT1.
Conventional parenting approaches often fall short of the mark for children who exhibit difficult behavior, sometimes inadvertently leading to increased oppositionality and poor self-esteem. As a result, parents of child...Conventional parenting approaches often fall short of the mark for children who exhibit difficult behavior, sometimes inadvertently leading to increased oppositionality and poor self-esteem. As a result, parents of children with intense personalities and challenging behaviors need strategies that work very differently. The Nurtured Heart Approach is a philosophy/technique developed to help parents rewrite the often negative parenting scripts used with these children by limiting the amount of attention given to negative or undesirable behaviors while noticing and acknowledging even small positive behaviors, naming them, "energizing" attention given to them, and valuing their occurrence. Although there has been very limited empirical study of the Nurtured Heart Approach to date, it has been used, with anecdotal reports of success, in a variety of settings, including Head Start programs, schools, foster care agencies, a treatment center, and a pre-adolescent diversion program (Glasser, 2000).
Autism spectrum disorders (ASDs) are a group of developmental disabilities that can cause significant social, communication, and behavioral challenges for children and families. An estimated one in 88 children in the Uni...Autism spectrum disorders (ASDs) are a group of developmental disabilities that can cause significant social, communication, and behavioral challenges for children and families. An estimated one in 88 children in the United States are affected by an ASD. Early identification and intervention have been shown to improve outcomes for these children, and the routine well-child visit is a critical opportunity for pediatric health care providers to obtain developmental information relating to ASD identification. Although current recommendations suggest ASD screening at 18 and 24 months of age, research suggests that ASD-specific behaviors and delays emerge earlier in infancy. The purpose of this article is to identify key developmental tasks that can be assessed by pediatric primary care providers to determine increased risk for ASD in infants at nine, 12, and 15 months prior to formal screening for ASD at 18 and 24 months.
A pre-test post-test control group design was used to compare the effectiveness of high-fidelity simulation (HFS) with traditional static mannequins as a teaching strategy for pediatric staff nurse education. Thirty-thre...A pre-test post-test control group design was used to compare the effectiveness of high-fidelity simulation (HFS) with traditional static mannequins as a teaching strategy for pediatric staff nurse education. Thirty-three nurses from a metropolitan pediatric Magnet hospital completed the study that evaluated knowledge retention, skill performance, and team confidence during the American Heart Association's (AHA) Pediatric Emergency Assessment, Recognition and Stabilization (PEARS) course. Written exams, competency and skill performance measures, and the Mayo High Performance Teamwork Scale (MHPTS) were used to compare the outcomes between the two groups. Results indicated that knowledge retention was maintained, skill performance improved, and teamwork performance scores increased in the experimental group. This study provides a foundation supporting the use of HFS as an effective teaching modality when educating pediatric staff nurses in the identification and intervention of the deteriorating pediatric patient.
The purpose of this secondary study of cross-sectional data was to examine patterns of scores on the Eating Disorders Inventory in a healthy sample of female adolescents thought to have a high potential for risk. Data we...The purpose of this secondary study of cross-sectional data was to examine patterns of scores on the Eating Disorders Inventory in a healthy sample of female adolescents thought to have a high potential for risk. Data were obtained as part of a consultation to identify risk of developing eating disorders. The screening and subsequent group level analysis was carried out with 44 female dancers 12 to 17 years of age enrolled in grades 7 to 12 in a Magnet school. This secondary analysis examined three components of the Eating Disorder Inventory (EDI-3): body dissatisfaction, drive for thinness, and bulimia for the purpose of comparing group findings across ages and grades. Some level of body dissatisfaction was widespread in the population, body dissatisfaction increased beginning notably at age 14 and increased sharply at age 15, with further increases until age 16. The correlation between body dissatisfaction and drive for thinness was shown to be statistically significant (r = 0.83, p < 0.001). Awareness that body dissatisfaction and drive for thinness increase at ages 15 and 16 means disordered eating may begin at this time. If body dissatisfaction and drive for thinness begins early in life and markedly increases at ages 14 and 15, eating disorder prevention must begin in childhood and continue into adolescence.
Influenza is a highly contagious virus that causes an average of 20,000 hospitalizations a year in children under five years of age. As of March 30, 2013, the 2012-2013 flu season had seen 111 pediatric deaths, with 21 d...Influenza is a highly contagious virus that causes an average of 20,000 hospitalizations a year in children under five years of age. As of March 30, 2013, the 2012-2013 flu season had seen 111 pediatric deaths, with 21 deaths in the 0- to 23-month-old range. Rates of influenza-associated hospitalization are substantially higher among infants and young children than among older children, and those under six months old are at the highest risk. Research shows that influenza vaccine is not as effective in children two years of age relative to adults, and the vaccine is not approved in infants younger than six months. Thus, preventing influenza and proper treatment are important for keeping this high-risk group safe from complications. With infants being highest at risk for complications and the extrapolation of efficacy and safety from the older population, the U.S. Food and Drug Administration (FDA) recently approved the use of the antiviral oseltamivir phosphate (Tamiflu) for treatment of uncomplicated influenza in patients two weeks and older. This young population is susceptible to the benefits as well as the risks of the drug. Health care providers must be aware of dosing, adverse reactions, and monitoring parameters to better treat and educate their patients.