Translational Research – Changing the Landscape of Pediatric Nursing Becky J. Christian PhD, MSN, RN PII: DOI: Reference:
S0882-5963(14)00175-4 doi: 10.1016/j.pedn.2014.05.008 YJPDN 1157
To appear in:
Journal of Pediatric Nursing
Received date: Accepted date:
14 May 2014 15 May 2014
Please cite this article as: Christian, B.J., Translational Research – Changing the Landscape of Pediatric Nursing, Journal of Pediatric Nursing (2014), doi: 10.1016/j.pedn.2014.05.008
This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.
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ACCEPTED MANUSCRIPT
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Research Commentary Column
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Translational Research – Changing the Landscape of Pediatric Nursing
Journal of Pediatric Nursing
MA
(July/August, Issue 4)
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CE
PT
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Becky J. Christian, PhD, MSN, RN Professor School of Nursing The University of Alabama at Birmingham 1720 Second Avenue South Birmingham, AL 35294-1210 Phone: 205.934.6489 | Fax: 205.996.7183 [email protected]
submitted May 14, 2014
ACCEPTED MANUSCRIPT
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The landscape of pediatric nursing is being transformed through translational research and evidence-based practice. With this transformation, pediatric nursing continues to focus on
SC
the health and care of children and their families; but with innovative intervention strategies being tested through clinical nursing research and translated into practice, the quality of care is
NU
enhanced. Indeed, new evidence generated from clinical nursing research improves nursing
MA
practice (Polit & Beck, 2012). Moreover, evidence-based practice improves the quality of health outcomes (Melnyk & Fineout-Overholt, 2011), and enhances care for children and their families
ED
(Hockenberry & Wilson, 2011). Thus, these new interventions developed and tested through research and quality improvement projects generate new evidence that is then translated into
PT
pediatric nursing practice (Christian, 2013a). As a result, the development of new evidence and
CE
innovative intervention strategies not only improves the care of children and their families, but changes the landscape of pediatric nursing practice (Christian, 2013b).
AC
In this issue of the Journal of Pediatric Nursing, twelve articles illustrate the changing the landscape of pediatric nursing practice and the advent of new evidence designed to improve care for children and their families and the quality of pediatric nursing practice by: (a) evaluating the current practice of maintaining peripherally inserted central catheter (PICC) line patency in pediatric patients with heart failure receiving continuous inotropic support with continuous low dose heparin; (b) evaluating the effectiveness of a commercially-available, peripheral IV (PIV) stabilization device and the rate of complications as compared to standard sterile transparent dressing in hospitalized children; (c) determining the effectiveness of a pediatric skin integrity clinical practice guideline quality improvement (QI) project to decrease the incidence of skin
ACCEPTED MANUSCRIPT breakdown in children hospitalized in the pediatric cardiac intensive care unit (PCICU); (d) exploring experienced pediatric nurses’ use of non-pharmacological approaches for pain relief in
T
hospitalized children in Norway; (e) describing parent-reported sleep disturbances and behavior
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problems in school-age children with juvenile idiopathic arthritis (JIA), as compared with typically developing, healthy children; (f) identifying levels of fatigue in children, adolescents,
SC
and young adults receiving care in acute care and ambulatory care outpatient settings at a
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university-affiliated, tertiary care children’s hospital; (g) describing and evaluating the use of a memory book intervention for grief and loss recovery in orphaned children living at two
MA
Christian-based children’s homes in South Africa; (h) exploring the relationships among health literacy, social support, self-efficacy, and interpersonal interactions with health care providers in
ED
low-income Latina mothers; (i) exploring the experiences of parents of premature infants with
PT
transportation from the neonatal intensive care unit (NICU) at a university hospital to NICUs at two local hospitals in Norway; (j) examining pediatric nurses’ grief experiences and the
CE
relationships among children’s deaths, burnout, and job satisfaction; (k) reviewing fecal
AC
microbiota transplantation (FMT) experimental investigational biologic drug therapy procedure in pediatric patients diagnosed with Clostridium difficile infection (CDI) and ulcerative colitis (UC); and (l) identifying research priorities for children’s nursing in an acute care setting in Ireland using a three-round Delphi survey. The twelve articles in this issue of the Journal of Pediatric Nursing provide new evidence and innovative intervention strategies for translation into pediatric nursing practice to improve care of children and their families:
A retrospective, 2:1 case control design study was conducted to evaluate the current practice of maintaining peripherally inserted central catheter (PICC) line patency in
ACCEPTED MANUSCRIPT pediatric patients (< 1 year to 21 years) with heart failure (N = 33) receiving continuous inotropic support with continuous low dose heparin, as compared to those who did not
T
receive heparin (Giangregorio, Mott, Tong, Handa, Gauvreau, & Connor, 2014). Charts
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were reviewed for children (n = 22) in the cohort who received continuous low dose heparin were compared to children (n = 11) in the cohort who did not receive heparin
SC
prior to practice change implementation. Although no statistically significant differences
NU
were found between groups for duration of patency (number of days) and need for thrombolytic agents, clinically significant differences were noted. Median duration of
MA
patency for the children in the heparin cohort was 24 days, as compared to 16 days for the children who did not receive heparin support. Further, use of thrombolytic agents was
ED
less for those who received heparin (28%) as compared with children who did not receive
PT
heparin support (50%). Interestingly, significant differences between groups were found for emergent admissions accounting for 64% admissions of the heparin group and 36% of
CE
the control group (p = 01), reflecting a change in practice encouraging pediatric patients
AC
to stay at home until admission was absolutely emergent. Findings from this study demonstrated clinically significant differences between children with heart failure with PICC who received continuous low dose heparin as compared to those who did not.
The effectiveness of a commercially-available, peripheral IV (PIV) StatLock stabilization device and the rate of complications was evaluated in comparison with standard sterile transparent dressing in hospitalized children (2 to 17 years, N = 80) using a two-group, quasi-experimental design (Laudenbach, Braun, Klaverkamp, & Hedman-Dennis, 2014). No statistically significant differences were found between comparison groups [stabilization device group (n = 36); taping group (n = 44)] in relation to PIV
ACCEPTED MANUSCRIPT complication rates, although 22.5% (n = 18) of the children experienced PIV complications [stabilization device group (n = 8); taping group (n = 10)]. Further, there
T
were no statistically significant differences between StatLock stabilization device and
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standard taping groups for age, PIV placement site, and administration of medications. Interestingly, the mean duration time of PIV placement for children was relatively brief
SC
(1.5 days) and may indicate that the use of a stabilization device is unwarranted for short-
NU
term PIVs in children.
A quality improvement (QI) project was evaluated through chart review to determine the
MA
effectiveness of implementation of a clinical practice guideline to decrease the incidence of skin breakdown in children (N = 200) hospitalized in the pediatric cardiac intensive
ED
care unit (PCICU) (Kiss & Heiler, 2014). The QI project was designed to determine the
PT
effectiveness of a pediatric skin integrity clinical practice guideline by comparing preimplementation (n = 100) and 6-month post-implementation (n = 100) through random
CE
chart review of children who were patients in the PCICU. No significant differences were
AC
found for identified risk factors. A significant decrease in skin breakdown was found for children post-implementation of the practice guideline (p < .0422), with those admitted prior to guideline implementation 1.35 times more likely to have skin breakdown. Logistic regression analysis indicated significant differences for reducing the incidence of skin breakdown after implementation of the protocol (p < .0389), and length of intubation (p < .0156), with a decreased incidence of skin breakdown from 41% to 18% after implementation.
Qualitative focus groups were used to explore and describe experienced pediatric nurses’ (N = 14) use of non-pharmacological approaches for pain relief in hospitalized children in
ACCEPTED MANUSCRIPT Norway (Svendsen & Bjørk, 2014). Findings revealed that experienced pediatric nurses focused on establishing a relationship and building cooperation with the child especially
T
during painful invasive procedures. Establishing cooperation with the child was identified
RI P
as essential for nurses during painful invasive procedures. Three different nonpharmacological approaches for pain relief were identified as the most frequent methods
SC
for pain relief: (a) encouraging, connecting and maintaining a positive attitude (most
NU
comprehensive approach); (b) giving the child control over the situation; (c) moving focus away from the situation. Moreover, these experienced pediatric nurses stressed that
MA
cooperation represented the opposite of restraint during painful invasive procedures, and the use of distraction could be unsafe because it threatened future cooperation by the
ED
child. Thus, it is important to allow adequate time in clinical practice to establish
pain relief.
CE
Sleep disturbances and behavior problems in school-age children (6 to 11 years) with juvenile idiopathic arthritis (JIA) (n = 70) as identified by parent-report were compared
AC
PT
cooperation with the child for maximum benefit of non-pharmacological approaches for
with typically developing, healthy children (n = 46), using a descriptive, correlational design (Ward, Sonney, Ringold, Stockfish, Wallace, & Landis, 2014). Significant associations were found for overall mean sleep disturbances with externalizing behavior problems (r = .32, p < .001), and internalizing behavior problems (r = .22, p < .02). A linear regression model was significant in predicting parent-reported externalizing behavior problems, explaining 7% of the variance (p < .001), after controlling for age, study group, medications, joint pain, and overall sleep disturbances. The regression model testing prediction of internalizing behavior problems was not significant (p < .20).
ACCEPTED MANUSCRIPT Parent-reported sleep disturbances were greater in children with JIA when compared to typically developing, healthy children, although these differences were not statistically
A point-prevalence audit survey was conducted to identify levels of fatigue in children,
RI P
T
significant.
SC
adolescents, and young adults (5 to 26 years) (N = 354) who received care in nine acute care units and 11 ambulatory care outpatient settings at a university-affiliated, tertiary
NU
care children’s hospital (McCabe, & Branowicki, 2014). Sixty-six percent (n = 234) of the total sample reported significant levels of fatigue and 60% reported high levels of
MA
tiredness; 75% adolescents reported high levels of fatigue. When compared to published data from healthy and chronically ill peers, the children, adolescents, and young adults in
ED
this sample reported higher levels of fatigue. Thus, it is critical for pediatric healthcare
A qualitative phenomenological approach was used to describe and evaluate the use of a
CE
memory book intervention for grief and loss recovery in orphaned children living at two Christian-based children’s homes in South Africa (Braband, Faris, & Wilson-Anderson,
AC
PT
providers to evaluate fatigue in pediatric patients.
2014). Qualitative focus groups were conducted with orphaned children (N = 22) and three care providers. Orphaned children (10 to 18 years; 16 female and 6 male participants) had worked on their memory books (including photos, drawings of themselves and families, written descriptions, mementos, and correspondence with sponsors, letter, and cards) for up to 7 years. Five major themes were identified by the children through their memory books in rank order: identity, relationships, emotion, coping, and hope. The memory book intervention provided children the opportunity to have adult-guided interactions to work through grief and loss to preserve their memories
ACCEPTED MANUSCRIPT and tell their life stories, as well as demonstrate their capacity for healing and recovery, and hope for the future. The relationships among health literacy, social support, self-efficacy, and interpersonal
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interactions with health care providers (HCPs) in low-income Latina mothers (N = 124) was explored using a cross-sectional, descriptive correlational study (Fry-Bowers,
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Maliski, Lewis, Macabasco-O’Connell, DiMatteo, 2014). Maternal health literacy was
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significantly associated with acculturation (r = .312, p < .001), but was not associated with formal social support (p < .063). Maternal self-efficacy was marginally associated
MA
with informal support (r = .180, p < .046), total support (r = .187, p < .037), and interpersonal interactions with HCPs (r = .245, p < .006). In multiple regression analyses,
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maternal health literacy did not significantly predict discrimination due to race/ethnicity
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in interpersonal interactions with HCPs (p < .548). Informal support significantly predicted self-efficacy in low-income Latina mothers, explaining 13.9% of the variance
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(p < .009); and when controlling for demographic variables, acculturation, and informal
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support, self-efficacy predicted maternal perception of the child’s HCP’s ability to elicit and respond to her concerns (p < .013), explaining 14.5% of the variance (p < .007). Thus, interventions focused on improving maternal self-efficacy among low-income Latina mothers may have a positive influence on child health outcomes.
The experiences of parents (N = 11 families; 11 mothers and 9 fathers) of premature infants (median 28 weeks gestation) with transportation from the neonatal intensive care unit (NICU) at a university hospital to NICUs at two local hospitals in Norway were explored in a descriptive qualitative study (Granrud, Ludvigsen, & Andershed, 2014). Parent interviews about their experiences associated with transportation from the NICU
ACCEPTED MANUSCRIPT were described by the main theme, living in uncertainty about whether the baby will survive, with three categories: (a) being distanced from the baby, (b) fearing that
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something would happen to the baby during transportation, and (c) experiencing
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closeness to the baby. Moreover, parents experienced multiple transitions, including
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developmental, situational, and health-illness transitions.
Pediatric nurses (N = 120) were surveyed to examine the relationships among grief
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experiences from children’s deaths, burnout, and job satisfaction using a cross-sectional descriptive, correlational design study (Adwan, 2014). Pediatric nurses’ grief was
MA
significantly associated with greater emotional exhaustion (burnout) (r = .38, p < .001), fewer personal accomplishments (burnout), (r = -.244, p < .009), and greater
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depersonalization (burnout) (r = .192, p < .042), as well as less job satisfaction (r = -.29,
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p < .002). In multiple regression analyses, pediatric nurses’ guilt related to grief over patients’ deaths explained 7% of the variance in personal accomplishments (burnout) (p =
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.003); while job satisfaction and grief-existential tension explained 31% of the variance
AC
in pediatric nurses’ emotional exhaustion (burnout). Moreover, emotional exhaustion (burnout) (p < .001), length of time the nurse knew the patient (p = .02) and number of primary patients who died in previous 12 months (p = .047) explained 25% of the variance in pediatric nurses’ grief. Thus, pediatric nurses experience grief over patients’ deaths in a manner similar to the family caregivers.
A review of the fecal microbiota transplantation (FMT) experimental investigational biologic drug therapy procedure in pediatric patients diagnosed with Clostridium difficile infection (CDI) and ulcerative colitis (UC) is presented to improve understanding and
ACCEPTED MANUSCRIPT discuss implications for nursing practice in clinical and research settings (Samuel, Crumb, & Duba, 2014). Research priorities for children’s nursing in an acute care setting in Ireland were
T
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identified using a three-round Delphi survey (N = 587) design study (Brenner, Hilliard, Regan, Coughlan, Hayden, Drennan, & Kelleher, 2014). The three-round survey included
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pediatric nurse participants (N = 587) at the children’s hospital. Round 1 nurses (n= 107)
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generated 44 research priorities that were reduced to 27 research priorities. During round 2, nurses (n= 231) ranked the importance of the 27 research priorities, while in round 3
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consensus was reached by participants (n= 249) with the ranking 27 research priorities. The resulting top three research priorities for children’s nursing in an acute care setting in
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Ireland were identified as: (a) recognition and care of the deteriorating child, (b) safe
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transfer of the critically ill child between acute health care facilities, and (c) the child and
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family’s perceptions of care at end-of-life.
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The changing landscape of pediatric nursing practice is reflected in innovative intervention strategies and new evidence translated into practice. Indeed, excellence in pediatric nursing practice is demonstrated through translational research and evidence-based practice resulting in improved quality of care for children and their families (Christian, 2011). For example, as highlighted by these articles in this issue, the scope of pediatric nursing practice is comprised of intervention strategies to improve the health and care of infants, children, adolescents and their families worldwide, across a variety of health care settings and home, to develop a better understanding of parents and families, the functioning of pediatric nurses, as well as targeting new research priorities for pediatric research. To that end, changing the
ACCEPTED MANUSCRIPT landscape of pediatric nursing practice is exemplified by the development of new evidence that is translated into pediatric nursing practice, transforming the quality of care and health outcomes
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for children and their families worldwide.
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Becky J. Christian, PhD, MSN, RN University of Alabama at Birmingham, School of Nursing, Birmingham, AL email: [email protected]
ACCEPTED MANUSCRIPT References
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Adwan, J.Z. (2014). Pediatric nurses’ grief experience, burnout, and job satisfaction. Journal of Pediatric Nursing, 29(4), XXX. Braband, B.J., Faris, T., & Wilson-Anderson, K. (2014). Evaluation of a Memory Book intervention with orphaned children in South Africa. Journal of Pediatric Nursing, 29(4), XXX. Brenner, M., Hilliard, C., Regan, G., Coughlan, B., Hayden, S., Drennan, J., & Kelleher, D. (2014). Research priorities for children’s nursing in Ireland: A Delphi study. Journal of Pediatric Nursing, 29(4), XXX. Christian, B.J. (2011). Hallmark of excellence: Research and evidence-based practice as the foundation for quality pediatric nursing. Journal of Pediatric Nursing, 26(2), 170-171. Christian, B.J. (2013a). Rebirth and renewal through research – New evidence and strategies for improving the quality of pediatric nursing care. Journal of Pediatric Nursing, 28(3), 305308. Christian, B.J. (2013b). Translational research – The imperative for integrating evidence into pediatric nursing practice to improve health outcomes. Journal of Pediatric Nursing, 28(5), 508-510. Fry-Bowers, E.K., Maliski, S., Lewis, M.A., Macabasco-O’Connell, A., DiMatteo, R. (2014). The association of health literacy, social support, self-efficacy, and interpersonal interactions with health care providers in low-income Latina mothers. Journal of Pediatric Nursing, 29(4), XXX. Giangregorio, M., Mott, S., Tong, E., Handa, S., Gauvreau, K., & Connor, J.A. (2014). Management of peripherally inserted central catheters (PICC) in pediatric heart failure patients receiving continuous inotropic support. Journal of Pediatric Nursing, 29(4), XXX. Granrud, M.D., Ludvigsen, E., & Andershed, B. (2014). Parents’ experiences of their premature infants’ transportation from a university hospital NICU to NICU at two local hospitals. Journal of Pediatric Nursing, 29(4), XXX. Hockenberry, M.J., & Wilson, D. (2011). Wong's nursing care of infants and children (9th Ed.). St. Louis: Mosby. Kiss, E.A., & Heiler, M. (2014). Pediatric skin integrity practice guideline for institutional use: A quality improvement project. Journal of Pediatric Nursing, 29(4), XXX. Laudenbach, N., Braun, C.A., Klaverkamp, L., & Hedman-Dennis, S. (2014). Peripheral IV stabilization and the rate of complications in children: An exploratory study. Journal of Pediatric Nursing, 29(4), XXX. McCabe, M., & Branowicki, P. (2014). Fatigue in the acute care and ambulatory setting. Journal of Pediatric Nursing, 29(4), XXX. Melnyk, B.M., & Fineout-Overholt, E. (2011). Making the case for evidence-based practice and cultivating a spirit of inquiry (pp. 3-24). In B.M. Melnyk, & E. Fineout-Overholt, (Eds.), Evidence-based practice in nursing and healthcare. (2nd Ed.). Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins. Polit, D.F., & Beck, C.T. (2012). Nursing research: Generating and assessing evidence for nursing practice (9th Ed.). Philadelphia: Lippincott Williams & Wilkins. Samuel, B.P., Crumb, T.L., & Duba, M.M. (2014). What nurses need to know about fecal microbiota transplantation: Education, assessment, and care for children and young adults. Journal of Pediatric Nursing, 29(4), XXX.
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Svendsen, E.J., & Bjørk, I.T. (2014). Experienced nurses’ use of non-pharmacological approaches comprise more than relief from for pain. Journal of Pediatric Nursing, 29(4), XXX. Ward, T.M., Sonney, J., Ringold, S., Stockfish, S., Wallace, C.A., & Landis, C.A. (2014). Sleep disturbances and behavior problems in children with and without arthritis. Journal of Pediatric Nursing, 29(4), XXX.
S0882-5963(14)00175-4 doi: 10.1016/j.pedn.2014.05.008 YJPDN 1157
To appear in:
Journal of Pediatric Nursing
Received date: Accepted date:
14 May 2014 15 May 2014
Please cite this article as: Christian, B.J., Translational Research – Changing the Landscape of Pediatric Nursing, Journal of Pediatric Nursing (2014), doi: 10.1016/j.pedn.2014.05.008
This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.
RI P
T
ACCEPTED MANUSCRIPT
SC
Research Commentary Column
NU
Translational Research – Changing the Landscape of Pediatric Nursing
Journal of Pediatric Nursing
MA
(July/August, Issue 4)
AC
CE
PT
ED
Becky J. Christian, PhD, MSN, RN Professor School of Nursing The University of Alabama at Birmingham 1720 Second Avenue South Birmingham, AL 35294-1210 Phone: 205.934.6489 | Fax: 205.996.7183 [email protected]
submitted May 14, 2014
ACCEPTED MANUSCRIPT
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T
The landscape of pediatric nursing is being transformed through translational research and evidence-based practice. With this transformation, pediatric nursing continues to focus on
SC
the health and care of children and their families; but with innovative intervention strategies being tested through clinical nursing research and translated into practice, the quality of care is
NU
enhanced. Indeed, new evidence generated from clinical nursing research improves nursing
MA
practice (Polit & Beck, 2012). Moreover, evidence-based practice improves the quality of health outcomes (Melnyk & Fineout-Overholt, 2011), and enhances care for children and their families
ED
(Hockenberry & Wilson, 2011). Thus, these new interventions developed and tested through research and quality improvement projects generate new evidence that is then translated into
PT
pediatric nursing practice (Christian, 2013a). As a result, the development of new evidence and
CE
innovative intervention strategies not only improves the care of children and their families, but changes the landscape of pediatric nursing practice (Christian, 2013b).
AC
In this issue of the Journal of Pediatric Nursing, twelve articles illustrate the changing the landscape of pediatric nursing practice and the advent of new evidence designed to improve care for children and their families and the quality of pediatric nursing practice by: (a) evaluating the current practice of maintaining peripherally inserted central catheter (PICC) line patency in pediatric patients with heart failure receiving continuous inotropic support with continuous low dose heparin; (b) evaluating the effectiveness of a commercially-available, peripheral IV (PIV) stabilization device and the rate of complications as compared to standard sterile transparent dressing in hospitalized children; (c) determining the effectiveness of a pediatric skin integrity clinical practice guideline quality improvement (QI) project to decrease the incidence of skin
ACCEPTED MANUSCRIPT breakdown in children hospitalized in the pediatric cardiac intensive care unit (PCICU); (d) exploring experienced pediatric nurses’ use of non-pharmacological approaches for pain relief in
T
hospitalized children in Norway; (e) describing parent-reported sleep disturbances and behavior
RI P
problems in school-age children with juvenile idiopathic arthritis (JIA), as compared with typically developing, healthy children; (f) identifying levels of fatigue in children, adolescents,
SC
and young adults receiving care in acute care and ambulatory care outpatient settings at a
NU
university-affiliated, tertiary care children’s hospital; (g) describing and evaluating the use of a memory book intervention for grief and loss recovery in orphaned children living at two
MA
Christian-based children’s homes in South Africa; (h) exploring the relationships among health literacy, social support, self-efficacy, and interpersonal interactions with health care providers in
ED
low-income Latina mothers; (i) exploring the experiences of parents of premature infants with
PT
transportation from the neonatal intensive care unit (NICU) at a university hospital to NICUs at two local hospitals in Norway; (j) examining pediatric nurses’ grief experiences and the
CE
relationships among children’s deaths, burnout, and job satisfaction; (k) reviewing fecal
AC
microbiota transplantation (FMT) experimental investigational biologic drug therapy procedure in pediatric patients diagnosed with Clostridium difficile infection (CDI) and ulcerative colitis (UC); and (l) identifying research priorities for children’s nursing in an acute care setting in Ireland using a three-round Delphi survey. The twelve articles in this issue of the Journal of Pediatric Nursing provide new evidence and innovative intervention strategies for translation into pediatric nursing practice to improve care of children and their families:
A retrospective, 2:1 case control design study was conducted to evaluate the current practice of maintaining peripherally inserted central catheter (PICC) line patency in
ACCEPTED MANUSCRIPT pediatric patients (< 1 year to 21 years) with heart failure (N = 33) receiving continuous inotropic support with continuous low dose heparin, as compared to those who did not
T
receive heparin (Giangregorio, Mott, Tong, Handa, Gauvreau, & Connor, 2014). Charts
RI P
were reviewed for children (n = 22) in the cohort who received continuous low dose heparin were compared to children (n = 11) in the cohort who did not receive heparin
SC
prior to practice change implementation. Although no statistically significant differences
NU
were found between groups for duration of patency (number of days) and need for thrombolytic agents, clinically significant differences were noted. Median duration of
MA
patency for the children in the heparin cohort was 24 days, as compared to 16 days for the children who did not receive heparin support. Further, use of thrombolytic agents was
ED
less for those who received heparin (28%) as compared with children who did not receive
PT
heparin support (50%). Interestingly, significant differences between groups were found for emergent admissions accounting for 64% admissions of the heparin group and 36% of
CE
the control group (p = 01), reflecting a change in practice encouraging pediatric patients
AC
to stay at home until admission was absolutely emergent. Findings from this study demonstrated clinically significant differences between children with heart failure with PICC who received continuous low dose heparin as compared to those who did not.
The effectiveness of a commercially-available, peripheral IV (PIV) StatLock stabilization device and the rate of complications was evaluated in comparison with standard sterile transparent dressing in hospitalized children (2 to 17 years, N = 80) using a two-group, quasi-experimental design (Laudenbach, Braun, Klaverkamp, & Hedman-Dennis, 2014). No statistically significant differences were found between comparison groups [stabilization device group (n = 36); taping group (n = 44)] in relation to PIV
ACCEPTED MANUSCRIPT complication rates, although 22.5% (n = 18) of the children experienced PIV complications [stabilization device group (n = 8); taping group (n = 10)]. Further, there
T
were no statistically significant differences between StatLock stabilization device and
RI P
standard taping groups for age, PIV placement site, and administration of medications. Interestingly, the mean duration time of PIV placement for children was relatively brief
SC
(1.5 days) and may indicate that the use of a stabilization device is unwarranted for short-
NU
term PIVs in children.
A quality improvement (QI) project was evaluated through chart review to determine the
MA
effectiveness of implementation of a clinical practice guideline to decrease the incidence of skin breakdown in children (N = 200) hospitalized in the pediatric cardiac intensive
ED
care unit (PCICU) (Kiss & Heiler, 2014). The QI project was designed to determine the
PT
effectiveness of a pediatric skin integrity clinical practice guideline by comparing preimplementation (n = 100) and 6-month post-implementation (n = 100) through random
CE
chart review of children who were patients in the PCICU. No significant differences were
AC
found for identified risk factors. A significant decrease in skin breakdown was found for children post-implementation of the practice guideline (p < .0422), with those admitted prior to guideline implementation 1.35 times more likely to have skin breakdown. Logistic regression analysis indicated significant differences for reducing the incidence of skin breakdown after implementation of the protocol (p < .0389), and length of intubation (p < .0156), with a decreased incidence of skin breakdown from 41% to 18% after implementation.
Qualitative focus groups were used to explore and describe experienced pediatric nurses’ (N = 14) use of non-pharmacological approaches for pain relief in hospitalized children in
ACCEPTED MANUSCRIPT Norway (Svendsen & Bjørk, 2014). Findings revealed that experienced pediatric nurses focused on establishing a relationship and building cooperation with the child especially
T
during painful invasive procedures. Establishing cooperation with the child was identified
RI P
as essential for nurses during painful invasive procedures. Three different nonpharmacological approaches for pain relief were identified as the most frequent methods
SC
for pain relief: (a) encouraging, connecting and maintaining a positive attitude (most
NU
comprehensive approach); (b) giving the child control over the situation; (c) moving focus away from the situation. Moreover, these experienced pediatric nurses stressed that
MA
cooperation represented the opposite of restraint during painful invasive procedures, and the use of distraction could be unsafe because it threatened future cooperation by the
ED
child. Thus, it is important to allow adequate time in clinical practice to establish
pain relief.
CE
Sleep disturbances and behavior problems in school-age children (6 to 11 years) with juvenile idiopathic arthritis (JIA) (n = 70) as identified by parent-report were compared
AC
PT
cooperation with the child for maximum benefit of non-pharmacological approaches for
with typically developing, healthy children (n = 46), using a descriptive, correlational design (Ward, Sonney, Ringold, Stockfish, Wallace, & Landis, 2014). Significant associations were found for overall mean sleep disturbances with externalizing behavior problems (r = .32, p < .001), and internalizing behavior problems (r = .22, p < .02). A linear regression model was significant in predicting parent-reported externalizing behavior problems, explaining 7% of the variance (p < .001), after controlling for age, study group, medications, joint pain, and overall sleep disturbances. The regression model testing prediction of internalizing behavior problems was not significant (p < .20).
ACCEPTED MANUSCRIPT Parent-reported sleep disturbances were greater in children with JIA when compared to typically developing, healthy children, although these differences were not statistically
A point-prevalence audit survey was conducted to identify levels of fatigue in children,
RI P
T
significant.
SC
adolescents, and young adults (5 to 26 years) (N = 354) who received care in nine acute care units and 11 ambulatory care outpatient settings at a university-affiliated, tertiary
NU
care children’s hospital (McCabe, & Branowicki, 2014). Sixty-six percent (n = 234) of the total sample reported significant levels of fatigue and 60% reported high levels of
MA
tiredness; 75% adolescents reported high levels of fatigue. When compared to published data from healthy and chronically ill peers, the children, adolescents, and young adults in
ED
this sample reported higher levels of fatigue. Thus, it is critical for pediatric healthcare
A qualitative phenomenological approach was used to describe and evaluate the use of a
CE
memory book intervention for grief and loss recovery in orphaned children living at two Christian-based children’s homes in South Africa (Braband, Faris, & Wilson-Anderson,
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providers to evaluate fatigue in pediatric patients.
2014). Qualitative focus groups were conducted with orphaned children (N = 22) and three care providers. Orphaned children (10 to 18 years; 16 female and 6 male participants) had worked on their memory books (including photos, drawings of themselves and families, written descriptions, mementos, and correspondence with sponsors, letter, and cards) for up to 7 years. Five major themes were identified by the children through their memory books in rank order: identity, relationships, emotion, coping, and hope. The memory book intervention provided children the opportunity to have adult-guided interactions to work through grief and loss to preserve their memories
ACCEPTED MANUSCRIPT and tell their life stories, as well as demonstrate their capacity for healing and recovery, and hope for the future. The relationships among health literacy, social support, self-efficacy, and interpersonal
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interactions with health care providers (HCPs) in low-income Latina mothers (N = 124) was explored using a cross-sectional, descriptive correlational study (Fry-Bowers,
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Maliski, Lewis, Macabasco-O’Connell, DiMatteo, 2014). Maternal health literacy was
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significantly associated with acculturation (r = .312, p < .001), but was not associated with formal social support (p < .063). Maternal self-efficacy was marginally associated
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with informal support (r = .180, p < .046), total support (r = .187, p < .037), and interpersonal interactions with HCPs (r = .245, p < .006). In multiple regression analyses,
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maternal health literacy did not significantly predict discrimination due to race/ethnicity
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in interpersonal interactions with HCPs (p < .548). Informal support significantly predicted self-efficacy in low-income Latina mothers, explaining 13.9% of the variance
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(p < .009); and when controlling for demographic variables, acculturation, and informal
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support, self-efficacy predicted maternal perception of the child’s HCP’s ability to elicit and respond to her concerns (p < .013), explaining 14.5% of the variance (p < .007). Thus, interventions focused on improving maternal self-efficacy among low-income Latina mothers may have a positive influence on child health outcomes.
The experiences of parents (N = 11 families; 11 mothers and 9 fathers) of premature infants (median 28 weeks gestation) with transportation from the neonatal intensive care unit (NICU) at a university hospital to NICUs at two local hospitals in Norway were explored in a descriptive qualitative study (Granrud, Ludvigsen, & Andershed, 2014). Parent interviews about their experiences associated with transportation from the NICU
ACCEPTED MANUSCRIPT were described by the main theme, living in uncertainty about whether the baby will survive, with three categories: (a) being distanced from the baby, (b) fearing that
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something would happen to the baby during transportation, and (c) experiencing
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closeness to the baby. Moreover, parents experienced multiple transitions, including
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developmental, situational, and health-illness transitions.
Pediatric nurses (N = 120) were surveyed to examine the relationships among grief
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experiences from children’s deaths, burnout, and job satisfaction using a cross-sectional descriptive, correlational design study (Adwan, 2014). Pediatric nurses’ grief was
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significantly associated with greater emotional exhaustion (burnout) (r = .38, p < .001), fewer personal accomplishments (burnout), (r = -.244, p < .009), and greater
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depersonalization (burnout) (r = .192, p < .042), as well as less job satisfaction (r = -.29,
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p < .002). In multiple regression analyses, pediatric nurses’ guilt related to grief over patients’ deaths explained 7% of the variance in personal accomplishments (burnout) (p =
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.003); while job satisfaction and grief-existential tension explained 31% of the variance
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in pediatric nurses’ emotional exhaustion (burnout). Moreover, emotional exhaustion (burnout) (p < .001), length of time the nurse knew the patient (p = .02) and number of primary patients who died in previous 12 months (p = .047) explained 25% of the variance in pediatric nurses’ grief. Thus, pediatric nurses experience grief over patients’ deaths in a manner similar to the family caregivers.
A review of the fecal microbiota transplantation (FMT) experimental investigational biologic drug therapy procedure in pediatric patients diagnosed with Clostridium difficile infection (CDI) and ulcerative colitis (UC) is presented to improve understanding and
ACCEPTED MANUSCRIPT discuss implications for nursing practice in clinical and research settings (Samuel, Crumb, & Duba, 2014). Research priorities for children’s nursing in an acute care setting in Ireland were
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identified using a three-round Delphi survey (N = 587) design study (Brenner, Hilliard, Regan, Coughlan, Hayden, Drennan, & Kelleher, 2014). The three-round survey included
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pediatric nurse participants (N = 587) at the children’s hospital. Round 1 nurses (n= 107)
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generated 44 research priorities that were reduced to 27 research priorities. During round 2, nurses (n= 231) ranked the importance of the 27 research priorities, while in round 3
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consensus was reached by participants (n= 249) with the ranking 27 research priorities. The resulting top three research priorities for children’s nursing in an acute care setting in
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Ireland were identified as: (a) recognition and care of the deteriorating child, (b) safe
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transfer of the critically ill child between acute health care facilities, and (c) the child and
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family’s perceptions of care at end-of-life.
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The changing landscape of pediatric nursing practice is reflected in innovative intervention strategies and new evidence translated into practice. Indeed, excellence in pediatric nursing practice is demonstrated through translational research and evidence-based practice resulting in improved quality of care for children and their families (Christian, 2011). For example, as highlighted by these articles in this issue, the scope of pediatric nursing practice is comprised of intervention strategies to improve the health and care of infants, children, adolescents and their families worldwide, across a variety of health care settings and home, to develop a better understanding of parents and families, the functioning of pediatric nurses, as well as targeting new research priorities for pediatric research. To that end, changing the
ACCEPTED MANUSCRIPT landscape of pediatric nursing practice is exemplified by the development of new evidence that is translated into pediatric nursing practice, transforming the quality of care and health outcomes
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for children and their families worldwide.
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Becky J. Christian, PhD, MSN, RN University of Alabama at Birmingham, School of Nursing, Birmingham, AL email: [email protected]
ACCEPTED MANUSCRIPT References
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Adwan, J.Z. (2014). Pediatric nurses’ grief experience, burnout, and job satisfaction. Journal of Pediatric Nursing, 29(4), XXX. Braband, B.J., Faris, T., & Wilson-Anderson, K. (2014). Evaluation of a Memory Book intervention with orphaned children in South Africa. Journal of Pediatric Nursing, 29(4), XXX. Brenner, M., Hilliard, C., Regan, G., Coughlan, B., Hayden, S., Drennan, J., & Kelleher, D. (2014). Research priorities for children’s nursing in Ireland: A Delphi study. Journal of Pediatric Nursing, 29(4), XXX. Christian, B.J. (2011). Hallmark of excellence: Research and evidence-based practice as the foundation for quality pediatric nursing. Journal of Pediatric Nursing, 26(2), 170-171. Christian, B.J. (2013a). Rebirth and renewal through research – New evidence and strategies for improving the quality of pediatric nursing care. Journal of Pediatric Nursing, 28(3), 305308. Christian, B.J. (2013b). Translational research – The imperative for integrating evidence into pediatric nursing practice to improve health outcomes. Journal of Pediatric Nursing, 28(5), 508-510. Fry-Bowers, E.K., Maliski, S., Lewis, M.A., Macabasco-O’Connell, A., DiMatteo, R. (2014). The association of health literacy, social support, self-efficacy, and interpersonal interactions with health care providers in low-income Latina mothers. Journal of Pediatric Nursing, 29(4), XXX. Giangregorio, M., Mott, S., Tong, E., Handa, S., Gauvreau, K., & Connor, J.A. (2014). Management of peripherally inserted central catheters (PICC) in pediatric heart failure patients receiving continuous inotropic support. Journal of Pediatric Nursing, 29(4), XXX. Granrud, M.D., Ludvigsen, E., & Andershed, B. (2014). Parents’ experiences of their premature infants’ transportation from a university hospital NICU to NICU at two local hospitals. Journal of Pediatric Nursing, 29(4), XXX. Hockenberry, M.J., & Wilson, D. (2011). Wong's nursing care of infants and children (9th Ed.). St. Louis: Mosby. Kiss, E.A., & Heiler, M. (2014). Pediatric skin integrity practice guideline for institutional use: A quality improvement project. Journal of Pediatric Nursing, 29(4), XXX. Laudenbach, N., Braun, C.A., Klaverkamp, L., & Hedman-Dennis, S. (2014). Peripheral IV stabilization and the rate of complications in children: An exploratory study. Journal of Pediatric Nursing, 29(4), XXX. McCabe, M., & Branowicki, P. (2014). Fatigue in the acute care and ambulatory setting. Journal of Pediatric Nursing, 29(4), XXX. Melnyk, B.M., & Fineout-Overholt, E. (2011). Making the case for evidence-based practice and cultivating a spirit of inquiry (pp. 3-24). In B.M. Melnyk, & E. Fineout-Overholt, (Eds.), Evidence-based practice in nursing and healthcare. (2nd Ed.). Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins. Polit, D.F., & Beck, C.T. (2012). Nursing research: Generating and assessing evidence for nursing practice (9th Ed.). Philadelphia: Lippincott Williams & Wilkins. Samuel, B.P., Crumb, T.L., & Duba, M.M. (2014). What nurses need to know about fecal microbiota transplantation: Education, assessment, and care for children and young adults. Journal of Pediatric Nursing, 29(4), XXX.
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Svendsen, E.J., & Bjørk, I.T. (2014). Experienced nurses’ use of non-pharmacological approaches comprise more than relief from for pain. Journal of Pediatric Nursing, 29(4), XXX. Ward, T.M., Sonney, J., Ringold, S., Stockfish, S., Wallace, C.A., & Landis, C.A. (2014). Sleep disturbances and behavior problems in children with and without arthritis. Journal of Pediatric Nursing, 29(4), XXX.
