Pediatric nursing最新文献

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.

Background: Many children present to the emergency department (ED) in pain and/or experience pain as a result of interventions necessary to manage their illness. Pediatric pain assessment and management is complex and challenging. Despite the presence of published standards of care specific to pain assessment and management, nurses in the ED may not know about and/or consistently use these evidence-based practices. In particular, pediatric patients are inconsistently and/or inappropriately assessed for pain in the ED.

Methods: The aim of this project was to make standard the utilization of evidence-based practices regarding pediatric pain assessment in the ED at a community hospital. The purpose of this project was to develop, implement, and evaluate a pediatric pain education program and pain assessment protocol to improve nurses' knowledge and standardize care in a community hospital emergency department.

Results: Seventy-eight ED nurses completed the education program, consisting of an online module with content addressing pediatric pain assessment and management, and then used the protocol. Education program evaluations were very positive. A statistically significant difference in the mean pre- and post-test scores indicated significant learning gains among participants; strong reliability of this test was demonstrated. Sixty patient medical records were reviewed two weeks after the educational program. Pain assessment at triage and use of an appropriate pain scale for all assessments were the most consistently used components of the protocol. A low percentage of protocol adherence was found regarding assessment of pain characteristics.

Conclusion: Significant improvements in nurses' pain knowledge are demonstrated via an education program. Implementation of a pain assessment protocol is one mechanism to standardize nursing practice with pediatric patients in the ED setting.

Existing research shows that hospitalized patients, especially pediatric burn patients, are often sleep deprived. A pre-existing diagnosis of attention deficit/hyperactivity disorder (ADHD) further compounds a burn patient's inability to sleep. This retrospective study compared the effectiveness of zolpidem on patients with acute burns with ADHD (n = 23) and patients with acute burns without ADHD (n = 23). Effectiveness was defined based on the need for a change in the sleep medication or an increase in the zolpidem dose during the first 12 days of treatment. This study found that sleep dysfunction was similar in pediatric burn patients with and without a concurrent diagnosis of ADHD. Sixteen (69.6%) patients with and 13 (56.5%) patients without ADHD required a sleep medication change (p = 0.541). Further, while patients with ADHD required a sleep medication change (median = 5 days) sooner than those without ADHD (median = 9 days), it appears that zolpidem is not an effective drug for managing sleep in pediatric burn patients with or without ADHD.

In the last two decades, the number of new cases of type 2 diabetes mellitus (T2DM) among U.S. adolescents has increased (Fagot-Campagna et al., 2000; SEARCH Study Group, 2006), which may be related to the lack of health-promoting behaviors, such as a balanced diet and adequate physical exercise. This descriptive correlational study examined the relationship between perceived risk for T2DM, dietary intake, and physical activity in adolescents (N = 80) 13 to 18 years of age. The Children's Health Belief Model (Bush & lannotti, 1990) was the conceptual framework used for testing the theoretical relationships. Participants completed the following instruments: 1) Knowledge of Risk Factors for T2DM, 2) Health Beliefs for T2DM, 3) Godin-Shepard Leisure-Time Exercise Questionnaire (Godin & Shepard, 1997), and 4) the Demographic/Medical Questionnaire. Significant relationships were found between perceived risk, a subset of the Health Beliefs for T2DM scale, and the health promoting behaviors of dietary intake and physical activity. Implications for health-promoting nursing practice related to adolescent perception of risk and health-promoting behaviors of dietary intake and physical activity are addressed.

Gluten is a protein complex found in the endosperm portion of wheat, rye, and barley. "Gluten-related disorder" is a term used to describe conditions related to ingestion of gluten-containing foods. Gluten has been implicated as the cause of a variety of gastrointestinal (GI) and extraintestinal symptoms. These symptoms are often non-specific and variable, making it difficult for the primary care provider to diagnose the cause and develop a management plan. Recently, gluten-related disorders have received much attention in the popular press, and the sale of gluten-free foods has become a multi-billion dollar business. It is important for pediatric primary care providers to understand the potential role of gluten in GI health and symptomatology so appropriate screening, diagnostic testing, and management can be provided.

Anger is a common factor in two causes of death in adolescence: homicide and suicide. This study looked at the level of anger in non-clinical convenience sample of adolescents (N = 139) between the ages of 12 and 19 years (early: 12 to 14 years, mid: 15 to 16 years, late: 17 to 19 years) from a large Southeastern Baptist church. Participants completed the State-Trait Anger Expression Inventory, Beck and Children's Depression Inventories, and Children of Alcoholics Screening Test (CAST). The level of self-reported anger was low. The difference in anger between the three age groups was not statistically significant. Differences in gender were generally not significant statistically. A strong correlation exists between stress and anger. A minor relationship between parental drinking behaviors, as measured by the CAST, and anger was found. A significant relationship between anger and depression, and frequency of participation in religious activity and decreased anger was established. By increasing the current knowledge of anger in adolescents, it may be possible to gain insight into risk factors or triggers that cause anger. Interventions must be implemented early to prevent juvenile detention and to help adolescents remain in the community. Public policies addressing anger in adolescents are essential. Health care providers must work together to identify adolescents with disorders or feelings of isolation or disconnect and provide treatment based in communities so adolescents can still function and not be isolated. It is relevant that a mentor or someone that can be trusted is provided to build a safe and secure environment. This greater knowledge may aid in assessment and treatment of adolescents with dysfunctional anger.