Journal of Pediatric Health Care最新文献

Background: Discharge delays of Medical-Surgical Pediatric Intensive Care Unit (PICU) patients with Obstructive Sleep Apnea (OSA) following tonsillectomy or tonsillectomy with adenoidectomy (T&A) negatively impact hospital bed availability.

Aim statement: This project identified process improvements to reduce discharge delays and increase PICU bed availability.

Methods: A Failure Modes and Effects Analysis (FMEA) was implemented to identify care and process failures that result in discharge delays.

Intervention: Through the FMEA, failure risk profile numbers with the highest impact were recognized for improvement (Institute for Healthcare Improvement, 2017; VHA National Center for Patient Safety, 2023).

Results: Forty failure modes were identified. High-impact failures included not administering dexamethasone early for patient pain or desaturation, intervening for desaturations consistent with the patient's baseline, and not anticipating family needs for discharge.

Conclusions: The FMEA identified several actionable changes that if implemented, could promote timely discharge of patients with OSA following tonsillectomy or T&A.

Introduction: The purpose of this study is to explore challenges within the home care system encountered by parental caregivers of children with medical complexity in Massachusetts.

Method: A qualitative descriptive study was completed with 11 parental caregivers interviewed.

Results: Using conventional content analysis of transcripts, three themes emerged: (1) lack of discharge preparedness causes emotional distress, (2) care becomes increasingly complex creating new unanticipated challenges, and (3) psychological toll of parents assuming provider role.

Discussion: Navigating a variety of complex systemic challenges with minimal preparation or support contributes to an overall feeling of parental caregiver burnout. Additionally, mental health supports for parental caregivers are lacking, further exacerbating the negative impact of these challenges. Future work should focus on research, advocacy, and system reform that ensures parental caregivers receive necessary supports to care for children within a sustainable and supportive home care model. Nurses across the profession are in unique position to facilitate this change.

Introduction: This study aimed to assess Ghanaian parental attitudes toward a new malaria vaccine, R21/Matrix-M, and its associated determinants.

Method: A cross-sectional survey was conducted anonymously in July and August 2023 using snowball and convenience sampling techniques, using the Parental Attitude about Children Vaccination Scale.

Results: A total of 818 individuals were included, 67.2% were females, their median age was 32 years, and 29.01% were hesitant to vaccinate their children. People living in forests, with younger children, having the youngest child aged 1-3 years, skipping antenatal care or scheduled vaccinations, and not being willing to give the R21/Matrix-M vaccine to children, were vaccine-hesitant. However, healthcare workers, those having a relative who died from malaria, and those who vaccinated their child against malaria were less hesitant.

Discussion: A large sector of parents expressed willingness to vaccinate their children against malaria. Addressing parental hesitancy requires intervention programs targeting the identified factors and enhancing parental knowledge.

Background: Social media use has been correlated to worsening anxiety and depression in teenagers.

Local problem: In the United Staes, social media is frequently used amongst adolescents, and rates of anxiety and depression in this population have increased over time.

Methods: A convenience sample of adolescents aged 12 to 18 years old were evaluated using a pre-post design.

Interventions: This quality improvement project introduced screen time assessment and motivational interviewing to decrease social media use and improve mental health among adolescents.

Results: PHQ-9 scores remained consistent throughout the project. There was an overall decrease in participant SCARED scores and social media use declined over the 12-week period.

Conclusions: Results from this project suggest an opportunity for pediatric healthcare providers to standardize social media use screening in adolescent care and utilize motivational interviewing to promote adolescent wellbeing.

Background: Immigrants, asylum seekers, and refugees live with extreme stress, consistent vulnerability, and life-long health consequences. Children in these populations face an increased risk of poor mental health because of adverse childhood experiences (ACEs).

Aim: To implement an ACE screening questionnaire for all migrant children aged < 19 years in a community shelter.

Method: The Model for Improvement.

Intervention: The Pediatric ACEs and Related Life Events Screener was implemented over 10 weeks in a community shelter.

Results: All children screened had at least 1 ACE. Initiation of screening led to the recognition of adverse experiences, thus allowing for mental health support and referrals to mental health specialists.

Conclusions: This quality improvement project supports screening for ACEs in migrant children to uncover potential mental health concerns and provide targeted support, recognizing the long-term effects of trauma on their well-being.

Introduction: This study explored the understanding and experiences related to health among Dominican American adolescents in an urban setting in the northeastern United States.

Method: A qualitative descriptive study was conducted, applying thematic analysis to focus group interview data from 23 students.

Results: Five themes emerged: (1) Health is All About Healthy Eating, (2) Sugarcoating, (3) Dynamics Affecting Adherence, (4) Dominican Cultural Influences on Health, and (5) Toll of the Immigrant Life.

Discussion: Cultural expectations, particularly deference to family members, substantially impact health care providers' interactions with Dominican American adolescents. Limited communication hinders discussion on topics like healthy eating and mental health. Parental reliance on home remedies over seeking professional care adds another layer of complexity. This study establishes a foundational understanding of Dominican American adolescents' health experiences, highlighting areas where pediatric nurse practitioners can target interventions to support Dominican American adolescents' health journeys.

These case reports describe two neonates, born at term, diagnosed with bacterial meningitis and septicemia caused by uncommon organisms. The clinical presentation, diagnostic reasoning, national guidelines, hospital course, and follow-up are discussed. Meningitis is among the differential diagnoses when there is a concern for neonatal sepsis. Concern for sepsis can arise from a variety of antepartum, intrapartum, and postpartum risk factors and present with a variety of symptoms. Neonatal sepsis is a significant cause of mortality, with 750,000 infant deaths annually. Effective treatment of neonatal sepsis requires timely diagnosis and tailored antimicrobial therapy that targets the causative pathogens.

The prevalence of substance use disorders is increasing among children and adolescents. We present a case of a 3-year-old girl who was admitted to our hospital with complaints of acute onset difficulty walking and speaking. Neurological examination revealed dysarthria, truncal ataxia, hypotonia, and hyporeflexia. Brain magnetic resonance imaging, cerebrospinal fluid analysis, and routine blood and urine analyses were normal. Urine drug testing revealed positive results for ecstasy and methamphetamine. The patient's symptoms improved during hospitalization. To our knowledge, this is the youngest reported case of methamphetamine and ecstasy-induced acute reversible cerebellar neurotoxicity. It is essential to carefully monitor acute reversible neurological symptoms related to methamphetamine and ecstasy.

The adolescent development age is the period between 10 and 19 years when a child becomes a young adult and learns to make important health decisions independently. Adolescents consenting to receive a vaccine without parental or legal guardian consent is adolescent self-consent. Adolescent self-consent for the human papillomavirus (HPV) vaccine is a health policy issue that could increase vaccine uptake rates. Adolescent self-consent for the vaccine may increase adolescents' autonomy with their healthcare decisions. Pediatric advanced practice nurses and other healthcare providers should advocate for adolescents and encourage parents to allow adolescents to be more active regarding the HPV vaccine.

Objective: This study examines the associations between family and friend support and depressive and anxiety symptoms among adolescents, considering potential sex differences.

Methods: Secondary data from a longitudinal cohort study of 1,348 adolescents ages 11-17 were analyzed using descriptive statistics and multiple linear regression, controlling for relevant factors. Interaction terms between sex and support were created to examine moderation by sex.

Results: Youth who reported higher family support reported lower depressive symptoms (b = -0.53, p < .001) and lower anxiety symptoms (b = -0.39, p < .001). Similarly, youth's higher reported friend support was associated with lower depressive symptoms (b = -0.52, p < .001) and lower anxiety symptoms (b = -0.44, p < .001). Effects were not modified by sex.

Conclusion: Understanding modifiable factors such as supportive systems is important to mitigate mental health disorders. Further investigation of protective factors for promoting adolescent mental health is needed.