The purpose of this paper is to describe the implementation of evidence-based, individualized coping plans and to compare the rates of child anxiety, child cooperation, and parent anxiety before and after implementation of these coping plans for children receiving recurring BoNT-A injections emphasizing the role of Certified Child Life Specialists (CCLSs) within the interdisciplinary team approach.
Design and Methods
A retrospective chart review was conducted for children receiving BoNT-A injections at a Physical Medicine clinic pre- and post-implementation of the coping plan. Descriptive statistics were used to evaluate care plan implementation, child cooperation, child anxiety, and parent anxiety.
Results
Post-implementation of coping care plans, children experienced improved cooperation during BoNT-A injections. Parental anxiety decreased once coping plans were implemented. Documentation improved after the implementation of coping plans specific to areas involving cooperation, child's anxiety and distress, and parental anxiety and distress. It was also noted that there was an increase in child anxiety assessments within documentation.
Practice Implications
CCLS were able to utilize their expertise to collaboratively create individualized coping care plans to increase child's cooperation and decrease parental anxiety during BoNT-A injections.
{"title":"Certified Child Life Specialist role in implementation of individualized coping plans for children receiving botulinum toxin injections","authors":"Brittany Mikuluk MEd, CCLS, Parishma Guttoo MBBS, MPH, Avery Anderson BSN, RN, Micah Skeens PhD, RN, CPNP","doi":"10.1111/jspn.12413","DOIUrl":"10.1111/jspn.12413","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Purpose</h3>\u0000 \u0000 <p>The purpose of this paper is to describe the implementation of evidence-based, individualized coping plans and to compare the rates of child anxiety, child cooperation, and parent anxiety before and after implementation of these coping plans for children receiving recurring BoNT-A injections emphasizing the role of Certified Child Life Specialists (CCLSs) within the interdisciplinary team approach.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Design and Methods</h3>\u0000 \u0000 <p>A retrospective chart review was conducted for children receiving BoNT-A injections at a Physical Medicine clinic pre- and post-implementation of the coping plan. Descriptive statistics were used to evaluate care plan implementation, child cooperation, child anxiety, and parent anxiety.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Post-implementation of coping care plans, children experienced improved cooperation during BoNT-A injections. Parental anxiety decreased once coping plans were implemented. Documentation improved after the implementation of coping plans specific to areas involving cooperation, child's anxiety and distress, and parental anxiety and distress. It was also noted that there was an increase in child anxiety assessments within documentation.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Practice Implications</h3>\u0000 \u0000 <p>CCLS were able to utilize their expertise to collaboratively create individualized coping care plans to increase child's cooperation and decrease parental anxiety during BoNT-A injections.</p>\u0000 </section>\u0000 </div>","PeriodicalId":54900,"journal":{"name":"Journal for Specialists in Pediatric Nursing","volume":null,"pages":null},"PeriodicalIF":1.3,"publicationDate":"2023-06-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9790186","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Ángela M. Henao-Castaño RN, MSN, Claudia Lorena Motta-Robayo RN, MSN, Ingrid Tatiana Rojas-Ruiz RN, MSN
Purpose
To determine the incidence and factors related to the presence of Delirium in children under 5 years of age hospitalized in the pediatric intensive care unit (PICU).
Design and Methods
Prospective observational study, through a convenience sampling. Fifty-two patients hospitalized in the PICU between 6 months and 5 years of age were included. The Preschool Confusion Assessment Method for the intensive care units (PSCAM-ICU) instrument was applied in its Spanish version. A bivariate analysis was performed to identify possible related factors.
Results
The incidence of delirium in the pediatric population under 5 years of age was 71.1%, with mainly hypoactive typology. Those who presented the event were characterized because they were mainly female, with an average age of 31 months, with lower weight compared with those who did not have delirium. Possible risk factors for delirium were found to be longer stays in the PICU and mechanical ventilation, higher levels of carbon dioxide pressure, lower levels of oxygen pressure, having orotracheal intubation, and medication with sedatives and analgesics.
Practice Implications
The high incidence of delirium in the pediatric population is notorious, mainly for younger girls and lower-weight children. The factors that showed to be potential risk factors were like those found in the literature. These factors can be incorporated by the care staff in PICUs, to prevent or identify delirium promptly and thus mitigate its impact.
{"title":"Incidence and factors associated with delirium in critically ill patients under 5 years old","authors":"Ángela M. Henao-Castaño RN, MSN, Claudia Lorena Motta-Robayo RN, MSN, Ingrid Tatiana Rojas-Ruiz RN, MSN","doi":"10.1111/jspn.12412","DOIUrl":"10.1111/jspn.12412","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Purpose</h3>\u0000 \u0000 <p>To determine the incidence and factors related to the presence of Delirium in children under 5 years of age hospitalized in the pediatric intensive care unit (PICU).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Design and Methods</h3>\u0000 \u0000 <p>Prospective observational study, through a convenience sampling. Fifty-two patients hospitalized in the PICU between 6 months and 5 years of age were included. The Preschool Confusion Assessment Method for the intensive care units (PSCAM-ICU) instrument was applied in its Spanish version. A bivariate analysis was performed to identify possible related factors.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The incidence of delirium in the pediatric population under 5 years of age was 71.1%, with mainly hypoactive typology. Those who presented the event were characterized because they were mainly female, with an average age of 31 months, with lower weight compared with those who did not have delirium. Possible risk factors for delirium were found to be longer stays in the PICU and mechanical ventilation, higher levels of carbon dioxide pressure, lower levels of oxygen pressure, having orotracheal intubation, and medication with sedatives and analgesics.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Practice Implications</h3>\u0000 \u0000 <p>The high incidence of delirium in the pediatric population is notorious, mainly for younger girls and lower-weight children. The factors that showed to be potential risk factors were like those found in the literature. These factors can be incorporated by the care staff in PICUs, to prevent or identify delirium promptly and thus mitigate its impact.</p>\u0000 </section>\u0000 </div>","PeriodicalId":54900,"journal":{"name":"Journal for Specialists in Pediatric Nursing","volume":null,"pages":null},"PeriodicalIF":1.3,"publicationDate":"2023-06-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9799015","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
The aim of this concept analysis was to define the concept of transitional care as it applied to adolescents with chronic health conditions as they transfer from pediatric to adult care.
Design and Methods
Walker and Avant's eight step method was used to guide this concept analysis. An electronic search of the literature using CINAHL, PubMed, and MEDLINE was conducted in March of 2022. Articles were included if they were peer-reviewed articles published in English between 2016 and 2022 and aided in the development of the concept.
Results
A total of 14 articles met inclusion criteria within the search. These articles were used to identify the defining attributes of transitional care as it applied to adolescents with chronic disease. These attributes were empowerment, a comprehensive process, and transfer completion. The antecedents identified were aging, readiness, and support. For an individual to begin the transition process all of these must be present. Consequences include growth, independence, and improved quality of life and health outcomes. Model, borderline, related, and contrary cases were presented to exemplify the concept.
Practice Implications
Adolescents and young adults with chronic disease require unique care as they transition to adulthood. Defining the concept of transitional care as it relates to this population provided a foundation of knowledge that has implications for nursing practice. This conceptual structure provided a foundation of knowledge for theory development and encouraged widespread use of transition programs. Future research should explore the long-term outcomes of specific interventions used during transitional care.
{"title":"Transition of care in adolescents with chronic disease: A concept analysis","authors":"Abby Seydel RN, BSN","doi":"10.1111/jspn.12414","DOIUrl":"10.1111/jspn.12414","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Purpose</h3>\u0000 \u0000 <p>The aim of this concept analysis was to define the concept of transitional care as it applied to adolescents with chronic health conditions as they transfer from pediatric to adult care.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Design and Methods</h3>\u0000 \u0000 <p>Walker and Avant's eight step method was used to guide this concept analysis. An electronic search of the literature using CINAHL, PubMed, and MEDLINE was conducted in March of 2022. Articles were included if they were peer-reviewed articles published in English between 2016 and 2022 and aided in the development of the concept.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 14 articles met inclusion criteria within the search. These articles were used to identify the defining attributes of transitional care as it applied to adolescents with chronic disease. These attributes were empowerment, a comprehensive process, and transfer completion. The antecedents identified were aging, readiness, and support. For an individual to begin the transition process all of these must be present. Consequences include growth, independence, and improved quality of life and health outcomes. Model, borderline, related, and contrary cases were presented to exemplify the concept.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Practice Implications</h3>\u0000 \u0000 <p>Adolescents and young adults with chronic disease require unique care as they transition to adulthood. Defining the concept of transitional care as it relates to this population provided a foundation of knowledge that has implications for nursing practice. This conceptual structure provided a foundation of knowledge for theory development and encouraged widespread use of transition programs. Future research should explore the long-term outcomes of specific interventions used during transitional care.</p>\u0000 </section>\u0000 </div>","PeriodicalId":54900,"journal":{"name":"Journal for Specialists in Pediatric Nursing","volume":null,"pages":null},"PeriodicalIF":1.3,"publicationDate":"2023-06-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10176008","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Children experience painful invasive procedures very intensely. The aim of health professionals is to help children minimize this traumatic experience. The Simplified Faces Pain Scale (S-FPS) and Simplified Concrete Ordinal Pain Scale (S-COS) tools offer children the possibility of self-assessing their pain. This can then be the basis for tailoring pain relief to the child's individual need. The aim of this study is to present the validation procedure of the S-FPC, S-COS methods.
Design and Methods
135 children aged 3−6 years assessed their pain using the self-reported S-FPS and S-COS methods at three consecutive times, and their results were compared with the commonly used Face, Legs, Activity, Cry, Consolability assessment scale. Intra-class correlations (ICC) were used to assess inter-rater agreement. Convergent validity was verified using Spearman's correlation coefficient.
Results
This study demonstrated good validity for both the S FPS and S-COS assessment tools. The ICC coefficient showed good inter-rater correlation. Spearman's correlation coefficient showed a strong correlation between the scales.
Practice Implications
It is not possible to clearly select a best method of pain assessment in preschool children. To choose the most appropriate method, it is necessary to take into account the child's cognitive development and preferences.
{"title":"Validity of simplified self-report methods versus standard use method for pain assessment in preschool-aged children","authors":"Petra Kasparova MSc, Jane Greaves","doi":"10.1111/jspn.12411","DOIUrl":"10.1111/jspn.12411","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Purpose</h3>\u0000 \u0000 <p>Children experience painful invasive procedures very intensely. The aim of health professionals is to help children minimize this traumatic experience. The Simplified Faces Pain Scale (S-FPS) and Simplified Concrete Ordinal Pain Scale (S-COS) tools offer children the possibility of self-assessing their pain. This can then be the basis for tailoring pain relief to the child's individual need. The aim of this study is to present the validation procedure of the S-FPC, S-COS methods.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Design and Methods</h3>\u0000 \u0000 <p>135 children aged 3−6 years assessed their pain using the self-reported S-FPS and S-COS methods at three consecutive times, and their results were compared with the commonly used Face, Legs, Activity, Cry, Consolability assessment scale. Intra-class correlations (ICC) were used to assess inter-rater agreement. Convergent validity was verified using Spearman's correlation coefficient.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>This study demonstrated good validity for both the S FPS and S-COS assessment tools. The ICC coefficient showed good inter-rater correlation. Spearman's correlation coefficient showed a strong correlation between the scales.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Practice Implications</h3>\u0000 \u0000 <p>It is not possible to clearly select a best method of pain assessment in preschool children. To choose the most appropriate method, it is necessary to take into account the child's cognitive development and preferences.</p>\u0000 </section>\u0000 </div>","PeriodicalId":54900,"journal":{"name":"Journal for Specialists in Pediatric Nursing","volume":null,"pages":null},"PeriodicalIF":1.3,"publicationDate":"2023-06-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10172043","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Lígia Lima MSc, PhD, Sara Lemos RN, MSc, PhD, Maria Do Céu Barbieri-Figueiredo RN, MSc, PhD, Teresa Martins RN, MSd, PhD, Luísa Andrade RN, MSd, PhD
Purpose
This study aims to assess the psychometric properties of the European Portuguese version of the Pediatric Quality of Life Inventory™ Family Impact Module in parents of children/adolescents with chronic health conditions.
Design and Methods
The European Portuguese version of the Pediatric Quality of Life Inventory™ Family Impact Module was administered to 237 parents of children/adolescents with chronic disease and/or chronic disorder. Participants were recruited from the day hospital and/or outpatient services of four hospitals in Northern Portugal, the majority being mothers (87.3%) aged between 31 and 50 years (86.9%). The questionnaire was administered online through the REDCap platform. The hierarchical factor model of the Pediatric Quality of Life Inventory™ Family Impact Module proposed by Varni and colleagues was tested.
Results
Confirmatory Factor Analysis indicated good model fit, with the following indices (χ2/gL = 2.19; comparative fit index [CFI] = 0.90; root mean square error of approximation [RMSEA] = 0.07 immune cell [IC] 90% = 0.06−0.07). Internal consistency values were high (parent quality of life subtotal, α = .96; family functioning subtotal, α = .92; total score, α = .96).
Practice Implications
The European Portuguese version of the PedsQL™ FIM is a reliable and valid measurement tool for nurses to assess the impact of the child/adolescent chronic conditions on family's quality of life and to develop interventions to improve their well-being.
{"title":"Psychometric properties of the European Portuguese version of the Pediatric Quality of Life Inventory™ family impact module","authors":"Lígia Lima MSc, PhD, Sara Lemos RN, MSc, PhD, Maria Do Céu Barbieri-Figueiredo RN, MSc, PhD, Teresa Martins RN, MSd, PhD, Luísa Andrade RN, MSd, PhD","doi":"10.1111/jspn.12406","DOIUrl":"10.1111/jspn.12406","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Purpose</h3>\u0000 \u0000 <p>This study aims to assess the psychometric properties of the European Portuguese version of the Pediatric Quality of Life Inventory™ Family Impact Module in parents of children/adolescents with chronic health conditions.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Design and Methods</h3>\u0000 \u0000 <p>The European Portuguese version of the Pediatric Quality of Life Inventory™ Family Impact Module was administered to 237 parents of children/adolescents with chronic disease and/or chronic disorder. Participants were recruited from the day hospital and/or outpatient services of four hospitals in Northern Portugal, the majority being mothers (87.3%) aged between 31 and 50 years (86.9%). The questionnaire was administered online through the REDCap platform. The hierarchical factor model of the Pediatric Quality of Life Inventory™ Family Impact Module proposed by Varni and colleagues was tested.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Confirmatory Factor Analysis indicated good model fit, with the following indices (<i>χ</i><sup>2</sup>/gL = 2.19; comparative fit index [CFI] = 0.90; root mean square error of approximation [RMSEA] = 0.07 immune cell [IC] 90% = 0.06−0.07). Internal consistency values were high (parent quality of life subtotal, <i>α</i> = .96; family functioning subtotal, <i>α</i> = .92; total score, <i>α</i> = .96).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Practice Implications</h3>\u0000 \u0000 <p>The European Portuguese version of the PedsQL™ FIM is a reliable and valid measurement tool for nurses to assess the impact of the child/adolescent chronic conditions on family's quality of life and to develop interventions to improve their well-being.</p>\u0000 </section>\u0000 </div>","PeriodicalId":54900,"journal":{"name":"Journal for Specialists in Pediatric Nursing","volume":null,"pages":null},"PeriodicalIF":1.3,"publicationDate":"2023-04-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9846148","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
The Covid-19 pandemic contributed to adverse adolescent mental health outcomes globally. Adolescents with chronic conditions have four times the odds of self-harm than peers. Little evidence exists to guide pediatric nurses on how to engage this vulnerable population with mental health support as the pandemic continues. In adults with chronic conditions, positive health assets (health access literacy, health self-efficacy, and emotional well-being) are directly related to improved patient engagement. The objective of this study was to gain a deeper understanding of engagement with mental health supports in adolescents with chronic conditions to inform practice.
Design and Methods
Using mixed methods, we surveyed and interviewed adolescents with chronic conditions aged 10–20 years. Random sampling was applied to avoid bias. Valid and reliable scales were used to measure health access literacy, health self-efficacy, and emotional well-being. Textual data were collected using a semistructured interview guide. Integrated data analysis was conducted using structural equation models and interpretive phenomenology.
Results
One hundred fifty-four participants provided numerical data and 17 participants provided textual data (mean age 15.5 years; 56% female, 5.8% agender; 56% White; 16.9% Black or African American, 4.5% Asian; 51.9% Hispanic or Latinx; 23.4% LGBTQ+). The structural model was an acceptable fit for the data (comparative fit index [CFI] = 0.97, Tucker–Lewis index [TLI] = 0.95). Participants reported higher levels of health access literacy (M = 3.88, SD = 0.848) than health self-efficacy (M = 2.98, SD = 0.646), and engagement (M = 1.78, SD = 1.71). Health access literacy predicted emotional well-being (β = .33, p < .001, 95% confidence interval [CI] [.20, .50]) and health self-efficacy (β = .52, p < .001, 95% CI [0.42, .062]). Emotional well-being positively predicted health self-efficacy (β = .21, p < .003, 90% CI [0.10, 0.033]). Health self-efficacy predicted engagement (β = .20, p < .01, 90% CI [0.07, 0.034]). Participants reported not engaging until “it was really, really bad” citing fear, stigma, and lack of connectedness with providers as barriers.
Practice Implications
Regardless of health access literacy and health self-efficacy, adolescents with chronic conditions may not engage until crisis levels. Pediatric nurses can aim to engage with this vulnerable population proactively.
{"title":"Adolescents with chronic conditions: Engagement with children's mental health systems during the Covid-19 pandemic","authors":"Suzanne E. Courtwright PhD, PNP, NEA-BC, Jacqueline Jones PhD, RN, Amy Barton PhD, RN, ANEF, Kerry Peterson PhD, DNP, PMHNP-BC, RN, Karen Eigen MD, Jessica Feuerstein DO, Anil Pawa MD, Akhil Pawa BS, Jennifer Northridge MD, Harpreet Pall MD, MBA, CPE","doi":"10.1111/jspn.12403","DOIUrl":"10.1111/jspn.12403","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Purpose</h3>\u0000 \u0000 <p>The Covid-19 pandemic contributed to adverse adolescent mental health outcomes globally. Adolescents with chronic conditions have four times the odds of self-harm than peers. Little evidence exists to guide pediatric nurses on how to engage this vulnerable population with mental health support as the pandemic continues. In adults with chronic conditions, positive health assets (health access literacy, health self-efficacy, and emotional well-being) are directly related to improved patient engagement. The objective of this study was to gain a deeper understanding of engagement with mental health supports in adolescents with chronic conditions to inform practice.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Design and Methods</h3>\u0000 \u0000 <p>Using mixed methods, we surveyed and interviewed adolescents with chronic conditions aged 10–20 years. Random sampling was applied to avoid bias. Valid and reliable scales were used to measure health access literacy, health self-efficacy, and emotional well-being. Textual data were collected using a semistructured interview guide. Integrated data analysis was conducted using structural equation models and interpretive phenomenology.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>One hundred fifty-four participants provided numerical data and 17 participants provided textual data (mean age 15.5 years; 56% female, 5.8% agender; 56% White; 16.9% Black or African American, 4.5% Asian; 51.9% Hispanic or Latinx; 23.4% LGBTQ+). The structural model was an acceptable fit for the data (comparative fit index [CFI] = 0.97, Tucker–Lewis index [TLI] = 0.95). Participants reported higher levels of health access literacy (<i>M</i> = 3.88, SD = 0.848) than health self-efficacy (<i>M</i> = 2.98, SD = 0.646), and engagement (<i>M</i> = 1.78, SD = 1.71). Health access literacy predicted emotional well-being (<i>β</i> = .33, <i>p</i> < .001, 95% confidence interval [CI] [.20, .50]) and health self-efficacy (<i>β</i> = .52, <i>p</i> < .001, 95% CI [0.42, .062]). Emotional well-being positively predicted health self-efficacy (<i>β</i> = .21, <i>p</i> < .003, 90% CI [0.10, 0.033]). Health self-efficacy predicted engagement (<i>β</i> = .20, <i>p</i> < .01, 90% CI [0.07, 0.034]). Participants reported not engaging until “it was really, really bad” citing fear, stigma, and lack of connectedness with providers as barriers.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Practice Implications</h3>\u0000 \u0000 <p>Regardless of health access literacy and health self-efficacy, adolescents with chronic conditions may not engage until crisis levels. Pediatric nurses can aim to engage with this vulnerable population proactively.</p>\u0000","PeriodicalId":54900,"journal":{"name":"Journal for Specialists in Pediatric Nursing","volume":null,"pages":null},"PeriodicalIF":1.3,"publicationDate":"2023-02-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9691723","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Dana E. Stallings DNP, FNP-C, CDCES, BC-ADM, Jean R. Duetsch MSN, CPNP-PC, IBCLC, Tina S. Gustin DNP, CNS, RN, Victoria M. Goode PhD, CRNA
Purpose
The COVID-19 pandemic highlighted disparities in healthcare access and outcomes, particularly among individuals with chronic conditions. A positive outcome of the pandemic was an increased use of telehealth and the creation of innovative models of care. In many organizations, nurses became the leaders for these new models. Before this change, pediatric medicine had far fewer telehealth models than adult medicine due to limited Medicaid reimbursement and equipment that was not designed with children in mind. This article describes a new model of care for children with diabetes. We will review how a nurse-led initiative with the incorporation of telehealth modalities can improve access and outcomes while reducing cost. Successful models of care will be reviewed, as well as programmatic planning, financial implications, and regulatory considerations.
Conclusions
It is no longer necessary for families living in rural communities to drive long distances, missing school and work, to attend the frequent appointments needed for optimal management of pediatric diabetes. Telemedicine can bridge gaps in access to specialty care, and is feasible, reimbursable, and well-accepted by families and providers.
Practice Implications
Nurses in both primary care and pediatric specialty offices can initiate and support innovative telehealth models of care, such as this proposal. To win the backing of practice leadership, the availability of cost-effective videoconferencing equipment and software, improvements in telehealth reimbursement prompted by the pandemic, and enhanced patient and parent satisfaction and outcomes should be emphasized.
{"title":"An interdisciplinary telemedicine innovation to enhance pediatric diabetes care in rural communities: A proposed practice initiative","authors":"Dana E. Stallings DNP, FNP-C, CDCES, BC-ADM, Jean R. Duetsch MSN, CPNP-PC, IBCLC, Tina S. Gustin DNP, CNS, RN, Victoria M. Goode PhD, CRNA","doi":"10.1111/jspn.12405","DOIUrl":"10.1111/jspn.12405","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Purpose</h3>\u0000 \u0000 <p>The COVID-19 pandemic highlighted disparities in healthcare access and outcomes, particularly among individuals with chronic conditions. A positive outcome of the pandemic was an increased use of telehealth and the creation of innovative models of care. In many organizations, nurses became the leaders for these new models. Before this change, pediatric medicine had far fewer telehealth models than adult medicine due to limited Medicaid reimbursement and equipment that was not designed with children in mind. This article describes a new model of care for children with diabetes. We will review how a nurse-led initiative with the incorporation of telehealth modalities can improve access and outcomes while reducing cost. Successful models of care will be reviewed, as well as programmatic planning, financial implications, and regulatory considerations.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>It is no longer necessary for families living in rural communities to drive long distances, missing school and work, to attend the frequent appointments needed for optimal management of pediatric diabetes. Telemedicine can bridge gaps in access to specialty care, and is feasible, reimbursable, and well-accepted by families and providers.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Practice Implications</h3>\u0000 \u0000 <p>Nurses in both primary care and pediatric specialty offices can initiate and support innovative telehealth models of care, such as this proposal. To win the backing of practice leadership, the availability of cost-effective videoconferencing equipment and software, improvements in telehealth reimbursement prompted by the pandemic, and enhanced patient and parent satisfaction and outcomes should be emphasized.</p>\u0000 </section>\u0000 </div>","PeriodicalId":54900,"journal":{"name":"Journal for Specialists in Pediatric Nursing","volume":null,"pages":null},"PeriodicalIF":1.3,"publicationDate":"2023-02-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9696987","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Sarah McAlister MS, RN, CPNP, Jean A. Connor PhD, RN, CPNP, FAAN, Shannon Engstrand MPH, Mary C. McLellan MPH, BSN, RN
Purpose
Sedation and analgesia are administered to critically ill patients, which may result in physical dependence and subsequent iatrogenic withdrawal. The Withdrawal Assessment Tool-1 (WAT-1) was developed and validated as an objective measurement of pediatric iatrogenic withdrawal in intensive care units (ICUs), with a WAT-1 score ≥ 3 indicative of withdrawal. This study's objectives were to test interrater reliability and validity of the WAT-1 in pediatric cardiovascular patients in a non-ICU setting.
Design and methods
This prospective observational cohort study was conducted on a pediatric cardiac inpatient unit. WAT-1 assessments were performed by the patient's nurse and a blinded expert nurse rater. Intra-class correlation coefficients were calculated, and Kappa statistics were estimated. A two-sample, one-sided test of proportions of weaning (n = 30) and nonweaning (n = 30) patients with a WAT-1 ≥3 were compared.
Results
Interrater reliability was low (K = 0.132). The WAT-1 area under the receiver operating curve was 0.764 (95% confidence interval; ± 0.123). There was a significantly higher proportion (50%, p = 0.009) of weaning patients with WAT-1 scores ≥3 compared to the nonweaning patients (10%). The WAT-1 elements of moderate/severe uncoordinated/repetitive movement and loose, watery stools were significantly higher in the weaning population.
Practice Implications
Methods to improve interrater reliability warrant further examination. The WAT-1 had good discrimination at identifying withdrawal in cardiovascular patients on an acute cardiac care unit. Frequent nurse re-education may increase accurate tool use. The WAT-1 tool may be used in the management of iatrogenic withdrawal in pediatric cardiovascular patients in a non-ICU setting.
{"title":"Validation of the withdrawal assessment tool-1 (WAT-1) in pediatric cardiovascular patients on an inpatient unit","authors":"Sarah McAlister MS, RN, CPNP, Jean A. Connor PhD, RN, CPNP, FAAN, Shannon Engstrand MPH, Mary C. McLellan MPH, BSN, RN","doi":"10.1111/jspn.12404","DOIUrl":"10.1111/jspn.12404","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Purpose</h3>\u0000 \u0000 <p>Sedation and analgesia are administered to critically ill patients, which may result in physical dependence and subsequent iatrogenic withdrawal. The Withdrawal Assessment Tool-1 (WAT-1) was developed and validated as an objective measurement of pediatric iatrogenic withdrawal in intensive care units (ICUs), with a WAT-1 score ≥ 3 indicative of withdrawal. This study's objectives were to test interrater reliability and validity of the WAT-1 in pediatric cardiovascular patients in a non-ICU setting.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Design and methods</h3>\u0000 \u0000 <p>This prospective observational cohort study was conducted on a pediatric cardiac inpatient unit. WAT-1 assessments were performed by the patient's nurse and a blinded expert nurse rater. Intra-class correlation coefficients were calculated, and Kappa statistics were estimated. A two-sample, one-sided test of proportions of weaning (<i>n</i> = 30) and nonweaning (<i>n</i> = 30) patients with a WAT-1 ≥3 were compared.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Interrater reliability was low (<i>K</i> = 0.132). The WAT-1 area under the receiver operating curve was 0.764 (95% confidence interval; ± 0.123). There was a significantly higher proportion (50%, <i>p</i> = 0.009) of weaning patients with WAT-1 scores ≥3 compared to the nonweaning patients (10%). The WAT-1 elements of moderate/severe uncoordinated/repetitive movement and loose, watery stools were significantly higher in the weaning population.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Practice Implications</h3>\u0000 \u0000 <p>Methods to improve interrater reliability warrant further examination. The WAT-1 had good discrimination at identifying withdrawal in cardiovascular patients on an acute cardiac care unit. Frequent nurse re-education may increase accurate tool use. The WAT-1 tool may be used in the management of iatrogenic withdrawal in pediatric cardiovascular patients in a non-ICU setting.</p>\u0000 </section>\u0000 </div>","PeriodicalId":54900,"journal":{"name":"Journal for Specialists in Pediatric Nursing","volume":null,"pages":null},"PeriodicalIF":1.3,"publicationDate":"2023-02-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9693960","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Jun Sung Hong, Jungtae Choi, Lisa A. O'Donnell, Dorothy L. Espelage, Maha Albdour, Chi-Fang Wu
Purpose
A few studies have found that children whose families are economically disadvantaged and financially struggling are at an elevated risk of victimization by their peers. However, extant research is largely descriptive. To address this gap, this study empirically tested the proposed pathways from family financial struggle to children's bullying victimization, including the role of barriers to healthcare access in this association using a nationally representative sample.
Design and Methods
The study utilizes the 2016 National Survey of Children's Health, a survey of a cross-sectional, weighted probability sample of US children (ages 0–17 years) living in 50 states and the District of Columbia, and their caregivers. The sample used for the current study included 14,374 racially and ethnically diverse caregivers of children, aged 6–11 years.
Results
Positive significant associations between family financial struggle and children's bullying victimization, and between financial struggle and barriers to healthcare access were found. Barriers to healthcare access mediated the association between family financial struggle and bullying victimization.
Practice Implications
Given the documented effects of bullying victimization on children, findings point to the importance of developing psychotherapeutic practices that are appropriate for children who are flagged as “high-risk.”
{"title":"Exploring the linkage between family financial struggle and children's bullying victimization: Implications for nursing and psychotherapeutic practices","authors":"Jun Sung Hong, Jungtae Choi, Lisa A. O'Donnell, Dorothy L. Espelage, Maha Albdour, Chi-Fang Wu","doi":"10.1111/jspn.12400","DOIUrl":"10.1111/jspn.12400","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Purpose</h3>\u0000 \u0000 <p>A few studies have found that children whose families are economically disadvantaged and financially struggling are at an elevated risk of victimization by their peers. However, extant research is largely descriptive. To address this gap, this study empirically tested the proposed pathways from family financial struggle to children's bullying victimization, including the role of barriers to healthcare access in this association using a nationally representative sample.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Design and Methods</h3>\u0000 \u0000 <p>The study utilizes the 2016 National Survey of Children's Health, a survey of a cross-sectional, weighted probability sample of US children (ages 0–17 years) living in 50 states and the District of Columbia, and their caregivers. The sample used for the current study included 14,374 racially and ethnically diverse caregivers of children, aged 6–11 years.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Positive significant associations between family financial struggle and children's bullying victimization, and between financial struggle and barriers to healthcare access were found. Barriers to healthcare access mediated the association between family financial struggle and bullying victimization.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Practice Implications</h3>\u0000 \u0000 <p>Given the documented effects of bullying victimization on children, findings point to the importance of developing psychotherapeutic practices that are appropriate for children who are flagged as “high-risk.”</p>\u0000 </section>\u0000 </div>","PeriodicalId":54900,"journal":{"name":"Journal for Specialists in Pediatric Nursing","volume":null,"pages":null},"PeriodicalIF":1.3,"publicationDate":"2022-12-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10597940","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
The objective of this study was (1) to examine sleep changes in first graders before and after school closure and (2) to examine the association between parental work rearrangement and children's sleep change during the coronavirus disease 2019 (COVID-19) pandemic.
Design and Methods
This was an observational study. The children's sleep habit questionnaire was completed by 103 parents of first-graders before and after school closure. Paired t-test and the general linear model were applied to data analysis.
Results
Children delayed their bedtime and rising time, but total sleep duration increased. Moreover, parents who rearranged their work during the pandemic perceived more child parasomnia symptoms (p = .029) and less delayed sleep-wake patterns in their children.
Practical Implication
Sleep is an indicator that reflects children's behavioral changes in response to the COVID-19 pandemic. As routine changes, parents should be aware of child's parasomnia symptoms. Nursing interventions could aim at promoting sufficient external cues in the daytime during home confinement.
{"title":"Sleep changes in Taiwanese first graders before and after school closure during the COVID-19 pandemic","authors":"Han-Yi Tsai MSN, RN, Wei-Wen Wu PhD, RN, Chia-Chun Tang PhD, RN, Shao-Yu Tsai PhD, RN, FAAN","doi":"10.1111/jspn.12401","DOIUrl":"10.1111/jspn.12401","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Purpose</h3>\u0000 \u0000 <p>The objective of this study was (1) to examine sleep changes in first graders before and after school closure and (2) to examine the association between parental work rearrangement and children's sleep change during the coronavirus disease 2019 (COVID-19) pandemic.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Design and Methods</h3>\u0000 \u0000 <p>This was an observational study. The children's sleep habit questionnaire was completed by 103 parents of first-graders before and after school closure. Paired <i>t</i>-test and the general linear model were applied to data analysis.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Children delayed their bedtime and rising time, but total sleep duration increased. Moreover, parents who rearranged their work during the pandemic perceived more child parasomnia symptoms (<i>p</i> = .029) and less delayed sleep-wake patterns in their children.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Practical Implication</h3>\u0000 \u0000 <p>Sleep is an indicator that reflects children's behavioral changes in response to the COVID-19 pandemic. As routine changes, parents should be aware of child's parasomnia symptoms. Nursing interventions could aim at promoting sufficient external cues in the daytime during home confinement.</p>\u0000 </section>\u0000 </div>","PeriodicalId":54900,"journal":{"name":"Journal for Specialists in Pediatric Nursing","volume":null,"pages":null},"PeriodicalIF":1.3,"publicationDate":"2022-12-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10605025","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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