Improving Transitions in Care for the Child with Medical Complexity Using Betty Neuman's Systems Model.

Children with medical complexity are an increasing population with frequent use of intensive care services within hospitals. As children's health improves, they are often transferred to a general unit before being discharged to home. This transition often leads to an acute decline in health, resulting in emergent interventions. Betty Neuman's systems model provides the foundation to guide prevention interventions on stress mitigation to promote stability. An evidence-based transition bundle of care may be a valuable tool to prevent stress at the time of transfer from the intensive care unit and prevent deterioration.

Nurse perceptions of caring for pediatric patients with behavioral health needs on non-psychiatric units during the COVID-19 pandemic.

PURPOSE: The study examined nurses' perceptions of barriers and needs when caring for pediatric patients with behavioral health needs in inpatient non-psychiatric units during the pandemic. DESIGN AND METHODS: A quantitative descriptive comparative design was used. Members of Society of Pediatric Nurses and National Pediatric Nurse Scientist Collaborative were recruited. The survey included questions about perceived barriers and needs in caring for children with behavioral health needs in their units. RESULTS: A total of 335 nurses across the United States participated. Descriptive statistics, chi-square, and Kruskal-Wallis evaluated responses. Nurses in Southeast/Southwest regions were less fearful when caring for pediatric patients with behavioral health needs (p = .03), more often knew what to do (p = .01), and were supported by a behavioral health team with regular rounding (p = .035). Nurses in adult/pediatric hospitals were less likely to have adequate education to feel competent (p = .012). Nurses in the emergency department were less fearful (p = .02), more confident (p = .025), and more competent (p = .006). Nurses with up to two years of experience were likelier to feel assignments reflected the patient workload (p = .001) and more familiar with trauma-informed care protocols (p = .013). CONCLUSIONS: This study illustrated significant variations in competence, readiness, and attitudes among nurses across different regions, hospital types, departments, and experience levels when caring for pediatric patients with behavioral health needs. PRACTICE IMPLICATIONS: Results from this study could lead to the development of clinical practice guidelines, protocols, or policies to guide practice.

Care coordination for children with medical complexity and caregiver empowerment in the process: A literature review.

PURPOSE: Advances in health care have led to an increase in infants and children being discharged home with increasingly complex conditions. Children with medical complexity require care from many physicians and specialties to thrive in their home environment. While some care coordination programs are in place, these programs are often dependent upon the child living within the geographic area of a major healthcare system. Additionally, children with medical complexity often need specialized care from providers outside the participating healthcare system, placing the onus of care coordination on the child's family. This literature review aimed to examine care coordination programs for children with medical complexity and what tools have been created to empower the child's family in the process. METHOD: Qualitative and quantitative research studies published from 2015 to 2021 found in Academic Search Complete, Cumulative Index to Nursing and Allied Health Literature, and Medline that included a review of a care coordination program for children with medical complexity were included. Nonresearch articles, articles written about adults, or written in languages other than English were excluded. The Johns Hopkins Nursing Evidence-Based Practice grading scale was used to appraise the evidence. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist was utilized to structure this review to deter the risk of bias. A qualitative synthesis was used to analyze and present the results. CONCLUSIONS: There are varying strategies used to facilitate care coordination of children with medical complexity. Effects of care coordination on the child are inconsistent; however, the child's caregiver considers high-quality care coordination to improve quality of life. There are limited tools available for caregivers of children with medical complexity to coordinate their child's care across healthcare systems. Generalizability is a concern due to the small sample sizes of studies and underrepresentation of non-English speaking families in the research. Risk of bias is possible due to highly engaged families willing to participate in the selected research studies. PRACTICE IMPLICATIONS: There is an opportunity to develop further and study care coordination tools to empower the caregivers of children with medical complexity.

Using an Innovative Clinical Nurse Leader Practice Model to Sustain High-Quality Patient Care and Promote a Positive Work Environment During the COVID-19 Pandemic.

The clinical nurse leader (CNL) provides clinical leadership at the point of care, offers staff mentorship, assumes accountability for clinical outcomes within the microsystem, and promotes evidence-based patient care. The CNL has the skills and competencies needed to facilitate improvement science and lead care delivery redesign in the ever-changing world of health care, including in times of crisis. This article aims to detail 1 pediatric medical center's journey in utilizing the CNL to sustain high-quality patient care and promote a positive work environment during the COVID-19 pandemic using an innovative, evidence-based CNL practice model.

Implementation of a Nurse-Driven Pediatric Bowel Management Algorithm: A Quality Improvement Project.

BACKGROUND: In September 2018, a staff survey on a 16-bed pediatric neuro-rehab care unit (RCU) revealed nurses felt their care was limited with few resources available to treat patients experiencing constipation. Based on guidelines published by the North American and European Societies for Pediatric Gastroenterology, Hepatology, and Nutrition, an evidence-based algorithm was implemented in the RCU. AIMS: The aims of this project were to reduce the need for invasive constipation treatment and to improve nurse satisfaction. METHODS: An evidence-based interventional quality improvement project, based on the Plan-Do-Study-Act (PDSA) method, was initiated by RCU's clinical nurse leader. To measure impact on patients, use of invasive treatment was tracked in the electronic medical record. To measure impact on staff, a staff satisfaction survey was completed pre- and post- project implementation. RESULTS: There was a statistically significant reduction in average rates of invasive medication administration between pre-intervention (M = 2.23, SD = 0.77) and post-intervention (M = 0.79, SD = 0.52; t (7) = 3.38, p = 0.01). A Wilcoxon Signed Rank Test revealed a statistically significant improvement in post-intervention nurse satisfaction for having tools and resources (z = -5.196, p < 0.001). CONCLUSIONS: The findings of this quality improvement project showed that nurse-driven protocols based on current evidence can improve the prevention and treatment of constipation by reducing the need for invasive constipation treatment and improve nurse satisfaction.

Boot Camp for Caregivers of Children With Medically Complex Conditions.

BACKGROUND: The safe transition of children with complex medical conditions who are dependent on technology from hospital to home requires that caregivers receive specialized training from qualified health care professionals. Inadequate caregiver training can lead to discharge delays and hospital readmissions, often resulting in caregiver distress. OBJECTIVE: To determine the effectiveness of a structured boot camp-style predischarge training program for caregivers of pediatric patients with complex medical conditions. METHODS: We conducted a quasi-experimental interventional study to compare outcomes before and after implementation of the training program, which involved 34 caregivers. Pre-boot camp data were collected retrospectively from the medical records of 34 control patients. RESULTS: After program implementation, statistically significant decreases were found in mean unit length of stay (92 vs 60 days; P = .02), mean discharge training days (60 vs 16 days; P < .001), and median total parental stress score, expressed as a percentile (49 vs 45; P < .001). More than 90% of caregiver participants were very satisfied with the program. On the basis of minimal length of stay limits, cost savings were estimated at between $53 300 and $69 900 per patient. CONCLUSION: The results of this study indicate that the training program is a valuable tool to track and verify caregiver education, reduce hospital length of stay, increase caregiver satisfaction, decrease caregiver stress, and reduce medical costs.