Understanding the effects of overnight vital signs monitoring on sleep duration and disruptions in hospitalized children: A scoping review.

PROBLEM: Overnight vital signs are typically taken every four hours on pediatric acute care units, despite limited evidence supporting the efficacy of this practice. Vital signs are often ordered and collected without considering the patient's clinical status or potential impact that they may have on sleep. We sought to understand the impact that overnight vital sign monitoring has on sleep duration and disruptions among hospitalized children in an acute care setting. ELIGIBILITY CRITERIA: We conducted a scoping review using the Preferred Reporting Items for Systematic Reviews and Meta-analysis Protocols extension for scoping reviews (PRISMA-ScR). Studies were included if they addressed the relationship between vital signs monitoring and sleep among children hospitalized in an acute care unit. SAMPLE: Eleven studies from 2012 to 2022 were included in the final review. RESULTS: Vital signs monitoring is the most common sleep disruptor among hospitalized children in acute care units and early evidence suggests that minimizing overnight vital signs may be a safe intervention for clinically stable children. Methods for measuring sleep duration and disruptions are heterogenous and validated tools are not often used. Finally, nurses report comfort with forgoing overnight vital signs when their patient's clinical status is stable. CONCLUSION: Despite a lack of evidence regarding the efficacy of every 4 h vital signs, overnight vital signs monitoring is consistently the greatest disruptor to sleep for hospitalized children. IMPLICATIONS: Nurses should play a central role in guiding vital signs monitoring that maintains safety and improves sleep in hospitalized children.

Engaging parents of hospitalized neonates during a pandemic.

BACKGROUND: Engaging families through patient- and family-centered care (PFCC), the NICU nurse upholds the core concepts providing holistic care. The novel coronavirus (COVID-19) pandemic altered the daily routine of visiting parents to hospitals around the nation, particularly for pediatric and neonatal populations. METHODS: This paper describes innovative strategies implemented in a large Level IV NICU to promote the core concepts of PFCC that ensured parent-infant bonding while limiting exposure to a pandemic infection, such as COVID-19. DISCUSSION: Strategies discussed include virtual visits between parents and infants to promote bonding; virtual parent support groups to encourage information sharing; remote music therapy options which included take-home music kits; diaries, albums, and celebration boards to support participation; among others. Parent collaboration throughout implementation promoted partnership. CONCLUSION: Utilizing a variety of unique and innovative approaches to promote PFCC strategies became a critical component of routine planning and care delivery for one large neonatal intensive care unit.

The Heart Failure Journey Board to Discharge.

BACKGROUND: Patients with heart failure (HF) require lifestyle changes to improve functional status and health outcomes. LOCAL PROBLEM: Heart failure was the most common readmitting diagnosis, with costs per patient of $5332, length of stay (LOS) of 5.9 days, and readmission rate of more than 30%. IMPLEMENTATION: The purpose was to adapt and implement a journey board discharge tool for adults with HF. METHODS: A journey board was created, piloted, and trialed on 1 nursing unit. Large journey boards were attached to communication boards in patient rooms for nurses to mark off topics, listed in the form of a tile (n = 19), as complete following education sessions. RESULTS: Nurses reported the tool helped them know what educational topics were covered by previous shifts. Following implementation, the average LOS was 5.3 days, patient cost per patient was $4848, and readmission rate was 28%. CONCLUSIONS: Utilizing journey board discharge education tools with patients can improve communication and evidence-based self-care instruction.

Game-Based Quality Improvement Teaching: Using Taters in Nursing Education.

BACKGROUND: Quality improvement (QI) is difficult to teach in the classroom; therefore, nursing students are often under-prepared to participate in such projects after graduation. The Plan-Do-Study-Act method is commonplace in QI instruction and is often used in nursing. This study proposed and evaluated a gameful learning approach to improve understanding and engagement of a QI process using Potato Head figures. METHOD: An observational design was utilized. Following classroom activity, students self-selected to join focus groups to discuss gameful learning experiences in learning QI techniques. Transcripts were analyzed using thematic analysis. RESULTS: Overall, learners found the activity was effective in teaching QI. Positive and negative themes were identified, including fun and competitive, interactive and communication, and teamwork; disconnection between QI topic and game, and unclear instruction, respectively. CONCLUSION: Using gameful learning helped students understand and engage with QI projects that may translate to clinical practice for new graduate nurses. [J Nurs Educ. 2021;60(10):590-593.].

How to Write a Good Test Question: Nine Tips for Novice Nurse Educators.

Nurses are lifelong learners who are always seeking ways to improve and perfect their skills. Test item writing is a skill that must be practiced and perfected over time. Often, nurses in a clinical role are promoted to the role of nurse educator without receiving training on how to write good test questions. This article presents nine tips for item writing to help nurse educators and clinical educators to create better test questions [J Contin Educ Nurs. 2019;50(1):12-14.].

Discharge Processes: What Evidence Tells Us Is Most Effective.

The quality of discharge teaching is statistically linked to decreased readmission rates. Nursing most often bears the major responsibility of patient and caregiver teaching. Currently, discharge teaching is complicated by problems including time constraints, patient and caregiver overload, and coexisting comorbidities that add complexity to the patient's care needs at home. Not only are readmissions a preventable cost, more importantly, but they also are a negative patient experience signifying to our patients that they are unable to optimally care for themselves or that their disease or healing is not something they can care for alone. The following is a review of Agency for Healthcare Research and Quality's IDEAL discharge process, common problems in discharge teaching, and nursing's responsibilities with assessing a patient and his or her caregiver for discharge readiness. IDEAL is a structured discharge process with tools to help healthcare organizations improve their discharge process to decrease readmissions rates.