Relationships among psychological safety, the principles of high reliability, and safety reporting intentions in pediatric nursing.

PURPOSE: The purpose of this study was to explore relationships among psychological safety, the principles of high reliability, and safety reporting intentions in pediatric nursing. Patient safety events are underreported and costly. To promote reporting, many healthcare organizations have adopted the high reliability framework with strategies to foster team psychological safety. DESIGN: A web-based survey was distributed through the Society of Pediatric Nurses and the National Pediatric Nurse Scientist Collaborative. Data were collected from 244 pediatric nurses using a demographic form, Safety Organizing Scale, Team Psychological Safety Scale, and Intention to Report Safety Events Scale. Data were analyzed using logistic and linear regression. RESULTS: Psychological safety and perception of working in a high reliability organization (HRO) showed positive statistically significant relationships with reporting intentions (p = 0.034). Odds of nurses achieving highest reporting intention scores increased by a factor of 0.3 with each practice year. CONCLUSIONS: Psychological safety was found to be a predictor for intention to report safety events among pediatric nurses. Findings also demonstrated that nurses' perceptions of whether they worked in a high reliability setting also profoundly affect their attitude towards reporting. PRACTICE IMPLICATIONS: Focusing organizational efforts on cultivating psychological safety and embedding the high reliability framework into professional practice may significantly affect attitudes towards safety event reporting.

Cultural care needs of Spanish speaking parents with limited English proficiency whose children are hospitalized: An ethnonursing study.

PURPOSE: Parents' inability to speak English proficiently is associated with communication barriers in the care process of their children, social determinants of health, and poor child health outcomes. Research exploring perspectives of Spanish speaking parents with limited English proficiency (SSP-LEP) whose children are hospitalized in the context of culture is lacking in the literature. The purpose of this study was to explore the cultural experiences, values, and beliefs of SSP-LEP, of Mexican origin, whose children were hospitalized and to understand nurses' roles in providing culturally congruent care. DESIGN AND METHODS: Leininger's qualitative, ethnonursing method was used for this study. The Theory of Culture Care Diversity and Universality provided a guiding framework. Eleven SSP-LEP, of Mexican origin, participated in interviews conducted in-person and via Zoom. Data was analyzed using Leininger's four phases of qualitative analysis. RESULTS: Three themes emerged: 1. role of the mother as an ever-present manager of care for the hospitalized child and family, 2. parents' difficult, fearful, stressful, and unknowing experiences in the presence of a language barrier, and 3. expected nursing care that was kind, respectful, compassionate, and attentive. CONCLUSIONS: Lack of knowledge creates hardships for parents who desire to be involved, informed caregivers. Communication in Spanish language is integral to parents' understanding and expected nursing care. SSP-LEP may have negative feelings; yet describe a positive care experience. PRACTICE IMPLICATIONS: Culturally congruent care should incorporate language services for information sharing that facilitates parent participation and decision-making; be kind, respectful, compassionate, and attentive; and promote maternal role maintenance.

Single-Blinded Randomized Controlled Study on Use of Interactive Distraction Versus Oral Midazolam to Reduce Pediatric Preoperative Anxiety, Emergence Delirium, and Postanesthesia Length of Stay.

PURPOSE: The purpose of this study was to compare effects of tablet-based interactive distraction (TBID; 1 minute preseparation) with oral midazolam (15 to 45 minutes of preseparation) on preoperative anxiety, emergence delirium, and postanesthesia length of stay in children, 4 to 12 years undergoing outpatient surgery. DESIGN: Single-blinded prospective design with randomized assignment to TBID or oral midazolam group was conducted at a large pediatric hospital in southwestern United States. METHODS: A total of 102 children and caregivers were enrolled. Outcome measures included anxiety scores at baseline, separation, and mask induction; postemergence delirium scores; caregiver ratings of child anxiety and satisfaction; and time from postanesthesia care unit arrival to discharge and posthospital behaviors. FINDINGS: The TBID group demonstrated significantly lower anxiety at separation and mask induction (P < .001) and emergence delirium at 15 minutes postawakening (P = .001), were extubated earlier (P = .007), arrived to phase II earlier (P = .03), and discharged earlier (P = .0001). CONCLUSIONS: TBID was more effective than oral midazolam in reducing preoperative anxiety, emergence delirium, and postanesthesia length of stay.

The Impact of Critical Thinking on Clinical Judgment During Simulation With Senior Nursing Students.

AIM: The study examined the impact of critical thinking (CT) on clinical judgment (CJ) during a pediatric Objective Structured Clinical Evaluation (OSCE) with 160 pre-licensure nursing students. BACKGROUND: Educators are called to transform teaching strategies to develop CJ but confusion exists over definitions. METHOD: A descriptive correlational design was used to examine demographics and Tower of Hanoi (TOH) and Health Science Reasoning Test (HSRT) scores. CJ was measured by scores on the Lasater Clinical Judgment Rubric (LCJR) from videotaped OSCEs. RESULTS: Participants were: 86 percent female, 42 percent Caucasian, median 23 years, with 49 percent having health care experience. Students averaged seven moves over minimum on the TOH. Average scores were: HSRT 25/38 and LCJR 31/44. Statistically significant predictors of CJ were gender, ethnicity, HSRT deduction, and analysis; 11 CT variables accounted for 17 percent of LCJR scores. CONCLUSION: Educators need to utilize/develop innovative teaching strategies addressing CJ predictors.

Atlas-guided volumetric diffuse optical tomography enhanced by generalized linear model analysis to image risk decision-making responses in young adults.

Diffuse optical tomography (DOT) is a variant of functional near infrared spectroscopy and has the capability of mapping or reconstructing three dimensional (3D) hemodynamic changes due to brain activity. Common methods used in DOT image analysis to define brain activation have limitations because the selection of activation period is relatively subjective. General linear model (GLM)-based analysis can overcome this limitation. In this study, we combine the atlas-guided 3D DOT image reconstruction with GLM-based analysis (i.e., voxel-wise GLM analysis) to investigate the brain activity that is associated with risk decision-making processes. Risk decision-making is an important cognitive process and thus is an essential topic in the field of neuroscience. The Balloon Analog Risk Task (BART) is a valid experimental model and has been commonly used to assess human risk-taking actions and tendencies while facing risks. We have used the BART paradigm with a blocked design to investigate brain activations in the prefrontal and frontal cortical areas during decision-making from 37 human participants (22 males and 15 females). Voxel-wise GLM analysis was performed after a human brain atlas template and a depth compensation algorithm were combined to form atlas-guided DOT images. In this work, we wish to demonstrate the excellence of using voxel-wise GLM analysis with DOT to image and study cognitive functions in response to risk decision-making. Results have shown significant hemodynamic changes in the dorsal lateral prefrontal cortex (DLPFC) during the active-choice mode and a different activation pattern between genders; these findings correlate well with published literature in functional magnetic resonance imaging (fMRI) and fNIRS studies.

Expansion of the Fertility Preservation Program to All Newly Diagnosed Prepubertal Patients with Cancer at a Pediatric Hospital.

Background: As the majority of pediatric patients with cancer survive their disease, generating a population of over 500,000 childhood cancer survivors in the United States, it is imperative to minimize the lifelong consequences of treatment, which include temporary or permanent infertility caused by certain cancer treatments. A fertility consultation at diagnosis can provide patients and families with the opportunity to be informed regarding the likelihood of gonadal dysfunction and to consider fertility preservation. Method: After our pediatric hospital started to offer tissue cryopreservation, we initiated this evidence-based interventional quality improvement project. Our primary aim was to ensure that all newly diagnosed prepubertal patients with cancer who met the criteria for fertility tissue preservation were correctly identified and offered an educational consultation and preservation. Results: Between July 15, 2022 and October 30, 2022, 54 patients' treatment plans were evaluated to determine treatment-related infertility risk using the Oncofertility Consortium Pediatric Initiative Network's Risk Assessment tool. Fifteen patients were at a high level of significantly increased risk and 13 were eligible for consultation. Seven (46%) patients and their families received a consultation. Initiation of treatment before referral was the primary reason for lack of consultation. Six of seven patients receiving consultation (86%) elected to undergo preservation. Preservation procedures did not cause a delay in starting treatment for those patients. Discussion: A fertility preservation program with established policies and processes can increase the likelihood that prepubertal patients at high risk for infertility are correctly identified, educated, and offered preservation.

Comparison of neural correlates of risk decision making between genders: an exploratory fNIRS study of the Balloon Analogue Risk Task (BART).

Functional magnetic resonance imaging (fMRI) research rarely reports gender differences in the neural correlates of risk decision making due to small sample sizes. In this functional near-infrared spectroscopy (fNIRS)-based imaging study of active and passive risk decision making, gender differences in oxygenated hemoglobin (HbO) concentration changes were investigated in the prefrontal cortex (PFC) of healthy adults. Forty adult participants (25-44 years; males=23) completed two sets of 15 balloon trials in active and passive decision making modes of the Balloon Analogue Risk Task (BART). In active mode, participants chose the number of balloon inflations, decided when to collect money, or risked accrued money if balloons exploded. BART is psychometrically well established and has predictive validity to real-world risk taking. The blocked experimental design and modification of BART for fNIRS were guided by a previous fMRI study that examined the neural correlates of risk decision making in young adults [Rao, H., Korczykowski, M., Pluta, J., Hoang, A., Detre, J.A., 2008. Neural correlates of voluntary and involuntary risk taking in the human brain: An fMRI study of the Balloon Analog Risk Task (BART). NeuroImage 42, 902-910]. Our findings were consistent with the previous fMRI study: no or little PFC activation during passive mode but strong PFC activation during active wins and losses among total sample. Active losses in females were associated with more significant bilateral activation in dorsal lateral prefrontal cortex (DLPFC) than males; no significant gender differences were found in DLPFC activation during active wins. Gender differences existed in direction and strength of correlations between BART behavioral and hemodynamic data. This study shows that use of fNIRS is a feasible, accessible, and less costly way to achieve adequate study power and investigate gender differences in neural correlates of risk decision making.

Impact of emergency management in a simulated home environment for caregivers of children who are tracheostomy dependent.

PURPOSE: Children who are tracheostomy dependent require comprehensive caregiver preparation for safe hospital-to-home transition. Although a structured discharge education program successfully trained caregivers to provide routine daily tracheostomy care, emergency response training was limited, lacking realistic experiences. Initiation of simulated emergency training for caregivers indicated performance confusion related to tracheostomy cardiopulmonary resuscitation (CPR). This study evaluated the effectiveness of an evidence-based tracheostomy CPR education intervention via caregiver participation in a high-fidelity simulation of a home-based emergency scenario on the performance of essential behaviors, comfort, and satisfaction. DESIGN AND METHODS: The study utilized a prospective descriptive pre- and post interventional design; 44 caregivers of children who were tracheostomy dependent participated. All caregiver participants completed: video- and instructor-assisted specialized tracheostomy CPR class, high-fidelity simulation performance of a home-based emergency (respiratory failure with cardiac arrest), postsimulation video debriefing, performance assessment with an objective scoring rubric, and pre- and post simulation surveys on levels of comfort and satisfaction. RESULTS: On the performance of essential emergency management behaviors, 86.4% of caregivers performed all four behaviors, but only 36.4% performed these essential behaviors in order. Post simulation caregiver comfort with emergency management significantly increased from pre simulation (p = .001). All caregivers were satisfied with this training and would recommend simulation of home-based emergencies for all caregivers. Qualitative feedback from caregivers revealed themes of gratitude and the importance of hands-on practice with guided debriefing/feedback. Study power was 0.98. PRACTICE IMPLICATIONS: Objective evaluation of caregiver performance demonstrated specialized tracheostomy CPR education prepared caregivers to respond in a home emergency. Caregivers viewed simulation as an opportunity to gain hands-on experience and improve emergency responses. It may be beneficial for other similar programs to include specialized tracheostomy CPR and emergency scenario simulation in their discharge education protocols and subsequently compare this program to other similar programs to establish best practice guidelines.

Qualitative analysis of student beliefs and attitudes after an objective structured clinical evaluation: implications for affective domain learning in undergraduate nursing education.

This qualitative study explored the feelings, beliefs, and attitudes of senior-level undergraduate pediatric nursing students upon completion of a medication administration Objective Structured Clinical Evaluation (OSCE). The affective domain is the most neglected domain in higher education, although it is deemed the "gateway to learning." Quantitative assessments of clinical skills performed during OSCEs usually address two of the three domains of learning: cognitive (knowledge) and psychomotor skills. Twenty students volunteered to participate in focus groups (10 per group) and were asked three questions relevant to their feelings, beliefs, and attitudes about their OSCE experiences. Students integrated the attitude of safety first into future practice but felt that anxiety, loss of control, reaction under pressure, and no feedback affected their ability to connect the OSCE performance with future clinical practice. The findings affect future affective domain considerations in the development, modification, and assessment of OSCEs across the undergraduate nursing curriculum.

Bio-behavioural research in a rare disease population: a doctoral student's experience.

BACKGROUND: Novice researchers who aspire to contribute to the body of knowledge concerning rare diseases face unique challenges in developing and conducting studies. These include unknown effect sizes in previous research, limitations in recruitment and enrolment, and managing data from a multi-site sample. AIM: To describe the challenges in researching rare diseases and possible solutions using a doctoral student exemplar from a cross-sectional correlational study of fatigue. DISCUSSION: The authors discuss the lessons learned from the study, including the challenges in recruitment, communication, collecting biological data and managing data in general. They posit possible solutions, including improving multi-site coordination, feasible methods for exploring sleep and stress, and measures to prevent equipment and data loss. CONCLUSION: Rare populations, such as young survivors of childhood brain tumours, deserve a voice in building the body of knowledge needed for more precise, personalised healthcare. It is possible with foresight for the novice researcher to make such a contribution. IMPLICATIONS FOR PRACTICE: Improved knowledge and assessment of symptoms during childhood will improve the detection of health risk factors and enable earlier intervention.

Innovations in basic life support education for healthcare providers: improving competence in cardiopulmonary resuscitation through self-directed learning.

Providing cardiopulmonary resuscitation is an essential competency for nurses. Nurse educators involved in staff development and continuing education spend numerous hours offering basic life support courses and conducting performance improvement activities such as mock codes. This study provides evidence that cardiopulmonary resuscitation performance skills using self-directed learning methods are as good as or, on a number of parameters, better than those achieved with a more resource- and time-intensive traditional approach.

Improving workplace safety training using a self-directed CPR-AED learning program.

Adequate training in cardiopulmonary resuscitation (CPR) and use of an automated external defibrillator (AED) is an important component of a workplace safety training program. Barriers to traditional in-classroom CPR-AED training programs include time away from work to complete training, logistics, learner discomfort over being in a classroom setting, and instructors who include information irrelevant to CPR. This study evaluated differences in CPR skills performance between employees who learned CPR using a self-directed learning (SDL) kit and employees who attended a traditional instructor-led course. The results suggest that the SDL kit yields learning outcomes comparable to those obtained with traditional instructor-led courses and is a more time-efficient tool for CPR-AED training. Furthermore, the SDL kit overcomes many of the barriers that keep individuals from learning CPR and appears to contribute to bystanders' confidently attempting resuscitation.

Psychometric Evaluation of a Tool for Assessment of Clinical Development in Newly Licensed Registered Nurses.

BACKGROUND AND PURPOSE: For effective evaluation of clinical development, established psychometric properties of reliability and validity are essential. The Clinical Development Assessment (CDA) tool was developed within a 12-month pediatric nurse residency program. Benner's novice-to-expert model framed the development of the CDA. METHODS: Data from 129 nurse residents and their preceptors were used to evaluate internal consistency reliability and face, content, and construct validity. Nine elements were assigned a six-point Likert scale scored as (a) unsafe, (b) novice, (c) advanced beginner, (d) competent, (e) proficient, and (f) expert. RESULTS: Moderately strong reliability was found. Using exploratory factor analysis, a single factor accounted for 68% of the variance in clinical development. Face and content validity were confirmed. CONCLUSIONS: This study identified a brief, valid, and reliable tool to evaluate clinical development in newly licensed registered nurses.

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.

Are there gender differences in young vs. aging brains under risk decision-making? An optical brain imaging study.

Few research publications have reported on gender-dependent neural correlates of risk decision-making in older adults. In this study, we utilized functional near-infrared spectroscopy (fNIRS) to comprehensively investigate both age- and gender-dependent differences in neural correlates in response to a well-utilized risk decision-making protocol, the Balloon Analog Risk Task (BART). A newly-developed technique, atlas-guided diffuse optical tomography (atlas-DOT), was used to image the prefrontal cortices (PFC) of healthy subjects in two age groups (25-40 years; 60-92 years) using BART stimulation. The behavioral measures and brain activations imaged by atlas-DOT were recorded and compared for both age groups. Three-factor analysis of variance was conducted to include all effects of age (young, old), gender (male, female), case (win, lose) and their interactions for both behavioral and hemodynamic responses. The results indicated age differences in cortical activation patterns, activation amplitudes, and brain-behavior correlations. Larger areas of cortical activation with reduced amplitudes in the PFC were observed in older adults when they performed BART. Brain-behavior correlations indicated that young adults took more risks, whereas older adults were more risk-averse. Results also revealed a gender effect in young adults, but not in older adults. Both male and female older adults demonstrated strong PFC responses and the same risk-averse patterns under lose outcomes. This is the first study to examine the neural correlates of risk decisions in older adults by optical brain imaging.

Automated voxel classification used with atlas-guided diffuse optical tomography for assessment of functional brain networks in young and older adults.

Atlas-guided diffuse optical tomography (atlas-DOT) is a computational means to image changes in cortical hemodynamic signals during human brain activities. Graph theory analysis (GTA) is a network analysis tool commonly used in functional neuroimaging to study brain networks. Atlas-DOT has not been analyzed with GTA to derive large-scale brain connectivity/networks based on near-infrared spectroscopy (NIRS) measurements. We introduced an automated voxel classification (AVC) method that facilitated the use of GTA with atlas-DOT images by grouping unequal-sized finite element voxels into anatomically meaningful regions of interest within the human brain. The overall approach included volume segmentation, AVC, and cross-correlation. To demonstrate the usefulness of AVC, we applied reproducibility analysis to resting-state functional connectivity measurements conducted from 15 young adults in a two-week period. We also quantified and compared changes in several brain network metrics between young and older adults, which were in agreement with those reported by a previous positron emission tomography study. Overall, this study demonstrated that AVC is a useful means for facilitating integration or combination of atlas-DOT with GTA and thus for quantifying NIRS-based, voxel-wise resting-state functional brain networks.

Tutorial on use of intraclass correlation coefficients for assessing intertest reliability and its application in functional near-infrared spectroscopy-based brain imaging.

Test-retest reliability of neuroimaging measurements is an important concern in the investigation of cognitive functions in the human brain. To date, intraclass correlation coefficients (ICCs), originally used in interrater reliability studies in behavioral sciences, have become commonly used metrics in reliability studies on neuroimaging and functional near-infrared spectroscopy (fNIRS). However, as there are six popular forms of ICC, the adequateness of the comprehensive understanding of ICCs will affect how one may appropriately select, use, and interpret ICCs toward a reliability study. We first offer a brief review and tutorial on the statistical rationale of ICCs, including their underlying analysis of variance models and technical definitions, in the context of assessment on intertest reliability. Second, we provide general guidelines on the selection and interpretation of ICCs. Third, we illustrate the proposed approach by using an actual research study to assess interest reliability of fNIRS-based, volumetric diffuse optical tomography of brain activities stimulated by a risk decision-making protocol. Last, special issues that may arise in reliability assessment using ICCs are discussed and solutions are suggested.