Perceptions of the Moral Obligations of Pediatric Nurses During an Active Shooter Event in a Children's Hospital.

PURPOSE: To explore and compare the perceptions of nurses and parent/family advisors regarding pediatric nurses' moral obligations to children and families during an active shooter event in a children's hospital. DESIGN AND METHODS: This was a descriptive, exploratory study using survey methodology. A convenience sample of all licensed nurses and parent/family advisors from four children's hospitals across the United States were recruited. Surveys consisted of five primary domains including Appropriateness of National Guidelines, Personal Preparedness, Moral Accountability, Professional/Legal Concerns, and Personal Risk Expectations. Frequency counts and percentages were calculated for each survey item. RESULTS: Data from 874 pediatric nurses and 81 parent/family advisors were analyzed. Most respondents believed the Run-Hide-Fight campaign should be changed to Secure-Preserve-Fight. Only 30% of nurses felt mentally prepared to respond to an active shooter event. Most respondents agreed that nurses have a professional duty to protect their patients, but agreed that it was a personal choice, not a moral obligation, to accept potentially fatal risks. Hospital setting and patient vulnerability often influenced nurses' perceived obligations to patients. Most respondents reported they would not leave their patient/child during an active shooter event. CONCLUSIONS: Nurses feel morally obligated to patients, but must balance their own personal risk tolerance level against the need to protect patients and families. PRACTICE IMPLICATIONS: Hospitals need in-depth active shooter training for both nurses and parents as well as safety plans that address both evacuation protocols and measures to secure in place to protect the lives of patients, families, and staff.

Methodological Challenges Encountered in a Study of the Impact of Animal-assisted Intervention in Pediatric Heart Transplant Patients.

PURPOSE: The purpose of this pilot study was to examine the impact of animal-assisted intervention (AAI) on ambulation, physiologic stability, patient satisfaction, and perceived benefit in hospitalized pediatric heart transplant patients. DESIGN AND METHODS: This pilot study used a two-period, two-sequence cross-over design. Using a convenience sample of heart transplant patients between the ages six and nineteen, each subject participated in one AAI and one non-AAI study session over one week. All study sessions started with an aspect of walking. RESULTS: Three males and two females participated. Average age was 15 years. Subjects walked on average 1906 ft during the AAI session as compared to 1933 ft in the non-AAI session. Subjects spent a longer time (17 min) walking in the AAI session as compared to the non-AAI session (15 min). Blood pressure and respiratory rates remained stable. All subjects reported they liked working with the dog. Eighty percent of subjects actively engaged in physical contact and communication with the dog. No safety-related adverse events were reported. CONCLUSIONS: AAI may assist adolescent heart transplant patients to be more motivated to participate in therapeutic ambulation when walking with a dog. Further studies are needed to identify successful recruitment strategies in this highly vulnerable patient population. PRACTICE IMPLICATIONS: Many clinical challenges exist in implementing AAI research in the pediatric heart transplant population. A conceptual model is introduced to better understand the methodological challenges of conducting AAI research in the hospital setting. Key components include research, organizational, AAI, subject and time factors.

The Emotional Cost of Caring for Others: One Pediatric Hospital's Journey to Reduce Compassion Fatigue.

OBJECTIVE: This study examined the prevalence of compassion fatigue and life stress of pediatric nurses. BACKGROUND: Distressing patient situations over time may affect nurses' professional quality of life and result in compassion fatigue. If not addressed, compassion fatigue may have personal and organizational consequences. METHODS: Using a descriptive, correlational design, a convenience sample of 268 nurses completed a web-based survey. RESULTS: High compassion satisfaction and moderate to low burnout and secondary traumatic stress were described by 49% of participants. Education was statistically associated with burnout and secondary traumatic stress. Life stress scores were significantly associated with age, experience, organizational tenure, and professional engagement. Narrative commentary yielded 5 themes: staffing, recognition, boundaries, expectations, and hopelessness. Organizational initiatives to prevent or mitigate compassion fatigue focused on awareness, balance, and connections. CONCLUSIONS: Nurses are negatively impacted by the emotional cost of caring. Future studies need to identify interventions to minimize compassion fatigue.

Use of the Council Health Survey to Assess Shared Governance in a Pediatric Hospital During the COVID-19 Pandemic.

This project used the Council Health Survey to evaluate the effectiveness of shared governance councils in a children's hospital during the COVID-19 pandemic. A SWOT analysis was performed to assess the organization's strengths, weaknesses, opportunities, and threats regarding council health and to inform strategies to sustain the shared governance environment. The well-established shared governance infrastructure allowed the organization to rapidly pivot council operations to sustain nurse engagement while balancing the unprecedented staffing and resource challenges of the pandemic. Organizations must remain flexible and innovative to maintain an environment supportive of nurse empowerment and shared governance during public health emergencies.

"Is that for here or to go?" Drive-Through Pediatric Vaccine Clinic as a Novel Approach during a Global Pandemic.

OBJECTIVE: Routine childhood vaccination and well-child visits are essential for pediatric patients' preventative and public healthcare services. The COVID-19 pandemic had an immediate and significant decline in well-child visits and vaccine administration. A one-of-a-kind 'Drive-Through Vaccine Clinic' was established to improve the vaccination rate and alleviate parental anxiety about being exposed to COVID-19 infection. METHODS: Our initial focus was on children between 18 months - 4 years of age at the start of the pandemic, and then extended this to the back-to-school vaccines and the Influenza vaccines. RESULTS: The Drive-Through Immunization Station provided 745 vaccines to 415 patients between April and September, 2020. The median wait time involved from patient arrival to completion of vaccine administration was 5 minutes at the Drive-Through location. Patient and parent feedback was positive. The addition of the Drive-Through Clinic helped to significantly increase the total number of vaccines administered compared to the previous year. CONCLUSION: In a global pandemic, innovative ideas to increase access to preventive healthcare should be a priority. In the future, this method of non-traditional vaccine administration, will allow for improved outreach efforts to underserved populations in our communities, and better disaster preparedness.

And the Beat Goes On: Heartbeat Recordings through Music Therapy for Parents of Children with Progressive Neurodegenerative Illnesses.

Background: Music is a powerful therapeutic intervention to promote physical and psychological health, healing, and well-being. In pediatric palliative care, music therapists are often involved in preloss care. Heartbeat recordings (HBRs) synchronize the rhythm of the heartbeat into a favorite song. In preloss care, HBRs show promise in helping parents of children with progressive neurodegenerative illnesses (PNDI) cope with their chronic sorrow and the loss of their child. Objective: To explore the lived experience of HBRs for bereavement in the lives of parents of children with PNDI. Design: Phenomenological study. Setting/Subjects: Purposeful sample of 11 English-speaking parents of children with PNDI receiving palliative care services in an academic pediatric hospital were interviewed three months after receiving their child's HBR. Measurements: A semistructured interview guide was used to collect data concurrently with the mind mapping process. Results: Data from interviews revealed 4 major themes and 10 subthemes: (1) Bifocal View (parental lens vs. medical lens); (2) Navigating Life and Relationships (caregiver fatigue, grief and loss, marriage, job, brought us together, paying it forward); (3) Coping through Spirituality; and, (4) Legacy Creation (HBR as a connection, song selection). Conclusions: Parents of children with PNDI experience chronic sorrow. The HBR assisted in meaning-making that validated the child's life and supported the parents' expression of grief and their ability to cope. Further research is needed to validate the impact of HBRs in diverse populations.