Oral Feeding Outcome in Infants with a Tracheostomy.

PURPOSE: Currently, there is a lack of evidence-based guidelines on the proper protocol for feeding infants with a tracheostomy in the neonatal intensive care unit (NICU). The purpose of this study was to provide preliminary insight into the outcomes of these infants in one mid-Atlantic pediatric hospital. DESIGN AND METHODS: Retrospective and descriptive. The study team reviewed 114 patient records, 42 of which met the inclusion criteria. Data were organized based on: 1) general demographics and history; b) feeding-related variables at multiple points; c) speech-related variables, including assessments and swallowing studies; d) respiratory variables at multiple points; and, e) discharge data. Other variables included birth-related information, ventilation settings and feeding modifications. RESULTS: Infants were placed into three groups at discharge based on feeding outcomes. Forty-three percent were discharged on full oral feeds, 38% on combined oral and gavage, and 19% of infants were discharged on full gavage feeds. Informal analysis showed that all three categories of infants gained weight during hospitalization, different PEEP pressures and different lengths of hospitalization were observed among the groups, and infant characteristics (e.g., APGAR, gestational ages) were similar across groups. CONCLUSIONS: Overall results provide insight into factors that may be predictive of feeding status at discharge for infants with a tracheostomy in an NICU. PRACTICAL IMPLICATIONS: Results of this study can provide important insight into the feeding outcomes of infants in a NICU with a tracheostomy and can hopefully lead to additional research to help determine the most efficacious procedures for feeding this patient population.

Parental Satisfaction With Pediatric Preoperative Assessment and Education in a Presurgical Care Center.

PURPOSE: The aim of this study was to evaluate parental satisfaction with preoperative assessment and education in a pediatric presurgical care center (PSCC) as well as parental use of a computer instructional video, EMMI, which is a product of Emmi Solutions (Chicago, IL), a health information company for patients. DESIGN: A prospective, exploratory, comparative, and correlational descriptive design was implemented. METHODS: A 23-item questionnaire was completed by 542 parents or legal guardians at the end of their child's PSCC visit. FINDINGS: Very high overall satisfaction was seen with the visit. Highest overall satisfaction was seen related to nurse practitioner and registered nurse behaviors and lowest satisfaction to operational aspects. CONCLUSIONS: This study validates parents' perceptions of the high value of nurses' explanations, respect shown, and response to questions during preoperative assessment of the child and education of the family anticipating surgery. Identification of less satisfying aspects of the presurgical experience provides opportunities for improvement.

Orientation to emergency nursing: perceptions of new graduate nurses.

INTRODUCTION: Emergency nursing is one of the most challenging and understaffed areas of professional nursing. Currently, little is known about how new graduate nurses perceive their experiences as novice emergency nurses. The purpose of this study was to gain an understanding of how new graduate nurses who are oriented to emergency nursing as their first professional area of nursing employment perceive the orientation program and emergency nursing at the beginning and end of a 6-month program. METHOD: This descriptive study incorporated qualitative and quantitative methods consisting of interviews and a survey. Study participants included 15 women and 3 men. Their mean age was 32 years. All were employed full time in their first position as a graduate nurse. They were asked their perceptions of the program at 3 and 6 months. RESULTS: Participants shared their perceptions of why they had been attracted to the program, characteristics of the emergency department and emergency nursing, being in a new job and role, reflections on their performance, the classroom and clinical components of the program, and their recommendations for future orientation programs. Results of the quantitative survey on participants' perceptions of their first job as a registered nurse indicated that they found the work of the orientation program to be stressful. DISCUSSION: Understanding the experience of new graduate nurses to the emergency setting provides crucial information for orientation program design. Incorporating active teaching and socialization strategies early in the program may facilitate the transition from novice to beginning competent emergency nurse.

ENA's Delphi study on national research priorities for emergency nurses in the United States.

INTRODUCTION: This study identified and prioritized research questions with greatest value to emergency nurses and of highest importance for health care consumers. METHODS: Three hundred twenty emergency nursing leaders were invited to participate in 3 rounds of mailed surveys aimed at developing consensus. During round I, 147 nurses submitted 456 research problems. These problems were synthesized into 154 researchable questions, encompassing 17 themes. The round II questionnaire listed these questions in random order. Respondents used a 7-point Likert scale to rate each question's value for practicing nurses and importance for health care consumers. One hundred one nurses rated 106 questions >5.0. The round III questionnaire was individualized to provide each respondent's round II score and each item's median group score. Reflecting on these data, subjects again rated the 106 questions. RESULTS: Seventy-nine nurses rated 16 questions 6.0 or greater for value for practicing nurses; 3 questions were rated 6.0 or greater for importance to consumers. Optimum staff to patient ratios, effects of mandatory overtime, holding admitted patients, and ED overcrowding, as well as effective strategies for educating and ensuring competence of nurses, were highest priority research problems for practicing nurses. Pain relief, impact of and methods of decreasing holding/lengthy ED stay, and effective strategies for patient teaching were judged most important for consumers. DISCUSSION: Nurses' concerns with staff shortages and overcrowding of emergency departments and their effects on patients are paramount. Pain management and patient education were chief clinical issues requiring research. The mission of ENA is "to provide visionary leadership for emergency nursing and emergency care." This mission encompasses a number of values, including the following: "The discipline of emergency nursing includes a defined and evolving body of knowledge based on research."(1) In 1998, the ENA appointed vision councils to develop futuristic ideas to advance ENA's mission. The Research Vision Council proposed that ENA develop a center for emergency nursing research to provide leadership and focus for scientific approaches to the many issues that concern emergency nurses and their patients. The Board of Directors supported this idea by formulating a work group to develop the National Institute for Emergency Nursing Research. In 1999, the work group proposed that a study be conducted to determine national priorities for emergency nursing research. This article reports on the methods and results of a Delphi study conducted for that purpose.

A description of clinical nurse specialist programs in the United States.

Changes have occurred in clinical nurse specialist educational requirements in recent years, and it is not known how programs have responded. The purpose of this descriptive survey was to identify the number of clinical nurse specialist programs in the United States, describe curricula, and examine enrollment and employment trends. This report contains data from 157 separate clinical nurse specialist programs/majors representing 139 different schools. The mean number of credit hours for semester- and quarter-based programs was 41.4 and 52.2, respectively. The mean number of clinical/practical clock hours was 416.2. Approximately half of the respondents (56%) used the National Association of Clinical Nurse Specialists to guide curricula. Nearly 66% of the programs had from 1 to 10 applicants during the previous year. The majority (68%) indicated that their graduates do not have difficulty finding employment after graduating. These findings indicate that efforts to revise curricula and clarify the CNS role must continue.

Incidence of adult immunization for influenza and pneumonia in a preadmission testing unit.

Health care-associated (nosocomial) infection is now more common in surgical patients than surgical-site or wound infection. Elderly patients and those having abdominal, neck, cardiac, or other thoracic procedures are at the highest risk. Pneumococcal pneumonia and influenza are the fifth leading cause of mortality in the elderly population. In the United States, only 54% of persons older than 65 years have received a pneumococcal vaccine, whereas approximately 67% have been immunized for influenza. In this study, interviews were conducted with 160 elderly patients seen in the preadmission testing unit of a large community hospital. Results showed immunization rates of 57% for pneumonia and 76% for influenza. Similar to findings of previous studies, minorities were less likely to be immunized than whites. Of those who were not immunized for pneumonia or could not recall their immunization status, 71% stated they had not been offered immunization. Sixty-four percent stated they would take the vaccine to prevent pneumonia if it were offered. Of those patients who were not immunized for influenza, 54% had not been offered this protection and 41% stated they would take the influenza vaccine if offered. Although vaccination rates of participants in the present study surpassed the 1998 national baseline for noninstitutionalized adults, there is much opportunity for improvement. Perianesthesia nurses have an important role in reducing surgical patients' risks of developing health care-associated pneumonia and invasive bacteremia by assessing the patient's immunization status and being proactive in helping surgical patients obtain appropriate vaccinations. Routine documentation of a vaccination history for pneumococcal pneumonia and influenza during preadmission testing and use of a standard protocol for educating and immunizing those who lack this protection are strategies that can be easily implemented by nurses practicing in perianesthesia settings such as ambulatory surgical sites and preadmission testing units. This practice would foster achievement of the Healthy People 2010 goal of 90% vaccination rates for persons at high risk for these deadly diseases.

Into thinner air.

At a Colorado ski resort with an altitude of 8,500 feet, a guest is overcome by exhaustion, nausea, and headache. Could it be acute mountain sickness?