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.

Implementation of a Nurse Driven Pathway to Reduce Incidence of Hospital Acquired Pressure Injuries in the Pediatric Intensive Care Setting.

PURPOSE: A large, freestanding pediatric hospital in the southern United States saw a 117% increase in reported hospital acquired pressure injuries (HAPI) between 2013 and 2015, with the intensive care units being the units of highest occurrence. Design and Methods A quality improvement project was designed and implemented to assist with pressure injury prevention. Literature review confirmed that pediatric HAPIs are a challenge and that usage of bundles and user-friendly guidelines/pathways can help eliminate barriers to prevention. The aim of this quality improvement project had two aims. First, to reduce HAPI incidence in the PICU by 10%. Second, to increase consistent usage of pressure injury prevention strategies as evidenced by a 10% increase in pressure injury bundle compliance. The third aim was to identify if there are differences in percentage of interventions implemented between two different groups of patients. Donabedian's model of Structure, Process, and Outcomes guided the development and implementation of this quality improvement project. Interventions focused on risk assessment subscale scores have the opportunity to mitigate specific risk factors and improve pressure injury prevention. RESULTS: Through implementation of the nurse driven pathway there was as 57% decrease in reported HAPIs in the PICU as well as a 66% increase in pressure ulcer prevention bundle compliance. CONCLUSIONS: Implementation of the nurse driven pressure injury prevention pathway was successful. There was a significant increase in bundle compliance for pressure ulcer prevention and a decrease in reported HAPIs. PRACTICE IMPLICATIONS: The pathway developed and implemented for this quality improvement project could be adapted to other populations and care settings to provide guidance across the continuum.

Online Focus Groups with Parents And Adolescents with Heart Transplants: Challenges and Opportunities.

Pediatric heart transplant recipients are scarce and widely dispersed. Previous studies of adolescents in this population were limited to small homogenous samples. Although online focus groups are an emerging data collection method, its use in pediatric populations has not been fully realized. The purpose of this study was to explore the feasibility of using online focus groups with pediatric populations. Adolescents (aged 13 to 21 years) at least 6 months post-heart transplant and their parents were recruited from two children's hospitals. An online discussion forum (iTracks) was used to conduct asynchronous focus groups with separate parent and adolescent groups. Six parents and four adolescents participated in the discussions. iTracks provided a framework for conducting focus groups in dispersed populations. Access to the discussion transcripts enhanced data analysis and eliminated transcription costs. Overall, online discussion forums were a feasible and cost-effective option to conduct online focus groups in this pediatric population.

Transition to self-management after pediatric heart transplant.

CONTEXT: Little is known about adolescent transition to self-management after heart transplant. This gap in knowledge is critically important because the consequences of poor self-management are costly and life-threatening, often resulting in nonadherence, rejection, repeated hospitalizations, and poor quality of life. OBJECTIVE: To explore how adolescents and parents perceive their roles in self-management, and how adolescents integrate self-management into their daily lives and navigate the transition from parent-dominated to self-management. DESIGN: Qualitative descriptive design, using online focus groups. SETTING: Online focus groups using itracks, an online qualitative software program. PARTICIPANTS: A purposive sample of 4 adolescents, 13 to 21 years old, who were at least 6 months posttransplant, and of 6 parents of adolescent heart transplant recipients. RESULTS: Several parallel themes emerged from the parent and adolescent online focus groups. Managing medications was the predominant theme for both parents and adolescents. For the remaining themes, parents and adolescents expressed similar ideas that were categorized into parallel themes, which included staying on top of things/becoming independent, letting them be normal/being normal, and worries and stressors. CONCLUSIONS: The transition to self-management after heart transplant was a clear goal for both parents and adolescents. The transition is a shared responsibility between parents and adolescents with a gradual shift from parent-directed to self-management. The process of transition was not linear or smooth, and in several instances, parents described efforts to transfer responsibility to the adolescent only to take it back when complications arose. Additional research with a larger sample is needed in order to fully understand adolescent heart transplant recipients' transition to self-management.

Increasing capacity for evidence-based practice through the evidence-based practice academy.

Although mentoring is an important aspect of implementing evidence-based practice (EBP), few models exist for EBP education. The EBP Academy is an innovative, 6-month educational program designed to develop clinical staff as EBP nurse mentors. Sessions provide protected time for participants to work on their EBP projects with assigned mentors who have EBP expertise and similar clinical or research interests. Participants develop EBP projects focused on improving care in their clinical areas. Evaluation of the EBP Academy is based on a four-level model, including participant feedback about the program, perception of meeting program objectives, ability to apply knowledge to practice through EBP projects, and outcome data measured as a result of implementing the EBP changes. By developing EBP mentors, capacity to move nursing practice to a stronger evidence-based foundation can be enhanced. Positive, professional nursing and patient outcomes have been demonstrated when structured EBP education is provided.

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.

"It has its ups and downs": adolescents' quality of life after heart transplantation.

CONTEXT: Heart transplantation is not curative and results in a high-morbidity chronic illness. Despite this, little research has focused on adolescents' quality of life after heart transplant. Such research is critically needed because of the complex developmental changes experienced by adolescents and the need for transition to self-management during this vulnerable period. OBJECTIVE: To examine adolescents' perceptions of their quality of life and factors affecting it. DESIGN: Focused ethnography. SETTING AND PARTICIPANTS: Fourteen adolescents (mean age, 17 years) who had received a heart transplant at least 6 months earlier were recruited from a large children's hospital. The ethnically diverse sample (7 black, 5 white, 1 Asian, and 1 Hispanic) included 8 females and 6 males. Data Collection and Analysis-The adolescents participated in audio-taped qualitative interviews, which were transcribed verbatim and entered into Ethnograph to assist with data management. Thematic analysis was used to identify recurrent themes. RESULTS: Participants described life after transplant by saying, "It has its ups and downs". Major themes included these: (1) I am normal and I am not normal, (2) I am grateful and I am resentful, and (3) I am managing and I am not managing. The themes reflect the dichotomous nature of the adolescents' experiences and provide insight into the complex needs of adolescents after heart transplant.

Soft on sticks: an evidence-based practice approach to reduce children's needlestick pain.

Soft on Sticks is a comprehensive, interdisciplinary, evidence-based practice initiative that was implemented to ensure consistent use of pharmacologic and nonpharmacologic interventions to reduce pain associated with needlestick procedures performed on children. Pre- and postimplementation data from children, parents, and nurses showed positive results from the practice change and identified areas for further improvement.

Constantly responsible, constantly worried, constantly blessed: parenting after pediatric heart transplant.

CONTEXT: Very little research has focused on the long-term caregiving demands associated with parenting a child after a transplant or on the parents' perceptions of those demands. PURPOSE: To describe parents' experiences parenting a school-aged child after heart transplant. DESIGN: Focused ethnography. PARTICIPANTS AND SETTING: Eleven parents of children who had undergone heart transplant 2 or more years before the study were recruited from a large children's hospital. DATA COLLECTION AND ANALYSIS: Parents were interviewed in a private location of their choice. Verbatim interview transcripts were analyzed by using content analysis and constant comparison. RESULTS: The parents described their experiences in positive terms, yet acknowledged hardships. Key themes included (1) constantly responsible, (2) constantly worried, (3) constantly blessed, and (4) coping with life. The identified themes provide direction for interventions to help parents cope with the experience of parenting a child after heart transplant.

Bereaved caregivers as educators in pediatric palliative care: their experiences and impact.

BACKGROUND: With the continuing growth of pediatric palliative care, there is an increasing need to develop effective training for health care professionals. Bereaved parents have participated in the training of health care professionals utilizing curriculum from the Initiative for Pediatric Palliative Care (IPPC), but the experience of bereaved parents as educators has not been studied. OBJECTIVES: This qualitative research examined the experience of bereaved parents involved in pediatric palliative care education of health care professionals and the challenges and possible benefits for the health care professionals. METHODS: Nine bereaved parents and eleven health care professionals were interviewed about their experiences in a pediatric palliative care education program utilizing the IPPC curriculum. The interviews were recorded, transcribed, coded and analyzed for themes and subthemes. RESULTS: Major themes found were a sense of purpose for the parents and benefits and challenges for both parents and professionals. The experience for parents contributed to their meaning-making for both their children's lives and deaths. Parents and professionals identified mutual learning and increased mutual understanding. Some professionals noted that the presence of parents may have limited the openness of discussion of the professionals and parents acknowledged challenges of emotional management in their participation in the educational program. Both parents and professionals recognized and described challenges involved in working sensitively with patients and families without being overwhelmed by the intensity of situations where children die. CONCLUSION: More benefits than burdens were experienced by both parents and health care professionals from the participation of bereaved parents in the palliative care trainings.