Identifying Best Practice for Healthcare Providers Caring for Autistic Children Perioperatively.

This column shares the best evidence-based strategies and innovative ideas on how to facilitate the learning and implementation of EBP principles and processes by clinicians as well as nursing and interprofessional students. Guidelines for submission are available at https://onlinelibrary.wiley.com/journal/10.1111/(ISSN)1741-6787.

Operational Failures Detected by Frontline Acute Care Nurses.

Frontline nurses encounter operational failures (OFs), or breakdowns in system processes, that hinder care, erode quality, and threaten patient safety. Previous research has relied on external observers to identify OFs; nurses have been passive participants in the identification of system failures that impede their ability to deliver safe and effective care. To better understand frontline nurses' direct experiences with OFs in hospitals, we conducted a multi-site study within a national research network to describe the rate and categories of OFs detected by nurses as they provided direct patient care. Data were collected by 774 nurses working in 67 adult and pediatric medical-surgical units in 23 hospitals. Nurses systematically recorded data about OFs encountered during 10 work shifts over a 20-day period. In total, nurses reported 27,298 OFs over 4,497 shifts, a rate of 6.07 OFs per shift. The highest rate of failures occurred in the category of Equipment/Supplies, and the lowest rate occurred in the category of Physical Unit/Layout. No differences in OF rate were detected based on hospital size, teaching status, or unit type. Given the scale of this study, we conclude that OFs are frequent and varied across system processes, and that organizations may readily obtain crucial information about OFs from frontline nurses. Nurses' detection of OFs could provide organizations with rich, real-time information about system operations to improve organizational reliability. © 2017 Wiley Periodicals, Inc.

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.

Implementation and impact of an automated group monitoring and feedback system to promote hand hygiene among health care personnel.

BACKGROUND: Despite substantial evidence to support the effectiveness of hand hygiene for preventing health care-associated infections, hand hygiene practice is often inadequate. Hand hygiene product dispensers that can electronically capture hand hygiene events have the potential to improve hand hygiene performance. A study on an automated group monitoring and feedback system was implemented from January 2012 through March 2013 at a 140-bed community hospital. METHODS: An electronic system that monitors the use of sanitizer and soap but does not identify individual health care personnel was used to calculate hand hygiene events per patient-hour for each of eight inpatient units and hand hygiene events per patient-visit for the six outpatient units. Hand hygiene was monitored but feedback was not provided during a six-month baseline period and three-month rollout period. During the rollout, focus groups were conducted to determine preferences for feedback frequency and format. During the six-month intervention period, graphical reports were e-mailed monthly to all managers and administrators, and focus groups were repeated. RESULTS: After the feedback began, hand hygiene increased on average by 0.17 events/patient-hour in inpatient units (interquartile range = 0.14, p = .008). In outpatient units, hand hygiene performance did not change significantly. A variety of challenges were encountered, including obtaining accurate census and staffing data, engendering confidence in the system, disseminating information in the reports, and using the data to drive improvement. CONCLUSIONS: Feedback via an automated system was associated with improved hand hygiene performance in the short-term.

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.

Lack of Tularemia Among Health Care Providers With Close Contact With Infected Patients-A Case Series.

Francisella tularensis has a low infectious dose and can infect laboratory staff handling clinical specimens. The risk to health care providers exposed during patient care is poorly defined. We describe 9 examples of health care providers who did not develop tularemia after significant exposures to infected patients.

Self-reported sleep problems in adolescent survivors of childhood cancer.

BACKGROUND: Although sleep problems are common among adult cancer survivors, little is known about sleep problems in adolescent survivors of childhood cancer (ASCC). OBJECTIVES: This study sought to describe (a) the prevalence of self-reported sleep problems among ASCC before treatment, during treatment, following treatment, and in survivorship follow-up; (b) the relationship between sleep problems and self-reported adverse psychosocial outcomes; and (c) the relationship between sleep problems, treatment, and disease. METHODS: Baseline surveys were received from 173 ASCC aged 13-19 years. Chi-square analyses and odds ratios were used to determine associations between sleep problems and adverse psychosocial outcomes and treatment-related variables. FINDINGS: Sleep problems were reported before treatment (6%), during treatment (18%), after treatment (15%), and at present (11%). ASCC reporting sleep problems reported more adverse psychosocial outcomes than those without. Significant associations (p ≤ 0.05) between sleep problems and difficulty in school were identified at all time points. Sleep problems were associated with depressive symptoms, memory problems, and anxiety during and after treatment and at present.

The effect of portable pulsed xenon ultraviolet light after terminal cleaning on hospital-associated Clostridium difficile infection in a community hospital.

There is evidence that contamination of patient rooms from previous occupants is associated with hospital-associated Clostridium difficile infection (HA-CDI). During January 2011, the use of 2 portable pulsed xenon ultraviolet light devices (PPX-UV) to disinfect patient rooms was added to routine hospital discharge cleaning in a community hospital. In 2010, the HA-CDI rate was 9.46 per 10,000 patient-days; in 2011, the HA-CDI rates was 4.45 per 10,000 patient-days (53% reduction, P = .01). The number of deaths and colectomies attributable to hospital-associated C difficile infection also declined dramatically.

Parental grief responses and personal growth following the death of a child.

Conceptualizing parental grief as a psychosocial transition, this cross-sectional study of bereaved mothers (N = 35) examined the relationship of dispositional factors, grief reactions, and personal growth. More optimistic mothers reported less intense grief reactions and less distress indicative of complicated grief. Additionally, mothers who usually coped actively had less intense grief reactions. Mothers who habitually coped using positive reframing had less intense grief reactions and less complicated grief. Personal growth, a positive dimension of grief, was associated with all three coping dispositions; mothers' active coping, support seeking, and positive reframing suggesting more personal growth occurred in mothers exhibiting more of these coping dispositions. These findings increase understanding of dispositional factors associated with bereaved mothers' grief responses and expand knowledge concerning personal growth as an outcome of bereavement.

Optimism, anxiety, and coping in parents of children hospitalized for spinal surgery.

Optimistic expectations about outcomes have significant implications for behaviors. Knowing the role that dispositional optimism plays in parents' anxiety and coping responses during their child's surgical experience is essential to aid professionals in bolstering parents' coping and providing support. Parental optimism, anxiety and coping, and whether optimism moderated (changed) the anxiety-coping relationship preoperatively and postoperatively were the factors evaluated in this study. Parents (N = 60) primarily white of middle and upper middle class, were administered the Life Orientation Test to assess optimism, Spielberger's State Anxiety Scale and the Ways of Coping Questionnaire. Parental anxiety decreased significantly from preoperative to postoperative levels but remained high, indicating that parents continue to be emotionally distressed during their child's recovery. Reappraising the situation more positively (positive reappraisal) was the most often used emotion-focused coping strategy and seeking social support was the most often used problem-focused coping strategy. The preoperative and postoperative anxiety-coping relationships also depended on parents' levels of optimism. The use of emotion-focused coping strategies was not effective for reducing anxiety in highly optimistic parents. Recommendations include continually assessing the parents' need for reassurance and support throughout the surgical experience. Professionals can bolster parental coping by stressing the benefits of surgery and encouraging parents to be actively involved in the child's care and progress.