Pediatric palliative care: beyond the end of life.

Palliative care is an emerging nursing specialty and is developing a dedicated spot in the field of pediatrics. As a specialty, palliative care focuses on quality of life and symptom management for patients who are living with chronic and life-threatening diseases. In pediatrics, advances in health care mean that many children are living longer with these conditions and could benefit from services that focus on quality of life and superior symptom management. Palliative care can be provided concurrently with curative therapies and is philosophically similar yet distinct from hospice services.

Harmonization of postmortem donations for pediatric brain tumors and molecular characterization of diffuse midline gliomas.

Children diagnosed with brain tumors have the lowest overall survival of all pediatric cancers. Recent molecular studies have resulted in the discovery of recurrent driver mutations in many pediatric brain tumors. However, despite these molecular advances, the clinical outcomes of high grade tumors, including H3K27M diffuse midline glioma (H3K27M DMG), remain poor. To address the paucity of tissue for biological studies, we have established a comprehensive protocol for the coordination and processing of donated specimens at postmortem. Since 2010, 60 postmortem pediatric brain tumor donations from 26 institutions were coordinated and collected. Patient derived xenograft models and cell cultures were successfully created (76% and 44% of attempts respectively), irrespective of postmortem processing time. Histological analysis of mid-sagittal whole brain sections revealed evidence of treatment response, immune cell infiltration and the migratory path of infiltrating H3K27M DMG cells into other midline structures and cerebral lobes. Sequencing of primary and disseminated tumors confirmed the presence of oncogenic driver mutations and their obligate partners. Our findings highlight the importance of postmortem tissue donations as an invaluable resource to accelerate research, potentially leading to improved outcomes for children with aggressive brain tumors.

Perception of Clinical Learning at a Medical Camp.

Children with complex medical needs account for a high percentage of healthcare utilization and it is crucial that healthcare trainees get adequate exposure to this population. Camps dedicated to serving children with medical conditions often accept medical trainees from various disciplines, but little is known about how these camps compare to more traditional clinical experiences. We surveyed 37 learners from various healthcare disciplines at one medical camp. Participants reported that learning conditions at the camp were similar or superior to their other clinical experiences in all aspects questioned, suggesting medical camp is perceived as a positive non-traditional clinical learning environment.

Using high-fidelity simulation to bridge clinical and classroom learning in undergraduate pediatric nursing.

In Patricia Benner's book, Educating Nurses: A Call for Radical Transformation, she recommends essential changes in policy, curriculum, and in the way nursing programs approach student learning. This study explored how two of Benner's key recommendations, (1) integrating the theoretical component and the clinical component and (2) moving education from an emphasis on critical thinking to an emphasis on clinical reasoning, could be achieved by integrating the use of high-fidelity patient simulation in a pediatric curriculum. Qualitative and quantitative data were collected from the group of traditional and nontraditional baccalaureate students (n=131). The quantitative data revealed learning objectives were met over 80% of the time in simulation exercises and the qualitative themes revealed a positive experience with the simulation exercises with a large proportion of students offering the sentiments that these scenarios become requirement prior to the start of clinical rotations.

Study of lone working magnetic resonance technologists in Western Australia.

OBJECTIVES: It is recommended that magnetic resonance (MR) technologists should not work alone due to potential occupational health risks although lone working is legally acceptable. The objective of this study was to investigate the current situation of lone working MR technologists in Western Australia (WA) and any issue against the regulations. MATERIALS AND METHODS: A questionnaire regarding the issues of occupational health of lone working MR technologists was developed based on relevant literature and distributed to WA MR technologists. Descriptive (percentage of frequency, mean and standard deviation) and inferential statistics (Fisher's exact, Chi(2) and t tests, and analysis of variance) were used to analyze the responses of the yes/no, multiple choice and 5 pt scale questions from the returned questionnaires. RESULTS: The questionnaire response rate was 65.6% (59/90). It was found that about half of the MR technologists (45.8%, 27/59) experienced lone working. The private magnetic resonance imaging (MRI) centers were more likely to arrange technologists to work alone (p < 0.05). The respondents expressed positive views on issues of adequacy of training and arrangement, confidence and comfort towards lone working except immediate assistance for emergency (mean: 3). Factors of existence of MRI safety officer (p < 0.05) and nature of lone working (p < 0.001-0.05) affected MR technologists' concerns. CONCLUSIONS: Lone working of MR technologists is common in WA especially in private centers. The training and arrangement provided seem to be adequate for meeting the legal requirements. However, several areas should be improved by the workplaces including enhancement on immediate emergency assistance and concern relief.

The camp experience for siblings of pediatric cancer patients.

Siblings of pediatric cancer patients experience difficulties coping and adapting to the experience of a cancer diagnosis. A variety of emotional and behavioral changes as well as somatic complaints have been reported. Children describe many negative changes after their sibling is diagnosed with cancer. Many social supports and therapeutic interventions have been proposed for siblings, one of which is a camp experience. The literature has demonstrated that camps have a positive impact and offer siblings of children with cancer a supportive peer environment. Camp encourages discussion with peers and health care providers and facilitates participation in activities that improve knowledge, social confidence, and self-esteem. Nurses can help siblings by recommending camp experiences, volunteering at camps, and adding a camp experiences to existing sibling support programs.

A descriptive study of noise in the neonatal intensive care unit. Ambient levels and perceptions of contributing factors.

PURPOSE: To examine the baseline acoustic environment in several mid-Atlantic region neonatal intensive care units (NICUs) and investigate the perceived factors contributing to noise levels in these NICUs. SUBJECTS: Quantitative data were collected from 3 urban, mid-Atlantic level IIIB and level IIIC NICUs. Qualitative data were collected via interview from 2 RNs employed in each of the study NICUs. DESIGN: This was an exploratory descriptive study utilizing a mixed-methods approach. A quantitative method was used for sound-level data collection, and a qualitative method was utilized during interviews with nurses to examine perceptions of factors contributing to noise. METHODS: Ambient sound levels, measured in decibels, were taken at 5-minute intervals over a 2-hour period during both day and night shifts in a central location at each NICU. In addition, nurses were interviewed using a standardized interview questionnaire, and these interviews were then reviewed to determine themes regarding perceived factors contributing to sound levels. MAIN OUTCOME MEASURES: Hourly mean sound levels in each NICU ranged from 53.9 dB to 60.6 dB, with no statistically significant difference between noise levels recorded on day shift versus night shift, and no statistically significant difference among sites. Qualitative data showed that nurses' believed day shift to be louder than night shift and many perceived their own NICU as "pretty quiet." Key contributing factors to increased sound levels were stated as monitors or alarms, performing invasive procedures, presence of family, nurses or doctors giving report or rounds, and ringing phones. PRINCIPAL RESULTS: Noise levels were found to be above the American Academy of Pediatrics--recommended 45-dB level and often louder than the 50-dB level, which should not be exceeded more than 10% of the time. The recommended impulse maximum of 65 dB was also exceeded. Environmental Protection Agency recommendations for hospitals include sound levels no louder than 35 dB on night shift; this standard was also violated. CONCLUSIONS: Elevated sound levels need to be addressed in individual NICUs around the country. Further exploratory studies, as well as research regarding effective methods of decreasing sound levels in the NICU environment, are necessary. NICUs can implement behavioral and structural changes that can decrease the sound levels in the NICU environment and decrease the potential for exposure of patients to the harmful physiological effects of increased sound levels.

A descriptive study of noise in the neonatal intensive care unit: ambient levels and perceptions of contributing factors.

PURPOSE: To examine the baseline acoustic environment in several mid-Atlantic region neonatal intensive care units (NICUs) and investigate the perceived factors contributing to noise levels in these NICUs. SUBJECTS: Quantitative data were collected from 3 urban, mid-Atlantic level IIIB and level IIIC NICUs. Qualitative data were collected via interview from 2 RNs employed in each of the study NICUs. DESIGN: This was an exploratory descriptive study utilizing a mixed-methods approach. A quantitative method was used for sound-level data collection, and a qualitative method was utilized during interviews with nurses to examine perceptions of factors contributing to noise. METHODS: Ambient sound levels, measured in decibels, were taken at 5-minute intervals over a 2-hour period during both day and night shifts in a central location at each NICU. In addition, nurses were interviewed using a standardized interview questionnaire, and these interviews were then reviewed to determine themes regarding perceived factors contributing to sound levels. MAIN OUTCOME MEASURES: Hourly mean sound levels in each NICU ranged from 53.9 dB to 60.6 dB, with no statistically significant difference between noise levels recorded on day shift versus night shift, and no statistically significant difference among sites. Qualitative data showed that nurses' believed day shift to be louder than night shift and many perceived their own NICU as "pretty quiet." Key contributing factors to increased sound levels were stated as monitors or alarms, performing invasive procedures, presence of family, nurses or doctors giving report or rounds, and ringing phones. PRINCIPAL RESULTS: Noise levels were found to be above the American Academy of Pediatrics-recommended 45-dB level and often louder than the 50-dB level, which should not be exceeded more than 10% of the time. The recommended impulse maximum of 65 dB was also exceeded. Environmental Protection Agency recommendations for hospitals include sound levels no louder than 35 dB on night shift; this standard was also violated. CONCLUSIONS: Elevated sound levels need to be addressed in individual NICUs around the country. Further exploratory studies, as well as research regarding effective methods of decreasing sound levels in the NICU environment, are necessary. NICUs can implement behavioral and structural changes that can decrease the sound levels in the NICU environment and decrease the potential for exposure of patients to the harmful physiological effects of increased sound levels.