Nursing Surveillance for Deterioration in Pediatric Patients: An Integrative Review.

PROBLEM: Adverse events occur in up to 19% of pediatric hospitalized patients, often associated with delays in recognition or treatment. While early detection is recognized as a primary determinant of recovery from deterioration, most research has focused on profiling patient risk and testing interventions, and less on factors that impact surveillance efficacy. This integrative review explored actions and factors that influence the quality of pediatric nursing surveillance. ELIGIBILITY CRITERIA: Original research on nursing surveillance, escalation of care, or cardiopulmonary deterioration in hospitalized pediatric patients in non-critical environments, published in English in peer reviewed journals. SAMPLE: Twenty-four studies from a literature search within the databases of CINAHL, PubMed, and Web of Science were evaluated and synthesized using a socio-technical systems theory framework. Study quality was assessed using The Mixed Methods Appraisal Tool. RESULTS: Assessment, documentation, decision-making, intervening and communicating were identified as activities associated with surveillance of deterioration. Factors that influenced nurses' detection of deterioration were patient acuity, nurse education, experience, expertise and confidence, staffing, standardized assessment and communication tools, availability of emergency services, team composition and opportunities for multidisciplinary care planning. CONCLUSIONS: Research provides insight into some aspects of nursing surveillance but does not adequately explore factors that affect clinical data interpretation and synthesis, and role integration between nurse and parents, and nurse and other clinicians on surveillance of clinical stability. IMPLICATIONS: Research is needed to enhance understanding of the contextual factors that impact nursing surveillance to inform intervention design to support nurses' timely recognition and mitigation of clinical deterioration.

Perinatal hospice care in the opinion of nurses and midwives.

OBJECTIVES: Perinatal medicine is a relatively new, dynamically developing branch of medicine. Its main purpose is taking care of a woman in the pre-conception period, pregnancy and delivery, as well as taking care of a newborn baby. The main aim of the study was to assess the state of knowledge and opinion on hospice perinatal care of professionally active nurses and midwives. MATERIAL AND METHODS: An original and anonymous questionnaire containing 30 questions was used for the study. 572 nurses and midwives from the Silesian Voivodeship took part in the study. The obtained data were analyzed. RESULTS: Only 31.6% of respondents defined the level of their knowledge of pregnancy and neonatal care as high. 12.8% of respondents were able to indicate the definition of perinatal care and accurately determine its goals. The women participating in the study were in favor of enclosing the information about not attempting resuscitation (DNAR) in medical record of children with incurable disease diagnosed in fetal life (99.3%). CONCLUSIONS: The study showed deficits in practical and theoretical knowledge of nurses and midwives in the area of hospice perinatal care. Lack of proper preparation is also one of the most frequently mentioned difficulties in taking care of a child and family with poor prognosis.

How do student nurses learn to care? An analysis of pre-registration adult nursing practice assessment documents.

There is international concern about the quality of nursing in resource constrained, high technology health care settings. This paper reports findings from a research study which explored the experiences and views of those involved in the education and learning of 'caring' with adult pre-registration students. A novel dataset of 39 practice assessment documents (PADs) were randomly sampled and analysed across both bachelors and masters programmes from September 2014-July 2015. Using an appreciative enquiry approach, the Caring Behaviours Inventory aided analysis of qualitative text from both mentors and students within the PADs to identify how student nurses learn to care and to establish whether there were any differences between Masters and Bachelors students. In contrast with existing research, we found a holistic, melded approach to caring. This combined softer skills with highly technologized care, and flexible, tailored approaches to optimise individualised care delivery. Both of these were highly valued by both students and mentors. Pre-registration MSc students tended to have higher perceptual skills and be more analytical than their BSc counterparts. We found no evidence to suggest that caring behaviour or attitudes diminish over the course of either programme.

Benefits of Simulation and Role-Playing to Teach Performance of Functional Assessments.

The use of simulation is an innovative teaching strategy that has proven to be valuable in nursing education. This article describes the benefits of a simulation lab involving faculty role-play to teach baccalaureate nursing students how to properly assess the functional status of older adults. Details about the simulation lab, which involved functional assessments of two elderly community-dwelling residents, are presented, along with student and faculty evaluations of this teaching modality.

The possibilities and challenges in providing pediatric spiritual care.

The purpose of this article was to present discussions on how pediatric nurses can perform spiritual care to children and adolescents and discuss the challenges of integrating such care in health-care settings. Based on the literature, the article presents an overview of spiritual care in pediatric settings highlighting the assessment of spirituality, expected outcomes, and the corresponding nursing interventions. Spiritual care provided to children and adolescents should take into account all aspects of the developmental stage, life experiences, and familiar and sociocultural contexts. Different approaches can be used to perform spiritual care. However, lack of knowledge and time are highlighted as the main challenges in integrating spiritual care into the clinical practice. Spiritual care is crucial to the well-being of children and adolescents in times of illness and hospitalization when the goal is to provide holistic care.

The Neonatal Eating Assessment Tool: Development and Content Validation.

PURPOSE: To develop and content validate the Neonatal Eating Assessment Tool (NeoEAT), a parent-report measure of infant feeding. DESIGN: The NeoEAT was developed in three phases. Phase 1: Items were generated from a literature review, available assessment tools, and parents' descriptions of problematic feeding in infants.Phase 2: Professionals rated items for relevance and clarity. Content validity indices were calculated. Phase 3: Parent understanding was explored through cognitive interviews. SAMPLE: Phase 1: Descriptions of infant feeding were obtained from 12 parents of children with diagnosed feeding problems and 29 parents of infants younger than seven months. Phase 2: Nine professionals rated items. Phase 3: Sixteen parents of infants younger than seven months completed the cognitive interview. MAIN OUTCOME VARIABLE: Content validity of the NeoEAT. RESULTS: Three versions were developed: NeoEAT Breastfeeding (72 items), NeoEAT Bottle Feeding (74 items), and NeoEAT Breastfeeding and Bottle Feeding (89 items).

Exploring the oxygen supply and demand framework as a learning tool in undergraduate nursing education.

In nursing education, physiological concepts are typically presented within a body 'systems' framework yet learners are often challenged to apply this knowledge in the holistic and functional manner needed for effective clinical decision-making and safe patient care. A nursing faculty addressed this learning challenge by developing an advanced organizer as a conceptual and integrative learning tool to support learners in diverse learning environments and practice settings. A mixed methods research study was conducted that explored the effectiveness of the Oxygen Supply and Demand Framework as a learning tool in undergraduate nursing education. A pretest/post-test assessment and reflective journal were used to gather data. Findings indicated the Oxygen Supply and Demand Framework guided the development of pattern recognition and thinking processes and supported knowledge development, knowledge application and clinical decision-making. The Oxygen Supply and Demand Framework supports undergraduate students learning to provide safe and effective nursing care.

A Recipe for Improved Nonsurgical Cosmetic Outcomes: Know Your Herbs and Spices.

The nonsurgical cosmetic arena continues to grow, with more people consistently seeking minimally invasive procedures for facial rejuvenation. However, although these prospective patients are not seeking surgical correction to obtain their results, there is still the potential for nonsurgical procedures to yield adverse events posttreatment. Patients often do not realize that their dietary regimens may affect their nonsurgical cosmetic outcomes. For example, many patients desiring these types of treatments are often found to be taking prescription medications, herbs, and spices on a daily basis that may have the capacity to potentiate adverse outcomes such as bleeding and/or bruising. For these reasons, it is important for clinicians to be inclusive while taking health histories and to properly educate their patients so that administered treatments have the best chance of yielding the desired results. The focus of this article is to provide health care providers information on many of the herbs and spices that have the potential to negatively impact nonsurgical cosmetic outcomes.

Contemplative Activities in Undergraduate Nursing Courses.

BACKGROUND: Affective learning is valued in nursing, but it is often difficult to plan and evaluate learning activities in this domain. Contemplative activities can promote learning and are relatively easy to implement. These activities can promote deep, reflective thinking. METHOD: A variety of contemplative activities were used in undergraduate nursing courses. Students participated in and reflected on a vigil promoting domestic violence awareness. They attended two different art exhibits and related these exhibits to nursing. The students used journals and eportfolios to reflect on the entire nursing program. They participated in breathing exercises and guided imagery meditations. RESULTS: Students evaluated the activities positively, and their reflections were thoughtful. CONCLUSION: Contemplative activities can be useful to develop affective competencies. [J Nurs Educ. 2017;56(6):378-382.].

Towards Integrating the Principlist and Casuist Approaches to Ethical Decisions via Multi-Criterial Support.

An interactive decision support tool based on Multi-Criteria Decision Analysis (MCDA) can help health professionals integrate the principlist (principle-based) and casuist (case-based) approaches to ethical decision making in both their training and practice. MCDA can incorporate generic ethical principles as criteria; then draw on case-based reasoning as the basis for specifying, in the individual case, the available options, the ratings of each option on each criterion, and the relative weighting of the criteria. This produces a personalised, transparent and decomposable opinion on the merits of each option, as a contribution to enhanced deliberation. As proof of concept and method an exemplar aid adds veracity and confidentiality to beneficence, non-maleficence, autonomy and justice, as the criteria, with case-based reasoning supplying the necessary inputs for the decision of whether a nurse should disclose the poor prognosis of a patient to a close relative of the patient, when asked, on their first encounter.

Fragilidad en el paciente con estenosis aórtica severa: una valoración enfermera multidimensional / Fragility in severe aortic stenosis patient: a multidimensional assessment from nursing

El interés por estudiar la fragilidad en adultos mayores es un hecho emergente en cardiología por la incidencia de pacientes que se someten a cirugías de recambio valvular en unas condiciones de salud difícilmente cuantificables desde el punto de vista meramente clínico. En este sentido, el perfil de los pacientes ha ido cambiando y frecuentemente se identifican personas mayores con una mayor vulnerabilidad manifestada por diferentes aspectos que pueden relacionarse con la lentitud en la marcha, la fuerza de prensión, la independencia para las actividades de la vida diaria o aspectos emocionales que condicionen su calidad de vida. Este tipo de pacientes requieren ser identificados previamente a la cirugía con la finalidad de ofrecer la mejor alternativa terapéutica. Por ello, en nuestro centro nos propusimos identificar a este grupo de población frágil con una valoración multidimensional donde la enfermera, a través de un test específico, puede establecer el grado de fragilidad de aquellos pacientes que presenten una mayor vulnerabilidad. En este artículo se describe la valoración multidimensional enfermera llevada a cabo en una experiencia piloto con 115 pacientes, donde se analizaron las características de los pacientes, proporcionando una visión global del perfil de fragilidad en el adulto mayor con valvulopatía aórtica

The interest in studying frailty in older adults is an emerging fact in cardiology due to the incidence of patients undergoing valve replacement procedures in conditions difficult to quantify from the purely clinical point of view. In this regard, the profile of patients has been changing and often elderly people identify with greater vulnerability shown by different aspects such as walking speed, grip strength, independence for activities of daily living or emotional issues that condition their quality of life. These patients need to be identified prior to surgery in order to offer the best therapeutic option. Therefore, in our centre we set out to identify this group of fragile population with a multidimensional assessment where the nurse, through a specific assessment test, can set the degree of fragility of those patients who have an increased vulnerability. In this article we describe the multidimensional assessment in a pilot experience with 115 patients, where patient characteristics were analyzed, providing an overview of the profile of frailty in the elderly with aortic valve heart disease

Turkish Nurses' Use of Nonpharmacological Methods for Relieving Children's Postoperative Pain.

CONTEXT: The experience of pain is frequently observed among children undergoing surgery. Hospitalization and surgery are stressful experiences for those children. OBJECTIVE: The research was conducted to investigate and analyze Turkish nurses' use of nonpharmacological methods to relieve postoperative pain in children. DESIGN: The study was cross-sectional and descriptive. SETTING: The study took place at 2 hospitals in eastern Turkey. PARTICIPANTS: Participants were 143 nurses whose patients had undergone surgical procedures at the 2 hospitals. OUTCOME MEASURES: The researchers used a questionnaire, a checklist of nonpharmacological methods, and a visual analogue scale (VAS) to collect the data. To assess the data, descriptive statistics and the χ² test were used. RESULTS: Of the 143 nurses, 73.4% initially had applied medication when the children had pain. Most of the nurses (58.7%) stated the children generally experienced a middle level of postoperative pain. The most frequent practices that the nurses applied after the children's surgery were (1) "providing verbal encouragement" (90.2%), a cognitive-behavioral method; (2) "a change in the child's position" (85.3%), a physical method; (3) "touch" (82.5%), a method of emotional support; and (4) "ventilation of the room" (79.7%), a regulation of the surroundings. Compared with participants with other educational levels, the cognitive-behavioral methods were the ones most commonly used by the more educated nurses (P < .05): (1) encouraging patients with rewards, (2) helping them think happy thoughts, (3) helping them use their imaginations, (4) providing music, and (5) reading books. Female nurses used the following methods more than the male nurses did (P < .05): (1) providing encouragement with rewards, (2) helping patients with deep breathing, (3) keeping a desired item beside them, (4) changing their positions, and (5) ventilating the room. CONCLUSION: Undergoing surgery is generally a painful experience for children. Nurses most commonly use cognitive-behavioral methods in the postoperative care of their pediatric patients after surgery.

Administering a two-stage spiritual assessment in healthcare settings: a necessary component of ethical and effective care.

AIM: This article delineates rationales for administering a spiritual assessment as a universal component of care. BACKGROUND: The notion that nurses should identify and address patients' spiritual needs remains controversial, particularly in the UK where criticisms derived from secularization theory have appeared in the literature. EVALUATION: To respond to these criticisms and to develop rationales supportive of spiritual assessment, I draw upon scholarship from a variety of disciplines including social work, sociology, and medicine. KEY ISSUES: Five rationales are posited to support the concept of universal spiritual assessments: professional ethics, patient autonomy, knowledge of patients' worldviews, the identification of spiritual assets, and accrediting and governmental requirements. Criticisms based on secularization theory are discussed and analysed. CONCLUSION: A two-stage spiritual assessment - consisting of a brief preliminary assessment followed, if necessary, by a comprehensive assessment - provides a mechanism to efficiently identify patients' spiritual needs. IMPLICATIONS FOR NURSING MANAGEMENT: As key members of the healthcare team, nurse managers are ideally situated to ensure that all patients receive a spiritual assessment as a routine component of care. In so doing, they help ensure the provision of ethical and effective care to the diverse spiritual groups that will continue to populate the UK for the foreseeable future.

[A simple tool to measure the immediate wellbeing of elderly people in nursing homes]. / Un outil simple pour mesurer le bien-être immédiat des personnes âgées en Ehpad.

Immediate wellbeing and quality of life in an institution are of paramount importance. The assessment of the quality of life of elderly people is both complex and poorly adapted to daily practices. The instant assessment of wellbeing tool (EVIBE), developed in the field, is an original and practical alternative. This tool allows caregivers to carry out an immediate assessment and a qualitative approach with residents while involving professionals in a well-treatment approach improving daily practices.

Examination of the newborn: the key skills--Part 4 the testes.

Midwives are increasingly performing the examination of the newborn. In the final of this four-part series, we consider the importance of the examination of the testes in the screening process. The significance of history taking, knowledge of risk factors and the testes examination will be explored, along with referral pathways that the National Screening Committee requires, as will be highlighted. The impact of late detection and poor referral of undescended testes on the lives of children and adults will also be considered.