Mother's Lived Experience During Repair of Long-Gap Esophageal Atresia: A Phenomenological Inquiry.

BACKGROUND: Infants born with long-gap esophageal atresia (LGEA) pose unique physiologic risks in the newborn period. Anatomic and physiologic anomalies require an extended hospitalization with procedural analgesia and sedation that impact the mother's experience of birth, maternal response, and nurturing of her infant. PURPOSE: The aim of this study was to understand the meaning of experiences that mothers of infants born with LGEA encounter in the neonatal intensive care unit while their infant undergoes esophageal repair. METHODS: A hermeneutical phenomenological design was used to guide this inquiry. Three mothers were interviewed on 3 separate occasions. The conversations were audio-recorded and transcribed verbatim. The findings were analyzed using fundamental existential lifeworld themes. RESULTS: The essence that conceptualized the study was "making connections: day-by-day." Themes that emerged are (a) the many phases; (b) the long and winding road; (c) a new me, my purpose; and (d) our new community. IMPLICATIONS FOR PRACTICE: Nurses' knowledge and understanding of maternal experiences of having an infant with LGEA will enable for increased physical closeness, optimizing time spent together to learn their infant's unique personality. Creating partnerships with mothers can enhance our understanding of their perspectives, concerns, needs, and guide interventions. IMPLICATIONS FOR RESEARCH: Further exploration of family dynamics including fathers, siblings, and contextual factors may illuminate interventions to enhance relationships and communication that may influence developmental outcomes for families of infants with LGEA.

A Comparison of Antibiotic Serum Concentrations Drawn Simultaneously from Peripherally Inserted Central Catheters and Peripheral Veins in Children with Respiratory Infection.

The purpose of the study was to evaluate serum concentration of antibiotics drawn from a peripherally inserted central catheter (PICC) compared with a peripheral venipuncture. This prospective comparative study included patients with ages 1month to 21years admitted with a respiratory infection requiring IV vancomycin or IV tobramycin via a newly placed PICC. The difference between the antibiotic levels from the venipuncture and PICC samples was statistically significant for both the peak and trough levels. However, the difference in values was not enough to impact antibiotic dosing and therefore was not clinically significant.

Characteristics of Maine and Massachusetts nurses interested in advanced nursing degrees.

BACKGROUND: Maine (ME) and Massachusetts (MA) nursing programs aim to develop collaborative training programs, but need to identify which nurses have interest in such programs. PURPOSE: We sought to determine sociodemographics of nurses seeking advanced nursing degrees nationally, and in ME and MA using the 2018 publicly available, National Sample Survey of Registered Nurses (NSSRN). METHODS: Weighted multivariable logistic regression for advanced degree-seeking, adjusted for sociodemographics. RESULTS: Of the n = 47,274 nurses (weighted n [Wn] = 3,608,633), 90.7 % were female, 74.1 % were white, and 15.8 % sought an advanced nursing degree on average 12.7 (SD 0.2) years after their first. Females vs. males had lower odds (OR 0.63, 95%CI [0.44-0.90]) and Black vs. White race had higher odds (OR 1.30, 95%CI [1.05-1.60]) of seeking doctorates. In Maine (Wn = 20,389), age 24-29 had higher odds (OR 2.98 (95%CI [1.06-3.74]), but in Massachusetts (Wn = 101,984), age 30+ had lower odds (OR 0.32, 95%CI [0.13-0.78]) of degree-seeking vs. <24 years. Initial nursing degrees earned between 1980 and 1989 had higher odds (OR 1.99, 95%CI [1.06-3.74]) in Maine, but between 2010 and 2014 had lower odds (OR 0.32, 95%CI [0.14-0.72]) in Massachusetts of degree-seeking, vs. before 1980. CONCLUSIONS: Targets for advanced nursing training programs may vary by state and sociodemographic profile.

An Analysis of Orientation and Preceptorship Influence on Nurse Job Satisfaction Across Two States.

A large public nursing data set was used to determine whether orientation and/or preceptor programs impact job satisfaction among registered nurses in Maine and Massachusetts. There was no association between orientation and preceptor programs and satisfaction, nor evidence that new nurse status modified the relationship. There is a need for evaluation of orientation and preceptor programs' structure and effectiveness, and innovation is needed in promoting job satisfaction, thereby increasing nurse retention.

Nurse practitioner experiences providing nutrition counseling to adult patients in primary care.

BACKGROUND: Poor nutrition is one of the leading risk factors for preventable chronic diseases in the United States. Nutrition counseling has been shown to improve clinical outcomes in the adult primary care setting. Nurse practitioners (NPs) can help fill the critical need for nutrition counseling, yet little is known about their role providing nutrition counseling. PURPOSE: To describe the primary care NP's experience in providing nutrition counseling to adult patients in primary care practice. METHODS: Qualitative descriptive study design. Data were collected through virtual semi-structured interviews with 18 board-certified primary care NPs. Interviews were audio-recorded, de-identified, transcribed verbatim, and analyzed. Data collection and analysis took place concurrently and continued until data saturation was achieved. RESULTS: Five themes emerged from NPs' descriptions of their experiences in providing nutrition counseling to adult patients in primary care practice: (1) role of nutrition counseling in NP primary care practice; (2) developing NP self-efficacy in nutrition counseling; (3) nutrition counseling is more than the provision of information; (4) emotional aspect of nutrition; and (5) barriers to behavior change. CONCLUSIONS: Findings suggest that although NPs understand the importance of nutrition counseling in primary care practice and provide it in some capacity, its continuance is limited by multiple barriers. Future research should evaluate ways to enhance NPs' preparedness to provide nutrition counseling, assess specific resources and tools to aid in nutrition counseling, and determine best practices for communication when delivering nutrition counseling. IMPLICATIONS FOR PRACTICE: Future interventions have the potential to positively affect patients' dietary practices and improve clinical outcomes.

Parents and technology in the inpatient pediatric setting: a beginning model for study.

Medical technology has an increasing presence in the pediatric general care unit (GCU) and is an important tool in the provision of nursing care to children. As a result, both nurses and parents or other patient caregivers have had to integrate medical technology into their roles in the GCU setting. For nurses, this integration of technology into their workflow may be less stressful because new technologies are seen as additional resources to be used to provide proficient, safe patient care. Parents and other caregivers, however, may be more challenged by the sudden presence of technology in their caregiver role. Despite the increased presence of technology in the GCU, the impact of medical technology on nurse-parent-child relationships has not been explicitly researched. A descriptive review of the literature addresses some of the elements in these relationships and nursing care. A theoretical model of the influence of technology on the nurse-parent-child relationship is proposed, and suggestions for future research are made.

The therapeutic effects of journal writing for parents of PICU patients: A research brief.

PURPOSE: The admission of a critically ill child to the Pediatric Intensive Care Unit (PICU) is well known to be a stressful experience for parents. The overall aim of this study was to explore whether the use of journal writing would be acceptable and feasible to PICU parents as a stress-reducing intervention. DESIGN AND METHODS: A longitudinal, quasi-experimental two-group study design was conducted with a convenience sample of 28 parents. Experimental group parents were given instructions on how to journal write each day their child was hospitalized, while control group parents received usual care. Data were collected at three evaluation time points. RESULTS: The response rates at the final time point (6-8 weeks after discharge) were 93% for the control group and 71% for the experimental group. Outcome measure trends were similar for parents in both groups, with most perceiving mild-to-moderate stress from the PICU environment. A significant correlation was found between the perceived stress from the PICU environment and parental traumatic stress symptoms 6-8 weeks postdischarge for the experimental group (Time 1 r = .919, p = .00; Time 2 r = .969, p = .00). The majority of the experimental group parents wrote in their journals daily and found the intervention helpful. PRACTICE IMPLICATIONS: Although further research is warranted, journal writing is a simple-to-do intervention that should be considered for use with future PICU parents.

The role of 5-HT3 receptor antagonists in preventing postoperative nausea and vomiting.

Postoperative nausea and vomiting (PONV) is a frequent complication of surgery. Guidelines recommend using a 5-HT3 receptor antagonist (eg, ondansetron, dolasetron, granisetron) combined with a second agent (eg, dexamethasone) for patients at moderate to high risk for PONV. Although all 5-HT3 antagonists are effective, ondansetron and granisetron have been found to be effective at substantially lower doses than those approved by the US Food and Drug Administration. Metabolism of granisetron differs from metabolism of other 5-HT, antagonists, so it is less likely to adversely interact with other medications. This article explains the clinical pharmacology of 5-HT3 antagonists and provides recommendations for nursing management of PONV.

School-age children's perceptions of their PICU hospitalization.

The aim of this cross-sectional study was to explore the effects of a PICU hospitalization on critically ill school- age children. Few studies have examined the impact of the PICU experience on children themselves. A convenience sample was recruited of 21 developmentally appropriate children who were aged 7-12 years and had never been hospitalized. Children were asked open-ended questions related to their PICU experience, frequency and effectiveness of coping strategies was measured, and drawings were used to evaluate anxiety. Although not detailed, most children did have some recollection of their PICU stay. People in the PICU (i.e., nurses, physicians) were remembered as good, while feelings the children had (i.e., tired, didn't like it) were described as what was bad about the PICU. Children's coping strategies scores were very low. Most children had an average level of anxiety based on analysis of their drawings. Children's repertoire of coping strategies may be limited by the PICU, especially while intubated. Nurses should never underestimate the effect their behavior and responsiveness has on children. Feasible coping strategies and use of therapeutic play for PICU children should be explored further.

Long-term effects of pediatric intensive care unit hospitalization on families with young children.

OBJECTIVE: The purpose of this study was to prospectively examine the long-term effects of the pediatric intensive care unit experience on parents and on family adaptation. DESIGN: A three-group prospective, comparison, convenience sample was used in this study. SETTING: The study took place in a midwestern university-affiliated tertiary pediatric medical center. SUBJECTS: Three groups of parents (parents with children in the pediatric intensive care unit, parents with children in a general care unit, and parents with nonhospitalized ill children) were studied. The children were ages 5 years or younger. OUTCOME MEASURES: Indicators of family adaptation included parental stress, stress symptoms, family functioning, and life events. RESULTS: The mothers' stress symptoms in all groups were more prevalent than a normative sample, and they perceived their families as dysfunctional after discharge from the hospital. Slope analysis was used to examine the patterns of stress symptoms and family functioning and indicated little directional change over time for the mothers. CONCLUSION: Despite the smaller than expected sample sizes over time, results suggest that parents are still having stress-related symptoms and difficulties with family functioning as long as 6 months after a child's illness event.

Father stress during a child's critical care hospitalization.

INTRODUCTION: There is a dearth of research on the experiences of fathers with critically ill children. The specific aim of this study was to examine stress and specific stress symptoms of fathers with a child in the pediatric intensive care unit (PICU) and compare their stress and stress symptoms with those of fathers with a child in a general care unit (GCU). METHOD: In this descriptive, comparative study, fathers were recruited from a large Midwestern children's hospital within 24 hours of their child's admission. The sample included 15 PICU and 10 GCU fathers who completed the Parental Stressor Scale: PICU and the Symptom Checklist-90-Revised. RESULTS: PICU fathers perceived significantly greater stress than did GCU fathers from the sights and sounds of the unit and by procedures their child underwent. PICU fathers also reported greater frequencies of stress symptoms, such as headache, low energy, annoyance, and worrying. DISCUSSION: Advanced practice and staff nurses should know how fathers of critically ill children feel and what stresses them so they can provide interventions specific for fathers during this stressful time.