Become the PPUPET Master: Mastering Pressure Ulcer Risk Assessment With the Pediatric Pressure Ulcer Prediction and Evaluation Tool (PPUPET).

Hospital acquired pressure ulcers (HAPU) are serious, debilitating, and preventable complications in all inpatient populations. Despite evidence of the development of pressure ulcers in the pediatric population, minimal research has been done. Based on observations gathered during quarterly HAPU audits, bedside nursing staff recognized trends in pressure ulcer locations that were not captured using current pressure ulcer risk assessment tools. Together, bedside nurses and nursing leadership created and conducted multiple research studies to investigate the validity and reliability of the Pediatric Pressure Ulcer Prediction and Evaluation Tool (PPUPET).

Comparison of neonatal skin sensor temperatures with axillary temperature: does skin sensor placement really matter?

PURPOSE: Appropriate thermoregulation affects both morbidity and mortality in the neonatal setting. Nurses rely on information from temperature sensors and radiant warmers or incubators to appropriately maintain a neonate's body temperature. Skin temperature sensors must be repositioned to prevent skin irritation and breakdown. This study addresses whether there is a significant difference between skin sensor temperature readings from 3 locations on the neonate and whether there is a significant difference between skin sensor temperatures compared with digital axillary temperatures. SUBJECTS: The study participants included 36 hemodynamically stable neonates, with birth weight of 750 g or more and postnatal age of 15 days or more, in a neonatal intensive care unit. Gestational age ranged from 29.6 to 36.1 weeks at the time of data collection. DESIGN: A method-comparison design was used to evaluate the level of agreement between skin sensor temperatures and digital axillary thermometer measurements. METHODS: When the neonate's skin sensor was scheduled for routine site change, 3 new skin sensors were placed-1 each on the right upper abdomen, left flank, and right axilla. The neonate was placed in a supine position and redressed or rewrapped if previously dressed or wrapped. Subjects served as their own controls, with temperatures measured at all 3 skin sensor sites and followed by a digital thermometer measurement in the left axilla. The order of skin sensor temperature measurements was randomly assigned by a computer-generated number sequence. MAIN OUTCOME MEASURES: An analysis of variance for repeated measures was used to test for statistical differences between the skin sensor temperatures. The difference in axillary and skin sensor temperatures was calculated by subtracting the reference standard temperature (digital axillary) from the test temperatures (skin temperatures at 3 different locations), using the Bland-Altman method. The level of significance was set at P < .05. PRINCIPAL RESULTS: No statistically significant differences were found between skin temperature readings obtained from the 3 sites (F2,70 = 2.993, P = .57). Differences between skin temperature readings and digital axillary temperature were also not significant when Bland-Altman graphs were plotted. CONCLUSIONS: For hemodynamically stable neonates in a supine position, there were no significant differences between skin sensor temperatures on abdomen, flank, or axilla or between skin sensor temperatures and a digital axillary temperature. This may increase nurses' confidence that various sites will produce accurate temperature readings.

Traditional nurse instruction versus 2 session nurse instruction plus DVD for teaching ostomy care: a multisite randomized controlled trial.

PURPOSE: This randomized controlled trial compared 2 methods of ostomy care instruction to determine their effect on patients' knowledge, skills, and confidence related to postoperative ostomy care. SUBJECTS AND SETTING: Eighty-eight adults with newly created ostomies were randomly assigned to 1 of 2 groups. Of the 88 enrolled patients, 68 completed the study: 10 patients were discharged from the hospital prior to completion of the study interventions; 10 others were withdrawn because they no longer met study inclusion criteria. The remaining subjects, who were equally split between men and women, ranged in age from 23 to 84 years. There were 23 colostomy and 45 ileostomy patients in our sample. The study setting was 2 acute care hospitals within a large tertiary health care system in the midwestern United States. METHODS: We used a posttest-only experimental design to compare 2 methods of postoperative ostomy education. Traditional education comprised 3 WOC nurse-led instruction sessions and the experimental intervention comprised 2 nurse-led instruction sessions plus DVD instruction that could be accessed in between nurse-led sessions. All patients received one-on-one instruction from certified WOC nurse at their bedside. Patients completed a written test of ostomy knowledge, a self-care skills demonstration, and a Visual Analog Scale rating their confidence with ostomy self-care. RESULTS: There were no significant differences between the 2 teaching methods or type of ostomy with regard to knowledge of ostomy care (F3,64 5 1.308, P 5 0.28), ostomy care skills (F3,64 5 0.163, P 5 0.92), or confidence in performing ostomy self-care (F3,64 5 0.629, P 5 0.59). Differences between the study groups' self-reported learning style, education level, age, room type, and gender also did not significantly impact their knowledge, skills, or confidence. CONCLUSION: When teaching first-time ostomy patients postoperative self-care, a Nurse Instruction plus DVD method is as effective as Nurse Instruction alone.

Cervical spine clearance in the nonalert, noncommunicative, or unreliable pediatric blunt trauma patient.

Currently, there is no nationally recognized evidence-based guideline or protocol for cervical spine clearance in nonalert, noncommunicative, or unreliable pediatric blunt trauma patients. This descriptive survey study sought to identify current practices and elicit expert opinion data regarding pediatric cervical spine clearance in a specialized population of children in trauma centers in the United States. A 93-item electronic Pediatric Cervical Spine Clearance Survey was sent to 309 members of the Pediatric Special Interest Group of the National Society of Trauma Nurses. The main areas of interest in the survey included trauma verification, annual volume of pediatric trauma cases, and sequence and time frames of diagnostic testing for cervical spine clearance by age group. Additional areas of interest were perceived supports and barriers to meeting target time frames for diagnostic testing and outcomes to evaluate the impact of a cervical spine clearance guideline for pediatric blunt trauma. The results from 44 respondents demonstrate that trauma centers are using a variety of diagnostic testing sequences and time frames when clearing children for suspected cervical spine injury.