Development of a Self-Management Theory-Guided Discharge Intervention for Parents of Hospitalized Children.

BACKGROUND: Parents of hospitalized children, especially parents of children with complex and chronic health conditions, report not being adequately prepared for self-management of their child's care at home after discharge. PROBLEM: No theory-based discharge intervention exists to guide pediatric nurses' preparation of parents for discharge. PURPOSE: To develop a theory-based conversation guide to optimize nurses' preparation of parents for discharge and self-management of their child at home following hospitalization. METHODS: Two frameworks and one method influenced the development of the intervention: the Individual and Family Self-Management Theory, Tanner's Model of Clinical Judgment, and the Teach-Back method. A team of nurse scientists, nursing leaders, nurse administrators, and clinical nurses developed and field tested the electronic version of a nine-domain conversation guide for use in acute care pediatric hospitals. CONCLUSIONS: The theory-based intervention operationalized self-management concepts, added components of nursing clinical judgment, and integrated the Teach-Back method. CLINICAL RELEVANCE: Development of a theory-based intervention, the translation of theoretical knowledge to clinical innovation, is an important step toward testing the effectiveness of the theory in guiding clinical practice. Clinical nurses will establish the practice relevance through future use and refinement of the intervention.

Implementation of the Bedside Paediatric Early Warning System (BedsidePEWS) for nurse identification of deteriorating patients.

PURPOSE: The purpose was to explore nurses' and physicians' recognition of signs of deterioration and management of symptoms. DESIGN AND METHODS: This descriptive, cross-sectional study used an electronic survey with 35 nurses and 17 physicians. RESULTS: Nurses using the Bedside Paediatric Early Warning System (BedsidePEWS) were significantly more likely to recognize risk for deterioration and respond with appropriate interventions. Physicians incorporating BedsidePEWS were more likely to choose reliable indicators of deterioration and reported significantly more effective communication from nurses to identify deterioration. PRACTICE IMPLICATIONS: BedsidePEWS may improve nurses' and physicians' abilities to recognize early signs of patient deterioration, communicate findings to providers, and plan interventions.