ABSTRACT
INTRODUCTION: Family-centered care recognizes the integral role of the family in the health and well-being of the pediatric patient. However, implementing a family-centered care approach often requires significant philosophical, practice, and environmental changes. A self-assessment inventory of family-centered practices can identify areas for change. METHODS: ENA conducted a validation study on an instrument used to assess family-centered care in the emergency department. Nine emergency departments of varying demographics used the Family-centered Care Self-assessment Inventory to evaluate their family-centered care practices. The inventory is organized into 7 sections: (1) vision, mission, and philosophy of care; (2) family support; (3) information and decision making; (4) services coordination and continuity; (5) personnel practices; (6) quality improvement; and (7) community partnerships. Individual and group interviews were completed with a variety of staff in each emergency department. RESULTS: All 9 emergency departments demonstrated some integration of family-centered care principles. However, staff knowledge about family-centered care varied. Support of family-centered care was most consistent in the departments with specific competencies, educational programs, and practices that were inclusive of the family. DISCUSSION: The Family-centered Care Self-assessment Inventory tool was effective in evaluating family-centered care for pediatric patients in emergency departments. The assessment tool helped the departments to identify current family-centered care practices. Based on those assessments, the departments were able to identify areas of strength and opportunities for improvement in the care of children and their families.
Subject(s)
Emergency Nursing/organization & administration , Emergency Service, Hospital/organization & administration , Family Nursing , Pediatrics/organization & administration , Professional-Family Relations , Child , Child, Hospitalized , Decision Making , Humans , Organizational Objectives , Organizational Policy , United StatesABSTRACT
Children treated for hydrocephalus frequently experience chronic constipation. A retrospective chart review was conducted to determine if there is a population of children with ventriculoperitoneal (VP) shunt dysfunction in whom constipation might be a factor in the shunt dysfunction. Of 51 cases reviewed, 19 had documented constipation, such as no bowel movement for 2 or more days, small hard ball-like stools or fullness of the colon noted on physical examination or abdominal radiographs. In 6 cases, a bowel cleansing was performed and signs and symptoms of shunt dysfunction resolved without shunt revision. This review suggests that constipation may affect the fluid or pressure dynamics of the VP shunt and contribute to shunt dysfunction.
Subject(s)
Constipation/complications , Hydrocephalus/surgery , Postoperative Complications/nursing , Ventriculoperitoneal Shunt/nursing , Adolescent , Adult , Cerebrospinal Fluid Pressure/physiology , Child , Child, Preschool , Chronic Disease , Constipation/nursing , Equipment Failure , Female , Humans , Hydrocephalus/nursing , Infant , Male , Retrospective Studies , Ventriculoperitoneal Shunt/instrumentationABSTRACT
A ventriculoperitoneal (VP) shunt is the treatment of choice for hydrocephalus, functioning by means of a pressure differential between the ventricular system and peritoneal cavity. Constipation is frequently a concomitant problem in children with VP shunts. A case study is reported in which signs and symptoms of shunt dysfunction appear to have developed as a result of constipation. Nurses and physicians must address the need for preventing constipation much more aggressively in the population requiring shunts.