Chylothorax development in infants and children in the UK.

AIM: To describe the incidence, patient profile, management strategies and outcome for infants and children who developed a chylothorax in the UK. METHODS: A prospective study of infants and children ≥24 weeks' gestation - ≤16 years, who developed a chylothorax in the UK and were reported through the British Paediatric Surveillance Unit (BPSU). Clinicians completed a questionnaire on the presentation, diagnosis, management and outcome of these children. Three further data sources were accessed to confirm these data. RESULTS: The incidence in children in the UK was 0.0014% (1.4 per 100,000) and 3.2% (3200 per 100,000) for those developing a chylothorax following a cardiac surgical procedure. The incidence was highest in infants ≤12 months at 16 per 100,000 (0.016%). A total of 219 questionnaires were returned with 172 cases meeting the eligibility criteria. Development of a chylothorax was most commonly associated with cardiac surgical procedure (65.1%) and was most frequently confirmed by laboratory verification of triglyceride content of the pleural fluid ≥1.1 mmol/L (66%). Although a variety of management strategies were employed, treatment with an intercostal pleural catheter (86.5%) and a medium chain triglyceride (MCT) diet (89%) was most commonly reported. The majority of the children had a prolonged hospital stay with a reported mortality of 12.2%. CONCLUSIONS: Development of a chylothorax in infants and children in the UK was not common. The primary association was with a cardiac surgical procedure. The child's hospital stay was lengthy and therefore the impact on the child, family and hospital resources were significant. Common management strategies existed but national guidance is required to optimise practice. This study allows for better information relating to this serious complication to be given to patients and families and provides the basis for future research and practice development.

Using evidence-based practice to address gaps in nursing knowledge.

Implementing evidence based-practice and research findings into nursing care has been identified as a challenge to nursing staff. This article identifies key barriers to the use of research in the international literature, however, there are limited suggestions as to how to improve this in the clinical arena. This article aims to identify how nurses could optimize the implementation of evidence and research into their clinical care and reviews barriers to implementing and undertaking nursing research, suggesting a framework for improvement. It considers the widely varied levels of knowledge of research and equally varied critical appraisal skills present both at a pre and post-registration nursing level. The authors discuss an innovative, collaborative approach that considers the role of the nurse consultant, clinical academic and research facilitator posts. To ensure quality evidence-based practice is implemented into clinical nursing care a realistic and practical structure must be applied. With the appropriate framework, clinical structure and organizational support, promotion of evidence-based practice and research for patient benefit can be optimized. The implications for practice are also discussed. The implementation of a realistic research framework into clinical nursing practice has the potential to influence and develop a more active nursing research culture and promote evidence-based care within the workplace.

Celebrating nursing.

International Nurses Day is celebrated around the world each year on May 12, Florence Nightingale's birth date (1820). Her theories were published in Notes on Nursing in 1860 and contributed significantly to the development of public health and leadership in hospital management. On Nurses Day, however, it is important to acknowledge the contribution of other great nurses in history, such as Mary Seacole, and to celebrate the contribution that nurses continue to make to the health and wellbeing of society.

Promoting care for acutely ill children-development and evaluation of a paediatric early warning tool.

The primary purpose of this paper was to develop and evaluate a physiologically based system for the identification of acutely ill children in hospital environments. The dependency of children in hospital is increasing and ensuring the appropriate and timely intervention by a team of health personnel experienced in the care of these children is paramount to ensure their optimal outcome. A paediatric early warning (PEW) tool was designed and demographic and physiological data collected on all children (n = 360) who triggered the tool over a 6-month period, between September 2003 and February 2004. Analysis of the data was undertaken on each criterion within the tool and by reviewing it against patient outcome, the decision for its retention or removal was made. The modified tool showed a 99% sensitivity and a 66% specificity. The resultant Paediatric Early Warning Tool has been validated for use in a tertiary children's hospital in the United Kingdom (UK). The use of such a tool by all staff caring for acutely ill children in hospital environments can help to ensure their early recognition and timely treatment. The tool together with an action plan must, however, be appropriate for use in individual ward or hospital areas.

Parental satisfaction with paediatric intensive care.

Literature reviews, parental consultation and multi-disciplinary input informed the development of a questionnaire to evaluate parental satisfaction with a regional paediatric intensive care service. The questionnaire was tested in a postal survey of 220 parents (response rate 50 percent) following their child's discharge from the unit in order to measure satisfaction levels, determine positive service attributes and identify strategies for future service development. There was a high level of parental satisfaction with many aspects of the service, particularly the standard of care, the perceived competency of staff and the level of support and involvement experienced. Satisfaction with facilities was more variable, although this was largely in relation to the hospital as a whole, rather than paediatric intensive care (PIC) facilities. Respondents provided suggestions for service development, particularly regarding information, communication and preparation for the transition from PIC to ward environments. Many of the strategies identified to optimise the service were not dependent upon extensive organisational change or excessive additional resources.

Acutely ill children within ward areas-care provision and possible development strategies.

This report presents the key findings of a travel scholarship to selected paediatric centres in the United Kingdom (UK), Australasia and the United States of America, where services provision for the care of acutely ill children within ward areas was investigated. In total, 15 centres were visited over a 5-month period, and comprehensive programs of information exchange were arranged in all locations. Key areas of interest discussed were the concepts of paediatric critical care outreach services and the use of paediatric early warning assessment tools. Information was collated and applied to the existing service provision within a tertiary children's hospital in the UK. It is hoped that the information gained during this professional study tour will add to the current available literature. It has helped to clarify the position of other key centres with regard to the care provision for acutely ill children in ward areas and confirmed the potential value of a support system and/or use of clinical assessment tool for staff caring for these children.

Parents' experiences of living through their child's suffering from and surviving severe meningococcal disease.

The aim of this study was to describe the lived experience of parents whose child had suffered from and survived severe meningococcal disease. A Heideggerian phenomenological approach was used within the study and data were collected from long focused interviews. In total, eight parents took part in the study; one was a woman recruited as a pilot interview and the other seven were recruited for the main study. The data were analysed using Colaizzi's (1978) method. Eleven themes emerged: (1) complications/side effects; (2) emotional turmoil; (3) child's physical appearance; (4) family disruption; (5) fear of death; (6) loss of parenting role; (7) need for support and understanding; (8) need and value of communication, information and publicity; (9) parental intuition; (10) technological interventions and (11) the impact of care delivery. A review of the literature arising out of the data was undertaken, and a final synthesis statement as perceived by the parents was achieved. Living through this experience is perceived as a major emotional stressor, and although health professionals have some insight into the experience, they are largely naive to the enormity of the situation.

The establishment of a nurse consultant role in paediatric intensive care: a reflective analysis.

Through a review of literature and research, together with reflection on clinical practice, this article reflectively analyses and evaluates the concept of the establishment and development of a nurse consultant post in paediatric intensive care. Manley's (1997) conceptual framework is used as a structure for the reflection, which has enabled a detailed and logical approach and allowed both reflection and analysis of the role in relation to the speciality. It is evident that nurse consultant posts have been developed in a variety of clinical specialities and are providing a real opportunity to improve patient care, progress nursing as a profession and provide a clinical career framework for nurses. The concept of the nurse consultant in paediatric intensive care is both innovative and strategic: Manley has identified many sub-roles, skills and processes necessary to influence and develop the role. The elements of 'transformational leadership', 'change agent' and 'collaborator' identified by Manley appear to hold the key to the ability to influence and develop paediatric intensive care nursing from a practice perspective.