Quality of Sleep in a Pediatric Hospital: A Descriptive Study Based on an Assessment of Interruptions, Perceptions, and the Environment.

OBJECTIVE: To investigate the amount and type of hospitalized children's nighttime sleep interruptions, perceptions, and efficiency. BACKGROUND: Sleep in hospitals is notoriously poor and impedes healing. Pediatric studies have been limited including breadth of diagnoses, age, or measures. METHODS: Actigraphy, sleep surveys, and nursing diaries were used to describe sleep on 2 nursing units along with environmental assessments. RESULTS: Ninety-five children from 1 month to 17 years with multiple diagnoses participated. The median number of awakenings was 2.7 per night. The median for the longest uninterrupted episode of sleep was 5.5 hours. Children need 8 to 17 hours of daily sleep, while this sample had a median of 7.5 hours of night sleep. Sensors showed talk as the predominant noise, whereas surveys showed alarms and vital signs awakened patients. CONCLUSIONS: Children are not getting essential, minimally interrupted sleep in hospitals. Disseminating results will increase awareness and accelerate environmental changes.

Comparison of Online and Face-to-Face Parent Education for Children with Autism and Sleep Problems.

Many children with autism spectrum disorder (ASD) have sleep disorders. Face-to-face (F2F) sessions have empowered parents to help their child sleep. Our goal was whether online technologies could provide similar improvements in children's sleep while also improving parents' quality of life. Identical programs were taught in two sessions to F2F and online parents. Measurements were compared from baseline to 4 and 8 weeks post teaching sessions. Twenty-three participants completed the program. Parent quality of life improved for both groups. Parent fatigue scores were improved and sustained for the online group. The total sleep score improved for both groups, while the online group had sustained decreases in night wakings. Online methods can conveniently help improve sleep for children with ASD.

Perianesthesia Nurses Are My Second Family: A Qualitative Descriptive Study.

PURPOSE: Identify the perceptions of perianesthesia nurses regarding behaviors that promote or detract from sustaining a safe, efficient, and satisfying work environment. DESIGN: Two focus groups and seven individual interviews (n=14) were conducted exploring the perceptions regarding team behavior of registered nurses in one pediatric perianesthesia unit. METHODS: Qualitative descriptive data collection, inductive content analysis. FINDINGS: Nurses described a responsive, engaged health care team whose leadership is available and directive when needed, as creating an effective, satisfying work environment. Primary themes that emerged were Leadership Sets the Tone, Playing Fair, No One Gets Hurt, and Why We Stay. This nursing team acknowledged that inattentive, distracted team members cause frustration, work inequities, and care delays, potentially undermining patient safety. CONCLUSIONS: Results demonstrate the need to create and sustain consistently respectful perianesthesia work cultures. Research focusing on unit specific approaches to work distribution, communication, leadership, and technology use is needed.

Resilience in Families of Children With Autism and Sleep Problems Using Mixed Methods.

PURPOSE: About 80% of children with autism spectrum disorder (ASD) have sleep problems that may disrupt optimal family functioning. We explored the impact of sleep problems on families' resilience. DESIGN AND METHODS: An explanatory sequential mixed methods design was used to discern whether resilience differed between families whose children with ASD have or do not have sleep problems, to seek predictors for family hardiness/resilience, and to determine whether narrative findings support, expand, or conflict quantitative findings. RESULTS: Seventy complete surveys were returned from parents of children with ASD to compare sleep and family functioning. Fifty-seven children had sleep problems and six interviews regarding eight of these children were conducted. Parents of children with ASD and sleep problems had lower levels of resilience than those who slept well. Predictors of hardiness were social support, coping-coherence (stress management), and lower strain scores. Qualitative content analysis revealed a journey analogy with themes: finding the trailhead, dual pathways, crossing paths and choosing travel companions, forging new paths, resting along the way, and seeing the vistas. CONCLUSIONS: Qualitative findings supported quantitative findings regarding the impact of sleep problems but also expanded them by illustrating how families' resilience and children's socialization improved over time. Social support predicted family hardiness. Parents revealed that sleep issues contributed to family strains and described their progression to resilience and embracing their child. PRACTICE IMPLICATIONS: Findings support the need for community and provider advocacy and implicates a need for development of sleep interventions on behalf of families and children with ASD.

Enteral Feeding Set Handling Techniques.

BACKGROUND: Enteral nutrition therapy is common practice in pediatric clinical settings. Often patients will receive a pump-assisted bolus feeding over 30 minutes several times per day using the same enteral feeding set (EFS). This study aims to determine the safest and most efficacious way to handle the EFS between feedings. METHODS: Three EFS handling techniques were compared through simulation for bacterial growth, nursing time, and supply costs: (1) rinsing the EFS with sterile water after each feeding, (2) refrigerating the EFS between feedings, and (3) using a ready-to-hang (RTH) product maintained at room temperature. Cultures were obtained at baseline, hour 12, and hour 21 of the 24-hour cycle. A time-in-motion analysis was conducted and reported in average number of seconds to complete each procedure. Supply costs were inventoried for 1 month comparing the actual usage to our estimated usage. RESULTS: Of 1080 cultures obtained, the overall bacterial growth rate was 8.7%. The rinse and refrigeration techniques displayed similar bacterial growth (11.4% vs 10.3%, P = .63). The RTH technique displayed the least bacterial growth of any method (4.4%, P = .002). The time analysis in minutes showed the rinse method was the most time-consuming (44.8 ± 2.7) vs refrigeration (35.8 ± 2.6) and RTH (31.08 ± 0.6) ( P < .0001). CONCLUSIONS: All 3 EFS handling techniques displayed low bacterial growth. RTH was superior in bacterial growth, nursing time, and supply costs. Since not all pediatric formulas are available in RTH, we conclude that refrigerating the EFS between uses is the next most efficacious method for handling the EFS between bolus feeds.

Perceptions of Caring for Adolescents With Eating Disorders Hospitalized on a General Pediatric Unit.

PURPOSE: To describe the perceptions of inpatient pediatric hospitalist physicians (HPs), registered nurses (RNs), and care assistants (CAs) at a tertiary pediatric hospital regarding caring for children with eating disorders (EDs) who are hospitalized for medical stabilization. DESIGN AND METHODS: A qualitative descriptive study was conducted using semi-structured individual interviews with aforementioned health care workers (HCWs) to explore their perspectives on caring for children/adolescents with EDs in relation to recent initiatives to transform their care. These initiatives focused on admitting patients to a designated "ED Unit", development of an ED consult team, providing ED education to staff, and development of ED standardized order sets (SOSs). RESULTS: Twenty HCWs representing the three disciplines completed individual interviews. Most participants reported that the system changes led to more consistent care of patients with ED. Content analysis of the interviews revealed the following themes: awkwardness and uncertainties of care, navigating family dynamics, establishing therapeutic boundaries, and finding rewards in ED care. CONCLUSIONS: Education, structure, and support for staff improved care for adolescents with EDs as perceived by HCWs. HCWs found satisfaction in providing care during the medical stabilization process. Study findings were positive for staff and future studies should include perceptions of patients/families to further design a therapeutic environment. PRACTICE IMPLICATIONS: Providing a standardized order set, expert consult team, and ongoing staff training can strengthen the therapeutic hospital environment for adolescents with EDs. Pediatric hospitals can provide excellent care for children with EDs while supporting their staff to provide a therapeutic environment.

Enteral Feeding Set Handling Techniques: A Comparison of Bacterial Growth, Nursing Time, Labor, and Material Costs.

BACKGROUND: Enteral nutrition therapy is common practice in pediatric clinical settings. Often patients will receive a pump-assisted bolus feeding over 30 minutes several times per day using the same enteral feeding set (EFS). This study aims to determine the safest and most efficacious way to handle the EFS between feedings. METHODS: Three EFS handling techniques were compared through simulation for bacterial growth, nursing time, and supply costs: (1) rinsing the EFS with sterile water after each feeding, (2) refrigerating the EFS between feedings, and (3) using a ready-to-hang (RTH) product maintained at room temperature. Cultures were obtained at baseline, hour 12, and hour 21 of the 24-hour cycle. A time-in-motion analysis was conducted and reported in average number of seconds to complete each procedure. Supply costs were inventoried for 1 month comparing the actual usage to our estimated usage. RESULTS: Of 1080 cultures obtained, the overall bacterial growth rate was 8.7%. The rinse and refrigeration techniques displayed similar bacterial growth (11.4% vs 10.3%, P = .63). The RTH technique displayed the least bacterial growth of any method (4.4%, P = .002). The time analysis in minutes showed the rinse method was the most time-consuming (44.8 ± 2.7) vs refrigeration (35.8 ± 2.6) and RTH (31.08 ± 0.6) (P < .0001). CONCLUSIONS: All 3 EFS handling techniques displayed low bacterial growth. RTH was superior in bacterial growth, nursing time, and supply costs. Since not all pediatric formulas are available in RTH, we conclude that refrigerating the EFS between uses is the next most efficacious method for handling the EFS between bolus feeds.

On SHiPs and safety: a journey of safe patient handling in pediatrics.

Nursing personnel have consistently been ranked among the top ten professions impacted by musculoskeletal injuries. Inpatient pediatric nurses witnessed an increase in injuries and upon discovering limited evidence applicable to pediatrics, conducted a research study to evaluate the effectiveness of a safe patient handling program. Surveys were distributed to assess risk and workplace safety perceptions. Post-implementation, surveys revealed a statistically significant (p>0.0001) increase in staff perception of workplace safety, reduction in risk perception for several nursing tasks, and reduction in injury related costs. As a result of this program, workplace safety was improved through education and equipment provision.

Change to a standardized airway clearance protocol for children with bronchiolitis leads to improved care.

Nurses at a pediatric hospital identified the liberal utilization of deep nasopharyngeal (NP) suction as the primary airway clearance modality in young children with bronchiolitis. This invasive practice lacked supporting evidence and a standardized approach. Nurses created an interdisciplinary team to develop a less invasive airway clearance protocol. Data from 2years, both pre and post protocol implementation, were analyzed. An 11% decrease in deep NP suctioning resulted in improved or unchanged balancing measures and perceptions of quality of care.

Nurses' perceptions of unaccompanied hospitalized children.

The purpose of this study was to acknowledge and interpret the stories and perceptions of pediatric nurses who care for children left unaccompanied during their hospitalization. This was a phenomenological qualitative study conducted via interviews using open-ended questions. The study was conducted in a large Midwestern pediatric hospital that has both urban and suburban settings. Twelve nurses voluntarily completed the interviews. Recruitment was accomplished though a group e-mail that was sent to all registered nurses at the hospital complex. Nurses made assumptions about families particularly when the family did not communicate the reason for their absence. Unaccompanied children received equal nursing care but often received more attention than children whose families were present. Care for unaccompanied hospitalized children presents more challenges to nurses and may not be optimal for children. Nurses should examine their feelings and judgments about non-attendant families. Staffing levels should take into account whether the child has a guardian at the bedside.

Unaccompanied hospitalized children: nurses' search for understanding.

PURPOSE: To explore the experiences and feelings of pediatric nurses who care for hospitalized children that are unaccompanied by their parents. DESIGN AND METHODS: This phenomenological study consisted of interviews with 12 pediatric nurses. Verbatim transcriptions were reviewed with participants and analyzed. FINDINGS: Pediatric nurses viewed the circumstances of unaccompanied hospitalized children through the perspective of their own life-worlds. They used both cognitive and emotional constructs to describe the phenomenon. Nurses' perceptions were affected by day-to-day contingencies of their life worlds which come through the four dimensions of space, mind/body, time, and relationships. These perceptions affected their assessment of parents' situated contexts. Nurses' assessments could lead to negative judgments of parents because they worried about ill effects on the unaccompanied children. Meanwhile,nurses often perceived that parents demonstrated trust when they relegated their child's care to them. CONCLUSIONS: Pediatric nurses dealt with increased emotional work while remaining compassionate with their patients. Nurses indicated that they needed to understand their own life-worlds and that parents' day-to-day contingencies may affect parents' ability to remain with their hospitalized children. Participants were aware of judgmental attitudes which could interfere with the development of therapeutic relationships with parents, and therefore, with hospitalized children.

Unaccompanied hospitalized children: a review of the literature and incidence study.

The aim of this study was to review literature on unaccompanied hospitalized children and report the incidence at a pediatric hospital over 2 weeks. The philosophical model of most pediatric hospitals is family-centered care (FCC) and reducing separation effects. Although the FCC model includes parents/guardians as collaborators and participants in the care of the child, parents cannot always be present. Nurses try to meet the needs of unaccompanied children. Children and parents express that they want to be together, but many parents have obstacles to participation including increased expectations. The incidence study found that about one third of children were sometimes unaccompanied.

Choosing a career in nursing: development of a career search instrument.

University students in this millennium will be older, culturally diverse and likely to change their career major several times during the course of their education. Methods to identify and guide appropriate students toward nursing are lacking. The purpose of this study was to develop and initially test a 48-item Likert-scaled instrument, the Career Search Questionnaire (CSQ), which assesses interest in and self-efficacy for nursing. Data were obtained from 300 volunteer students, with implied consent, enrolled in beginning-level courses at a Midwestern university. Response differences were apparent between individuals who reported nursing as a college major compared to those who sought a different major. Participants who reported nursing as their major obtained higher scores in both interest (p = 0.00) and self-efficacy (p = 0.00). The CSQ is psychometrically sound, with a reliability score of 0.87 and capable of identifying the student for whom nursing may be the suitable career.

Microbial contamination of enteral feeding sets used in the home of pediatric patients.

Bacterial contamination of enteral feeding sets has been well documented in studies of patients. Much of the literature on this subject validates problems with manipulations of the feeding sets such as mixing formula and handwashing by the caregiver. Rinsing and storing of the set could also have serious implications in the amount of contamination. There is currently no standard recommending the length of time for use of enteral feeding sets for home care patients, particularly in children. Nine homecare patients with ages ranging between 1 and 15 years participated in this study. Cultures of the formula in the feeding set were obtained at zero hours with a new set, and after 24 and 48 hours. The caregivers prepared and administered the formula in their usual manner. Clinical data were collected for 10-14 days before the samplings and for 7 days afterward. Data included weights before, during, and after the culture collection period. Medications, stools, and emesis were recorded during this timeframe. It is difficult to draw statistically significant conclusions based on the small sample size of this study. There was an undesirable level of contamination at 48 hours of enteral feeding set use that was not present at 24 hours in 2 of the patients (22.2%). Neither of these children had diarrhea, vomiting, or other clinical changes, but both showed a small weight loss. The majority of the patients (77.8%) demonstrated that using sets for 48 hours did not increase the amount of contamination.