NICU Nurses' Knowledge and Attitudes Regarding 2-Month Immunizations.

BACKGROUND: Nurses are an integral part of the healthcare team. Parents rely on nurses for information regarding the plan of care for their child. Medically stable infants under supervision in a newborn intensive care unit (NICU) can and should be immunized. PURPOSE: The purpose of this study was to explore attitudes and knowledge in NICU nurses regarding 2-month immunizations. METHODS: Participants were attendees of the National Association of Neonatal Nurses (NAAN) 33rd Annual Conference. Participants responded to a survey that focused on knowledge and attitudes regarding 2-month immunizations. FINDINGS/RESULTS: A total of 188 nurses attending the NAAN conference completed the survey. Most nurses had positive attitudes regarding immunizations. A majority (n = 117, 62.5%) of NICU nurses knew that immunizations should be given to medically stable infants in a NICU. However, as few as 27% of participants were able to identify recommended 2-month immunizations. Almost two-thirds of participants (n = 115, 61.1%) did not know current guidelines regarding minimum age at the time of administration of immunizations, although NPs were more likely to know current guidelines. Nurse practitioners were more comfortable talking family about immunizations and were more likely to view that the illnesses prevented by vaccines as serious. IMPLICATIONS FOR PRACTICE: NICU nurses would benefit from continued education focused on Centers for Disease Control and Prevention (CDC) guidelines for 2-month immunizations. Additionally, as a primary source of information for parents, NICU nurses should be encouraged to practice teaching parents and family about immunizations. This practice could reinforce nurse knowledge. IMPLICATIONS FOR RESEARCH: Further research regarding the effect of education, simulation, and yearly reinforcement of CDC guidelines could further enlighten our knowledge on this topic.

Pediatric nurse practitioner's perceived organizational support in academic and nonacademic institutions.

BACKGROUND: The role of the pediatric nurse practitioner (PNP) has changed since its inception over 50 years ago. Pediatric nurse practitioner practice has evolved from providing outpatient primary care to children to providing complex care in the acute practice environment. PURPOSE: The purpose of this study was to describe whether a difference existed in perceptions of organizational support (POS) of PNPs working in academic and nonacademic institutions and to describe the differences between PNP reporting structures and POS. METHODS: A quantitative cross-sectional design was used with a convenience sample (n = 86) of PNPs from the membership list of the Pediatric Nurse Credentialing Board (PNCB). A formal written request was sent to the PNCB to access their membership after which institutional review board approval was obtained from Case Western Reserve University. Participants received an online cover letter with links to the surveys to be completed. The PNPs were asked to complete a demographic/institution characteristic survey and Eisenberger Perceived Organizational Support Survey (POS). RESULTS: More than 63% of the PNPs participating in this national survey, practicing in both academic and nonacademic affiliated hospitals, had positive perceptions of organizational support. No differences were found between the academic and the nonacademic affiliations. IMPLICATIONS FOR PRACTICE: Because PNPs are integral to the provision of care to children, providing opportunities for PNPs to continue to enhance their clinical skills and practice to the full extent of their scope of practice will only enhance their perceptions of organizational support. This dynamic creates a win-win for the PNP, the institution, the patients they care for, and the US health care system.

Human Trafficking of Children: Nurse Practitioner Knowledge, Beliefs, and Experience Supporting the Development of a Practice Guideline: Part Two.

INTRODUCTION: Part 1 of this series addressed low levels of awareness about child trafficking among pediatric health care providers, supporting the need for clinical practice guidelines to aid evidence-based response to potential victims in the clinical setting. The purpose of this article was to explore evidence related to effective clinical response when encountering at-risk children or those who have experienced trafficking and make recommendations for a practice guideline. METHOD: An integrated review of the literature included electronic data search of PubMed, Ovid, and CINAHL and application of the social ecological model for thematic analysis. RESULTS: Research is primarily inconclusive on the effective clinical response for victims and potential victims of child trafficking, indicating the need for practice guidelines directed at both prevention and intervention. DISCUSSION: This review supports pediatric clinicians as ideally equipped and situated to intervene in a myriad of care settings on behalf of children with health disparities who are vulnerable to trafficking, advocating for prevention, and optimization of equitable health outcomes.

Pediatric clinician perspectives on communicating diagnostic uncertainty.

OBJECTIVE: Diagnosis often evolves over time, involves uncertainty, and is vulnerable to errors. We examined pediatric clinicians' perspectives on communicating diagnostic uncertainty to patients' parents and how this occurs. DESIGN: We conducted semi-structured interviews, which were audiotaped, transcribed, and analyzed using content analysis. Two researchers independently coded transcripts and then discussed discrepancies to reach consensus. SETTING: A purposive sample of pediatric clinicians at two large academic medical institutions in Texas. PARTICIPANTS: Twenty pediatric clinicians participated: 18 physicians, 2 nurse practitioners; 7 males, 13 females; 7 inpatient, 11 outpatient, and 2 practicing in mixed settings; with 0-16 years' experience post-residency. INTERVENTION(S): None. MAIN OUTCOME MEASURE(S): Pediatric clinician perspectives on communication of diagnostic uncertainty. RESULTS: Pediatric clinicians commonly experienced diagnostic uncertainty and most were comfortable seeking help and discussing with colleagues. However, when communicating uncertainty to parents, clinicians used multiple considerations to adjust the degree to which they communicated. Considerations included parent characteristics (education, socioeconomic status, emotional response, and culture) and strength of parent-clinician relationships. Communication content included setting expectations, explaining the diagnostic process, discussing most relevant differentials, and providing reassurance. Responses to certain parent characteristics, however, were variable. For example, some clinicians were more open to discussing diagnostic uncertainty with more educated parents- others were less. CONCLUSIONS: While pediatric clinicians are comfortable discussing diagnostic uncertainty with colleagues, how they communicate uncertainty to parents appears variable. Parent characteristics and parent-clinician relationships affect extent of communication and content discussed. Development and implementation of optimal strategies for managing and communicating diagnostic uncertainty can improve the diagnostic process.

Pediatric Nurse Practitioners' Knowledge and Attitudes Regarding Pain Management Study in Central China.

BACKGROUND: Nurses' level of knowledge about pain management directly determines the steps of implementation of clinical pain policies. METHOD: This study surveyed 2,882 pediatric nurse practitioners from six children's hospitals using demographics and pain management questionnaires, as well as the Chinese version questionnaire of the Pediatric Nurse Practitioners' Knowledge and Attitudes Survey Regarding Pain (PNKAS) via the WeChat application. RESULTS: The total score on the PNKAS was 14.88 ± 3.58 for the pediatric nurse practitioners. Multiple regression results showed the main factors influencing the PNKAS score related to position, the frequency of receiving training pain-related knowledge, and working department, which could account for 35.1% of the total variance. CONCLUSION: Pediatric nurse practitioners from pediatric hospitals were not found to have sufficient knowledge or an appropriate attitude regarding pain management. A new standardized training project of pain management that is closely related to clinical practice for children should be conducted in the future. [J Contin Educ Nurs. 2019;50(6):275-281.].

Estratégias de enfrentamento dos profissionais de enfermagem frente à morte na oncologia pediátrica: revisão integrativa / Nurses' coping strategies in pediatric oncology: an integrative review / Estrategias de enfrentamiento de los profesionales de enfermería frente a la muerte en la oncología pediátrica: revisión integrativa

Objective: This study's aim has been to identify the coping strategies used by nurses in pediatric oncology in face of the patient's death. Methods: This integrative review was carried out using the following databases: VHL, MEDLINE/PubMed, and Google Scholar, from April 1st to May 3rd, 2017. The following descriptors were used: death, nursing, child, health pediatrics, oncology, cancer, and coping. The final sample consisted of ten scientific papers. Results: The following coping strategies identified: psychological support from other professionals and from the institution; institutional training on death and the dying process; exchange of experiences among professionals; sports practice; and religion and faith. These strategies were carried out according to individual characteristics and the work environment. Conclusion: It was concluded that the strategies lead to supportive attitudes according to the needs of professionals, alleviating their suffering and improving their care process

Objetivo: Identificar as estratégias de enfrentamento utilizadas por profissionais de enfermagem que atuam na oncologia pediátrica diante da morte do paciente. Métodos: Revisão integrativa da literatura realizada nas fontes de informação: BVS, MEDLINE/PubMed e no Google Scholar, no período de 01 de abril a 03 de maio de 2017. Utilizou-se os descritores: death, nursing, child, health pediatrics, oncology, cancer, coping. A amostra final foi constituída por dez artigos científicos. Resultados: Estratégias de enfrentamento identificadas: apoio psicológico de outros profissionais e da instituição; capacitação institucional sobre a morte e o processo de morrer; troca de experiências entre profissionais; prática de esportes; religião e fé. As estratégias ocorrem de acordo com as características individuais e do ambiente de trabalho. Conclusão: Concluiu-se que as estratégias levam a atitudes auxiliadoras nas necessidades do profissional, amenizando seu sofrimento e melhorando seu processo de cuidar

Objetivo: Identificar las estrategias de enfrentamiento utilizadas por profesionales de enfermería que actúan en la oncología pediátrica ante la muerte del paciente. Métodos: Revisión integrativa de la literatura realizada en las siguientes fuentes de información: BVS, MEDLINE/PubMed y en Google Scholar, en el período del 01 de abril al 03 de mayo de 2017. Se utilizaron los descriptores: death, nursing, child, health pediatrics, oncology, cancer, coping. La muestra final fue constituida por diez artículos científicos. Resultados: Estrategias de enfrentamiento identificadas: apoyo psicológico de otros profesionales y de la institución; Capacitación institucional sobre la muerte y el proceso de morir; Intercambio de experiencias entre profesionales; Práctica de deportes; Religión y fe. Las estrategias ocurren de acuerdo con las características individuales y del ambiente de trabajo. Conclusión: Se concluyó que las estrategias llevan a actitudes auxiliares en las necesidades del profesional, amenizando su sufrimiento y mejorando su proceso de cuidar

Exploring the human factors of prescribing errors in paediatric intensive care units.

OBJECTIVE: To explore the factors contributing to prescribing error in paediatric intensive care units (PICUs) using a human factors approach based on Reason's theory of error causation to support planning of interventions to mitigate slips and lapses, rules-based mistakes and knowledge-based mistakes. METHODS: A hierarchical task analysis (HTA) of prescribing was conducted using documentary analysis. Eleven semistructured interviews with prescribers were conducted using vignettes and were analysed using template analysis. Contributory factors were identified through the interviews and were related to tasks in the HTA by an expert panel involving a PICU clinician, nurse and pharmacist. RESULTS: Prescribing in PICU is composed of 30 subtasks. Our findings indicate that cognitive burden was the main contributory factor of prescribing error. This manifested in two ways: physical, associated with fatigue, distraction and interruption, and poor information transfer; and psychological, related to inexperience, changing workload and insufficient decision support information. Physical burden was associated with errors of omission or selection; psychological burden was linked to errors related to a lack of knowledge and/or awareness. Social control through nursing staff was the only identified control step. This control was dysfunctional at times as nurses were part of an informal mechanism to support decision making, was ineffective. CONCLUSIONS: Cognitive burden on prescribers is the principal latent factor contributing to prescribing error. This research suggests that interventions relating to skill mix, and communication and presentation of information may be effective at mitigating rule and knowledge-based mistakes. Mitigating fatigue and standardising procedures may minimise slips and lapses.

Using Google to Survey PNPs About Agricultural Safety.

INTRODUCTION: Youth and children in agriculture are highly vulnerable to the health hazards associated with agricultural work and the rural environment. METHODS: The purpose of this study was to conduct a national needs assessment for developing a continuing education unit that increases the knowledge of pediatric nurse practitioners (PNPs) on safety in an agricultural environment using the Google family of products. This was a cross-sectional, one-group design descriptive-correlational study. RESULTS: Surveys were received from 315 participants. On Day 1, 57% of responses were received, and 91% were received within Week 1. DISCUSSION: The use of the free Google Forms and Google Sheets facilitated this researcher to obtain a sample size, saving research expense dollars, and entering data file into SPSS. In addition, a pattern of survey return rates was demonstrated. Second, clinical implications indicate that agricultural safety is missing from PNP curricula: PNPs are not knowledgeable about existing resources and would be interested in a continuing education unit.

Survey on Neonatal End-of-Life Comfort Care Guidelines Across America.

CONTEXT: Infants of age less than one year have the highest mortality rate in pediatrics. The American Academy of Pediatrics published guidelines for palliative care in 2013; however, significant variation persists among local protocols addressing neonatal comfort care at the end-of-life (EOL). OBJECTIVES: The purpose of this study was to evaluate current neonatal EOL comfort care practices and clinician satisfaction across America. METHODS: After institutional review board approval (516005), an anonymous, electronic survey was sent to members of the American Academy of Pediatrics Section on Neonatal-Perinatal Medicine. Members of the listserv include neonatologists, neonatal fellow physicians, neonatal nurses, and neonatal nurse practitioners from across America (U.S. and Canada). RESULTS: There were 346/3000 (11.5%) responses with wide geographic distribution and high levels of intensive care responding (46.1% Level IV, 50.9% Level III, 3.0% Level II). Nearly half (45.2%) reported that their primary institution did not have neonatal comfort care guidelines. Of those reporting institutional neonatal comfort care guidelines, 19.1% do not address pain symptom management. Most guidelines also do not address gastrointestinal distress, anxiety, or secretions. Thirty-nine percent of respondents stated that their institution did not address physician compassion fatigue. Overall, 91.8% of respondents felt that their institution would benefit from further education/training in neonatal EOL care. CONCLUSION: Across America, respondents confirmed significant variation and verified many institutions do not formally address neonatal EOL comfort care. Institutions with guidelines commonly appear to lack crucial areas of palliative care including patient symptom management and provider compassion fatigue. The overwhelming majority of respondents felt that their institutions would benefit from further neonatal EOL care training.

When Behavioral Health Concerns Present in Pediatric Primary Care: Factors Influencing Provider Decision-Making.

Primary care providers (PCPs) frequently encounter behavioral health (BH) needs among their pediatric patients. However, PCPs report variable training in and comfort with BH, and questions remain about how and when PCPs address pediatric BH needs. Existing literature on PCP decisions to address pediatric BH in-office versus referring to subspecialty BH is limited and findings are mixed. Accordingly, this study sought to examine parameters and contextual factors influencing PCP decisions and practices related to BH care. Qualitative interview results with 21 PCPs in Maryland indicated that decisions about how and when to address pediatric BH concerns are influenced by the type BH service needed, patient characteristics, the availability of BH services in the community, and possibly PCPs' perceptions of BH care as a distinct subspecialty. Findings suggest that efforts to support individual PCPs' capacity to address BH within primary care must be balanced by efforts to expand the subspecialty BH workforce.

'Our Care through Our Eyes'. Impact of a co-produced digital educational programme on nurses' knowledge, confidence and attitudes in providing care for children and young people who have self-harmed: a mixed-methods study in the UK.

OBJECTIVES: (1) To determine the impact of a digital educational intervention on the knowledge, attitudes, confidence and behavioural intention of registered children's nurses working with children and young people (CYP) admitted with self-harm.(2) To explore the perceived impact, suitability and usefulness of the intervention. INTERVENTION: A digital educational intervention that had been co-produced with CYP service users, registered children's nurses and academics. SETTING: A prospective, uncontrolled, intervention study with preintervention and postintervention measurement, conducted at a large acute NHS Trust in the UK. PARTICIPANTS: From a pool of 251 registered children's nurses and 98 participants were recruited to complete the intervention (response rate=39%). At follow-up, 52% of participants completed the postintervention questionnaire, with 65% (n=33) of those reporting to have completed the digital educational intervention. PRIMARY OUTCOME MEASURES: Attitude towards self-harm in CYP was measured using a 13-item questionnaire; knowledge of self-harm in CYP was measured through an adapted 12-item questionnaire; confidence in different areas of practice was measured through Likert Scale responses; self-efficacy for working with CYP who have self-harmed was measured through an adapted version of the Self-efficacy Towards Helping Scale; clinical behavioural intention was measured by the Continuing Professional Development Reaction Questionnaire. Semistructured interviews were undertaken with a purposive sample of participants. RESULTS: For those who completed the intervention (n=33), improvements were observed in knowledge (effect size, ES: 0.69), confidence, and in some domains relating to attitudes (effectiveness domain-ES: 0.49), and clinical behavioural intention (belief about consequences-ES:0.49; moral norm-ES: 0.43; beliefs about capability-ES: 0.42). Qualitative findings suggest participants experienced skill development, feelings of empowerment and reflection on own practice. CONCLUSIONS: The effect of the intervention is promising and demonstrates the potential it has in improving registered children's nurse's knowledge, confidence and attitudes. However, further testing is required to confirm this.

Preparing the Family and Children for Surgery.

The focus of this literature analysis is the concept of preparing the family and children for surgery. As posited in the literature, surgery causes stress and anxiety that have a negative impact on both parents and their children. Therefore, the need for health care professionals to facilitate positive preparation for surgery to minimize anxiety and enhance postoperative recovery is important. Preparing the family and children for surgery is discussed in depth under the following themes: Preoperative Anxiety in Children, the Impact of Preoperative Anxiety on the Pediatric Patients and Parents, Preoperative Psychological Preparation for Children and Parents, and the Role of Nurse Practitioners in Preoperative Preparation. Through reviewing the literature, it would appear that some areas of preparation for parents are not as sufficient as they could be, particularly with regard to adequate preoperative education programs. The majority of studies reported that therapeutic play and clown interventions used for psychological preparation of parents and their children have been effective in minimizing and decreasing anxiety levels.

Deprivation and its impact on non-urgent Paediatric Emergency Department use: are Nurse Practitioners the answer?

AIMS: This article reports on the quantitative findings from a large mixed method study that determined the extent to which the provision of alternatives to an Emergency Department and Index of Relative Social Disadvantage score influenced non-urgent paediatric Emergency Department use. BACKGROUND: In Australia, there is an increasing use of Emergency Departments for the provision of non-urgent care that may be better serviced in the community. Further, despite the plethora of literature describing the characteristics of non-urgent users of Emergency Departments the link to social and community characteristics remains under explored. DESIGN: This 2010 retrospective analysis of the Hospital Admission Status data from the paediatric Emergency Department provided the information on attendance types and numbers along with postcode details. The postcodes in conjunction with Australia Bureau of Statistics data provided the levels of deprivation from the Index of Relative Social Deprivation scores. METHOD: A logistic regression analysis determined the levels of influence of deprivation and General Practitioner or Nurse Practitioner provision on the use of Emergency Departments for non-urgent care. FINDINGS: Rates of use for non-urgent care is higher for populations who come from areas of deprivation and have limited primary care services, such as low levels of General Practitioners. Children from areas of high deprivation and limited access to primary care were up to six times more likely to use Emergency Department for non-urgent care. CONCLUSIONS: Deprivation impacts on the use of paediatric Emergency Departments for non-urgent care even in countries like Australia where there is government subsidized health care.

Advanced practice nursing in child maltreatment: practice characteristics.

INTRODUCTION: Child maltreatment is a problem of epidemic proportions in the United States. Pediatric nurse practitioners and other advanced practice nurses (APNs) have been caring for maltreated children for decades, yet to date no comprehensive assessment of their practice characteristics or their clinical and academic contributions to the field has been performed. The purpose of this study is to describe the practice characteristics of APNs who care for maltreated children. METHOD: A descriptive design was used for this study. Child advocacy centers and children's hospitals were contacted to inquire about employment of child maltreatment APNs in their institution, and contact information for the lead APN was obtained. The Nurse Practitioner Survey was then sent to lead APNs by e-mail. RESULTS: The majority of APNs who work primarily in child maltreatment are pediatric nurse practitioners who work in child advocacy centers. They are providing care to children with physical and/or sexual abuse concerns; however, APNs provide care for children with all types of child maltreatment concerns. DISCUSSION: APNs play a vital role in the care of abused/neglected children. Their important contributions include not only clinical care but also the provision of clinical and didactic education to other professionals, parents, and the public. Research and publication are also essential to their role.

Perinatal palliative care: barriers and attitudes of neonatologists and nurses in Poland.

OBJECTIVE: To identify barriers and personnel attitudes towards realization of palliative care principles in neonatological units. STUDY DESIGN: An anonymous questionnaire was posted to all heads of departments and head nurses of all the 27 neonatological units in the Lodz area. RESULTS: We received 46 (85%) questionnaires. Final analysis comprised 42 properly filled-in questionnaires (by 22 doctors and 20 nurses). In case of prenatal diagnosis of a lethal defect, 77.27% of doctors and 65% of nurses opted for informing the mother also about the possibility of pregnancy continuation and organization of palliative care after delivery. Most of respondents accepted conditions for abortion pointed by the Polish law. The most common barriers pointed out by both groups were insufficient knowledge of the personnel on palliative medicine and family preference for life sustaining treatment. CONCLUSIONS: Understanding attitudes of personnel towards palliative care and identification of barriers are a starting point for future efforts to improve the system of neonatological care.

The impact of education and simulation on pediatric novice nurses' response and recognition to deteriorating.

Adverse patient events related to preventable errors while hospitalized resulted in need for interventions to improve outcomes. One identified error is the lack of symptom recognition during patient deterioration. Pediatric patients' symptoms during deterioration vary from their adult counterparts and often go unrecognized. A Pediatric Crisis Recognition and Management course was designed to assist the novice pediatric nurse to recognize and respond appropriately through the use of high-fidelity simulation enhancing their clinical skills and improving patient outcomes during a crisis.