Procedures performed by pediatric transport nurses: how "advanced" is the practice?

INTRODUCTION: Pediatric interfacility transport teams often rely on advanced practice nurses as primary care providers. These individuals may be required to transport patients without the presence of a physician. There is, however, little information in the medical literature regarding how frequently advanced practice transport nurses perform advanced procedures, how often these procedures are successfully performed, and the rate of complications associated with nurse-performed procedures. PURPOSE: The purpose of this study was to determine how frequently advanced practice transport nurses were called on to perform advanced procedures and to determine the nurses' procedural success and complication rates. DESIGN: Prospective convenience sample of consecutive pediatric interfacility transports. METHODS: Transport nurses collected data on 336 pediatric interfacility transports that were performed during a 4-month period beginning in May 1997. All patient transports occurring during the study period were included. Data regarding procedures were recorded on data collection sheets. This data included the type of procedure performed, the outcome of the procedure, and the complications associated with the procedure. The number of attempts required to successfully complete the procedure was not recorded. During or after the patient's hospitalization, the medical record was reviewed to identify potential complications related to the transport that may not have been recorded on the data collection sheet. RESULTS: Nurses performed 95.2% of transports without the presence of a physician. Twenty-six patients (8.8%) required advanced procedures. Nurses performed eight tracheal intubations. Personnel at the referring hospital performed the remaining procedures. All tracheal intubations by transport nurses were successful. There were no complications related to these procedures. All patients were transported to the receiving hospital without incident. CONCLUSIONS: Although they had considerable training for advanced procedures, the transport nurses rarely used these skills. All tracheal intubations performed by transport nurses were successful, and there were no adverse consequences related to intubation by a transport nurse.

Nursing judgment: the key to pain assessment in critically ill children.

Pain assessment in critically ill children emphasizes the need to place expert nursing judgment prominently on the list of assessment strategies. The expert nurse is uniquely qualified to identify subtle responses to physiologic and environmental stimuli and to titrate analgesics and other pain relief strategies accordingly. While it is challenging to assess pain with limited verbal and behavioral cues, pain assessment is not only possible, but even more critical, when the available cues are subtle and can be easily overlooked or attributed to other causes. The question that sparked these comments reflects the passion I so often witness in intensive care nurses committed to eliminating pain as an emotional and physiological stressor for these vulnerable children. When that passion is empowered by evidence-based nursing judgment, children receive the best possible care.

Burn pain management in children.

Burn injuries present complex management problems that are exacerbated by the pain and suffering associated with burns. This pain commands primary consideration in the treatment plan, and the goal should be to achieve the least pain possible. This article describes strategies for assessing children's pain and for treating pain with a combination of pharmacologic and complementary therapies. An experienced interdisciplinary team is essential to successful pain management.

Addressing epistemologic and practical issues in multimethod research: a procedure for conceptual triangulation.

Although a combination of quantitative and qualitative methods are being used increasingly in nursing research, little practical advice exists about the conduct of such studies. Conceptual triangulation offers one approach to multimethod research, addressing epistemologic and practical issues that have long plagued investigators. Conducting quantitative and qualitative research as parallel studies and using method-specific criteria for rigor provide an alternative to blending methodologic assumptions. Systematic examination of the support for findings guides judgments about model development, and the provision for multiple conceptual models resolves issues about the interpretation of findings.

Symptom management outcomes. Do they reflect variations in care delivery systems?

OBJECTIVES: Symptom management is increasingly recognized as a critical element of patient care, particularly in managing chronic illness. However, research on outcomes related to symptom management is in its infancy, except for the symptom of pain. This symptom was therefore chosen as a prototype to review the state of the science regarding relations between organizational variables and symptom management outcomes and to illustrate the issues regardless of the symptom managed. This article discusses pain outcome measures appropriate for acute and cancer pain, proposes attributes of the care delivery system that may affect outcome measures, and identifies challenges associated with this type of research. METHODS: Review of quality assurance studies raises issues concerning the adequacy of currently used outcomes for pain and satisfaction with pain management. Although considerable effort has been expended in developing pain measurement in adults and children, critical issues for examining pain management outcomes include deciding what perspectives should be used as the most valid indicator of the pain outcome and when the measures should be obtained. RESULTS: Critical concerns are raised about the measure of satisfaction with pain management and its appropriateness as the end-result outcome. A key issue is whether respondents actually disentangle satisfaction with pain management from satisfaction with other aspects of care, including caring dispositions of health-care providers. Finally, the question is raised: Are pain outcomes affected by organizational context? CONCLUSIONS: Although the answer to this question is unknown, a few research studies suggest that organizational context is likely to influence pain outcomes. It is clear, however, from ongoing work that until several conceptual, methodological, and analytic challenges are resolved, research is unlikely to capture the influence of variations in care delivery systems on symptom management outcomes.

Multisite clinical research: a challenge for nursing leaders.

The need for the application of research-based data to diversified healthcare systems has led to more attempts by nurse researchers to investigate phenomena across clinical sites. Nurse executives increasingly are asked to justify resource allocation among organizations, and must compare patient-care practices within complex systems that are often geographically distant. This article describes the pitfalls encountered and the progress made by researchers during a 4-year multisite, multimethod clinical investigation collecting clinical outcome and organizational context data from seven hospitals.

Evaluating a pediatric pain management research utilization program.

Research-based pain assessment and management innovations are not fully utilized in clinical nursing practice. Thus children continue to suffer despite strategies that could eliminate or significantly reduce their pain. An educational program was developed and implemented to integrate state-of-the-art pain assessment and management strategies into the clinical practice of pediatric nurses. This article reports on evaluation of the research utilization process during development and implementation of the program. The program included formal classes, development of instruments for pain assessment and documentation, ongoing consultation on pain management strategies, and designation of a unit-based staff nurse liaison. Findings illuminated the process through which nursing staff on one unit came to learn about new ideas, try those ideas in their clinical practice, re-invent certain strategies to better meet their needs, and, ultimately, to adopt innovations deemed helpful in their work.

Effects of dietary composition on growth of M. leprae in mouse footpads.

The number of bacteria per mouse footpad were measured at intervals beginning with the third month in male, weanling BALB/c mice infected with M. leprae and fed for a period of 6 months to test the effects of diet on multiplication of bacteria. The mean bacteria count per footpad in mice remaining at 6 months in the two high fat diets was higher (p = 0.014) than the mean of the two low fat diets. Likewise, the pooled mean bacterial count of mice fed the two diets of animal origin had a tendency to a higher mean bacterial count compared to mice fed the two diets of plant origin. Low level of dietary protein in early life also seemed to predispose to M. leprae multiplication. Our data in mice suggest that the association of diet with human leprosy should be investigated.

Effect of diet on growth of M. leprae in mouse footpads.

Semipurified diets, with equal amounts of vitamins, minerals and fibre, but varied in protein and fat content from pork, barbel fish or soya beans were tested for their possible effect on the growth of M. leprae in mouse footpads. 105 BALB/c male weanling mice were randomly divided into five diet groups of 21 mice each and fed for six months. Differences between bacterial counts of diet groups were found. The mouse foot pad model is suitable for dietary study in leprosy.

The incidence of urogenital Chlamydia trachomatis infections among patients in Kumasi, Ghana.

The incidence of urogenital chlamydia infections among selected patients in Kumasi, Ghana was evaluated using an immunofluorescent monoclonal antibody technique. Chlamydia trachomatis was identified in 4 of 110 patients presenting for prenatal care, 2 of 55 female patients with infertility and 6 of 15 males with acute urethritis. The findings demonstrate that C. trachomatis is a frequently identified pathogen among male patients presenting with symptoms of acute urethritis; however, the incidence of chlamydia infections among asymptomatic patients is relatively low.

PIP: The incidence of urogenital chlamydia infections among selected patients in Kumasi, Ghana was evaluated using an immuno-florescent monoclonal antibody technique. Chlamydia trachomatis was identified in 4 of 110 patients presenting for prenatal care, 2 of 55 female patients with infertility and 6 of 15 males with acute urethritis. The findings demonstrate that C. trachomatis is a frequently identified pathogen among male patients presenting with symptoms of acute urethritis; however, the incidence of chlamydia infections among asymptomatic patients is relatively low. Sites for the study were the University of Science and Technology and the Komfo Anokye Teaching Hospital in Kumasi. These findings suggest that C. trachomatis is an important pathogen in sexually transmitted infection in Kumasi, Ghana; isolation rates from this area are consistent with those reported from western countries. An asymptomatic carriage rate of 3.6% is similar to that reported from nearby Accra. The present study did not demonstrate an increased incidence of C. trachomatis infections among patients with infertility, as has been noted in other studies. However, the etiology of infertility in these patients was not fully evaluated and prior chlamydial infections might have occurred.

Nutrition in leprosy: a review.

The literature relating diet to leprosy is abundant between 1900 and 1960, peaking around 1940. Dietary factors that appear to influence the etiopathogenesis of Hansen's disease include: vitamin A, vitamin B group, vitamin C, vitamin D, vitamin E, calcium, and zinc. We noted a frequent lack of detailed dietary data in much of the literature cited. This is particularly true when the thrust of the investigation is not dietary. The literature strongly suggests the beneficial influence of adequate diet on the outcome of Hansen's disease and the deleterious effect of a deficient diet. In contrast with the paucity of reported hard data in the previous reviews concerned with the effect of nutrition and diet on leprosy, is the increasing volume of literature reviews and experimental studies showing the profound impact of nutrition and diet on the immune system of man and laboratory animals. That diet has a global, if poorly understood, effect on the immune system is being increasingly recognized. The difficult question that remains is how to use this information in the control and prevention of disease. Therefore, we believe that more emphasis should be given to diet in the study of this important worldwide disease in light of the current understanding of biochemistry and immunology.