The Role of Pediatric Nurses During Preventable Adverse Event Disclosure: A Scoping Review.

OBJECTIVES: Preventable adverse events (PAEs) occur across the healthcare spectrum and unfortunately, errors, adverse events, and PAEs are common in pediatric care. Historically, the role of disclosure of PAEs to patients and their families occurred between the dyad of physician and patient, with physicians assuming the responsibility of disclosure. In recent years, a trend toward a multidisciplinary team-based approach has emerged in some institutions, yet the role of pediatric nurses within the team disclosing a PAE is not fully understood. Given the unique relationship between pediatric nurses and their patients and their families, it is essential to understand does the literature tell us about the role of pediatric nurses during PAE disclosure? METHODS: The Arksey and O'Malley scoping review method guided this study protocol and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews framework guided reporting. RESULTS: The final sample included five articles for synthesis: none reported or described a specific role for pediatric nurses during PAE disclosure. CONCLUSIONS: There is a gap in the literature on the role of pediatric nurses during PAE disclosure. Two themes emerged from this review: the use of a team-based approach to disclosure, and the need to provide emotional support to the pediatric patient and their family. There is a need for additional investigation into the role of pediatric nurses as part of a team-based disclosure process and how pediatric nurses currently provide, or desire to provide, emotional support to the patient and their family.

The Effects of Moral Distress on Resilience in Pediatric Emergency Department Nurses.

INTRODUCTION: Moral distress is widespread in health care, and nurses working in high-pressure environments, such as emergency departments, experience stress at high rates. Understanding how moral distress affects pediatric emergency nursing care is essential to moderate its negative impacts. Increased resilience has been promoted as a tool to mitigate moral distress. The purpose of this study, conducted prior to the pandemic, was to examine patterns of moral distress and the impact of moral distress on resilience among pediatric emergency nurses. METHODS: A cross-sectional exploratory study of pediatric emergency nurses was performed. Moral Distress Scale-Revised (Pediatric) and Connor-Davidson Resilience Scale 25© scores were collected and calculated. Exploratory factor analysis with principal components was used to identify patterns of moral distress that impact resilience. RESULTS: Four distinct patterns of moral distress that impact resilience were identified: (1) incompetent practice, (2) incongruent truth-telling, (3) potentially inappropriate care, and (4) discordant health care teams. DISCUSSION: Our study was the first to identify 4 patterns of moral distress in pediatric emergency nurses. As a result, actions to promote resilience include: (1) supporting competent practice, (2) upholding appropriate truth-telling, (3) recognizing and addressing potentially inappropriate care, and (4) building concordant health care teams and systems. This pre-pandemic data provides a foundational understanding of the relationship between moral distress and resilience in pediatric emergency nurses. Identifying factors of moral distress that impact resilience has significant implications for pediatric emergency nursing, including the development of future initiatives, education, and research.

Improving Use of Antibiotics for Pediatric Pneumonia in Community Hospital Emergency Departments.

BACKGROUND AND OBJECTIVES: The majority of pediatric patients present to community-hospital emergency departments (EDs). Pneumonia is among the most common reasons for ED visits; however, prescribing narrow-spectrum antibiotics occurs at rates below established best practices. We sought to increase prescription of narrow-spectrum antibiotics for pediatric pneumonia in 5 community hospital EDs using an interdisciplinary learning collaborative. We aimed to increase use of narrow spectrum antibiotics from 60% to 80% by December 2018. METHODS: A collaborative of 5 community hospitals developed quality improvement teams who held quarterly meetings over a 1 year period engaging teams in Plan-Do-Study-Act cycles. Interventions included deployment of an evidenced based guideline, educational interventions, and order set modification. Preintervention data were collected for 12 months. Using a standardized data form, teams collected monthly data during the intervention period and for an additional year after to assess for sustainability. Teams evaluated data using statistical process control charts and included any patient 3 months to 18 years with a diagnosis of pneumonia. RESULTS: The aggregated rate of narrow-spectrum antibiotic prescriptions increased from 60% during the baseline period to 78% during the intervention period. During the year after active implementation, this aggregate rate increased to 92%. Differences in prescribing patterns were noted by provider type, but narrow-spectrum antibiotic use improved for both general emergency medicine and pediatric providers. No return visits to the ED for failure of antibiotic treatment within 72 hours occurred. CONCLUSIONS: An interdisciplinary community hospital learning collaborative increased prescribing narrow-spectrum antibiotics by both general and pediatric ED providers.

Efficacy of feeding hydroxy-selenomethionine on plasma and milk selenium in mid-lactation dairy cows.

In this study, we aimed to determine the amount of Se transferred to milk and blood of mid- to late-lactation dairy cows when supplemental Se from hydroxy-selenomethionine (OH-SeMet) was fed compared with an unsupplemented group and a group supplemented with a seleno-yeast (SY). Twenty-four lactating Holstein cows (178 ± 43 d in milk) were used in a complete randomized block design for 91 d (7-d covariate period and 84-d treatment period). Treatments were (1) basal diet with an analyzed Se background of 0.2 mg of Se per kg as-fed (control); (2) basal diet + 0.3 mg of Se/kg as-fed from SY (SY-0.3); (3) basal diet + 0.1 mg of Se/kg as-fed from OH-SeMet (OH-SeMet-0.1); and (4) basal diet + 0.3 mg of Se/kg as-fed from OH-SeMet (OH-SeMet-0.3). During the trial, plasma and milk were analyzed for total Se, and plasma was analyzed for glutathione peroxidase activity. The mean plasma and milk Se concentrations exhibited the same relationship, where OH-SeMet-0.3 resulted in the highest values (142 µg/L of plasma and 104 µg/kg of milk), followed by SY-0.3 (134 µg/L and 85 µg/kg), OH-SeMet-0.1 (122 µg/L and 67 µg/kg), and the control group had the lowest values (120 µg/L and 50 µg/kg). The increment of Se in milk induced by OH-SeMet-0.3 (+54 µg/kg) was 54% higher than that induced by SY-0.3 (+35 µg/kg). Additionally, dietary supplementation of 0.2 mg/kg Se from OH-SeMet in the total mixed ration was estimated to be similar to 0.3 mg/kg Se from SY in the total mixed ration when considering the level of Se in the milk. There was no difference in plasma glutathione peroxidase activity between groups; however, OH-SeMet-0.3 significantly decreased somatic cell count. The results confirmed that supplementation with organic Se increases milk and plasma Se concentrations. Moreover, when administered at the same level of supplementation, OH-SeMet was shown to be more efficient than SY in improving milk quality by increasing Se content and decreasing milk somatic cell count.