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1.
J Pediatr Nurs ; 48: 55-62, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31325800

RESUMEN

PURPOSE: Pain assessment is the first step in managing pain; however, this can be challenging, particularly in settings such as the Pediatric Intensive Care Unit (PICU). This paper reports the current pain assessment practices from a study that was conducted describing the prevalence of pain, pain assessment, painful procedures, interventions, and characteristics of critically-ill children. Specifically, this paper addresses the child's communicative ability, pain scales, and characteristics of pain. DESIGN AND METHODS: The primary study was a cross-sectional, multi-site, descriptive design. Data from a 24-hour time period were collected from medical records and bedside nurses. RESULTS: Data were collected from the records of 220 children across 15 PICUs. The average number of pain assessments per child was 11.5 (SD 5.8, range 1-28). Seven behavioral scales and five self-report scales were used. There were times when no scale was used, "assume pain present" was recorded, or a sedation scale was documented. Twelve pain scales, including the target population, scoring, psychometric properties, and clinical utility are described. CONCLUSIONS: Results of this study indicate that a wide range of pain assessment tools are used, including behavioral scales for children unable to self-report. IMPLICATIONS: Foremost, the appropriate assessment method needs to be chosen for each child to manage pain. Knowledge of the criteria for the use of each pain assessment scale will help the clinician select the appropriate scale to use for each child. The practice of "assume pain present," as well as standardization of pain scales, and clinical support tools needs further investigation.

2.
Am J Crit Care ; 28(4): 265-273, 2019 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-31263009

RESUMEN

BACKGROUND: Pain management in critically ill children is complex. Epidemiological research is needed to identify how often patients in pediatric intensive care units experience pain and the practices being used to lessen pain. OBJECTIVES: To describe pain assessment and intervention practices in pediatric intensive care units, determine the prevalence of pain and painful procedures, and identify characteristics of children with moderate to severe pain. METHODS: A 24-hour observational cohort study was conducted in 15 units. Nurses completed surveys regarding patients' communicative ability. Patients' records were reviewed for pain assessments, painful procedures, and pharmacologic and nonpharmacologic interventions. RESULTS: For the 220 patients in this study, pain was assessed a median (interquartile range) of 10 (7-13) times, usually with behavioral pain scales. Sixty-eight percent of patients received pharmacologic interventions and 44% received nonpharmacologic interventions. Fentanyl was the most common analgesic provided. Repositioning was the most common nonpharmacologic intervention. Forty-five percent of patients had pain and 24% had moderate to severe pain. Patients experienced a median (interquartile range) of 7 (2-15) painful procedures in 24 hours. More frequent pain assessments and pharmacologic interventions and the ability to communicate were associated with moderate to severe pain. No patient in the moderate to severe pain category received neuromuscular blockers. CONCLUSIONS: Critically ill children experience pain and multiple painful procedures daily. Assessment and intervention practices vary considerably. Research is needed to establish best practices for pain assessment in patients with limited communicative ability and to determine which pain management strategies improve patients' outcomes.

3.
J Wound Ostomy Continence Nurs ; 46(3): 256-262, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31083070

RESUMEN

BACKGROUND: Recent revisions to the pressure injury staging system include guidance on differential diagnoses for deep tissue pressure injury (DTPI). Accurately identifying DTPI is critical; however, purpura in the setting of vascular disorders and systemic infectious processes can share similar features confounding diagnosis. CASES: In this three-case series, we describe suspected DTPI with an uncharacteristic shape or occurring in the presence of additional lesions distributed outside of typical pressure areas prompted further evaluation. CONCLUSIONS: The interdisciplinary approach we adapted was useful in determining the cause of purpura when the DTPI was ruled out by the certified wound care nurse.


Asunto(s)
Úlcera por Presión/clasificación , Púrpura/etiología , Región Sacrococcígea/anomalías , Adulto , Diagnóstico Diferencial , Femenino , Humanos , Masculino , Persona de Mediana Edad , Úlcera por Presión/complicaciones , Púrpura/clasificación , Región Sacrococcígea/irrigación sanguínea
4.
J Hosp Med ; 14(1): 38-41, 2019 01.
Artículo en Inglés | MEDLINE | ID: mdl-30667409

RESUMEN

We created Sleep for Inpatients: Empowering Staff to Act (SIESTA), which combines electronic "nudges" to forgo nocturnal vitals and medications with interprofessional education on improving patient sleep. In one "SIESTAenhanced unit," nurses received coaching and integrated SIESTA into daily huddles; a standard unit did not. Six months pre- and post-SIESTA, sleep-friendly orders rose in both units (foregoing vital signs: SIESTA unit, 4% to 34%; standard, 3% to 22%, P < .001 both; sleeppromoting VTE prophylaxis: SIESTA, 15% to 42%; standard, 12% to 28%, P < .001 both). In the SIESTAenhanced unit, nighttime room entries dropped by 44% (-6.3 disruptions/room, P < .001), and patients were more likely to report no disruptions for nighttime vital signs (70% vs 41%, P = .05) or medications (84% vs 57%, P = .031) than those in the standard unit. The standard unit was not changed. Although sleep-friendly orders were adopted in both units, a unit-based nursing empowerment approach was associated with fewer nighttime room entries and improved patient experience.

5.
HERD ; 12(2): 21-29, 2019 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-30380918

RESUMEN

OBJECTIVE: To investigate whether a patient's proximity to the nurse's station or ward entrance at time of admission was associated with increased risk of adverse outcomes. METHOD: We conducted a retrospective cohort study of consecutive adult inpatients to 13 medical-surgical wards at an academic hospital from 2009 to 2013. Proximity of admission room to the nurse's station and to the ward entrance was measured using Euclidean distances. Outcomes of interest include development of critical illness (defined as cardiac arrests or transfer to an intensive care unit), inhospital mortality, and increase in length of stay (LOS). RESULTS: Of the 83,635 admissions, 4,129 developed critical illness and 1,316 died. The median LOS was 3 days. After adjusting for admission severity of illness, ward, shift, and year, we found no relationship between proximity at admission to nurse's station our outcomes. However, patients admitted to end of the ward had higher risk of developing critical illness (odds ratio [ OR] = 1.15, 95% confidence interval [CI] = [1.08, 1.23]), mortality ( OR = 1.16, 95% CI [1.03, 1.33]), and a higher LOS (13-hr increase, 95% CI [10, 15] hours) compared to patients admitted closer to the ward entrance. Similar results were observed in sensitivity analyses adjusting for isolation room patients and considering patients without room transfers in the first 48 hr. CONCLUSIONS: Our study suggests that being away from the nurse's station did not increase the risk of these adverse events in ward patients, but being farther from the ward entrance was associated with increase in risk of adverse outcomes. Patient safety can be improved by recognizing this additional risk factor.

6.
J Nurses Prof Dev ; 32(6): 284-293, 2016.
Artículo en Inglés | MEDLINE | ID: mdl-27846078

RESUMEN

Practical training for nursing professional development specialists in the facilitation of clinical simulations was implemented using a six-step curriculum development framework. General and targeted needs assessments were conducted. Methods used to apply needs assessment findings into the course design and delivery and the participant's responses via program evaluations are described. The process used to develop this training may be applied by other nursing professional development departments to prepare educators in the delivery of simulated-based learning experiences.


Asunto(s)
Curriculum , Simulación de Paciente , Desarrollo de Programa/métodos , Desarrollo de Personal/métodos , Humanos , Evaluación de Necesidades , Desarrollo de Programa/normas , Desarrollo de Personal/normas
7.
J Pediatr Nurs ; 31(6): 691-700, 2016.
Artículo en Inglés | MEDLINE | ID: mdl-27600164

RESUMEN

The purpose of this study was to provide a current and comprehensive evaluation of nurses' beliefs regarding pain in critically ill children. DESIGN AND METHODS: A convergent parallel mixed-methods design was used. Nurse beliefs were captured via questionnaire and interview and then compared. RESULTS: Forty nurses participated. Most beliefs reported via questionnaire were consistent with effective pain management practices. Common inaccurate beliefs included the need to verify pain reports with physical indicators and the pharmacokinetics of intravenous opioids. Beliefs commonly shared during interviews concerned the need to verify pain reports with observed behavior, the accuracy of pain reports, the need to respond to pain, concerns regarding opioid analgesics, and the need to "start low" with interventions. Convergent beliefs between the questionnaire and interview included the use of physical indicators to verify pain, the need to take the child's word when pain is described, and concerns regarding negative effects of analgesics. Divergent and conflicting findings were most often regarding the legitimacy of a child's pain report. CONCLUSIONS: Findings from this study regarding the accuracy of nurses' pain beliefs for critically ill children are consistent with past research. The presence of divergent and conflicting responses suggests that nurses' pain beliefs are not static and may vary with patient characteristics. PRACTICE IMPLICATIONS: While most nurses appreciate the risks of unrelieved pain in children, many are concerned about the potential adverse effects of opioid administration. Interventions are needed to guide nurses in minimizing both of these risks.


Asunto(s)
Cuidados Críticos/métodos , Enfermedad Crítica/enfermería , Dimensión del Dolor/enfermería , Enfermería Pediátrica/métodos , Dolor Agudo/enfermería , Femenino , Humanos , Masculino , Relaciones Enfermero-Paciente , Personal de Enfermería en Hospital/psicología , Pautas de la Práctica en Enfermería
8.
J Pediatr Nurs ; 30(4): 580-90, 2015.
Artículo en Inglés | MEDLINE | ID: mdl-25682019

RESUMEN

The purpose of this concurrent mixed-methods study was to 1) examine the factors pediatric intensive care unit nurses consider when assessing and intervening for children who report severe pain and to 2) determine the effect of child behavior and diagnosis on the nurses' pain ratings and intervention choices for written and virtual human vignettes. Quantitative and qualitative results substantiated that despite recommendations to use self-report, many PICU nurses use behavior as the primary indicator to assess and treat pain, even when a child is old enough to articulate pain intensity and there is sufficient cause for pain to be present.


Asunto(s)
Unidades de Cuidado Intensivo Pediátrico , Evaluación en Enfermería , Manejo del Dolor/enfermería , Dimensión del Dolor/enfermería , Analgésicos Opioides/administración & dosificación , Niño , Niño Hospitalizado , Toma de Decisiones , Femenino , Humanos , Masculino , Enfermería Pediátrica , Sonrisa
9.
Simul Healthc ; 10(1): 14-20, 2015 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-25514587

RESUMEN

INTRODUCTION: As virtual experiences are increasingly used in health care training and research, it is important that adequate processes are applied for developing valid scenarios. We describe the development and validation of virtual human (VH) vignettes, computer-generated scenarios with animated patients and clinical information, for a mixed-methods study regarding nurses' assessment and intervention choices for critically ill children's pain. METHODS: We followed the case development and review process for high-fidelity simulation case scenarios, including the use of validated written vignettes and content experts. Forty nurses described their pain assessment and intervention choices for the newly derived VH vignettes and completed a pain questionnaire. Nurses' reports of VH vignette consistency with their professional experience and recognition of VH facial expressions were evaluated to establish face validity. Their pain ratings for the VH and written (questionnaire) vignettes were evaluated for convergent validity. Qualitative content analysis, descriptive statistics, correlations, and paired t tests were used. RESULTS: Most nurses (68.4%) supported vignette consistency with their professional experience. Facial expression recognition was 98.4%. Smiling children's pain was rated significantly lower than grimacing children in both VH and written vignettes. Pain was rated significantly lower for grimacing children in the VH vignettes than the written vignettes. Virtual human vignette pain ratings were strongly correlated with their written counterparts. CONCLUSIONS: This process was effective for developing VH vignettes that demonstrated good face validity with participants and convergent validity with written vignettes. Virtual human vignettes may be useful in studying the influence of facial actions on nurses' choices for children's pain assessment and treatment.


Asunto(s)
Simulación por Computador , Enfermedad Crítica/enfermería , Capacitación en Servicio/métodos , Manejo del Dolor/métodos , Dimensión del Dolor/métodos , Niño , Competencia Clínica , Instrucción por Computador/métodos , Conocimientos, Actitudes y Práctica en Salud , Humanos , Unidades de Cuidado Intensivo Pediátrico , Personal de Enfermería en Hospital , Factores Socioeconómicos , Interfaz Usuario-Computador
10.
J Adv Nurs ; 69(2): 465-80, 2013 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-22715857

RESUMEN

AIMS: To present a critique of the National League for Nursing/Jeffries simulation framework. DESIGN: Fawcett's criteria for theory analysis and evaluation are used. BACKGROUND: Use of simulated learning experiences in nursing education is widespread; a sound framework to guide educators across the globe in implementing these experiences effectively is essential. The basic assertion of the National League for Nursing/Jeffries simulation framework is that student-learning outcomes are influenced by the concepts of teacher, student, educational practices, and simulation design characteristics. DATA SOURCES: A literature search was performed using Cumulative Index to Nursing and Allied Health Literature, PubMed and Google Scholar to identify studies published in the English language, between 2005-June 2011, where the National League for Nursing/Jeffries simulation framework was tested or used as a theoretical framework for research. DISCUSSION: Sixteen publications (two articles in press) from the USA and UK were identified using the framework to guide research; outcomes included increased student satisfaction, confidence, and improved skill performance. IMPLICATIONS FOR NURSING: As a newer theoretical framework, the National League for Nursing/Jeffries simulation framework offers promise to guide the construction and implementation of simulation experiences resulting in positive student outcomes. CONCLUSION: Empirically supported definitions of concepts would strengthen the framework and help educators to consistently produce and identify positive outcomes. Additional rigorous research is necessary to further test relationships among concepts and the associated concept variables in the framework. More studies outside of the United States are needed to confirm the framework is relevant to nursing programs in other countries.


Asunto(s)
Educación en Enfermería/métodos , Enseñanza/métodos , Competencia Clínica/normas , Simulación por Computador , Humanos , Satisfacción Personal , Autoimagen , Estudiantes de Enfermería/psicología , Encuestas y Cuestionarios , Materiales de Enseñanza , Pensamiento , Reino Unido , Estados Unidos
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