Head home: implementation during COVID-19 pandemic.

BACKGROUND: Recent research suggests that between 20% and 50% of paediatric head injuries attending our emergency department (ED) could be safely discharged soon after triage, without the need for medical review, using a 'Head Injury Discharge At Triage' tool (HIDAT). We sought to implement this into clinical practice. METHODS: Paediatric ED triage staff underwent competency-based assessments for HIDAT with all head injury presentations 1 May to 31 October 2020 included in analysis. We determined which patients were discharged using the tool, which underwent CT of the brain and whether there was a clinically important traumatic brain injury or representation to the ED. RESULTS: Of the 1429 patients screened; 610 (43%) screened negative with 250 (18%) discharged by nursing staff. Of the entire cohort, 32 CTs were performed for head injury concerns (6 abnormal) with 1 CT performed in the HIDAT negative group (normal). Of those discharged using HIDAT, four reattended, two with vomiting (no imaging or admission) and two with minor scalp wound infections. Two patients who screened negative declined discharge under the policy with later medical discharge (no imaging or admission). Paediatric ED attendances were 29% lower than in 2018. CONCLUSION: We have successfully implemented HIDAT into local clinical practice. The number discharged (18%) is lower than originally described; this is likely multifactorial. The relationship between COVID-19 and paediatric ED attendances is unclear but decreased attendances suggest those for whom the tool was originally designed are not attending ED and may be accessing other medical/non-medical resources.

Effects of simulation training on COVID-19 control ability and psychological states of nurses in a children's hospital.

OBJECTIVE: This study aims to discuss the effects of simulation training on improving the pre-examination, triage, prevention, and control of coronavirus disease 2019 (COVID-19), explain the psychological states of pre-examination and triage staff in general hospitals during the COVID-19 epidemic, and analyze relevant influencing factors. This study may serve as a reference of psychological consultation services to medical staff. SUBJECTS AND METHODS: This study included 60 nurses assigned in the pre-examination department, fever clinics, and isolation wards of a general hospital from January 26th to February 1st, 2020. Before assuming the posts, the nurses received simulation training on the clinical reception of suspected patients with COVID-19. Operation skills of the nurses before and after the training were assessed. RESULTS: The percent of passing significantly increased from 65% before the training to 98.33% after training (p<0.05). Training also significantly relieved the anxiety and depression of the nurses (p<0.05). CONCLUSIONS: Scenario-simulation training can increase the emergency abilities of pediatric nurses in the prevention and control of the COVID-19 epidemic and relieve the anxiety of nurses.

Effectiveness of Clinical Nurses' interventions in reducing medication errors in a paediatric ward.

AIMS AND OBJECTIVES: To evaluate a bundle of interventions, developed and implemented by nurses, to reduce medication administration error rates and improve nurses' medication administration practice. BACKGROUND: Medication administration errors are a problematic issue worldwide, despite previous attempts to reduce them. Most interventions to date focus on isolated elements of the medication process and fail to actively involve nurses in developing solutions. DESIGN: An Action Research (AR) three-phase quantitative study. METHODS: Phase One aimed to build an overall picture of medication practice. Phase Two aimed to develop and implement targeted interventions. During this phase, the research team recruited six clinical paediatric nurses to be part of the AR Team. Five interventions were developed and implemented by the clinical nurses during this phase. The interventions were evaluated in Phase Three. Data collection included medication incident data, medication policy audits based on hospital medication policy and Safety Attitudes Questionnaire. Quantitative analysis was undertaken. The Standards for QUality Improvement Reporting Excellence (SQUIRE) checklist was followed in reporting this study. RESULTS: Postimplementing the interventions, medication error rates were reduced by 56.9% despite an increase in the number of patient admissions and in the number of prescribed medications. The rate of medication errors per 1,000 prescribed medications significantly declined from 2014 to 2016. The ward nurses were more compliant with the policy in postintervention phase than preintervention phase. The improvement in SAQ was reported in five of the seven domains. CONCLUSION: Clinically based nurse's participation in action research enabled practice reflection, development and implementation of a bundle of interventions, which led to a change in nursing practice and subsequent reduction in medication administration error rates. Active engagement of nurses in research empowers them to find solutions that are tailored to their own practice culture and environment.

Effect of organizational citizenship behavior on family-centered care: Mediating role of multiple commitment.

Family-centered care is one the most important indicators of high-quality care. The organizational citizenship behavior and commitment can enhance the quality of healthcare. This study aimed to investigate the effect of the organizational citizenship behavior on family-centered care considering the mediating role of multiple commitment. This descriptive study was conducted on 237 nurses working in pediatric and infant units of hospitals in Tehran city, Iran. The subjects were selected using the convenience sampling method. Data collection was performed using the Organizational Citizenship Behavior Scale, Perceived Family-Centered Care Staff Questionnaire, Affective Commitment Scale, and Commitment to the Supervisor Scale. The SPSS v.22 and SEM-PLS v.2 software were used for data analysis. Results were extracted in the form of a standard model and fitted for indices pertaining to the measurement and structural models. Accordingly, the organizational citizenship behavior had a direct effect on family-centered care (ß = 0.19, t = 2.39). Moreover, multiple commitment including commitment to the leader and commitment to the organization had indirect weak and moderate effects on the relationship between the organizational citizenship behavior and family-centered care, respectively. An inverse association was reported between commitment to the leader and family-centered care. Furthermore, the organizational citizenship behavior predicted family-centered care by 70% considering the mediating role of multiple commitment. Therefore, family-centered care as an indicator of high-quality care can be improved through enhancing the organizational citizenship behavior and organizational commitment among Iranian nurses working in pediatric wards.

Validez de contenido de una escala de confort crítico pediátrico mediante una metodología mixta / Validity of contents of a paediatric critical comfort scale using mixed methodology

Introducción: La enfermedad crítica en el paciente pediátrico incluye desde una patología aguda en un niño sano a una agudización de una enfermedad crónica, hecho que ha conllevado centrar su atención clínica en las Unidades de Cuidados Intensivos Pediátricos. El rol del/la enfermero/a pediátrico/a se centra también en promover el confort en estos pacientes críticos. Por este motivo, es necesario disponer de instrumentos de medida que permitan un correcto sensado del grado de confort. Objetivo: Describir el proceso de validación de contenido de una escala de confort crítico pediátrico mediante el empleo de una metodología mixta. Material y métodos: Se realizó una adaptación transcultural del inglés al español mediante el método de traducción-retraducción de la Comfort Behavior Scale. Posteriormente, se validó el contenido de la misma mediante una metodología mixta. Esta segunda etapa se dividió en una fase cuantitativa empleando un cuestionario ad hoc donde se valoró la relevancia/pertinencia y el redactado de cada dominio/ítem de la escala y en una cualitativa donde se realizaron dos reuniones con profesionales sanitarios, pacientes y un familiar siguiendo las recomendaciones de la metodología Delphi. Resultados: Todos los ítems y dominios obtuvieron un índice de validez de contenido >0,80, exceptuando el movimiento físico, en su relevancia, que obtuvo un 0,76. El índice global de validez de contenido de la escala fue de 0,87 (elevado). Durante la fase cualitativa se reformularon y/o eliminaron ítems de cada uno de los dominios de la escala para hacerla más comprensible y aplicable. Conclusiones: El empleo de una metodología mixta de validación de contenido otorga riqueza y sensibilidad evaluatoria al instrumento a diseñar (AU)

Introduction: Critical illness in paediatric patients includes acute conditions in a healthy child as well as exacerbations of chronic disease, and therefore these situations must be clinically managed in Critical Care Units. The role of the paediatric nurse is to ensure the comfort of these critically ill patients. To that end, instruments are required that correctly assess critical comfort. Objective: To describe the process for validating the content of a paediatric critical comfort scale using mixed-method research. Material and Methods: Initially, a cross-cultural adaptation of the Comfort Behavior Scale from English to Spanish using the translation and back-translation method was made. After that, its content was evaluated using mixed method research. This second step was divided into a quantitative stage in which an ad hoc questionnaire was used in order to assess each scale's item relevance and wording and a qualitative stage with two meetings with health professionals, patients and a family member following the Delphi Method recommendations. Results: All scale items obtained a content validity index >0.80, except physical movement in its relevance, which obtained 0.76. Global content scale validity was 0.87 (high). During the qualitative stage, items from each of the scale domains were reformulated or eliminated in order to make the scale more comprehensible and applicable. Conclusions: The use of a mixed-method research methodology during the scale content validity phase allows the design of a richer and more assessment-sensitive instrument (AU)

Promoting the Utilization of Science in Healthcare (PUSH) Project: A Description of the Perceived Barriers and Facilitators to Research Utilization Among Pediatric Nurses.

The purpose of this descriptive study was to identify the perceived barriers and facilitators to research utilization and evidence-based practice among nurses employed in a tertiary care children's hospital. Results revealed seven facilitator and six barrier themes that contribute to the understanding of the problem. The themes can be utilized by nursing professional development specialists to customize organizational infrastructure and educational programs.

Listening to paediatric primary care nurses: a qualitative study of the potential for interprofessional oral health practice in six federally qualified health centres in Massachusetts and Maryland.

OBJECTIVES: To explore the opportunities for interprofessional collaboration (IPC) to improve paediatric oral health in federally qualified health centres (FQHCs), to identify challenges to IPC-led integration of oral health prevention into the well-child visit and to suggest strategies to overcome barriers. SAMPLE: Nurse managers (NMs), nurse practitioners (NPs), paediatric clinical staff and administrators in six FQHCs in two states were interviewed using a semistructured format. DESIGN: Grounded theory research. Topics included feasibility of integration, perceived barriers and strategies for incorporating oral health into paediatric primary care. MEASUREMENTS: Qualitative data were coded and analysed using NVivo 10 to generate themes iteratively. RESULTS: Nurses in diverse roles recognised the importance of oral health prevention but were unaware of professional guidelines for incorporating oral health into paediatric encounters. They valued collaborative care, specifically internal communication, joint initiatives and training and partnering with dental schools or community dental practices. Barriers to IPC included inadequate training, few opportunities for cross-communication and absence of charting templates in electronic health records. CONCLUSIONS: NMs, NPs and paediatric nursing staff all value IPC to improve patients' oral health, yet are constrained by lack of oral health training and supportive charting and referral systems. With supports, they are willing to take on responsibility for introducing oral health preventive measures into the well-child visit, but will require IPC approaches to training and systems changes. IPC teams in the health centre setting can work together, if policy and administrative supports are in place, to provide oral health assessments, education, fluoride varnish application and dental referrals, decrease the prevalence of early childhood caries and increase access to a dental home for low-income children.

Nursing Staff's Perception of Barriers in Providing End-of-Life Care to Terminally Ill Pediatric Patients in Southeast Iran.

OBJECTIVE: To determine pediatric nurses' perceptions of intensity, frequency occurrence, and magnitude score of selected barriers in providing pediatric end-of-life (EOL) care. METHOD: A translated modified version of National Survey of critical care Nurses' s Regarding End-of-Life Care questionnaire was used to assess 151 nurses' perceptions of intensity and frequency occurrence of barriers in caring for dying children. RESULTS: The highest/lowest perceived barriers magnitude scores were "families not accepting poor child prognosis" (5.04) and "continuing to provide advanced treatment to dying child because of financial benefits to the hospital" (2.19). CONCLUSION: More high perceived barriers by nurses were family-related issues. One of the possible causes of such deficiencies was lack of palliative care (PC) education/PC units in Iran. Thus, developing EOL/PC education may enhance nurses' knowledge/skill to face EOL care challenges.

Nurses in Action: A Response to Cultural Care Challenges in a Pediatric Acute Care Setting.

Culturally congruent care is satisfying, meaningful, fits with people's daily lives, and promotes their health and wellbeing. A group of staff nurses identified specific clinical challenges they faced in providing such care for Hispanic and underserved Caucasian children and families in the pediatric medical-surgical unit of an urban regional children's hospital in the southeastern U.S. To address these challenges, an academic-practice partnership was formed between a group of nurse managers and staff nurses at the children's hospital and nursing faculty and graduate students at a local, research-intensive public university. Using the culture care theory, the partners collaborated on a research study to discover knowledge that would help the nursing staff resolve the identified clinical challenges. Twelve families and 12 healthcare providers participated. Data analysis revealed five care factors that participants identified as most valuable: family, faith, communication, care integration, and meeting basic needs. These themes were used to formulate nursing actions that, when applied in daily practice, could facilitate the provision of culturally congruent care for these children and their families. The knowledge generated by this study also has implications for healthcare organizations, nursing educators, and academic-practice partnerships that seek to ensure the delivery of equitable care for all patients.

Valoración enfermera de las Urgencias Pediátricas en Atención Primaria. Calidad del registro y satisfacción de usuarios y profesionales con el sistema VEUPAP / Nurse pediatric emergency valuation in primary care: quality record and patients and nurses satisfaction with tool VEUPAP

Objetivo. Valorar el grado de cumplimentación del registro VEUPAP y el nivel de satisfacción de los acompañantes de los niños y de las enfermeras con este sistema. Diseño. Estudio transversal descriptivo. Se valoró la cumplimentación del registro de forma global y específica por la enfermera según criterios de calidad definidos. La satisfacción de los acompañantes se valoró con el cuestionario AMABLE, la de las enfermeras con el CSLPS-EAP y la realización personal en el trabajo con el Maslach Bornout Inventory (MBI) en su versión validada en castellano. Resultados. Se evaluaron 266 casos registrados con VEUPAP. El cumplimiento general de los ítems supera el 95 % (92-98%), excepto en dificultad respiratoria, gastrointestinal y dolor abdominal, con 93 % (90-96 %), 90 % (86-94 %) y 67 % (61-73 %), respectivamente. Supera el 95 % (93-97 %) los usuarios que refieren estar satisfechos con la atención enfermera. El cien por cien de las enfermeras están muy satisfechas con sus tareas y actividades y la realización personal que consiguen; el 88 % (84-92 %) con la calidad de atención a los pacientes y logro de objetivos. Todas se sienten bastantes satisfechas con su grado de autonomía. La inestabilidad laboral supone un 50 % (44-56 %) de insatisfacción. El agotamiento emocional (AE) es bajo para el 94 % de las enfermeras y medio para el 6 %, la despersonalización (DP) alta para 17 % y baja para el 13 %, y la realización personal (RP) baja para el 53 % y media para el 47 %. Conclusiones. Calidad de registro, satisfacción del usuario y de la enfermera son tres piedras angulares de la atención pediátrica de Urgencias. VEUPAP incide de manera positiva sobre estos tres aspectos (AU)

Objective. To value the degree of completion of VEUPAP record, the level of satisfaction of the accompanists of children with nursing care and nurse satisfaction. Design. Descriptive study. There was valued the cumplimentation of record of global and specific form by nurse according to defined quality criteria. The satisfaction of the accompanists was valued by the AMABLE questionnaire, the nurses satisfaction with the use of VEUPAP by the CSLPS-EAP and the personal accomplishment in the work by the MBI in his validated spanish version. Results. 266 VEUPAP cases were evaluated. The general compliance of the items exceeds 95(92-98) %, except for three items. Completion of protocols fever, respiratory distress, gastrointestinal, and abdominal pain is 95(92-98) %, 93(90-96) %, 90(86-94) % and 67(61-73) % respectively. More than 95(93-97) % users referring to be satisfied with the nurses attention. The 100(100-100) % of the nurses are very satisfied with their tasks and activities and personal accomplishment they get, 88(84-92) % with the quality of patient care and achievement of objectives. All feel quite satisfied with their degree of autonomy. Job instability represents 50(44-56) % of dissatisfaction. The EE is low for 94% of nurses and a medium for 6 %, the DP high for 17 % and low for 13 % and the PA low for 53 % and medium for 47 %. Conclusions. Quality of registration, user satisfaction and the nurse who provides care satisfaction are three cornerstones of pediatric emergency care. VEUPAP impacts positively on these three aspects (AU)