Accuracy of infant emesis volume assessment.

Even though nurses assess volume output for blood, emesis, and stool using visual processing, assessment accuracy has not been studied nor has the application of information-processing theory to visual assessment been shown. The purpose of this investigation was to determine the application of information-processing theory to accuracy in visual assessment of emesis. Nursing students and practicing pediatric nurses (N=109) participated in this nonexperimental study in which 20 randomly selected volumes were presented as visual displays of formula on receiving blankets. Subjects were asked to determine the volume. Findings showed that few displays were assessed accurately (M=2.63), but that subjects who have been taught to use a mental frame of reference in assessment were significantly more accurate. Error increased with the display volume. Additional analysis showed that subject practice role, nature of clinical practice, and number of displays assessed for weight accounted for significant proportions of variance in relative error. These findings are consistent with information-processing theory and suggest that nurses who are doing visual assessment should learn a processing method that presents a mental frame of reference with which they compare the observed volume. Further, perceived weight of the object observed should be added to visual processing to increase accuracy.

Experiences in children of critically ill parents: a time of emotional disruption and need for support.

The purpose of this phenomenologic study was to describe effects of a parental critical care hospitalization on the family as viewed by children. Interviews were conducted with eleven male phenomenologic techniques and showed these four major themes: (1) emotional turmoil, (2) family disruption, (3) need for support, and (4) minor illnesses. These disruptions are strong and need to be treated through nursing interventions.

Behavioral responses of family members during critical illness.

This articles describes the behavioral responses of adult family members to critical illness and how these responses change over the course of the hospitalization. A convenience sample of 52 family members of patients in intensive units completed the Iowa ICU Family Scale, a self-report tool measuring sleep, eating, activity, family role, and support behaviors. Scales were completed by family members each day during the first week and then weekly throughout the patient's ICU stay. Family members reported sleeping less with a poorer quality of sleep, less nutritional intake, an increased use of cigarettes, alcohol, and over-the-counter and prescription medications, and spending more time talking, visiting the patient, and waiting. Stress was highest at the time of the ICU admission, began to plateau at Day 6, and then dropped considerably by Day 28. These findings suggest that crisis intervention is important during the early phase of caring for critically ill patients and their family members.

Siblings of hospitalized children: assessment and intervention.

The issues faced by children who have had a sibling recently hospitalized are summarized in this report. In addition, the research findings about this sibling experience as well as assessment and intervention strategies for siblings are presented. Craft and Knafl and their colleagues have found that the siblings who are at the greatest risk for adverse effects are younger and experiencing many changes, perceive their parents to be treating them differently as compared with before their sibling's hospitalization, have received little information about their ill brother or sister, and are being cared for outside of the home by care providers who are not relatives. Nurses need to assess siblings and intervene as indicated to ensure that the effects of short-term stress do not initiate adverse long-term sequelae.

Effects of child visitation in adult critical care units: a pilot study.

OBJECTIVE: To examine the behavioral and emotional responses of the child and of the nonhospitalized adult family member (NHAFM) to facilitated child visitation in the critical care setting. DESIGN: Quasi-experimental, posttreatment design. SETTING: An adult surgical intensive care unit at a large Midwestern teaching hospital. PARTICIPANTS: Twenty families participated in the study, 10 families in a restricted and 10 families in a facilitated visitation group. Each family unit had a child, an NHAFM, and a critically ill family member. In the control group the NHAFMs visited the patient in the customary routine, but children were restricted from visiting. After a 2-week waiting period a facilitated child visitation intervention was implemented for the experimental group. OUTCOME MEASURES: The child completed measures on anxiety as measured by the Manifest Anxiety Scale and behavioral and emotional changes as measured by the Perceived Change Scale. The NHAFM completed measures on anxiety as measured by the State-Trait Anxiety Inventory and mood as measured by the Mood Adjective Check List. Family functioning, as measured by the Feetham Family Functioning Survey, and life event changes, as measured by the Life Event Scale, were examined as extraneous variables. INTERVENTION: The Child Visitation Intervention encompassed systematic facilitation and supervision of children visiting a critically ill adult family member in a surgical intensive care unit and provision of emotional support before, during, and after visitation (the intervention protocol may be obtained from the investigators on request). RESULTS: Children in the facilitated visitation group had a greater reduction (t = 4.0, df = 18, p = 0.0004) in negative behavioral and emotional changes as measured by the Child-Perceived Change Scale when compared with children in the restricted visitation group. CONCLUSION: Facilitated child visitation may help children deal with the critical illness of an adult family member and deserves further study.

Program characteristics influencing nurse selection of CE offerings.

The purpose of this study was to identify program characteristics that influence decision-making in the selection of continuing education (CE) offerings by registered nurses licensed in a state with mandatory CE. A sample of 238 nurses were asked to identify the level of importance for 35 CE program characteristics on a Likert-like scale. The data indicated that all characteristics were of some importance to participants, with high levels of importance given to items demonstrating professional values. The findings suggest that even though CE may be mandatory, nurses still select educational offerings on the basis of quality and contribution to their professional practice.

Interventions related to family.

This group of 9 interventions related to families is a beginning in the work that lies ahead as nurses specify, validate, and test their interventions for the health and well-being of families and family members. It is the hope of the investigators that the reported findings and the discussion in this article will stimulate thought, action, and research as the practice and the science of nursing moves toward a standardized language for nursing diagnoses, interventions and outcomes.

Inductive methodology and a research team.

Large teams of researchers using inductive methodologies are relatively rare and present unique challenges to team members. A team from the University of Iowa reports on what it experienced during a project to develop a taxonomy of nursing interventions.

Classification of nursing interventions for care of the integument.

The Classification of Nursing Interventions research team at The University of Iowa, College of Nursing is building a taxonomy of nursing interventions that will include all of the direct care treatment activities that nurses perform on behalf of patients. This report describes the study in which 12 nursing interventions and their associated activities for care of the integument were extracted from a large database and validated through a two-round Delphi survey. Using an adaptation of Fehring's model for determining diagnostic content validity of nursing diagnoses, a definition, critical activities, and supporting activities were developed for each of the following interventions: Bathing, Bedrest Care, Hair Care, Nail Care, Oral Health Maintenance, Oral Health Promotion, Oral Health Restoration, Positioning, Pressure Management, Skin Care--Topical Treatments, Skin Surveillance, and Wound Care. Further research is needed to validate supporting activities and to continue classifying interventions and activities that nurses use in treating impaired skin integrity (potential and actual) and altered oral mucous membrane integrity (potential and actual).

Impact of adult critical care hospitalization: perceptions of patients, spouses, children, and nurses.

This phenomenologic study describes the effects of adult hospitalization in a critical care setting on the family as perceived by patients, spouses, children in the family, and nurses. Tape-recorded interviews were completed with 12 spouses, 9 patients (2 mothers and 7 fathers), 11 children, and 12 nurses. Responses were analyzed by using systematic thematic content analysis. Themes that emerged with regard to how this event affected the family unit and individuals in the family included (1) lack of communication among family members; (2) protecting children from anxiety-provoking information; (3) overriding threat, exemplified by feelings of vulnerability, uncertainty, intense emotions, and physical illness in children; (4) disruption of normal home routines; (5) changes in relationships; and (6) role conflict. Nurses' perceptions of the impact of this event on parents, spouses, and children demonstrated some incongruences with perceptions of patients and family members. Practice implications from this study include the following nursing actions: (1) eliciting more comprehensive information about relationships among family members and the impact on the family; (2) developing mechanisms to promote communication among family members; (3) making referrals to community resources such as school nurses, counselors, and chaplains; and (4) teaching nurses and parents ways to help children cope with this event.

Siblings as change agents for promoting the functional status of children with cerebral palsy.

This study evaluated the effectiveness of a four-month intervention program in which 31 siblings of 15 children with cerebral palsy were taught about cerebral palsy and what they could do to encourage their brother or sister to be more independent. The teaching was reinforced by home visits to develop individual plans for the children with cerebral palsy, and sibling group meetings were held to discuss progress and to provide support. Following this intervention, the children with cerebral palsy had significantly increased range of motion of the shoulder, elbow and wrist. There were also improvements in ambulation, personal hygiene, dressing and feeding. These findings indicate that siblings should be involved in the plant of care for children with disability, since they can be important teachers, rôle models and agents of change.

Accurate assessment of infant emesis volume.

When infants vomit, hospital nurses sometimes record these volumes in ccs. Fluid replacement is often based on these estimates. A review of the literature indicates that this subjective assessment is highly problematic.

Perceived changes in siblings of hospitalized children: a comparison of sibling and parent reports.

This study compared sibling perception of changes in feelings and behaviors to parental perception of sibling changes during a pediatric hospitalization. The data showed a low level of agreement on a Perceived Change Scale, with siblings reporting a significantly higher number of changes than did their parents. Further, the only significant main effect found on seven-way analysis of variance was sibling age, with a lower percentage of agreement for young siblings and their parents than for older siblings. Similarly, one significant two-way interaction revealed that the percentage of agreement increased for older siblings when they saw their parents more frequently, but it did not increase for younger siblings. In addition, siblings reported the worst parts of the experience and what could be done to help them. Implications of these findings for clinicians and researchers are presented.

Validation of responses reported by school-aged siblings of hospitalized children.

This study examined measurement of the effects of a pediatric hospitalization on siblings using a Perceived Change Scale. Data on perceived changes in feelings and behaviors were obtained from 39 siblings 5 to 10 years of age in a structured interview and from 41 siblings 11 to 17 years of age with a questionnaire. Responses to the questionnaire used to assess perceived changes in older siblings formed a single dimension with adequate reliability, criterion validity, and concurrent validity. Responses to the structured interview used for younger siblings formed three dimensions, with a lower alpha coefficient. Suggestions for use of these scales are made.

Behavior and feeling changes in siblings of hospitalized children.

The effects of hospitalization on ill children and their parents have been studied repeatedly, but effects on well siblings have received little attention. This investigation was designed to investigate sibling reactions when a brother or sister is hospitalized. The changes in feelings and behavior as reported by 123 sibling of hospitalized children and their parents from a large teaching hospital were studied. Young siblings were interviewed, while older siblings and parents were given a questionnaire. Siblings reported an average of four changes each. The number of changes reported by siblings was related significantly to several factors, such as sibling age, relationship of sibling with hospitalized child, explanation, fear of getting the illness, residence of sibling during hospitalization of the sick child, and perceived changes in parenting. Even though siblings reported 519 changes, their patents reported only one-half that number. Parents of hospitalized children may not know how their well children are reacting. For this reason, health professionals need to interview siblings as well as parents to assess sibling welfare accurately. In addition, health professionals can help siblings by insuring that an adequate explanation is given to siblings and by encouraging parents to maintain siblings at home, either with a sitter or family members.