Inpatient falls in freestanding children's hospitals.

Patient falls are considered a significant safety risk, but little evidence regarding the significance of falls in children is available. A multisite, observational study of fall events occurring in pediatric inpatients (younger than 18 years of age) from Child Health Corporation of America member hospitals was conducted to determine the prevalence and significance of falls. Fall prevalence was 0.84 per 1,000 patient days with 48% classified as preventable. Injuries occurred in 32%, but only two falls resulted in an increased length of stay; none resulted in permanent disability or death. Only 47% of the children who fell were identified to be at risk for fall. Alert mechanisms were used in 60% and preventive measures in 23%. These findings suggest that while inpatient pediatric fall rates are lower than those of adults, greater diligence in identification and risk reduction may further reduce the prevalence of falls and the proportion of fall-related injuries.

A telephone coaching intervention to improve asthma self-management behaviors.

Long recognizing that asthma, one of the most common chronic childhood diseases, is difficult to manage, the National Asthma Education Prevention Program developed clinical practice guidelines to assist health care providers, particularly those in the primary care setting. Yet, maintenance asthma care still fails to meet national standards. Therefore, in an attempt to improve and support asthma self-management behaviors for parents of children 5 to 12 years of age with persistent asthma, a novel nurse telephone coaching intervention was tested in a randomized, controlled trial. A detailed description of the intervention is provided along with parent satisfaction results, an overview of the training used to prepare the nurses, and a discussion of the challenges experienced and lessons learned.

Comparison of central venous catheter and peripheral vein samples of antibiotics in children with cystic fibrosis.

PURPOSE.: To determine if accurate serum antibiotic levels can be obtained from central venous catheters (CVCs) in pediatric patients with cystic fibrosis. DESIGN AND METHODS.: Fifty paired CVC-peripheral vancomycin or tobramycin specimens were collected within 5 min of each other following a 5-ml flush and discard. Specimen samples were randomized by first site drawn. RESULTS.: CVC-peripheral antibiotic levels were highly correlated (r =.97, p <.001), with no statistically significant difference (t = 1.18, p =.25). Bland-Altman plot analysis revealed a bias of.47, with limits of agreement ranging from -4.20 to 6.87. PRACTICE IMPLICATIONS.: Accurate antibiotic concentrations can be obtained from CVCs, reducing pediatric patient trauma and stress.

The role of the nurse research facilitator in building research capacity in the clinical setting.

With little guidance in the literature regarding best practices, clinical institutions have used different organizational models to meet the challenges of building research capacity. This article provides recommendations regarding the most productive models based on review of historical clinical research facilitation models and the results of a survey regarding extant models conducted among research facilitators who were members of the Midwest Nursing Research Society.

Nursing Student Research Assistant Program: A strategy to enhance nursing research capacity building in a Magnet status pediatric hospital.

For busy clinicians, time to conduct research is scarce. A novel solution, the Nursing Student Research Assistant Program (NS-RAP), was designed in collaboration with area nursing schools to build research capacity at a pediatric hospital. Undergraduate and graduate nursing students participated in a variety of research experiences that, in turn, aided the conduct of clinician-initiated research at the pediatric hospital. In this article, conceptualization, implementation, outcomes, challenges, and future directions of NS-RAP are discussed.

Evaluation of the role of the pediatric nurse practitioner in an inpatient asthma program.

INTRODUCTION: In 1994, pediatric nurse practitioners (PNPs) at St. Louis Children's Hospital developed a program to improve the care of children admitted with asthma. In the Asthma Intervention Model, PNPs directly manage the care of children hospitalized with asthma and are instrumental in hospital-wide education. An evaluation study was conducted to measure effectiveness of this inpatient PNP role. METHODS: Attending physicians, interns, nurses, and families were surveyed regarding their perceptions of the PNPs as care manager and educator. A 16-item asthma knowledge test was administered to interns at the start and conclusion of their intern year. Length of stay, readmission rate, and cost were evaluated. RESULTS: PNPs were found to be effective in the inpatient asthma role by all participants. Significant gains were noted in intern knowledge and confidence in caring for asthma. Interns identified the PNPs as important contributors to their education. No significant differences occurred between interns and PNPs in length of stay, cost, readmissions, or severity of the condition of the asthma patients. DISCUSSION: PNPs in the inpatient asthma setting are effective care managers and educators.

Developing an infrastructure for research in a free-standing hospital.

Hospital leaders who are not part of a university system often are not aware of the complexities associated with conducting research or the infrastructure required to successfully support a hospital-based research program. The author discusses a research program, provides recommendations for building a hospital-based infrastructure, and shares one hospital's experience.

The NICU experience of lactation and its relationship to family management style.

PURPOSE: To describe the impact of having a premature infant hospitalized in the neonatal intensive care unit (NICU) on the parents' management of the lactation experience. STUDY DESIGN AND METHODS: A descriptive study using interviews was conducted with nine couples who had decided to breastfeed, and who were parents of premature infants, 24 to 32 weeks gestation, hospitalized in a large, Midwestern NICU. The family management style conceptual framework guided the study. Qualitative descriptive methods were used to analyze the transcribed data. RESULTS: The situational context of having a premature infant in the NICU was defined as "stressful," "frightening," and "difficult," while the experience of providing breast milk was defined in terms of "altered expectations," "difficulties," and "rewards." These definitions along with the management behaviors of each parent validated three family management-style typologies for lactation in families of premature infants: facilitating, maintaining, and obstructing. CLINICAL IMPLICATIONS: The family management style of lactation, which can be easily ascertained by interviewing families, may be a useful tool in planning appropriate interventions to promote lactation success.

Fathers' perceptions of supportive behaviors for the provision of breast milk to premature infants.

PURPOSE: To explore fathers' perceptions of behaviors used to support the provision of breast milk to hospitalized premature infants. SUBJECTS: Sixteen English-speaking fathers who, each were at least 15 years of age, had a hospitalized premature infant between 24 and 32 weeks gestation and a partner who had decided to provide breast milk. DESIGN: As part of a larger, exploratory study, a qualitative descriptive study was conducted to analyze fathers' perceived contributions to the process of providing breast milk. METHODS: Fathers were interviewed with a semi-structured interview guide. All interviews were audiotaped, and verbatim transcripts were analyzed by using qualitative descriptive methods. MAIN OUTCOME MEASURE: Supportive behaviors as identified by fathers of hospitalized premature infants. PRINCIPAL RESULTS: Fathers described 3 types of behaviors used to support the provision of breast milk to their hospitalized premature infants: assistance with the pumping process, assumption of additional daily domestic responsibilities, and provision of moral support. CONCLUSIONS: Results from this study suggest several significant behaviors that fathers perceived they performed to support their partners' efforts to provide breast milk to their hospitalized premature infants.

The association between acute fatty liver of pregnancy and fatty acid oxidation disorders.

Acute fatty liver of pregnancy is a relatively rare but potentially fatal liver disorder of late pregnancy. Recent advances in molecular diagnostic procedures provide evidence of a genetic basis for this condition and a link to offspring disorders in fatty acid oxidation. This relationship implies the need for genetic testing and follow-up of at-risk women and their neonates.

Running a successful campaign against unionization.

Unions, once rare in healthcare, are now targeting hospital employees as potential members. In an industry that has seen an increase in regulations, mergers and acquisitions, rising financial pressures, and changing working conditions, it is easy to understand why discontented employees are being targeted by unions now more than ever. Hospital leaders must look to lessons learned in other organizations to develop strategies that will ensure a successful campaign. In 2003, St. Louis Children's Hospital defeated the Missouri Nurses Association/United American Nurse with a 77% no vote. The authors describe an overview of unionization in healthcare and the strategies they used to successfully win this union election.

Neurobehavioral effects in rat pups whose sires were exposed to alcohol.

Developmental neurobehavioral effects associated with maternal exposure to alcohol during pregnancy are well described, but little is known about the effects of paternal exposure prior to conception. Using a quasi-experimental, within-subjects design, neurobehavioral outcomes (reflex acquisition, activity, gait) and cerebral cortical layer thickness were assessed in Sprague-Dawley rat pups from breeding pairs where the sires were exposed to alcohol. Comparisons were made on the basis of the timing of conception relative to alcohol exposure: phase 1 (controls), prior to initiation of alcohol exposure; phase 2, during the period of treatment with 20% alcohol; and phase 3, following cessation of alcohol exposure. Phase 2 and 3 pups were noted to attain negative geotaxis and reflex suspension benchmarks earlier than control pups and to have more difficulty with balance. Phase 3 pups were noted to attain righting reflex earlier than controls. In addition, phase 3 pups demonstrated increased levels of reverse maze activity and a shorter and narrower gait. Brain morphometry revealed thickening of cortical sections I-IV and V-VI resulting in overall cortical enlargement in both phase 2 and 3 pups. Further analysis of phase 2 and 3 subphases based on the presumed stages of the spermatogenic cycle during which sires were exposed to alcohol revealed significant differences in maze activity, reflex acquisition, and gait length. These findings suggest pre-conception male exposure to alcohol may have an effect on the offspring and the extent of the effects may vary with the timing of alcohol exposure relative to conception.