Nurses' Understanding and Practice of Minimal Stimulation in the Pediatric Intensive Care Unit.

BACKGROUND: Pediatric patients receiving neurologic and neurosurgical critical care undergo many procedures that result in stimulation of the sympathetic nervous system, which increases their risk of poor outcomes. Nurses typically implement a variety of interventions to minimize such stimulation; however, minimal stimulation has not been specifically defined in the literature or described as a standardized bundle of care. OBJECTIVE: To examine pediatric intensive care unit nurses' interpretation and practice of minimal stimulation in patients with neurologic and neurosurgical conditions and specifically to triangulate nurses' descriptions of this practice with related findings in the literature. METHODS: This was a qualitative, descriptive, exploratory study that used naturalistic inquiry. RESULTS: A total of 13 pediatric intensive care unit nurses participated in the study. Three primary themes were identified regarding minimal stimulation: (1) new knowledge and practice, (2) communication, and (3) impact of minimal stimulation. CONCLUSIONS: The findings of this study help to establish a working definition of the nursing practice of minimal stimulation and provide a basis for future research. More detailed study is needed on the concept of a standardized minimal stimulation bundle and its impact on patient outcomes.

Formative Evaluation of CLABSI Adoption and Sustainment Interventions in a Pediatric Intensive Care Unit.

Background: Pediatric patients require central venous catheters to maintain adequate hydration, nutritional status, and delivery of life-saving medications in the pediatric intensive care unit. Although central venous catheters provide critical medical therapies, their use increases the risk of severe infection, morbidity, and mortality. Adopting an evidence-based central line-associated bloodstream infection (CLABSI) bundle to guide nursing practice can decrease and sustain low CLABSI rates, but reliable and consistent implementation is challenging. This study aimed to conduct a mixed-methods formative evaluation to explore CLABSI bundle implementation strategies in a PICU. Methods: The team used The Consolidated Framework for Implementation Research to develop the interview guide and data analysis plan. Results: Facilitators and barriers for the CLABSI bundle occurred in four domains: inner setting, process, characteristics of individuals, and innovation characteristics in each cycle that led to recommended implementation strategy opportunities. The champion role was a major implementation strategy that facilitated the adoption and sustainment of the CLABSI bundle. Conclusions: Implementation Science Frameworks, such as Consolidated Framework for Implementation Research (CFIR), can be a beneficial framework to guide quality improvement efforts for evidence-based practices such as the CLABSI bundle. Using a champion role in the critical care setting may be an important implementation strategy for CLABSI bundle adoption and sustainment efforts.

Evidence-based approach to mitigate cumulative stress in pediatric nurses through the development of respite rooms.

BACKGROUND: The cumulative stress toll on nurses increased during the COVID-19 pandemic. An evidence-based practice (EBP) project was conducted to understand what is known about the impacts of cumulative stress within nursing and if there are ways to mitigate stress during a nurse's shift. AIM/IMPLEMENTATION: A project team from three clinical units completed an extensive literature review and identified the need to promote detachment while supporting parasympathetic recovery. Based on this review, leaders from three pediatric clinical units (neonatal intensive care unit, cardiovascular intensive care unit, and acute pulmonary floor) implemented respite rooms. OUTCOMES: Follow-up outcomes showed a statistically significant stress reduction. For all shifts combined, the Wilcoxon Signed-Rank Test revealed that perceived stress scores from an 11-point Likert scale (0 = no stress and 10 = maximum perceived stress) were significantly lower in the post-respite room (Md = 3, n = 68) compared to in the pre-respite room (Md = 6, n = 68), Z = -7.059, p < .001, with a large effect size, r = .605. Nurses and other staff frequently utilized respite rooms during shifts. IMPLICATIONS FOR PRACTICE: Clinical inquiry and evidence-based practice processes can mitigate cumulative stress and support staff wellbeing. Respite rooms within the hospital can promote a healthy work environment among nurses and promote a self-care culture change. Evidence-based strategies to mitigate cumulative stress using respite rooms are a best practice to promote nurse wellbeing and mitigate cumulative stress.

National collaborative maximizes pediatric hospital-based nurse scientist impact and resources through strategic networking.

This paper describes how a national collaborative of pediatric nurse scientists has leveraged the expertise of their membership and strategic networking to guide the development of the evolving hospital-based nurse scientist role and influence centers of nursing research. Members' narratives illustrate how their networking across the collaborative has resulted in increased clarity and understanding of the hospital-based nurse scientist role, consistency in job responsibilities and expectations, title changes that more accurately reflect the nature of the role, establishment or expansion of centers of nursing research, success in talent recruitment, diversification of center team members, reporting structure alterations, and dedicated nursing research funding mechanisms. These tangible outcomes enable pediatric nurse scientists to become more effective in their roles and transform the care of pediatric patients and their families.

Diversity Practices for Hiring the New Graduate Nurse.

A multistep selection process was established to assist in securing top talent while achieving diversity objectives for a nurse residency program. The selection process incorporated objective scoring tools, diverse panel interviews, unconscious bias training, and standardized interview questions to decrease unconscious and implicit bias. As a result, the entry-level nursing workforce has become more diversified by race, gender, age, and academic training.

Managing central venous catheter dressings: a short gut syndrome case study.

HIGHLIGHTS: Central venous catheter care may be complicated by complex patient considerations. Central-line associated bloodstream infection (CLABSI) risk factors are multifaceted. Case report to highlight patient complexity that challenges bundled practices.

Exploring nurse beliefs and perceived readiness for system wide integration of evidence based practice in a large pediatric health care system.

PURPOSE: Evidence-based practice (EBP) within healthcare leads to improved patient outcomes, high-quality care, job satisfaction, reduced turnover, professional autonomy, and validates nursing practice. Although a plethora of research focuses on implementing EBP, there has been little attention on assessing organizational readiness for integration. The primary aims of this study were to explore nursing beliefs and attitudes about EBP and explore the culture and readiness among pediatric nurses for system-wide integration of EBP. DESIGN AND METHODS: This study was a quantitative, cross-sectional survey-based study conducted at a large pediatric health system. RESULTS: Overall pediatric nurses had a mean score of 61.78 ± 9.32 on the EBPB (n = 396). Results of the EBPB Scale and OCRSIEP showed no statistical difference between nursing roles EBPB scores; however, nursing leaders had higher scores than any other nursing role. The OCRSIEP had a mean score of 84.98 ± 19.53 (n = 388). CONCLUSIONS: Findings suggest that pediatric nurses believe that EBP results in the best clinical care for patients and can improve clinical care, but they lack the skills and time necessary to engage in the process. This study found that increasing awareness of EBP resources and developing EBP competencies may assist pediatric nurse leaders with EBP integration into daily practice. PRACTICE IMPLICATIONS: Increasing visibility and competencies of EBP may positively impact organizational readiness by increasing confidence needed to remove identified barriers and engrain EBP in the organization's culture.

Reducing central line-associated bloodstream infection in contaminated central venous catheters: case studies of a pediatric contamination guideline.

Healthcare organizations have prioritized patient safety and quality improvement efforts to reduce central line-associated bloodstream infections (CLABSIs). Implementation of central venous catheter (CVC) insertion and maintenance bundles have significantly reduced infection rates. Nevertheless, CLABSIs continue to be a significant cause of mortality and morbidity in hospitals, and further efforts are necessary to improve CVC care practices. A hospital-wide committee at a tertiary care pediatric hospital identified gaps in our CVC maintenance practices resulting from CVC contamination events from a patient's body fluids. A lack of published literature on the topic resulted in the need to create an institutional clinical practice guideline (CPG) to develop guidance to mitigate potential CLASBIs from CVC contamination. Utilization of the CVC CPG in all inpatient units and other reduction strategies resulted in a steady decline in our CLABSI rates, particularly in those related to CVC contamination events. Case reports illustrate the effectiveness of the CPG.

Pediatric Education Discharge Support Strategies for Newly Diagnosed Children With Cancer.

BACKGROUND: Discharge education practices vary among institutions and lack a standardized approach for newly diagnosed pediatric oncology patients and their parents. OBJECTIVE: The purpose of this American Nurses Credentialing Center-supported pediatric multisite trial was to determine the feasibility and effectiveness of 2 nurse-led Parent Education Discharge Support Strategies (PEDSS) for families with a child who is newly diagnosed with cancer. INTERVENTIONS/METHODS: A cluster randomized clinical trial design assigned 16 Magnet-designated sites to a symptom management PEDSS intervention or parent support and coping PEDSS intervention. Outcome measures evaluated at baseline, 1, and 2 months after diagnosis include symptom experiences, parent perceptions of care, unplanned service utilization, and parent evaluation of the PEDSS interventions. RESULTS: There were 283 newly diagnosed children and their parent participating in this study. Linear mixed models revealed pain differed over time by the intervention; children in the symptom management group had a greater decrease in pain. Greater nausea and appetite disturbances were experienced by older children in both groups. Fatigue and sleep disturbance showed a significant decrease over time in both groups. The symptom management group reported significantly greater satisfaction with the PEDSS intervention. CONCLUSIONS: This study is among the first to examine the effects of 2 different early-discharge planning strategies for families of a newly diagnosed child with cancer. The evidence supports a standardized discharge education strategy that can be successfully implemented across institutions. IMPLICATIONS FOR PRACTICE: Nurses play a major role in the educational preparation and discharge of newly diagnosed pediatric cancer patients and their families.

Transition From Hospital to Home Following Hematopoietic Stem Cell Transplantation: A Feasibility Study for "Rooming in".

Background: The experience of hematopoietic stem cell transplant (HSCT) on both the patients and their caregivers is complex and challenging during hospitalization and post discharge. Complex patient populations require heightened attention on discharge practices to ensure that they are prepared for home regimens. "Rooming in" is a standardized intervention implemented prior to discharge that allows patients and caregivers to assume post discharge care with the support of staff. Other complex patient populations have reported positive outcomes related to "rooming in." Aims: The purpose of this study was to assess the feasibility of a standardized "rooming in" intervention for discharge of pediatric HSCT patients. An additional aim was to describe the quality of discharge teaching, readiness for hospital discharge, and postdischarge coping difficulty in a cohort of HSCT patients using validated questionnaires. Method: Data were collected via medical chart review. A prospective cohort completed validated study questionnaires at discharge and 30 days postdischarge. Results: All caregivers of post-HSCT patients were able to complete the "rooming in" intervention. There was no statistically significant difference for length of stay between the retrospective and prospective cohorts. Caregivers enrolled on the study rated the Quality of Discharge Teaching Scale-Parent Form high (Mdn = 165). Conclusion: We conclude that "rooming in" is a feasible discharge intervention for caregivers of pediatric HSCT patients.

Promoting Direct Care Nurse Engagement in Research in Magnet Hospitals: The Parent Education Discharge Support Strategies Experience.

Multisite study participation provides an opportunity for hospitals to gain access to the resources required to facilitate nursing research. The nurse-led Parent Educational Discharge Support Strategies for children newly diagnosed with cancer (PEDSS) multisite study engaged direct care nurses for successful implementation across 16 Magnet-designated hospitals. This article addresses strategies to overcome barriers to nursing research demonstrated through the PEDSS experience.

Standardize, Engage, and Collaborate: An Initiative to Reduce Community Acquired Central Line Blood Stream Infections Across the Continuum of Care.

BACKGROUND: Community acquired blood stream infections (CA-CLABSI) are a major source of morbidity and mortality for pediatric patients. Many organizations discharge pediatric patients to home health agencies to care for central lines. To reduce the incidence of CA-CLABSIs requires a concentrated effort between hospitals and home health agencies. It is important for home health agencies to be accountable for the care and maintenance they provide to patients with central lines. Local Problem: At a large children's hospital, CA-CLABSI metrics and collaboration with home health agencies to reduce CACLABSI events lacked organizational standardization. METHODS: An organizational committee was formed to establish standards of care for CA-CLABSI follow-up and reduction. RESULTS: As a result of the committee's work, several best practices resulted including the creation of a CA-CLABSI resource booklet; a screening tool to identify contributing risks associated with a CA-CLABSI, and increased awareness of CA-CLABSIs. Since implementation of these best practices, the organization has seen a 30% reduction in the number of CA-CLABSIs. Standardization of CA-CLABSI efforts and proactive surveillance of central line care may lead to decreases in the number of CA-CLABSI events. Collaboration between service lines may identify siloed best practices that can be implemented organizationally that may have a large impact.

Orienting and Onboarding Clinical Nurse Specialists: A Process Improvement Project.

PURPOSE: Clinical nurse specialists (CNSs) have a unique advanced practice role. This article describes a process useful in establishing a comprehensive orientation and onboarding program for a newly hired CNS. DESCRIPTION: The project team used the National Association of Clinical Nurse Specialists core competencies as a guide to construct a process for effectively onboarding and orienting newly hired CNSs. Standardized documents were created for the orientation process including a competency checklist, needs assessment template, and professional evaluation goals. In addition, other documents were revised to streamline the orientation process. OUTCOME: Standardizing the onboarding and orientation process has demonstrated favorable results. As of 2016, 3 CNSs have successfully been oriented and onboarded using the new process. CONCLUSION: Unique healthcare roles require special focus when onboarding and orienting into a healthcare system. The use of the National Association of Clinical Nurse Specialists core competencies guided the project in establishing a successful orientation and onboarding process for newly hired CNSs.

Ensuring Safe Transfer of Pediatric Patients: A Quality Improvement Project to Standardize Handoff Communication.

BACKGROUND: During a single hospital stay, a patient's care is transferred several times between health care clinicians requiring multiple handoffs. Nurses often voice concerns about feeling unsafe when receiving patients from other areas. AIMS: The aims of the intradepartmental quality improvement project were to identify the safest way to transfer care of pediatric patients and to improve bedside nurses' knowledge on conducting an evidence based practice project. METHODS: Guided by clinical nurse specialists, nurses from various departments worked together and reviewed the literature regarding safe transfers, timing, and handoff communication. RESULTS: Findings from this quality improvement project led to creation and implementation of a system wide handoff tool. Use of the handoff tool decreased medication errors and improved nursing satisfaction. CONCLUSIONS: Partnering with bedside nursing staff to research and apply system wide quality improvements can increase knowledge and understanding of evidence based practice as well as quality of patient care.

Effectiveness of provider strategies for the early recognition of clinical deterioration due to sepsis in pediatric patients: a systematic review protocol.

REVIEW QUESTION: The objective of this review is to determine the effectiveness of provider strategies for the early recognition of clinical deterioration due to sepsis in pediatric patients. Specifically, the review question is: among pediatric, hospitalized patients, up to 18 years of age, what is the effectiveness of clinical assessment compared with use of early recognition screening tools for the recognition of clinical deterioration due to sepsis?