Harnessing the Humanities to Foster Staff Resilience: An Annual Arts and Humanities Rounds at a Children's Hospital.

Working in healthcare can be fulfilling, meaningful, and sometimes exhausting. Creative endeavors may be one way to foster personal resilience in healthcare providers. In this article, we describe an annual arts and humanities program, the Ludwig Rounds, developed at a large academic children's hospital. The event encourages staff to reflect on resilience by sharing their creative work and how it had an impact on their clinical careers. The multidisciplinary forum also allows staff to connect and learn about each other. We discuss the development of the program, its format and logistics, and lessons learned over the past 15 years.

KIDS CARE: A Behavioral Model To Strengthen Patient and Family Partnerships.

Patient- and Family-Centered Care is a core value of The Children's Hospital of Philadelphia (CHOP). Satisfaction/ experience data are closely tracked to assist in determining if hospital staff are partnering effectively with patients and families. When opportunities for improvement were identified within the Nursing Department, an existing institutional model, KIDS CARE, was used to promote change. KIDS CARE was developed to teach and reinforce respectful behaviors for nurses initiating partnerships with patients and families. The Patient Satisfaction Committee partnered with the Family Advisory Council and Shared Governance Council to revise this model to help achieve the goals of improving quality of care. Next steps involved educating patients, families, and staff using innovative multimodal strategies. By engaging in this renewed commitment to Patient- and Family-Centered Care, systems and structures were developed to keep KIDS CARE relevant and make strides toward improved outcomes for patients and families.

Patient, family, and provider complex care situations in pediatric acute medical care: Creation of the Red Flags Situation Assessment Tool.

PURPOSE: To develop and test a questionnaire to identify situations among patients, families, and providers that lead to complex pediatric medical care in a tertiary hospital setting. DESIGN: A mixed methods approach was used. Qualitative content analysis of hospital documents was conducted to develop questionnaire items. Psychometric analyses were used to measure reliability, and factor analysis was used to reduce instrument length. RESULTS: A 54-item questionnaire with 11 categories was distributed to 205 nurses and medical staff. Psychometric analysis of responses identified a final refined tool with 31 items comprised of six factors. PRACTICE IMPLICATIONS: The Red Flags Situation Assessment Tool can be used to identify complex care situations and address them earlier in a hospital course to avoid challenges to providing patient- and family-centered care.

Staff engagement during complex pediatric medical care: the role of patient, family, and treatment variables.

OBJECTIVE: To examine the role of patient, family, and treatment variables on self-reported engagement for physicians and nurses working with pediatric complex care patients. METHODS: Sixty-eight physicians and 85 registered nurses at a children's hospital reviewed eight case scenarios that varied by the patient and patient's family (each cooperative versus difficult) and the length of hospitalization (<30 days versus >30 days). Participants rated their engagement from highly engaged/responsive to distancing/disconnected behaviors. RESULTS: Nurses were more likely than physicians to engage in situations with a difficult patient/cooperative family but less likely to engage in situations with a cooperative patient/difficult family.Nurses were more likely to consult a colleague regarding the care of a difficult patient/difficult family,while physicians were more likely to refer a difficult patient/difficult family to a psychosocial professional. CONCLUSIONS: Differences were found for engagement with "difficult" patients/families, with physicians more likely to distance themselves or refer to a psychosocial professional, while nurses were more likely to consult with a colleague. PRACTICE IMPLICATIONS: Communication between health care team members is essential for optimal family-centered health care. Thus, interventions are needed that focus on communication and support for healthcare teams working with pediatric complex care patients and their families.

Working with complex care patients.

The following article provides the authors' definition of complex care patients. It is based on what they have learned about these special patients from the literature and from their personal clinical experiences. When I received this article for review, I decided to do a literature search on the term complex care patient and had a difficult time finding relevant articles. I asked a wonderful librarian from the Boston Children's Hospital, Alison Clapp, to help me with the search, and she had to maneuver through a maze of clinical subheadings. She described the search as "a difficult one." It is ironic that the search for information pertaining to these patients mirrors the complexity of care that they require from us. Are complex care patients the same as complex patients? The insertion of the word care may make a difference: You decide. There are complex patients who challenge us technically and intellectually, and then there are those who require even more from us--they challenge us technically, intellectually, physically, emotionally, and spiritually. The term complex care patient encompasses all these care dimensions. I think it is an excellent choice of words to make us consider what we are increasingly expected to do--and how we cannot do it alone.--Maura MacPhee, RN, PhD, Clinical Practice Column Editor.

Waiting together: translating the principles of therapeutic relationships one step further.

ISSUES AND PURPOSE: Inconsistent nursing practices created nurse-patient boundary issues on a cardiac step-down unit related to confidentiality, limit setting, and professionalism with patients and families awaiting organ transplantation. CONCLUSIONS: A staff work group designed and implemented a plan to translate the principles of therapeutic relationships into daily practice. PRACTICE IMPLICATIONS: A work plan developed for nursing staff outlined concrete solutions and resources available within the hospital. This framework can be used to empower staff in the ongoing effort to manage relationships with chronically ill patients and their families.

Modeling family-centered pediatric nursing care: strategies for shift report.

ISSUES AND PURPOSE: Family-centered care philosophies place the family as central to the plan of care. These philosophies are often challenging for nurses to put into clinical practice. The purpose of this article is to provide interventions for nurses to use with families who are stressed. CONCLUSIONS: Families' coping styles may be subject to judgments from the nurses, and these judgments may be passed on during shift report. Labels that are passed on in report can influence nurses' care. PRACTICE IMPLICATIONS: This article describes positive communication strategies for shift report that can facilitate successful family-centered care.

Nursing interventions for a chronically ill, nonadherent teenager with a psychiatric diagnosis.

ISSUES AND PURPOSE: To describe the complex care of an adolescent with chronic psychiatric and medical problems. CONCLUSIONS: The nonadherent, self-abusing, adolescent was empowered to progress developmentally, as well as medically. PRACTICE IMPLICATIONS: A planned team approach helped the adolescent become more developmentally appropriate and independent in self-care. The care plan designed by nursing staff included a change in nursing focus, creative problem solving, team nursing, and utilization of multidisciplinary resources.