Nurses' views on the presence of family members during invasive procedures in hospitalised children: A questionnaire survey.

AIMS AND OBJECTIVES: (I) To identify the opinion and practices of nursing professionals regarding the presence of family members during invasive procedures in hospitalised children; (II) to determine the knowledge of nursing professionals about the patient-and family-centred care model. BACKGROUND: Family presence in invasive procedures benefits the patient and their relatives, but varied attitudes exist among healthcare personnel, with some being favourable and others unfavourable toward family presence. DESIGN: Observational, descriptive, cross-sectional study. METHODS: Study population: Nurses from paediatric critical care services, emergency services, hospital wards, day hospitals and outpatient clinics at a Catalan tertiary hospital who participated voluntarily between September 2021 and July 2022. Data collection instrument: A questionnaire prepared by the researchers, based on the literature and reviewed by experts. REDCap link with access to the questionnaire was sent out to potential respondents through the institutional email. Bivariate analysis was performed with the R 4.2 program. The study was approved by the hospital's Clinical Research Committee and participants gave informed consent before responding to the questionnaire. RESULTS: A total of 172 nurses participated, and 155 valid responses were obtained. All respondents consider the family as a key element in paediatric care and report inviting family members to participate in the care given to their child. However, 12.0% of nurses do not invite the family to be present in invasive procedures. Almost all respondents note the need for training to acquire communication skills and improve the management of emotions. CONCLUSIONS: The results show a favourable opinion towards the presence of family members and highlight the need to train nurses to develop communication skills. RELEVANCE TO CLINICAL PRACTICE: The data provided can favour the design of measures to improve and promote the presence of parents during invasive procedures, reinforcing the patient-and family-centred care model and improving the quality of care provided. One example is the creation of family care protocols where the inclusion of parents and the roles of each individual involved in the care process appears.

Evaluation of an electronic medical record-based Paediatric Nutrition Screening Tool.

BACKGROUND: Nutrition screening is recommended to identify children at risk for malnutrition. A unique screening tool was developed based on American Society for Parenteral and Enteral Nutrition (ASPEN) recommendations and embedded in the electronic medical record to assess for nutrition risk. METHODS: The components of the tool included the Paediatric Nutrition Screening Tool (PNST) and other elements recommended by ASPEN. To evaluate the screening tool, retrospective data were analysed on all patients admitted to acute care units of Children's Wisconsin in 2019. Data collected included nutrition screen results, diagnosis and nutrition status. All patients who received at least one full nutrition assessment by a registered dietitian (RD) were included in analysis. RESULTS: One thousand five hundred seventy-five patients were included in analysis. The following screen elements were significantly associated with a diagnosis of malnutrition: any positive screen (p < 0.001), >2 food allergies (p = 0.009), intubation (p < 0.001), parenteral nutrition (p = 0.005), RD-identified risk (p < 0.001), positive risk per the PNST (p < 0.001), BMI-for-age or weight-for-length z-score (p < 0.001), intake <50% for 3 days (p = 0.012) and NPO > 3 days (p = 0.009). The current screen had a sensitivity of 93.9%, specificity of 20.3%, positive predictive value (PPV) of 30.9% and negative predictive value (NPV) of 89.8%. This is compared with the PNST which had a sensitivity of 32%, specificity of 94.2%, PPV of 71% and NPV of 75.8% in this study population. CONCLUSION: This unique screening tool is useful for predicting nutrition risk and has a greater sensitivity than the PNST alone.

A systematic integrative review of parents' experience and perception of sleep when they stay overnight in the hospital together with their sick children.

AIMS AND OBJECTIVES: To elucidate knowledge available on parents' experience and perception of sleep when they stay overnight in hospital together with their sick children. BACKGROUND: In Nordic countries, children are entitled to have at least one parent with them during hospitalisation. Parents' sleep, when accommodated at the hospital during the child's admission, may be a challenge. DESIGN: A systematic literature search was conducted in EMBASE, MEDLINE and PsycINFO; period is restricted from 1 January 2007 to 1 April 2019. Studies included were those in which parents were accommodated in hospital with their child, 0-18 years of age, for at least one night. Original peer-reviewed scientific research papers conducting qualitative, quantitative or mixed designs were included. Systematic reviews were not included. This systematic integrative review was registered in PROSPERO and performed according to the PRISMA guidelines. All authors participated in study selection, data extraction and quality assessment of the literature. RESULTS: Fifteen studies were included, and they varied in terms of origin, aims, design, methods used and sample size. Three overall main themes appeared: sleep quality, factors affecting sleep and consequences of sleep loss. Combined psychological factors were found to affect parents' sleep, as well as isolated psychological factors, for example, stress, anxiety, worries and difficult thoughts. Environmental and social factors were also identified, for example, privacy and caring for family. CONCLUSION: Study of this subject is still in its exploratory phase. There is a need for the development of theory of substance in the clarification of the meaning of sleep among parents during difficult times such as children's hospitalisation. RELEVANCE TO CLINICAL PRACTICE: Understanding risk factors associated with sleep and sleep deprivation in parents staying overnight in the hospital with their sick child is important, since lack of sleep may lead to serious stress-related outcomes for the parents.

Medication error trends and effects of person-related, environment-related and communication-related factors on medication errors in a paediatric hospital.

AIM: This study aimed to examine reported medication error trends in an Australian paediatric hospital over a 5-year period and to determine the effects of person-related, environment-related and communication-related factors on the severity of medication outcomes. In particular, the focus was on the influence of changes to a hospital site and structure on the severity of medication errors. METHODS: A retrospective clinical audit was undertaken over a 5-year period of paediatric medication errors submitted to an online voluntary reporting system of an Australian, tertiary, public teaching paediatric hospital. All medication errors submitted to the online system between 1 July 2010 and 30 June 2015 were included. RESULTS: A total of 3340 medication errors was reported, which corresponded to 0.56% medication errors per combined admissions and presentations or 5.73 medication errors per 1000 bed days. The most common patient outcomes related to errors requiring monitoring or an intervention to ensure no harm occurred (n = 1631, 48.8%). A new hospital site and structure had 0.354 reduced odds of producing medication errors causing possible or probable harm (95% confidence interval 0.298-0.421, P < 0.0001). Patient and family involvement had 1.270 increased odds of identifying medication errors associated with possible or probable harm compared with those causing no harm (95% confidence interval 1.028-1.568, P = 0.027). Interrupted time series analyses showed that moving to a new hospital site and structure was associated with a reduction in reported medication errors. CONCLUSION: Encouraging child and family involvement, facilitating hospital redesign and improving communication could help to reduce the harm associated with medication errors.

Sleep quality and mood in mothers and fathers accommodated in the family-centred paediatric ward.

AIMS AND OBJECTIVES: To describe sleep quality and mood in parents accommodated with their sick child in a family-centred paediatric ward. Secondary aims were to compare mothers' and fathers' sleep quality and mood in the paediatric ward and to compare the parents' sleep quality and mood between the paediatric ward and in a daily-life home setting after discharge. BACKGROUND: Frequent interruptions, ward noise and anxiety affect parents' sleep quality and mood negatively when accommodated with their sick child in paediatric wards. Poor sleep quality and negative mood decrease the parents' ability to sustain attention and focus, and to care for their sick child. METHODS: This was a prospective and descriptive study. Eighty-two parents (61 mothers and 21 fathers) with children (median age 6.25 years) admitted to six paediatric wards participated in the study. Uppsala Sleep Inventory, a sleep diary and the Mood Adjective Checklist were used to measure sleep quality and mood. RESULTS: The parents had a good sleep quality in the paediatric ward even though they had more nocturnal awakenings compared to home. Moreover, they were less alert, less interested and had reduced concentration, and were more tired, dull and passive in the hospital than at home after discharge. Vital sign checks, noises made by the staff and medical treatment were given reasons influencing sleep. Poor sleep quality correlated with negative mood. CONCLUSION: Parents' sleep quality in family-centred paediatric care is good. However, the habitual sleep efficacy before admittance to the hospital is lower than expected and needs to be further investigated. RELEVANCE TO CLINICAL PRACTICE: The healthcare professionals should acknowledge parents' sleep and mood when they are accommodated with their sick child. Further should care at night be scheduled and sleep promoted for the parents to maintain health and well-being in the family.

Exploring perspectives on restraint during medical procedures in paediatric care: a qualitative interview study with nurses and physicians.

The aim of this study was to explore nurses' and physicians' perspectives on and reasoning about the use of restraint during medical procedures on newly admitted preschoolers in somatic hospital care. We analysed qualitative data from individual interviews with a video recall session at the end with seven physicians and eight nurses. They had earlier participated in video recorded peripheral vein cannulations on preschool children. The data were collected between May 2012 and May 2013 at a paediatric hospital unit in Norway. The analysis resulted in three main themes: (1) disparate views on the concept of restraint and restraint use (2), ways to limit the use of physical restraint and its negative consequences, and (3) experience with the role of parents and their influence on restraint. Perspectives from both healthcare professions were represented in all the main themes and had many similarities. The results of this study may facilitate more informed and reflective discussions of restraint and contribute to higher awareness of restraint in clinical practice. Lack of guidance and scientific attention to restraint combined with conflicting interests and values among healthcare providers may result in insecurity, individual dogmatism, and a lack of shared discussions, language, and terminology.

[Influence of postcode on paediatric admissions in Seville]. / Influencia del código postal en las hospitalizaciones pediátricas en Sevilla.

INTRODUCTION: The postcode (where the home is situated) is an indicator of socioeconomic status and is associated with morbidity, mortality, and the use of health services. The aim of this study was to analyse its effects on paediatric admissions and to determine the rates of the most common causes of paediatric admissions in Seville. MATHERIAL AND METHODS: An observational cross-sectional study with two analysis units: under 15 year-old "admissions" in public hospitals in Seville (n=2,660) and "city districts" of Seville (n=11). The independent variable analysed was whether the postcode of the admitted patients was within a Regional Government designated "area with social transformation needs". The analysis of the admissions was performed using X2-test, Fisher test and Student-t test, with the description of rates using the calculation of crude and specific rates, and by rate ratio. RESULTS: Children living in districts with a lower socioeconomic status were on average 7 months younger (P<.001), and they were significantly more likely to be admitted via the emergency department (P<.001). There was no statistical difference detected in either the length of hospital stay or mortality. The crude admission rate ratio was higher in districts with a lower socioeconomic status (1.8), with a higher specific rate ratio detected in admissions due to asthma, respiratory infections, inguinal hernia, and epilepsy/convulsions. CONCLUSIONS: Paediatric hospital admission rates of the main diagnoses were higher in districts with a lower socioeconomic status. Children living in these districts were more likely to be admitted younger and via the emergency department.

Direct care nurses on the shared governance journey towards positive patient outcomes.

AIMS AND OBJECTIVES: To describe shared governance in action through the example of one paediatric institution's decision to institute daily chlorhexidine bathing. BACKGROUND: Shared governance processes are discussed extensively in the literature; however, implementation of the processes can be challenging. Recently nurses at one paediatric hospital were involved in a hospital-wide practice change where the theoretical approach of shared governance was actualised. Several questions arose from direct care nurses about unwarranted variations in bathing practices across settings and whether bathing standardisation could address the recent increase in central line-associated bloodstream infections. Shared governance council members identified daily chlorhexidine bathing as a potential intervention to standardise bathing across the hospital and to decrease infection rates. At this time, chlorhexidine bathing had been widely adopted in adult hospitals but was less commonly practiced in paediatric institutions. DESIGN: This is a position paper describing the use of shared governance to make a house-wide practice decision and positively impact patient outcomes. METHOD: Inquiry Council members conducted a systematic evidence search on best practices around chlorhexidine bathing. This evidence was used in Practice Council discussions to standardise house-wide practice. Once consensus was achieved, council members collaborated with Education Council to ensure understanding, competency, and the adoption and sustainment of the practice change. CONCLUSIONS: Patients with central lines are at decreased risk for acquiring a central line-associated blood stream infection due, in part, to the change in nursing practice to include daily chlorhexidine bathing. The shared governance structure was the vehicle through which this practice was vetted and instituted. RELEVANCE TO CLINICAL PRACTICE: This paper provides a real-life example of leveraging shared governance structures and the direct care nurse leaders within the councils when an organisation faces critical needs in patient care.

Medication errors in hospitalised children.

AIM: This study aims to explore the characteristics of reported medication errors occurring among children in an Australian children's hospital, and to examine the types, causes and contributing factors of medication errors. METHODS: A retrospective clinical audit was undertaken of medication errors reported to an online incident facility at an Australian children's hospital over a 4-year period. RESULTS: A total of 2753 medication errors were reported over the 4-year period, with an overall medication error rate of 0.31% per combined admission and presentation, or 6.58 medication errors per 1000 bed days. The two most common severity outcomes were: the medication error occurred before it reached the child (n = 749, 27.2%); and the medication error reached the child who required monitoring to confirm that it resulted in no harm (n = 1519, 55.2%). Common types of medication errors included overdose (n = 579, 21.0%) and dose omission (n = 341, 12.4%). The most common cause relating to communication involved misreading or not reading medication orders (n = 804, 29.2%). Key contributing factors involved communication relating to children's transfer across different clinical settings (n = 929, 33.7%) and the lack of following policies and procedures (n = 617, 22.4%). More than half of the reports (72.5%) were made by nurses. CONCLUSION: Future research should focus on implementing and evaluating strategies aimed at reducing medication errors relating to analgesics, anti-infectives, cardiovascular agents, fluids and electrolytes and anticlotting agents, as they are consistently represented in the types of medication errors that occur. Greater attention needs to be placed on supporting health professionals in managing these medications.

Percepções da equipe de enfermagem acerca da importância da presença do familiar/acompanhante no hospital / Percepciones del equipo de enfermería acerca de la importancia de la presencia del familiar/acompañante en el hospital / Nursing team’s perceptions of the relative/companion’s presence at the hospital

O estudo teve por objetivo identificar a percepção da equipe de enfermagem de unidade de pediatria acerca da importância da permanência do familiar/acompanhante junto à criança hospitalizada. Trata-se de estudo exploratório e descritivo, com abordagem qualitativa. Os dados foram coletados através de entrevistas semiestruturadas com cinco enfermeiras, três técnicas de enfermagem e duas auxiliares de enfermagem, no segundo semestre de 2006, na unidade de pediatria de um hospital universitário, do Estado do Rio Grande do Sul. Mediante o método hermenêutico-dialético, foi possível apreender que a equipe de enfermagem reconhece a importância da permanência do familiar/acompanhante junto à criança hospitalizada e seu papel como cuidador desse cliente. Conclui-se que a equipe de enfermagem percebe o familiar/acompanhante como alguém que favorece o estabelecimento de um clima emocional desejável para a criança e colabora no desenvolvimento do trabalho da equipe de enfermagem na realização dos cuidados.

This study aimed at investigating the perception the nursing team at the Paediatrics Ward has of the relative/companion’s permanence with the hospitalised child. It is an exploratory and descriptive study, with qualitative approach. Data were collected through semi structured interviews, with five nurses, three nursing technicians, and two nursing assistants in the second semester of 2006, at the paediatrics ward at a university hospital, in the state Rio Grande do Sul, Brazil. The use of the dialectic-hermeneutic method showed that the nursing team acknowledges the importance of the relative/companion’s stay with the child during its hospitalisation as well as their role as caregivers at the hospital. Conclusions show that the nursing team identifies the relative/companion as the provider of a desirable emotional atmosphere to the child and as the facilitator of the nursing team’s care giving job.

El estudio tuvo por objetivo identificar la percepción del equipo de enfermería de unidad de pediatría acerca de la importancia de la permanencia del familiar/acompañante cerca del niño hospitalizado. Se trata de estudio exploratorio y descriptivo, con enfoque cualitativo. Los datos fueron colectados a través de entrevistas semiestructuradas con cinco enfermeras, tres técnicas de enfermería y dos auxiliares de enfermería, en el segundo semestre de 2006, en la unidad de pediatría de un hospital universitario, del Estado de Rio Grande do Sul, Brasil. A través del método hermenéutico-dialéctico, fue posible entender que el equipo de enfermería reconoce la importancia de la permanencia del familiar/acompañante con el niño durante su hospitalización y su papel como cuidador de ese cliente. Se concluyó que el equipo de enfermería percibe el familiar/acompañante como alguien que favorece el establecimiento de un clima emocional deseable para el niño y ayuda en el desarrollo del trabajo del equipo de enfermería y en la realización de los cuidados.

Assistência de enfermagem à criança hospitalizada: breve retrospectiva / Nursing care of child: short retrospection / Asistencia de enfermería al niño: breve retrospectiva

O estudo enfoca o panorama da política de saúde infantil, em destaque no contexto hospitalar, na cidade do Rio de Janeiro, tendo como propósito descrever a assistência de enfermagem à criança hospitalizada na primeira metade do século. Trata-se de um estudo histórico, cujas fontes primárias escritas correspondem aos artigos publicados na Revista Brasileira de Enfermagem no período em estudo. As fontes secundárias estão constituídas pela literatura pertinente à temática. No início do século XX, o setor saúde deixa o caráter social e filantrópico para ser subsidiado pelo governo. Em relação a assistência à criança, inúmeros hospitais são inaugurados nos anos 30 e 40, apesar da política nacional de saúde caracterizar-se por ações preventivas. Conclui-se que a assistência à criança até os anos 50 caracteriza-se por transformações técnico-científicas no cenário hospitalar, favorecendo a construção do saber da enfermagem na área de pediatria.

This study focuses on the overview of the childhood health policy, highlighted in the context of a hospital, in the city of Rio de Janeiro, aiming at describing the nursing assistance provided to children in hospitals in the first half of the century. It is a historical study, the primary written sources of which correspond to articles published in the Revista Brasileira de Enfermagem during the period under scrutiny. The secondary sources are made up of literature relevant to the topic. In the beginning of the 20th century, health care loses its social and philanthropic character to be subsidized by the government. Concerning childhood assistance, numerous hospitals opened in the 30's and 40's, even though the national healthcare policy was based on preventive actions. It may be concluded that childhood assistance up to the 50's was characterized by technical and scientific transformations in the hospital scenario, encouraging the construction of nursing knowledge in the area of paediatrics.

El estudio enfoca el panorama de la política de la salud infantil, en el contexto hospitalario en Rio de Janeiro. El propósito es describir la asistencia de enfermería a los niños en los hospitales. Es un estudio histórico, cuyas fuentes primarias escritas corresponden a los artículos publicados en la Revista Brasileña de Enfermería durante la primera mitad del siglo. Las fuentes secundarias se constituyen por la literatura sobre esa temática. A principios del siglo XX, el sector de la salud deja de tener un carácter social y filantrópico y pasa a ser subvencionado por el gobierno. Respecto a la asistencia infantil, innumerables hospitales se inauguran en los años 30 y 40, a pesar de que la política nacional de salud se caracterizaba por acciones preventivas. Se concluye que la asistencia a los niños hasta los años 50 está caracterizada por unas transformaciones técnico-científicas en el escenario de los hospitales y con ello favorece la construcción del saber de enfermería en el campo de la pediatría.