The Effects of Moral Distress on Resilience in Pediatric Emergency Department Nurses.

INTRODUCTION: Moral distress is widespread in health care, and nurses working in high-pressure environments, such as emergency departments, experience stress at high rates. Understanding how moral distress affects pediatric emergency nursing care is essential to moderate its negative impacts. Increased resilience has been promoted as a tool to mitigate moral distress. The purpose of this study, conducted prior to the pandemic, was to examine patterns of moral distress and the impact of moral distress on resilience among pediatric emergency nurses. METHODS: A cross-sectional exploratory study of pediatric emergency nurses was performed. Moral Distress Scale-Revised (Pediatric) and Connor-Davidson Resilience Scale 25© scores were collected and calculated. Exploratory factor analysis with principal components was used to identify patterns of moral distress that impact resilience. RESULTS: Four distinct patterns of moral distress that impact resilience were identified: (1) incompetent practice, (2) incongruent truth-telling, (3) potentially inappropriate care, and (4) discordant health care teams. DISCUSSION: Our study was the first to identify 4 patterns of moral distress in pediatric emergency nurses. As a result, actions to promote resilience include: (1) supporting competent practice, (2) upholding appropriate truth-telling, (3) recognizing and addressing potentially inappropriate care, and (4) building concordant health care teams and systems. This pre-pandemic data provides a foundational understanding of the relationship between moral distress and resilience in pediatric emergency nurses. Identifying factors of moral distress that impact resilience has significant implications for pediatric emergency nursing, including the development of future initiatives, education, and research.

Reducing false-positive peripheral blood cultures in a pediatric emergency department.

INTRODUCTION: False-positive peripheral blood cultures due to contamination pose clinical and financial consequences for patients, families, and hospitals. Educating staff who draw peripheral blood cultures about hospital policy, using a blood culture-drawing kit, having a dedicated team obtaining peripheral blood cultures, and following up with staff who draw a contaminated peripheral blood cultures have been shown to reduce the rate of false-positive peripheral blood cultures. The objective of this study was to reduce the rate of false-positive peripheral blood cultures in a pediatric emergency department using the previously mentioned measures. METHODS: This quality-improvement initiative used a retrospective chart-review approach to examine false-positive peripheral blood cultures drawn in 2009. In June 2010 a month-long education campaign about the initiative was conducted for nurses and clinical assistant staff to reduce false-positive peripheral blood cultures. From July 2010 through June 2011, monthly retrospective chart audits of false-positive peripheral blood cultures were completed in conjunction with bimonthly e-mail communication about the study, development of a blood culture-drawing kit, and follow-up with staff who drew the false-positive cultures. RESULTS: In 2009 the false-positive peripheral blood culture rate in the emergency department was 2.1%. After educational interventions and use of a blood culture-drawing kit, the rate of false-positive peripheral blood cultures decreased to 1.4%. DISCUSSION: The decline in contaminated blood cultures shows that the interventions described significantly reduced the rate of false-positive peripheral blood cultures in the emergency department.

Care of the suicidal pediatric patient in the ED: a case study.

OVERVIEW: The suicide rate among children and adolescents has increased worldwide over the past few decades, and many who attempt suicide are first seen at EDs. At Childrens Hospital Boston (CHB), an algorithm-the Risk of Suicidality Clinical Practice Algorithm-has been developed to ensure evidence-based care supported by best practice guidelines. The authors of this article provide an overview of pediatric suicide and suicide attempts; describe screening, assessment, and interventions used at CHB; and discuss the nursing implications. An illustrative case study is also provided. KEYWORDS: algorithm, Asperger's syndrome, attempted suicide, bullying, emergency, emergency department, patient safety, pediatrics, pediatric suicide, suicide, suicide screening, triage.