Effects of the nursing Mutual Participation Model of Care on parental stress in the pediatric intensive care unit--a replication.

The pediatric intensive care unit (PICU) hospitalization of a child is stressful for parents. Helping parents to decrease their stress is warranted so that they can function in a vital role that is therapeutic to them and their critically ill child. Although many interventions have been recommended to help parents decrease their stress, only the Nursing Mutual Participation Model of Care (NMPMC) has been tested in the clinical setting. This article reports a study that expands on Curley's original work by investigating the effects of the NMPMC on parental stress when implemented by PICU staff nurses. Fifty-six parents participated in the study, which used a quasi-experimental design. Sequential sampling placed the first 31 subjects into the control group and the next 25 subjects in the experimental group. The experimental group received care from staff nurses instructed in the NMPMC. The dependent measure was the Parental Stressor Scale:Pediatric Intensive Care Unit (PSS:PICU) administered within 24 to 48 hours of PICU admission, every 48 hours thereafter, and 24 hours after PICU discharge. The results indicated that parents in the experimental group perceived less stress than the control group, specifically the stress related to alterations in parental role in the PICU setting. Implications for nursing care are discussed.     

以家庭为中心儿科护理模式创建与评价

目的：探索以家庭为中心儿科护理模式,提升患儿及家长的满意度和患儿安全。方法：创建以家庭为中心儿科护理模式,包括制定以家庭为中心儿科护理政策,配备数量充足和资历合格的护理人员,明确总责护士和责任护士的具体职责,对临床护理人员进行以家庭为中心儿科护理理论和实践的培训与考核,研制工具以评价护理人员执行以家庭为中心护理措施的情况,评价以家庭为中心儿科护理模式的实施效果。结果：患儿家长对以家庭为中心儿科护理模式的总体满意度为93.5%,患儿安全指标如给药错误发生率、跌倒/坠床发生率明显下降。结论：把以家庭为中心儿科护理理念转化为行动,深入到儿科护理实践的方方面面是一个长期持久的过程。而在患儿危机时刻,让家长和孩子在一起更是一个巨大的挑战,需要医护人员和患儿家长共同努力。     

The impact of utilization review on nursing

At first glance, nursing's role in UR appears to be of strategic significance to the profession. But there are several issues that nurse executives need to consider. First, since UR departments are seldom part of the nursing department, UR nurses are practicing outside the realm of nursing. What responsibility, if any, does the nursing department have to nurses practicing in the hospital, yet not in the nursing department? What can the nursing department do to help UR nurses maintain their identification with the profession and appreciate the strategic importance of their role, with its legal and financial ramifications? Second, UR is changing the established role of the primary care nurse. In your institution UR may already have taken the staff nurses' discharge planning function. It appears that several factors are contributing to this role change. Patient acuity has increased the time needed to administer physical care. The nursing shortage means more patients are assigned to each professional nurse and paraprofessionals are doing more patient care. There is less and less time left for the primary nurse to practice the professional attributes of nursing, primarily discharge planning. This function is shifting to the UR Department. Is discharge planning a function nurse executives wish to relinquish? Finally, we are entering another period of severe nurse shortages, where recruitment and retention of staff are paramount. Actively competing for our staff are the UR departments. Forty professional nurses work in three regional centers of the American Health Network, American Group Insurance Company (Dallas, Texas). In one hospital of 450 beds, nine nurses are employed by the UR department.(ABSTRACT TRUNCATED AT 250 WORDS)     

Discharge planning process: applying a model for evidence-based practice

Discharge planning is an integral but ill-defined process in most acute care settings. The time available to a healthcare team to adequately prepare patients for discharge has virtually evaporated with decreasing lengths of hospital stay. A research utilization (RU) team at a tertiary care teaching institution reviewed the literature from 1990 to 2002 in search of a research-based practice regarding staff nurses' roles in the discharge process. Review of the literature revealed varied discharge planning processes using staff nurses, advanced practice nurses, or case managers specifically prepared to implement the discharge planning process. Insufficient evidence was found to support a change from the current staff nurse practice.     

Spica cast care: a collaborative staff-led education initiative for improved patient care

One of the most challenging aspects for nurses caring for incontinent children in spica casts is maintaining healthy skin integrity. Noting an increase in the number of phone calls from parents of discharged children in spica casts concerning diaper rash and skin breakdown, inpatient orthopedics staff nurses lead an interdisciplinary quality improvement and educational initiative. They standardized pediatric spica cast care and education by creating an intranet narrated PowerPoint presentation for staff and parents of children with spica casts. A take-home DVD of this education module is now produced and given to parents, reinforcing nursing discharge teaching and giving parents the opportunity to review these new skills at home as needed. The purpose of this article is to share this experience of improving patient outcomes and empowering other orthopedics nurses to develop creative educational solutions.     

Preparing the family for home tracheotomy care

Children with tracheotomy tubes are frequently cared for by nurses in critical care settings, as well as on general patient care units. These children require tracheotomies for a variety of reasons and often are ready to be discharged before they are ready to be decannulated. As a result, many children are cared for at home by their parents, other family members, or other care givers. Discharging a child home with a tracheotomy is a process that involves many people. The staff nurse plays a valuable role in providing education and support to the child and family. After discharge, otolaryngology nurse-clinicians provide some of the support and continuing education the families may need, while parents and school personnel assist the families with support in normalizing their lives and meeting the developmental needs of the child.     

Discharge management for children with complex needs

There is now an expectation that children with complex (often technology-dependent) care needs will be cared for at home by parents who assume 24-hour responsibility following extensive training to nurse, care for and parent their child. A variety of models of discharge planning exist but the planning and process of discharge are persistently reported to be problematic from the perspective of families, professionals and commissioners. A consultation exercise with both parents and professionals indicated that nurses, doctors and social workers would benefit from some practical help and specific knowledge relating to complex discharge management. This article summarises best practice and, where possible, evidence-based principles and procedures with the intention of contributing to the establishment of effective models of discharge management and ongoing homecare, and improved outcomes for children and families. Guidance on putting together and costing a care package proposal, and applying risk management and clinical governance procedures in home-based settings will be published in the June issue of Paediatric Nursing.     

Power sharing. A transformational strategy for nurse retention, effectiveness, and extra effort

Power sharing with staff nurses is an essential strategy for organizational transformation. The current competitive health care environment requires a powerful team of participants, including staff at all levels, to provide health care in mutual partnership. The challenges of today's competitive and global environment call for collegial relationships among nurse executive leadership, middle nurse managers, and staff nurses. Research has demonstrated that middle nurse managers maintain primary responsibility for staff nurse retention. A higher retention rate was reported among nurses who were very satisfied with their nurse managers. Nurses considered favorably nurse managers who value staff contributions, promote information sharing, and exert influence for a stable work environment. Furthermore, as staff nurse satisfaction increased, effectiveness and extra effort also increased when staff nurses perceived transformational leadership strategies. Strategies for power sharing include serving as role models and mentors, energizing staff, resisting attitudes of staff ownership, reducing staff nurse stress of leader presence, and information sharing and commendations at meetings.     

护士指导家长减轻患儿注射疼痛认知的调查研究

目的 :描述护士在指导家长减轻患儿注射疼痛方面的认知情况。方法 :采用方便抽样法 ,抽取西安市 3所三级甲等医院护士 15 5名 ,以调查问卷的形式进行。结果 :护士未能经常给予患儿家长有关注射方面的知识 ,包括如何参与减轻患儿的注射疼痛。结论 :建议护士多提供给家长相关知识 ,帮助家长更好地参与患儿的护理 ,更有效地减轻患儿的注射疼痛。     

The role of the hospital liaison nurse in effective discharge planning for older people: perspectives of discharge planners

The study identified effective discharge planning for older people from the perspectives of older people, their carers and nursing and social work discharge planners at a city hospital. This article discusses findings from the discharge planners who argued discharge planning was dependent upon effective communication between hospital and community staff, older people and their carers. They felt frustrated in their attempts to facilitate continuity of care within a casemix environment, and identified the pivotal role of the hospital liaison nurse in effective discharge planning. In addition, they called for ongoing reviews of hospital and community discharge planning practice, secondment of nurses between sectors to increase knowledge of other health services, and collaborative research.     

Nurses' Views About the Barriers and Facilitators to Effective Management of Pediatric Pain

Children continue to experience moderate to severe pain during hospitalization. This paper presents data from two modified focus groups undertaken as part of a larger study exploring pediatric pain management practices in one hospital in the south of England. Thirty nurses took part in the focus groups and were asked questions about their views about the barriers and facilitators to effective pain management in the hospital. Participants identified a number of barriers which related to the staff, children and parents and the organization. Nurses indicated that they and the medical staff lacked knowledge about pain management. They also felt that staff shortages and a heavy workload detracted from the quality of the care they could provide. Several participants indicated that insufficient analgesic drugs were sometimes prescribed. Many of the barriers identified related to parents and children. It appears that nurses may not take as active a role as they could do in managing pediatric pain rather seeing it as the parents and child’s responsibility to let them know when they are experiencing pain. Nurses also felt that parents exaggerate their child’s pain and ask for analgesic drugs before their child needs them. There is a need to explore the interactions between nurses, children and parents in this context in more detail.     

Introduction of a liaison nurse role in a tertiary paediatric ICU.

INTRODUCTION: The Royal Children's Hospital in Melbourne is the only dedicated paediatric hospital in Victoria (population 5 million). The role of the PICU liaison nurse (LN) has been developed to bridge the gap between PICU and the wards within the hospital with the aim of reducing the number of readmissions to the PICU within 48h of discharge. RESULTS: The year of the PICU LN trial (July 2004-June 2005), 1388 patients were discharged from PICU. Sixty-seven patients had unplanned readmission within 48h. This readmission rate (4.8%) is lower than the readmission rate (5.4%) during the year prior to the implementation of the PICU LN. Staff and parents were surveyed at the end of the 12-month trial to evaluate the introduction of the LN role. The response from the surveys was very positive, 98.5% of staff believed the PICU LN to be beneficial and to have made a valuable impact on PICU-ward transfers. Ninety-nine percent of surveyed parents agreed that the LN role is a good idea. CONCLUSION: The PICU LN role at RCH has shown many positive outcomes including improved communication, ward education, improved patient outcomes and decreased readmission rates to ICU.     

Maximizing services along the continuum of care from inpatient to home

The nurse managers of the inpatient pediatric units and home care division of Robert Wood Johnson University Hospital met to restructure and optimize the quality of care delivered to children and their families in the home setting. A program was developed using inpatient pediatric staff nurses to perform home visits to children requiring follow-up after an inpatient hospital stay. The nurse managers found home visits could comfortably be delivered by pediatric inpatient nurses if they were appropriately oriented and precepted by experienced home care nurses. When home visits were performed by the nurses who cared for the patient in the hospital, both the child and the family appeared to have an increase in comfort and self-confidence in caring for their child. The program also was successful in reducing the costs associated with pediatric home care. This was achieved by facilitating the downsizing of the inpatient units in periods of low census, as well as in cost avoidance associated with not paying benefits to additional employees that otherwise would have been hired by the home care department. This program could be implemented successfully in institutions that support communication, coordination, and continuous improvement of the programs provided to children and families.     

Should Parents Be Present during Emergency Department Procedures on Children,and Who Should Make That Decision? A Survey of Emergency Physician and Nurse Attitudes

OBJECTIVE: To survey physician and nurse attitudes regarding parental presence during painful procedures on children performed in the emergency department (ED) and who should make that decision. METHODS: The design was an anonymous written survey consisting of six clinical scenarios distributed to all staff and resident physicians and nurses in ten EDs at institutions in the United States routinely caring for children. Participants were asked whether parents should remain with children undergoing intravenous (IV) placement, laceration repair, lumbar puncture, conscious sedation, major resuscitation, and major resuscitation with death. They also were asked who should make the decision. RESULTS: The percentage of physicians who responded that parents should be present was 91.3% for peripheral IV start, 93.3% for laceration repair, 65.7% for lumbar puncture, 83.1% for conscious sedation, 31.9% for major resuscitation, and 35.6% for major resuscitation where death was likely. The percentage of nurses who responded that parents should be present was 86.8% for peripheral IV start, 89.6% for laceration repair, 55.0% for lumbar puncture, 74.9% for conscious sedation, 41.4% for major resuscitation, and 54.3% for major resuscitation where death was likely. In 64.8% of the completed surveys, the physicians indicated that they alone or in conjunction with a parent should make the decision. In 61.5% of the completed surveys, the nurses indicated that they should be involved in the decision. CONCLUSIONS: A majority of emergency physicians and nurses indicated parents should be present for some invasive pediatric procedures. However, as the invasiveness of the pediatric procedures increased, fewer physicians and nurses believed that parents should be present.     

The impact of a liaison nurse on ICU nurses' perceptions of discharge planning.

The objective of the study was to examine the impact of a discharge liaison nurse on intensive care unit (ICU) nurses' perceptions of discharge planning. The discharge liaison nurse coordinated the discharge of patients from ICU to the ward, assisted with hospital discharge, provided clinical teaching and support to both ICU and ward nurses and supported patients and families during hospitalisation. A block intervention design was used. All ICU nurses within one Australian teaching hospital were surveyed prior to and following the implementation of the discharge liaison nurse. Measures included the perceptions of discharge planning scale and the general perceived self-efficacy scale. Following implementation of the liaison nurse, less nurses perceived that discharge planning in the ICU was premature (chi2(2, n=117)=7.759, p=0.021) and that ICU nurses lack an understanding of the discharge planning process (chi2(2, n=118)=15.557, p<0.001). Discharge planning was more frequently seen as the responsibility of the bedside nurse (chi2(2, n=115) =15.270, p<0.005) but there was greater recognition of discharge planning as a time consuming process (chi2(2, n=117)=8.560, p=0.015). Self efficacy in relation to discharge planning did not change over time. Some support was found for the role of the discharge liaison nurse in promoting attitudinal change towards discharge planning in the ICU. Future research is needed to investigate the processes by which the liaison nurse fosters attitudinal change and to document the actual discharge planning practices undertaken in ICU.     

Nurses' perceptions of discharge planning

The present paper investigates what the term discharge planning actually means to nurses working in the acute care environment. A qualitative approach was used for this study. Twelve volunteer registered nurses (RNs) working in a large metropolitan Victorian public hospital were interviewed. All participants stated emphatically that they were involved in the discharge planning process although differing levels of involvement existed. "Organizing" and "planning" were key words used by participants to define the term discharge planning. All but one participant considered the nurse to be the coordinator of the discharge planning process. How participants communicated with other nursing staff regarding the discharge planning needs of individual patients depended on the policy of each individual ward. Communication was perceived to be a major factor that either enhanced or impeded the discharge planning process.     

Education given to parents of children newly diagnosed with acute lymphoblastic leukemia: a narrative review

Over the past 30 years, diagnosis and treatment of childhood cancers has developed significantly due to medical research and advancements in technology. As a result, prognosis has improved, and approximately 80% of children diagnosed with cancer survive into adulthood. Care has also shifted from a sole inpatient setting to include outpatient treatment where possible, and both these trends have resulted in a shift in the focus of research to the psychosocial and psychological effects of treatment on children and their families. Increasingly, parents are taking on the role of providing "nursing" care for their children, for example, managing medications and emergency situations as well as everyday treatment needs. This article critically reviews the current literature surrounding the approaches and methods used by nursing staff to educate families to perform this care within the context of a planned first discharge from hospital. Twenty-two relevant articles were identified covering different aspects of education and discharge planning, including the following: facilitation of education and discharge planning, collaboration between professional disciplines and family, responsibilities and contractual agreements, timing and approach, care planning, and the information needs of families. Only 4 articles discussed what the family felt they needed to know and be prepared for prior to discharge. This review indicates that further research is required to establish the needs of parents and caregivers with regard to education prior to their child's first discharge from hospital in the pediatric hematology and oncology setting.