Pediatric Nursing Resources in Cyberspace

P urpose . To provide information on pediatric nursing resources on the Internet.

POPULATION.

POPULATION. Pediatric nurses in all settings.

CONCLUSIONS.

CONCLUSIONS. A basic understanding of essentials for "surfing the web" will open the doors to unprecedented opportunities to query, find, and share information with others.

PRACTICE IMPLICATIONS.

PRACTICE IMPLICATIONS. Pediatric nurses in every setting can benefit from access to the Internet and knowledge of what resources are available to enhance their practice and support their clients.     

The Effectiveness of a Standardized Educational Program for Children Using Patient-Controlled Analgesia

purpose . To examine the effectiveness of two types of preoperative education (routine education and a standardized educational program) for children undergoing spinal fusion.

design.

design. Two group, phase-lag design.

setting.

setting. Tertiary pediatric hospital.

participants.

participants. Children ages 8-18 years (N = 93)

main outcome measures.

main outcome measures. Adolescent Pediatric Pain Tool, Child Pain Scale, Post-PCA Satisfaction Interview, and PCA infusion pump data.

results.

results. No statistically significant differences between the groups on any of the main outcome variables. Children and parents reported, however, that the SEP provided them with invaluable information regarding the use of PCA and alleviated their concerns about getting "hooked on drugs," overdosing, side effects, and being able to get pain relief when needed.

conclusion.

conclusion. Children having spine fusion surgery experienced severe postoperative pain that was not ameliorated by optimizing use of PCA through standardized education. Further testing of the SEP with other populations is needed in order to more fully realize its potential for influencing pain outcomes.     

Welfare Reform: Loss of Supplemental Security Income (SSI) for Children With Disabilities

P urpose . To describe the changes the new welfare reform legislation, the Personal Responsibility and Work Opportunity Reconciliation Act of 1996, makes in children's eligibility for Supplemental Security Income (SSI) and the implications of the changes for low-income children with disabilities and their families.

POPULATION.

POPULATION. Low-income children and youth, 18 years of age and younger, who have one or more limitations in physical or mental function in performing age-appropriate skills.

CONCLUSIONS.

CONCLUSIONS. The tightened federal standards for determining whether children are disabled place thousands of children at risk for losing SSI cash benefits. This loss of necessary financial support has the potential to adversely affect the physical and psychological health of low-income children with disabilities and their families. The new law represents a step backward from the long awaited gains the 1990 Zebley v. Sullivan U.S. Supreme Court decision legislated for children with disabilities.

PRACTICE IMPLICATIONS.

PRACTICE IMPLICATIONS. Knowledge of the legal changes in children's SSI enables nurses to implement interventions that help low-income families maintain SSI eligibility for their children with disabilities and to advocate with the public and policymakers on behalf of this vulnerable population.     

Learning the Baby: A Maternal Thinking and Problem-Solving Process

purpose. To describe a maternal problem-solving process from new mothers' day-to-day experience of caring for and developing a relationship with their babies

design.

design. Qualitative study using grounded theory approach

setting.

setting. Mothers' homes (n = 23) and workplaces (n = 2)

participants.

participants. 25 mothers of babies from 2 weeks to 7 months

main outcome measures.

main outcome measures. Semi-structured interviews

results.

results. "Learning the Baby" was a major thinking process that emerged. Systematic thinking dominated mothers' problem-solving. Even after the babies were comforted, mothers were not certain their efforts alleviated the babies' problems, because they usually were not certain of the problem.

conclusions.

conclusions. Mothers' thinking directs their caregiving actions. The findings were related to previous problem-solving and women's thinking perspectives. Nurses must use planned and unplanned encounters effectively to collaborate with and teach mothers about baby behavior and health care.     

Parental Consent for Bone Marrow Transplantation in the Case of Genetic Disorders

purpose. To describe the responses of mothers and fathers who were offered bone marrow transplantation (BMT) for their children with genetic disorders

design.

design. Qualitative

setting.

setting. Private hospital rooms/offices

participants.

participants. Six mothers and 4 fathers of children with genetic disorders

results.

results. The basic social-psychological problem confronting the parents was the conflicting alternatives of life versus death for their children. It was certain that these children would die from their genetic disorders but without having to endure the pain and suffering of a BMT. The BMT would be difficult, possibly resulting in death, but with a chance of survival.

conclusions.

conclusions. Parents believed that BMT was the only chance of survival for their children, leaving them no choice except to pursue the BMT treatment     

Nebraska School Nurses Identify Emotional Maltreatment of School-Age Children: A Replication of an Ohio Study

P urpose . To determine how often school nurses identify emotional maltreatment using validated vignettes.

DESIGN.

DESIGN. Survey, with 16 behavior vignettes, mailed to 550 Nebraska school nurses. Four forms represented nonwhite and white, male and female children. Demographic questionnaire included.

SETTING.

SETTING. Survey mailed with regular spring school nurses' newsletter.

PARTICIPANTS.

PARTICIPANTS. One hundred twenty-one school nurses completed and returned surveys.

MAIN OUTCOME MEASURES.

MAIN OUTCOME MEASURES. Each vignette was an example of emotional abuse; subjects indicated "refer" or "not refer" decisions about the vignette. All items were positive for emotional abuse.

RESULTS.

RESULTS. Sixty-four of 121 (53%) respondents correctly identified 13 or more vignettes as referable for emotional maltreatment. No influence of child gender and race on reporting decision. No nurse characteristics correlated with referral rates.

CONCLUSIONS.

CONCLUSIONS. None of the variables studied significantly influenced school nurses' identification of emotional abuse. Further research is needed to ascertain correlation between text vignettes and reporting, and to identify interventions to increase the rate of identifying emotional abuse.     

A Randomized Trial of Heparin and Saline for Maintaining Intravenous Locks in Neonates

purpose . To determine, the effects of saline, heparin 2 units (U) per ml saline, and heparin 10 U/ml saline flush solutions on the duration of intravenous (IV) locks and the incidence of IV infiltration in neonates.

design.

design. Randomized double-blind experiment.

setting.

setting. Tertiary-care nursery.

participants.

participants. Neonates (N = 90) hospitalized at birth in the intensive, intermediate care, or newborn units.

main outcome measures.

main outcome measures. Total hours from the time the IV was inserted to the time the IV was removed; hours from the time the IV was first flushed to the time the IV was removed; number of IVs removed because of infiltration.

results.

results. No statistical or clinical differences between the three groups for duration of IV nor for incidence of complications.

conclusions.

conclusions. The use of heparin in IV lock flush solution did not affect the duration of IV locks nor the incidence of infiltration in neonates.     

Parental Self-Efficacy and Asthma Self-Management Skills

P urpose . To determine whether a formal asthma self-management program and social support using lay health advisors increases parent self-efficacy in the management of their child's asthma, and whether parent self-efficacy predicts asthma self-management skills.

DESIGN.

DESIGN. Quasi-experimental with four time points measured over 2 years.

PARTICIPANTS.

PARTICIPANTS. Low-income, primarily Hispanic parents (N = 303) of children with moderately severe to severe asthma.

SETTING.

SETTING. A Southwestern university medical setting in a rural state.

MAIN OUTCOME MEASURES.

MAIN OUTCOME MEASURES. Parent self-efficacy and parent asthma self-management skill score scales.

RESULTS.

RESULTS. Parent self-efficacy increased significantly from baseline, but there were no significant differences between the control and treatment groups. The increase in self-efficacy was apparent at 6 months, then leveled off. Parent self-efficacy at either baseline or 12 months did not predict parents' asthma self-management skill score.

CONCLUSIONS.

CONCLUSIONS. Individual education was just as effective as group education in increasing parental self-efficacy. Parents felt more comfortable treating asthma episodes than preventing them, thus clinicians need to spend time teaching preventive strategies.     

Parents'' Reports of "Tricks of the Trade" for Managing Childhood Chronic Illness

purpose . To examine how parents respond to and manage the challenges of childhood chronic illness.

design.

design. Qualitative, comparative, secondary analysis.

participants.

participants. Fifty-eight families (55 mothers, 44 fathers) with a school-age child (6-15 years old) with a chronic illness.

results.

results. Three approaches to illness management were identified: strict adherence, flexible adherence, and selective adherence. These approaches varied in the extent to which parents developed and relied on target management behaviors that concurred with or deviated from the treatment plan prescribed by healthcare providers.

conclusions .

conclusions . The three management approaches contribute to understanding the processes associated with differing interactions between healthcare professionals and parents when a child has a chronic illness.     

Varicella Zoster Infection in the Immunocompromised Child

purpose . To describe varicella zoster virus infection in the immunocompromised child and provide guidelines to decrease the risk of infection and complications for these children.

population.

population. Children infected with varicella zoster virus, particularly those with a compromised immune system.

conclusions.

conclusions. Varicella zoster virus infection can have serious consequences for children with malignancies and infection with the human immunodeficiency virus, as well as children on chronic steroid therapy.

practice implications.

practice implications. The advanced practice nurse often is responsible for identifying those children at increased risk for VZV infection and its complications and for planning and implementing interventions to decrease the risks to the immunocompromised child.     

Standards to Prevent Complications of Urinary Catheterization in Children: Should and Should-Knots

purpose. To share standards for urinary, catheterization developed at Children's Hospital, Washington, DC, to prevent complications from using feeding tubes, inserting intermittent catheters too far into the bladder, or not inserting Foley catheters far enough into the bladder.

population.

population. Infants and children requiring urinary catheterization.

conclusions.

conclusions. Using appropriate length urinary catheters and/or inserting catheterizing devices appropriate lengths based on sex, age, and purpose will help prevent knotting of catheters in the bladder and urethral trauma.

practice implications.

practice implications. Short urinary catheters should be used for intermittent urinary catheterization. If these are not available, standards for length of insertion of the catheterizing device should be followed. To prevent urethral trauma, Foley catheters should be inserted to the hub before inflation of the balloon.     

Language Plus for International Graduate Students in Nursing

To provide information about an English-language support program that focuses on the needs of international graduate nursing students. The growing presence of these students coincides with the increasing numbers of universities committed to world health. Crucial social and language competence affect the success and progress of international students in graduate nursing programs.

Design:

Reviewed literature was 1980 to 1998, in nursing and applied linguistic research including second-language acquisition, phonology, discourse analysis, and language pragmatics to identify social and language phenomena.

Findings:

Investigators suggest essential elements such as conventions of academic writing, reading comprehension, vocabulary, and pronunciation skills be included in the supportive Language Plus program.

Conclusions:

Ongoing development of the Language Plus program can promote collaboration between nurses and linguists and increase the success of international graduate nursing students.     

A Model for Cognitive-Behavioral Interventions in Cancer Pain Management

To propose a model for predicting success with cognitive-behavioral interventions in cancer pain management. Practice guidelines are useful, however nurses currently have little theoretic or empiric basis for choosing one particular strategy over another. Moreover, nurses have no way of knowing if a particular intervention is likely to work.

Organizing construct:

The model indicates characteristics of a person in relation to interventions including skill and ability, outcome expectancies, perceived credibility, history of use, preferred coping style, and pain outcomes.

Sources:

The model was developed using sources identified through a literature search of relevant topics in MEDLINE, CINAHL, and Psychlit (1996-1997), as well as through clinical experience.

Conclusions:

Continued empiric testing of the model is necessary to confirm proposed relationships and to assess accuracy of the model's predictions with various cognitive-behavioral interventions. With this testing, the model can help nurses select appropriate interventions for individual patients.     

Quality Care in an Era of Retrenchment

source and purpose. Constraints in the healthcare delivery system are resulting in unprecedented challenges to quality nursing care. In response to concerns expressed by readers in a JSPN survey, we solicited input from prominent SPN members.

conclusions.

conclusions. Quality care can be sustained through nurses' creativity, flexibility, leadership, and collaboration. The context for quality care is an organizatinal environment with attention to critical analysis, careful resource utilization, and improved outcomes.

practice implications.

practice implications. Nurses can not only maintain premium standards of quality care but, by assuming leadership, help shape the future of health care.     

Improving Access to Health Care for Children

issues and purpose. The number of uninsured children has been growing at an alarming rate. The most vulnerable children are those in lower-income families who are falling through the cracks between evolving government-sponsored health insurance programs. Recent policy initiatives may not be adequate to extend coverage to more children.

conclusions.

conclusions. Many low-income children actually are eligible for Medicaid but are not enrolled for a variety of reasons. The numbers of these children have risen due to welfare reform. Better outreach efforts are needed to ensure that new child health insurance programs and Medicaid expansions achieve their goals.

implications for practice.

implications for practice. A comprehensive assessment of insurance status and referral to community agencies should be an integral part of patient care for all healthcare providers.     

Agenda for Children and Youth: Linking Research, Policy, and Practice

issues and purpose. In this past century, we have made significant strides in our understanding of children's needs, but there is still much to learn as we enter the coming century. We must seek this new knowledge not only for the sake of knowing, but also for the sake of making change, ensuring that what we learn helps improve the future for our children and youth. These efforts require a strong link between policy, practice, and research.

conclusions.

conclusions. Research partnerships can build our base of knowledge and help answer emerging policy and practice questions. Through research that focuses on the diversity and developmental phases of children, we can bring policy and practice into line with an increasingly refined understanding of children and their needs.

practice implications.

practice implications. Because nurses look at the holistic needs of individuals, it is critical that they are involved in setting the social service research agenda and seeking ways that policy and practice can both inform and be informed by this research.