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Objective:To investigate the efficacy and safety of the Steward Scale(S Scale)and the Modified Aldrete Scale (A Scale) for resuscitation of children undergoing gastrointestinal endoscopy with general anesthesia.Methods:A total of 199 underage children who underwent non-intubated gastrointestinal endoscopy with general anesthesia in Children′s Hospital, Zhejiang University School of Medicine from July to December 2022 were retrospectively included in this study and divided into preschool group (36 cases), low school-age group (75 cases) and high school-age group (88 cases) according to age. S Scale and A Scale were also performed to evaluate the recovery from anesthesia. The vital signs of the children and the time required for reaching the target were recorded, and the scoring efficiency and safety of the two scales were compared.Results:The time required for S Scale to reach the standard (17.50 ± 9.29) min was significantly lower than that of A Scale (20.80 ± 12.61) min, and the difference between the two groups was statistically significant ( t = 2.97, P<0.01). In the low school-age group, oxygen saturation (0.989 ± 0.010) of A Scale was higher than that of S Scale (0.980 ± 0.015), the difference was significant ( t = 2.17, P<0.05). The time required for S Scale to reach the standard was negatively correlated with age ( r = -0.385, P<0.01). There was no significant correlation between the time required for A scale to reach the standard and the children′s age ( r = -0.089, P>0.05). Conclusions:Although Steward Scale is more efficient than modified Aldrete Scale in evaluating anesthesia resuscitation in underage children undergoing gastrointestinal endoscopy with general anesthesia, modified Aldrete Scale is safer than Steward Scale and is more conducive to ensuring the life safety of children.
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Objective:To construct the evaluation index system of the core competence of neonatal specialist nurses, so as to provide reference for clinical training of neonatal specialist nurses.Methods:From January 2020, through literature review, theoretical analysis, interview, Delphi method and superiority chart, the evaluation index and weight of core competence of neonatal specialist nurses were determined.Results:Totally 28 experts in China were invited for 3 rounds of consultation. The effective recovery rate of the questionnaires was 93.33%(28/30) in the first round. The effective recovery rate of the questionnaires was 100.00%(28/28) in the second and third rounds. The authority coefficient of the experts was 0.85 in the third round. The Kendall′s coefficients of concordance of the first-level indexes, second-level indexes and third-level indexes were 0.150, 0.221 and 0.161, respectively. The final evaluation index system of the core competence of neonatal specialist nurses included 5 first-level indicators, 17 second-level indicators and 58 third-level indicators.Conclusions:The evaluation index system of the core competence of neonatal specialist nurses constructed in this study has certain scientific, reliable and clinical application value, which is conducive to the training of newborn specialized nurses in China.
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Bronchial asthma is a heterogeneous disease characterized by chronic airway inflammation and airway hyperresponsiveness. With the development of the whole-life-cycle health concept, the focus of treatment for bronchial asthma in children has gradually shifted from initial pharmacological control to an integrated management model of functional rehabilitation and pharmacological assistance. As a non-pharmacological integrated approach, pulmonary rehabilitation plays an equally important role in the management of childhood asthma as pharmacological treatment. Studies have shown that breathing techniques such as Buteyko breathing, pursed lip breathing, diaphragmatic breathing training, threshold-pressure inspiratory muscle training and yoga breathing can improve lung function indicators such as FEV1, FVC, PEF and MVV in children. The comprehensive pre-exercise assessment, the development of exercise prescriptions, and the implementation and evaluation of exercise effects can improve the physical fitness, neuromuscular coordination and self-confidence of children with asthma. The comprehensive interventions of health education, psychological support and nutritional intervention can improve the compliance and effectiveness of rehabilitation training. This article reviews the research progress on respiratory training, physical exercise and comprehensive interventions in the pulmonary rehabilitation of asthmatic children, to provide theoretical basis and practical guidance for the scientific and rational management of pulmonary rehabilitation of asthmatic children in clinical settings.
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In pediatric nursing, the conflict between the principle of beneficial and non-maleficence is a major challenge for nurses. To systematically understand the current situation of the conflict in the nursing practice of pediatric nurses at home and abroad, this paper reviewed four clinical situations where conflict occurs frequently: end-of-life decision-making of critically ill children, physical restraint, the child abuse case report, and new pediatric clinical therapies, and analyzed the factors influencing the conflict of pediatric nurses in China, so as to provide reference for pediatric nurses to cope with the conflict between the principle of beneficial and non-maleficence.
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Objective:To establish a scientific and standardized routine for perioperative nursing in pediatric otolaryngology, reduce the incidence of postoperative delirium, and improve the quality of postoperative recovery by implementing the best practice of evaluation and intervention of postoperative delirium in pediatric otolaryngology.Methods:By reviewing literature related to evaluation, prevention, intervention and management of postoperative delirium in pediatric otolaryngology from March 2018 to September 2019, fourteen best practice were concluded. By combining the best evidence and the clinical circumstances, the evidenced-based criteria were established and then applied in the Otolaryngology and Head and Neck Surgery Department, the Children ′s Hospital of Zhejiang University School of Medicine. Results:After three rounds of reviews, the results showed that the criteria 2, 3, 6, and 8 had 100.0% complacence. Comparison of before and after applying the evidence, there was no statistically significant difference for the occurrence of postoperative delirium or pain ( P>0.05); there was a statistically significant reduction of pain score at 60 minutes after returning to the ward ( χ2=9.93, P<0.05); there was a statistically significant reduction of preoperative anxiety score of children ′s family members from (33.36 ± 6.84) points to (29.54 ± 6.94) points ( F=6.33, P<0.05); there was a statistically significant increase of doctors ′ score of delirium knowledge based on evidence from (23.00 ± 3.94) points to (33.43 ± 8.25) points ( t=-3.02, P<0.05); and there was a statistically significant increase of nurses ′ score of delirium knowledge based on evidence from (33.11 ± 8.46) points to (57.79 ± 6.58) points ( t=-10.35, P<0.05) when the evidence was applied. Conclusion:The evidence-based practice didn ′t significantly relieve the postoperative delirium in pediatric otolaryngology, but it was helpful to relieve the postoperative pain level of children and the anxiety level of their families. The management of postoperative delirium in pediatric otolaryngology needs to be further explored.
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The moral distress of nurses is an important ethical issue in nursing practice, especially in pediatric nursing, which is unique and specialized. It can lead to burnout and compassion fatigue, resulting in lower job engagement and job satisfaction, and higher turnover rates. In order to provide a comprehensive and timely understanding of the current state of moral distress of pediatric nurses and their influencing factors, this article reviews the current state of domestic and international research on the moral distress of pediatric nurses and the influencing factors. It showed that overseas research on the moral distress of pediatric nurses is more in-depth, while there was less research in China at present, and the research and attention on the moral distress of pediatric nurses in China was insufficient. The influencing factors mainly include three aspects: personal factors, organizational factors and external environment. The review provided a theoretical basis for implementing targeted interventions to prevent and mitigate moral distress among pediatric nurses and calls for nursing researchers, nursing educators, nursing managers and individuals in China to pay more attention to moral distress.
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Pulmonary rehabilitation is a multidisciplinary and comprehensive intervention for patients with chronic respiratory diseases, including exercise training, behavior change and self-management.It aims to improve the physical and psychological condition of people with chronic respiratory diseases and to promote the long-term adhe-rence to health-enhancing behaviors.Pulmonary rehabilitation has been extensively applied to adults with chronic respiratory diseases such as chronic obstructive pulmonary disease, and it also has been adopted for children with respiratory related diseases.Pulmonary rehabilitation strategies vary for different diseases.Individualized pulmonary rehabilitation programs should be made according to the underlying diseases of children.In this manuscript, the application of exercise training in children with asthma, cystic fibrosis, bronchiectasis, bronchopulmonary dysplasia, bronchiolitis obliterans, neuromuscular diseases complicated with respiratory problems and severe pneumonia were reviewed.
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Pulmonary rehabilitation is a multidisciplinary and comprehensive intervention for patients with chronic respiratory diseases, including exercise training, behavior change and self-management.It aims to improve the physical and psychological condition of people with chronic respiratory diseases and to promote the long-term adhe-rence to health-enhancing behaviors.Pulmonary rehabilitation has been extensively applied to adults with chronic respiratory diseases such as chronic obstructive pulmonary disease, and it also has been adopted for children with respiratory related diseases.Pulmonary rehabilitation strategies vary for different diseases.Individualized pulmonary rehabilitation programs should be made according to the underlying diseases of children.In this manuscript, the application of exercise training in children with asthma, cystic fibrosis, bronchiectasis, bronchopulmonary dysplasia, bronchiolitis obliterans, neuromuscular diseases complicated with respiratory problems and severe pneumonia were reviewed.
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Objective:To retrieve, evaluate and integrate relevant evidence on the management of the developmentally supportive environment in the neonatal intensive care unit(NICU), and to provide clinical references.Methods:Evidence on NICU environmental management was retrieved from Guidelines International Network, Joanna Briggs Institute, National Institute for Health and Care Excellence, Scottish Intercollegiate Guide Network, National Guideline Clearinghouse, Registered Nurses′ Association of Ontario, Yimaitong and other Websites, BMJ Best Practice, UpToDate, Cochrane Library, PubMed, Embase, Wanfang Database, CNKI and other database.The evidence included guidelines, evidence summaries, best clinical practice manuals, expert consensus and systematic reviews.The date limit was from the establishment of the databases to March 31, 2021.Results:Totally 16 articles were involved, including 4 guidelines, 9 systematic reviews, and 3 expert consensus.Finally, 20 pieces of best evidence on four aspects were su-mmarized: sound, light, touch, and smell.There were 11 A-level recommendations and 9 B-level recommendations.The evidence suggested that health care workers should reduce noise and protect premature infants from being exposed to bright light, noxious gases, and negative touch stimuli.Besides, benign auditory and olfactory stimuli, circadian light, and mother-infant skin-to-skin contact should be used to promote the development of premature infants.Conclusions:This study is a summary of the recommendations on NICU environmental management.It is well-designed and has achieved fruitful results, showing great significance for reducing environmental stress of premature infants in the NICU.However, the current recommended methods for providing benign stimulation require validation of more high-quality, well-designed research.It is recommended that medical staff should selectively apply the evidence to clinical practice according to the actual situation.
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Objective:To explore the application effect of flipped classroom combined with simulated case teaching in internship of pediatric nursing students.Methods:In the study, 52 nursing interns having internship in our department from July 2018 to January 2020 were selected and divided into control group and experimental group according to the internship period, including 26 interns in each group. The control group adopted traditional teaching method, while the experimental group adopted flipped classroom teaching method combined with simulated case drill. Indicators such as assessment scores and satisfaction surveys were compared between the two groups.Results:Compared with the control group, the test results of nursing students in the experimental group [(77.077±5.455) points] were significantly better than those [(67.692±4.905) points] in the control group ( P<0.01). The teaching satisfaction of nursing students in the experimental group (99.78%) was significantly better than that (89.92%) in the control group ( P<0.01). Conclusion:The application of flipped classroom combined with simulated case practice teaching method in the internship teaching of pediatric nursing students has achieved good results, which is worthy of promotion in the teaching of pediatric nursing drill.
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OBJECTIVE@#To study the working experience of COVID-19 care nurses.@*METHODS@#Twenty two nurses taking care of COVID-19 patients were interviewed by means of descriptive phenomenology. All the data were transcribed and recorded, and then processed into WORD documents. The Colaizzi 7 footwork was used to classify, encode, establish nodes and extract themes based on Nvivo11.0 software.@*RESULTS@#Two main themes were extracted: one is the positive feelings of nurses, including the sense of professional mission and pride, the sense of achievement and happiness, the improvement of self-worth and ability, the powerful support system and the power of role models; the other is the negative experience of nurses, including the worry and anxiety at work, the lack of experience and trust, the difficulty of work, and the inconvenience of isolating life.@*CONCLUSIONS@#s While fully affirming the work value of nurses, it is necessary for the society, hospitals and patients to give extensive and continuous support, care and respect to nurses, so as to stimulate their working enthusiasm and sense of professional achievement. Hospital managers need to implement all kinds of security work, meet the safety needs of nurses, pay attention to the physical and mental health of nurses, strengthen the training of nursing talents for critical and severe diseases and infectious diseases, improve the allocation of human resources, and enhance the ability of material allocation and reserve for major health events, so as to make adequate preparations for coping with public health events in the future.
Subject(s)
Humans , Betacoronavirus , Coronavirus Infections , Hospitals , Nurses , Pandemics , Pneumonia, Viral , Qualitative Research , WorkplaceABSTRACT
OBJECTIVE@#: To evaluate the application of three-in-one intelligent screening in outpatient pre-inspection in Children's Hospital.@*METHODS@#We randomly enrolled 100 children pre-screened by traditional in the outpatient department of Children's Hospital Zhejiang University School of Medicine from February 6th to 16th, 2020, and another 100 children by the intelligent three-in-one mode from February 17th to 27th, 2020. The traditional triage was conducted by nurses based on face-to-face, one-by-one interview of the epidemiological history and consultation department, and the temperature was measured before manual triage. The intelligent three-in-one model of pre-inspection and triage combined online rapid pre-inspection and triage, on-site manual confirmation, as well as synchronized online health education system. For on-line registered patients, the system automatically sent the COVID-19 epidemiological pre-screening triage questionnaire one hour before the appointment, requiring parents to complete and submit online before arriving at the hospital. The on-site registered patients were controlled at 100 m outside of the hospital entrance. The nurses guided the parents to scan the QR code and fill in the COVID-19 epidemiological pre-examination triage questionnaire. At the entrance of the hospital, the nurse checked the guide sheet and took the temperature again. The children with red guidance sheet for isolation clinic were checked again and confirmed by pre-examination nurses, and accompanied to the isolation clinic by a special channel. The children with yellow guidance sheet were guided to fever clinic; parents with green guidance sheet took their children to the designated area by themselves, and then went to the corresponding consultation area after on-site manual pre inspection and registration. The whole process of health education was associated with outpatient notes, and the system automatically posted the corresponding outpatient instructions and education courses. Parents would read the courses on their mobile phones and counsel online. The time of pre-examination and the coincidence rate of triage were compared between the two groups.@*RESULTS@#The three-in-one intelligent pre-inspection mode took an average of (25.6±8.0) seconds for each child, which was significantly shorter than the traditional pre-inspection mode (74.8±36.4 seconds) (=13.182, 0.05).@*CONCLUSIONS@#The three-in-one intelligent pre-inspection model can effectively shorten the patient pre-check time, with similar triage coincidence rate to traditional model.
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Objective:To investigate the uncertainty level of caregivers of children with imperforate anus, and determine the influence factors.Methods:Two hundred and twenty-nine caregivers were enrolled from three tertiary children′s hospital in Eastern China. The caregivers completed the Perception of Uncertainty Scale, Parent Stigma Scale and Social Support Scale. The demographic information of caregivers and affected children were also collected during the survey.Results:The average score of uncertainty of caregivers was (72.58±14.06) points, and multiple analysis showed that education level, the acceptance level of disease, social support and stigma were independent determinants of uncertainty ( P<0.01), and these factors could account for 26.9% of the variance. Conclusions:The caregivers of children with imperforate anus experience a high level of uncertainty, especially those with low education level, share low acceptance level of disease, receive low social support and experience higher level of stigma.
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OBJECTIVE@#To evaluate the application of three-in-one intelligent screening in outpatient pre-inspection in children's hospital.@*METHODS@#We randomly enrolled 100 children pre-screened by traditional method in the outpatient department of Children's Hospital of Zhejiang University from February 6th to 16th, 2020, and another 100 children by the intelligent three-in-one mode from February 17th to 27th, 2020. The traditional triage was conducted by nurses based on face-to-face, one-by-one interview of the epidemiological history and consultation department, and the temperature was measured before manual triage. The intelligent three-in-one model combined online rapid pre-inspection and triage, on-site manual confirmation, as well as synchronized online health education system. For on-line registered patients, the system automatically sent the COVID-19 epidemiological pre-screening triage questionnaire one hour before the appointment, requiring parents to complete and submit online before arriving at the hospital. The on-site registered patients were controlled at 100 m away from the hospital entrance. The nurses guided the parents to scan the QR code and fill in the COVID-19 epidemiological pre-examination triage questionnaire. At the entrance of the hospital, the nurse checked the guidance sheet and took the temperature again. The children with red guidance sheet were checked again and confirmed by pre-examination nurses, and accompanied to the isolation clinic through COVID-19 patients-only entrance. The children with yellow guidance sheet were guided to fever clinic. The children with green guidance sheet could go with their parents to the designated area, and then went to the corresponding consultation area. Health education was carried out throughout the treatment, and the system automatically posted the corresponding outpatient instructions and education courses. Parents would read the courses on their mobile phones and counsel online. The time of pre-examination and the coincidence rate of triage were compared between the two groups.@*RESULTS@#The three-in-one intelligent pre-inspection mode took an average of (25.6±8.0) s for each child, which was significantly shorter than the traditional pre-inspection mode (74.8±36.4) s (@*CONCLUSIONS@#The three-in-one intelligent pre-inspection model can effectively shorten the patient pre-check time, with similar triage coincidence rate to traditional model.
Subject(s)
Adult , Child , Humans , Betacoronavirus , COVID-19 , Coronavirus Infections/diagnosis , Internet , Outpatient Clinics, Hospital , Pandemics , Pneumonia, Viral/diagnosis , SARS-CoV-2 , Surveys and Questionnaires , Time , Triage/standardsABSTRACT
December 2019 witnessed the outbreak of COVID-19 in Wuhan, Hubei province of China, which soon spread nationwide and across national borders to pose a menacing pandemic threat. Children are themselves highly susceptible to infectious diseases in normal times not to mention an epidemic. Coupled with the high incidence of seasonal influenza, it is imperative to strengthen epidemiological screening of children, along with effective isolation, treatment, prevention and control measures. In view of the specifics of the hospital, the authors proposed to further improve the medical emergency procedure, for strictly enforcing screening and isolation regulations, and standardizing medical procedure. They also proposed scientific layout and use of the infection wards. All these measures are designed to control the epidemic and protect the safety of children, families and medical staff.
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The epidemic of COVID-19 has become the topmost public health threat worldwide. The authors suggested that in addition to strengthening the organization and leadership of the abovementioned work, greater attention be paid to establishing and improving the prevention and control mechanism.Furthermore, special efforts should be given to the safety of the medical workers, by strengthening their infection monitoring and outbreak management. Medical workers in different work areas and positions should be placed under careful protection with due cleaning and disinfection measures. The protection during specimen collection, transportation and medical waste management should also be prioritized. Such special issues in the management of pediatric patients, as allocation of nurses, the screening and management of caregivers, the problem of breastfeeding, and the disinfection of children′s toys and diapers were discussed. This paper also put forward management suggestions for the outpatient department, isolation ward and other key departments, which aim to guide the prevention and control of COVID-19 nosocomial infection in the pediatric outpatient and ward.
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December 2019 witnessed the outbreak of COVID-19 in Wuhan, Hubei province of China, which has soon spread nationwide and across national borders, posting a menacing pandemic threat. Children are themselves highly susceptible infectious diseases in normal times not to mention an epidemic period. Coupled with the high incidence of seasonal influenza, it is imperative to strengthen epidemiological screening of children, along with effective isolation, treatment, prevention and control measures. In view of specifics of the hospital, the authors proposed to further improve the medical emergency procedure, strictly enforcing screening and isolation regulations, and standardizing medical procedure. They also proposed scientific layout and use of the infection wards. These measures are designed to control the epidemic and protect the safety of medical staff.
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The pneumonia caused by the novel coronavirus (2019-nCoV), which began in December 2019, has become the most serious public health problem, threatening people's health and life. This threat is posing a severe challenge on the diagnosis and treatment of 2019-nCoV infection, the prevention and control of hospital cross infection of medical staff. It is suggested that in addition to strengthening the organization and leadership of the abovementioned work, establishing and improving the prevention and control mechanism deserve greater attention. Furthermore, special attention should be given to the safety of the medical staff, strengthening their infection monitoring and outbreak management. Medical staff in different work areas and positions should be placed under careful protection, cleaning and disinfection measures. The protection during specimen collection, transportation and medical waste management should also be prioritized. This paper also put forward management suggestions for the outpatient department, isolation ward and other key departments. These measures are proposed to provide a guidance for the prevention and control of 2019-nCoV nosocomial infection in the pediatric outpatient and ward.
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ObjectiveA preliminary study on pediatrics nursing-sensitive qualityindicators was carried out to construct a systematic, scientific and sensitive quality system. Methods Delphi method was used to conduct two rounds of questionnaires for 55 pediatric nursing experts, used SPSS20.0 statistical software for data analysis. Analytic hierarchy process method was used to determine the weight of the indicators. Results The final determination agreed rate of experts equal to 75 percent, the importance of assignment mean was>3.5 and the variation coefficient<0.25, which including 5 structure indicators, 17 process indicators and 18 outcome indicators. Conclusion The evaluation system of pediatrics nursing-sensitive quality indicators was constructed in preliminary which could provide the reference and basis for pediatric nursing managers.
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Objective: To explore the relationship between intra-operative blood product transfusion and post-operative prognosis in children with pediatric open heart surgery by cardiopulmonary bypass (CPB). Methods: A total of 1028 consecutive pediatric patients received the open heart surgery by CPB in our hospital were retrospectively studied. Uni- and multivariate Logistic regression analysis were conducted to analyze the relationship between intra-operative blood product transfusion and post-operative in-hospital death and complication rates. Results: There were 45/1028 (4.4%) of patients died, 143 (13.9%) with low cardiac output syndrome, 43 (4.2%) received dialysis, 26 (2.5%) with sustained pulmonary failure, 17 (1.7%) with infection, and 28 (2.7%) developed neurologic complications. Multivariate Logistic regression analysis indicated that duration and the lowest temperature of CPB, 24-hour post-operative pediatric risk of mortality (PRISM-III) score and intra-operative transfusion amount of RBC > median (20.3 ml/kg) were the independent risk factors for post-operative in-hospital death. Congenital heart disease (CHD) with pre-operative cyanosis, duration of CPB, 24-hour post-operative PRISM-III score, 6-hour post-operative mediastinal drain loss and intra-operative transfusion amount of RBC > 20.3 ml/kg were the independent risk factors for post-operative complication occurrence. Conclusion: Large volume of RBC transfusion in the open heart pediatric surgery with CPB may increase the risk of post-operative in-hospital death and complication occurrence, reducing RBC transfusion might be improving the post-operative prognosis in CHD patients.