Eliminate Unnecessary Laboratory Work to Mitigate Iatrogenic Anemia and Reduce Cost for Patients on Extracorporeal Membrane Oxygenation.

Laboratory testing is a helpful tool for clinicians, but can be costly and harmful to patients. A quality improvement project was initiated to reduce laboratory testing for patients receiving extracorporeal membrane oxygenation (ECMO) in a pediatric intensive care unit (PICU) at a tertiary care center. Preliminary data was gathered to demonstrate preimplementation practice, cost, and patient need for packed red blood cell (pRBC) transfusions. A new protocol was created by an interprofessional team based on best practice and benchmarking with high-performing organizations. The project was evaluated using two comparison groups, pre- and postimplementation for anyone receiving ECMO therapy in the PICU. The average laboratory tests per ECMO day decreased by 52% (128.4 vs. 61.1), cost per case decreased by 14.7%, pRBC transfusions decreased from 100% to 85%, length of stay (LOS) decreased by 8 days, and mortality rates decreased by 9.5%. The revised pediatric ECMO laboratory testing guidelines were successfully implemented and reduced laboratory cost without adverse effects on mortality rates or LOS.

CE: Assessing a Child's Pain.

: Effective pain assessment is a necessary component of successful pain management and the pursuit of optimal health outcomes for patients of all ages. In the case of children, accurate pain assessment is particularly important, because children exposed to prolonged or repeated acute pain, including procedural pain, are at elevated risk for such adverse outcomes as subsequent medical traumatic stress, more intense response to subsequent pain, and development of chronic pain.As with adults, a child's self-report of pain is considered the most accurate and reliable measure of pain. But the assessment of pain in children is challenging, because presentation is influenced by developmental factors, and children's responses to certain features of pain assessment tools are unlike those commonly observed in adults.The authors describe the three types of assessment used to measure pain intensity in children and the tools developed to address the unique needs of children that employ each. Such tools take into account the child's age as well as special circumstances or conditions, such as ventilation requirements, cognitive impairment, and developmental delay. The authors also discuss the importance of proxy pain reporting by the parent or caregiver and how nurses can improve communication between the child, caregiver, and health care providers, thereby promoting favorable patient outcomes.

An Evolutionary Concept Analysis of Compassion Fatigue.

PURPOSE: The purpose of this article is to fill the need for an updated concept analysis of compassion fatigue. METHODS: This review used Rodgers' Evolutionary Model to direct the analysis of 25 papers published between 2005 and 2015. This review focused strictly on healthcare providers in the formal healthcare setting. CONCLUSIONS: The authors provided an analysis of the evolution of compassion fatigue and identified surrogate terms, attributes and defining characteristics, and antecedents and consequences of the term, true to Rodgers' Evolutionary Model. Related terms are also discussed and a brief case model is provided. CLINICAL RELEVANCE: A better understanding of compassion fatigue will allow researchers and clinicians to identify its causes, prevention, and treatment. This could impact the rate at which healthcare providers leave clinical practice and their ability to compassionately engage with patients.

Understanding Compassion Fatigue in Healthcare Providers: A Review of Current Literature.

PURPOSE: The purpose of this integrative review was to identify, review, synthesize, and analyze the existing literature addressing compassion fatigue (CF) in healthcare providers (HCPs), with careful attention to provider role and practice area. CF needs to be better understood to identify, prevent, and treat it before it becomes problematic for HCPs. CF is representative of the cost of caring and results in physical, emotional, and psychological symptoms that contribute to the decision of the HCP to leave the profession. METHODS: A literature search, guided by search terms related to CF, was conducted using the Cumulative Index to Nursing and Allied Health Literature (CINAHL) and PubMed encompassing publications between 2005 and 2015. The selected literature was then systemically reviewed and synthesized for this narrative review. RESULTS: These preliminary searches resulted in 307 articles, of which 43 met inclusion criteria. These 43 articles were reviewed and reported that CF and related concepts (CF and RCs) were pervasive and affected a wide variety of HCPs working in many clinical settings; however, advanced practice registered nurses (APRNs), respiratory therapists, physical therapists, and occupational therapists were not well represented. The literature provided information regarding prevalence, risk factors, prevention measures, and symptoms of CF and RCs. CONCLUSIONS: While CF and RCs have been explored in a myriad of medical professionals, there is little published regarding APRNs, respiratory therapists, physical therapists, and occupational therapists. More research is needed to evaluate for the presence of CF in HCPs working in a variety of settings and the degree to which it affects personal and professional well-being, including interactions with patients, patient outcomes, and the quality of professional life. Additionally, as the definition and use of the term compassion fatigue has evolved, a need for a well-developed concept analysis has also become evident. CLINICAL RELEVANCE: A better understanding of current research on CF through narrative review, development of a concept analysis, and further exploration of its impact on HCPs has the potential to improve the overall well-being of HCPs, ultimately leading to better patient care and retention within the profession.

Preparing prelicensure and graduate nursing students to systematically communicate bad news to patients and families.

Communicating bad news, otherwise known as difficult conversations, is a complex communication skill that requires didactic learning and practical application. Students learn that what may be interpreted as bad news is determined by the recipient and not by the person who is delivering the news. Learning a systematic approach, such as the SPIKES (Setting, Perception, Invitation, Knowledge, Empathy, Strategy/Summary) mnemonic, prepares prelicensure and graduate nursing students for difficult conversations with patients and families in the clinical setting. Role-playing commonly includes clinical scenarios, and using video recording and playback of the encounters in such scenarios is one method of learning the systematic approach to communicating bad news. Follow-up practice after application in the clinical setting and feedback from faculty and mentors are essential for nursing students to achieve competence in this complex set of communication skills.