Impacting the Patient's Experience in a Children's Hospital Using a Communication Bundle Strategy.

BACKGROUND: The aim of this quality improvement project was to determine whether a communication bundle would impact parents' ratings of nurse-child communication in relation to (a) how often the nurse listened carefully to the child and (b) how often the nurse explained things in a way easy for the child to understand. LOCAL PROBLEM: The Child Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) scores on the unit lagged behind the hospital's 75th percentile external benchmark established by the National Research Corporation. METHODS: A convenience sample of the unit's staff participated in the project. INTERVENTIONS: The outcome measure was a comparison of Child HCAHPS scores and percentile ranks for the questions pre- and postimplementation of the communication bundle. RESULTS: Following implementation of the communication bundle, the unit's patient satisfaction scores for both questions exceeded the 75th-percentile benchmark. CONCLUSIONS: This project enhanced nurse communication at the bedside and the parent's perception of nurse-child communication.

A Pilot Study to Assess a Teaching Intervention to Improve Sleep-Wake Disturbances in Parents of Children Diagnosed With Epilepsy.

AIMS: The aim of this study was to assess the impact of screening and teaching interventions for sleep-wake disturbances in parents of childhood patients with epilepsy. METHODS: This was a prospective, descriptive study using convenience sampling. After informed consent was obtained from eligible parents who agreed to participate, study questionnaires were administered. All parents were provided with an individualized teaching intervention. Study tools were readministered 8-12 weeks later to evaluate if the individualized teaching intervention altered or improved sleep-wake disturbances. RESULTS: The t value for the paired t test of the Epworth Sleepiness Scale prescore and postscore was 0.000 with a two-tailed probability value of 1.000, and the t value for the paired t test of the Pittsburgh Sleep Quality Index prescore and postscore was 0.713 with a two-tailed probability value of .492, indicating no significant difference between pre and post Epworth Sleepiness Scale or Pittsburgh Sleep Quality Index scores. CONCLUSIONS: A sleep hygiene teaching intervention for parents of children with epilepsy was not effective in this setting of an inner-city epilepsy monitoring unit in changing postintervention scores on measures of both nighttime sleep quality and daytime sleepiness. These results must be interpreted with caution secondary to the small number included in the initial phase of this study. A larger number of participants will be needed to verify these findings. If the results remain consistent with a larger number, studies evaluating variables of cause may be helpful to determine more effective interventions.

Using QSEN to measure quality and safety knowledge, skills, and attitudes of experienced pediatric oncology nurses: an international study.

OBJECTIVE: This pilot study describes the development of an instrument to measure nursing quality knowledge, skills, and attitudes for practicing pediatric oncology nurses. Because many nurse leaders of academic centers are responsible for outcomes at both local and global level, ensuring nursing quality is critical, given the variability in practice outcomes. METHODS: Quality Improvement Knowledge, Skills, and Attitudes (QulSKA), a 73-item electronic questionnaire was developed using QSEN competencies; the six domains include: quality improvement (QI), safety, evidence-based practice, teamwork, patient-centered care, and informatics. Content validity was established by pediatric oncology, QI, and test-construction experts. Nurses from St Jude Children's Research Hospital and US and Latin American affiliate sites were surveyed. RESULTS: Thirty-seven of 216 RNs surveyed participated in the study. The QulSKA inter-item correlation coefficient was 0.839 (P = .001). The mean knowledge score (based on 100) was 69.2 +/- 11.3. Scores were highest for safety (82.9%) and lowest for teamwork (48.6%). The mean skills rating was 3.3 +/- 0.74 (used 2-4 times). Lowest rated skills were in analysis and QI tools. The mean attitude rating was 3.8 +/- 0.25 (highly important). CONCLUSION: Data suggest that QulSKA may be reliable to measure quality knowledge, skills, and attitudes among pediatric oncology nurses-nurses were knowledgeable in QI, yet they lacked skills in practice application.

A standardized curriculum to introduce novice health professional students to practice-based learning and improvement: a multi-institutional pilot study.

BACKGROUND: Practice-based learning and improvement (PBLI) combines the science of continuous quality improvement with the pragmatics of day-to-day clinical care delivery. PBLI is a core-learning domain in nursing and medical education. We developed a workbook-based, project-focused curriculum to teach PBLI to novice health professional students. PURPOSE: Evaluate the efficacy of a standardized curriculum to teach PBLI. DESIGN: Nonrandomized, controlled trial with medical and nursing students from 3 institutions. METHODS: Faculty used the workbook to facilitate completion of an improvement project with 16 participants. Both participants and controls (N = 15) completed instruments to measure PBLI knowledge and self-efficacy. Participants also completed a satisfaction survey and presented project posters at a national conference. RESULTS: There was no significant difference in PBLI knowledge between groups. Self-efficacy of participants was higher than that of controls in identifying best practice, identifying measures, identifying successful local improvement work, implementing a structured change plan, and using Plan-Do-Study-Act methodology. Participant satisfaction with the curriculum was high. CONCLUSION: Although PBLI knowledge was similar between groups, participants had higher self-efficacy and confidently disseminated their findings via formal poster presentation. This pilot study suggests that using a workbook-based, project-focused approach may be effective in teaching PBLI to novice health professional students.

Quality assessment of pediatric oncology nursing care in a Central American country: findings, recommendations, and preliminary outcomes.

In developing countries, where 80% to 85% of childhood cancer cases occur, the survival rate is often less than 10%. The mission of the International Outreach Program (IOP) at St. Jude Children's Research Hospital is to improve the survival rate of children with cancer. Essential to this mission is the provision of quality nursing care. In May 2006, the quality of nursing care at an IOP Central American partner-site was assessed using nursing standards endorsed by the Joint Commission International (JCI). The assessment provided objective and credible findings and a baseline from which nursing needs and recommendations were determined. After careful review of data, the IOP staff provided recommendations in the areas of education, staffing, compensation, and communication.