Presentation of Depressive Symptoms in Autism Spectrum Disorders.

BACKGROUND: Depressive disorders are frequently mis- and underdiagnosed in individuals with autism spectrum disorders (ASD). OBJECTIVE: Our objective was to identify and synthesize current knowledge regarding (1) the presentation of depressive symptoms and (2) the use of self-reports in assessing depressive symptoms in individuals with ASD and comparisons between self-reported and observer-reported symptoms. A scoping review was conducted to capture the full range of literature on the topic and to identify research gaps. METHODS: Articles were identified through a search of academic literature and screened for relevance to the aims of the review. RESULTS: In addition to typical depression symptoms, individuals with ASD may demonstrate atypical symptoms such as changes in autistic symptoms, self-injurious behavior, and psychomotor changes. Moreover, the review revealed a bias toward observer-reports of symptoms. Self-reports frequently were not included or were ascribed less weight than observer-reports. Self-reports typically differed from reports given by parents or other caregivers, but a consistent pattern in these differences has not been established. CONCLUSIONS: Further research on the use of self-reports in assessing depressive symptoms in individuals with ASD is needed. Self-reports may provide information not obtainable through observer-reports, and integrating both self- and observer-reports in psychiatric evaluations may produce more comprehensive and accurate assessments.

Safe Sleep Program for the NICU Nursing Staff: A Pilot Program.

PURPOSE: Following an assessment of safe sleep practices (SSP) and nurses' safe sleep knowledge in a Neonatal Intensive Care Unit (NICU), an evidence-based 2-part safe sleep program including nurse education and the use of safe sleep cards was developed in an attempt to increase SSP. DESIGN: A quality improvement project with time-series methodology, including observational and survey data collection. SAMPLE: To assess SSP, sleep environment audits were completed pre- (N = 48) and post- safe sleep program (N = 44). To assess nurses' safe sleep knowledge, a safe sleep questionnaire was distributed pre-education (N = 48) and post-education (N = 23). MAIN OUTCOME VARIABLE: The change in SSP (ΔSSP) following safe sleep program implementation and change in nurses' safe sleep knowledge (ΔKnowledge) following education. RESULTS: SSP increased from 25 percent to 61 percent compliance, and nurses' knowledge scores increased from 83 percent to 97 percent.

Sustained Reduction of Nasal Pressure Injuries in the Neonatal Intensive Care Unit With the Use of Bubble Continuous Positive Airway Pressure: A Quality Improvement Project.

PURPOSE: The purpose of this interprofessional team-driven quality improvement project was to implement a Bubble continuous positive airway pressure (CPAP) Skincare Protocol proactively to prevent potential device-related pressure injuries. PARTICIPANTS AND SETTING: The setting was a level 3, 60-bed single patient room neonatal intensive care unit (NICU) located within a Midwest urban academic medical center with more than 200 healthcare providers. Prior to the beginning of this project, the NICU had been using the CPAP apparatus that had documented 6 nasal pressure injuries over a 6-month period. Because of ease of use, the NICU moved to using Bubble CPAP (BCPAP), which is known to place patients at a higher risk of nasal pressure injuries due to the way the apparatus sits inside the nares. APPROACH: An evidence-based practice model provided the guiding framework for the development of our BCPAP Skincare Protocol. Knowing that the unit had already documented nasal pressure injuries, the interprofessional-devised protocol was developed to decrease the risk of nasal injuries with the use of BCPAP in premature infants. The protocol was disseminated via an all-healthcare provider educational program. OUTCOMES: During the first 3 months postprotocol implementation period, one stage 2 nasal injury was noted and immediately treated and healed without incident. During the next 24-month, postimplementation period, there were zero nasal pressure injuries reported. IMPLICATIONS FOR PRACTICE: The healthcare providers found that using an interprofessional team approach in developing and implementing an evidence-based BCPAP Skincare Protocol reduced the incidence of nasal pressure injuries associated with the use of BCPAP in the NICU.

Reducing Pressure Injuries in a Pediatric Cardiac Care Unit: A Quality Improvement Project.

The purpose of this quality improvement project was to develop an evidence-based protocol designed for pressure injury prevention for neonates and children in a pediatric cardiac care unit located in the Midwestern United States. The ultimate goal of the project was dissemination across all pediatric critical care and acute care inpatient arenas, but the focus of this initial iteration was neonates and children requiring cardiac surgery, extracorporeal support in the form of extracorporeal membranous oxygenation and ventricular assist devices in the cardiac care unit, or cardiac transplantation. A protocol based upon the National Pressure Ulcer Advisory Panel guidelines was developed and implemented in the pediatric cardiac care unit. Pediatric patients were monitored for pressure injury development for 6 months following protocol implementation. During the 40-month preintervention period, 60 hospital-acquired pressure injuries (HAPIs) were observed, 13 of which higher than stage 3. In the 6-month postintervention period, we observed zero HAPI greater than stage 2. We found that development and use of a standardized pressure injury prevention protocol reduced the incidence, prevalence, and severity of HAPIs among patients in our pediatric cardiac care unit.

Distinguishing the Clinical Nurse Specialist From Other Graduate Nursing Roles.

PURPOSE: Today's healthcare environment poses diverse and complex patient care challenges and requires a highly qualified and experienced nursing workforce. To mitigate these challenges are graduate nursing roles, each with a different set of competencies and expertise. With the availability of many different graduate nursing roles, both patients and healthcare professionals can be confused in understanding the benefit of each role. To gain the maximum benefit from each role, it is important that healthcare providers and administrators are able to distinguish the uniqueness of each role to best use the role and develop strategies for effective collaboration and interprofessional interaction. The purpose of this article was to define the role, educational preparation, role differences, and practice competencies for the clinical nurse specialist (CNS), nurse practitioner, clinical nurse leader, and nurse educator/staff development educator roles. A second purpose was to provide role clarity and demonstrate the unique value the CNS brings to the healthcare environment. DESCRIPTION: Using evidence and reviewing role competencies established by varying organizations, each role is presented with similarities and differences among the roles discussed. In addition, collaboration among the identified roles was reviewed, and recommendations were provided for the new and practicing CNSs. OUTCOMES: Although there are some similarities among the graduate nursing roles such as in educational, licensing, and certification requirements, each role must be understood to gain the full role scope and benefit and glean the anticipated outcomes. CONCLUSIONS: Healthcare providers must be aware of the differences in graduate nursing roles, especially in comparing the CNS with other roles to avoid confusion that may lead to roles being underused with a limited job scope. The CNS provides a unique set of services at all system outcome levels and is an essential part of the healthcare team especially in the acute care setting.

A Case Report and Review of Postural Orthostatic Syndrome in an Adolescent.

Because there are many young women between the ages of 12 and 25 years who have been diagnosed with postural orthostatic syndrome (POTS), with the time to the diagnosis of about 5 years, it is important for health care providers to have an understanding of the clinical presentation of POTS to manage the diagnosis appropriately. The purpose of this article is to present a case study review of an adolescent woman who experienced POTS syndrome at age 16 years and to provide a clinical overview of POTS in the adolescent population.

Putting the Family Back in the Center: A Teach-Back Protocol to Improve Communication During Rounds in a Pediatric Intensive Care Unit.

Patient- and family-centered care is endorsed by leading health care organizations. To incorporate the family in interdisciplinary rounds in the pediatric intensive care unit, it is necessary to prepare the family to be an integral member of the child's health care team. When the family is part of the health care team, interdisciplinary rounds ensure that the family understands the process of interdisciplinary rounds and that it is an integral part of the discussion. An evidence-based protocol to provide understanding and support to families related to interdisciplinary rounds has significant impact on satisfaction, trust, and patient outcomes.

Adolescent Perspectives Following Ostomy Surgery: A Grounded Theory Study.

PURPOSE: This purpose of this study was to provide a theoretical account of how adolescents aged 13 to 18 years process the experience of having an ostomy. DESIGN: Qualitative study using grounded theory design. SUBJECTS AND SETTING: The sample comprised of 12 English-speaking adolescents aged 13-18 years: 10 with an ostomy and 2 with medical management of their disease. METHODS: Respondents completed audio-recorded interviews that were transcribed verbatim. Data were analyzed using the constant comparative method until data saturation occurred. Dedoose, a Web-based qualitative methods management tool, was used to capture major themes arising from the data. RESULTS: Study results indicate that for adolescents between 13 and 18 years of age, processing the experience of having an ostomy includes concepts of the "physical self" and "social self" with the goal of "normalizing." Subcategories of physical self include (a) changing reality, (b) learning, and (c) adapting. Subcategories of social self include (a) reentering and (b) disclosing. CONCLUSIONS: This study sheds light on how adolescents process the experience of having an ostomy and how health care providers can assist adolescents to move through the process to get back to their desired "normal" state. Health care providers can facilitate the adolescent through the ostomy experience by being proactive in conversations not only about care issues but also about school and family concerns and spirituality. Further research is needed in understanding how parents process their adolescents' ostomy surgery experience and how spirituality assists adolescents in coping and adjustment with body-altering events.

Neonatal case studies using active leptospermum honey.

PURPOSE: Treatment of the neonatal patient with clinically complex wounds creates a challenge due to the safety and efficacy issues associated with the use of many advanced wound care products. The purpose of this case series was to present outcomes of 3 neonates with wounds of differing etiologies managed by Active Leptospermum Honey (ALH). DESIGN: Clinical case series. SUBJECTS AND SETTINGS: Clinical experiences with 3 neonates, 1 male and 2 females, are described. These premature infants received care at Rush University Medical Center, Houston, Texas, or Driscoll Children's Hospital, Corpus Christi, Texas. RESULTS: Each neonate presented with dissimilar wounds and differing treatment goals. For a premature infant with left foot ischemia, ALH dressings allowed for removal of nonviable tissue and facilitated the granulation of the open wounds. This removal of nonviable tissue coupled with the facilitation of granulation tissue enabled the premature infant's toe tips to be salvaged without requiring aggressive surgical intervention. For the 2 preterm infants with extravasation of intravenous solutions, ALH dressings allowed healing and increased tissue granulation without any noted toxicity to the wound bed. Further, the method of action of ALH includes an osmotic pull effect that reduced periwound erythema and edema. CONCLUSION: Although the use of ALH has been well documented in adult care, these case studies demonstrate its potential use in different wound etiologies in 3 neonatal patients.

Growth and development issues in adolescents with ostomies: a primer for the WOC nurses.

Caring for the adolescent (13-18 years of age) with an ostomy presents multiple challenges. The purpose of this article is to provide strategies to assist the WOC nurse in minimizing the potential impact on growth and development for this age group with an ostomy. This is relevant to the WOC nurse since it is estimated that between 6% and 14% of all adolescents have symptoms of irritable bowel disease, and many will require an ostomy. Thus the WOC nurse will be called upon to provide care to this age group. This article discusses normal adolescent growth and development and provides strategies to support the normal growth and development.

Right programming of pumps to prevent errors in the infusion process.

A problem area emerged in the programming, administration, and monitoring of infusion pumps. The authors describe their strategies for preventing general infusion pump errors and monitoring patient responses.