Improving care for patients who experience miscarriage in emergency departments: a practice innovation.

Vaginal bleeding during pregnancy is a common patient presentation in emergency departments (EDs), and in some cases this will occur due to miscarriage. However, there are several barriers to effective and sensitive communication with patients experiencing a miscarriage. Women presenting to EDs who are experiencing a miscarriage are more likely to be psychosocially vulnerable and less satisfied with their care compared with those seeking care in the outpatient setting. There is a gap in nursing and advanced practice provider preparation regarding techniques for breaking bad news to patients in the ED setting. At one high-volume, urban ED in the US, an education programme for staff regarding best practice in breaking bad news to patients experiencing a miscarriage was developed based on an established protocol. The intention was to increase the confidence levels of nurses and other healthcare professionals in breaking bad news to these patients. After the education programme, many participants self-reported increased confidence in breaking bad news and comfort in managing patients' emotions. The results can be used to inform education for healthcare professionals who deliver bad news in the ED and other departments.

A-TEAM: An Interprofessional Approach to Mandated Reporting in the Hospital Setting.

Reporting suspected child maltreatment in pediatric settings presents unique challenges. Variation in mandated reporter training may lead to discomfort and emotional dysregulation. Failure to collaborate inter-professionally potentially results in suboptimal care for vulnerable children and families. A-TEAM promotes awareness, transparency, empathy, a nonjudgmental strategy, and management by an interprofessional team when referring patients for child protective services evaluation. A faculty trained in pediatric trauma nursing led the development of A-TEAM. Integrating nursing and social work expertise protects the integrity of family-centered patient care. The A-TEAM approach may be a valuable contribution to the continuing education of pediatric health care professionals.

I Get by With a Little Help From My Peers: Mindfulness and Peer Support for Doctor of Nursing Practice Students.

ABSTRACT: Graduate nursing students faced numerous stressors while pursuing their education during the COVID-19 pandemic, with many working clinically while studying. The purpose of this pilot was to explore support strategies and decrease stress in first-year students enrolled in a doctor of nursing practice program during a time of uncertainty and crisis. Graduate students were assigned to practice a three-minute mindfulness activity and connect with a fellow student for a month. Students reported mindfulness benefits and social support. Modeling healthy practices is critical to support mastery of skills that will promote positive reactions to challenges in their future practice settings.

Together in Christ: Supporting Nursing Alumni During the COVID-19 Pandemic.

ABSTRACT: The StagsCare program at a Christian university offered support to recent nursing graduates and other alumni during the early days of the COVID-19 pandemic. Faculty of the Egan School of Nursing and Health Studies created the StagsCare program, providing opportunity for alumni spanning over 20 class years to join in community for prayer, reflection, and shared experience. Both new and seasoned nurses, most of whom did not know one another, offered support to one another and strengthened their spiritual foundations as they served on the frontlines of the pandemic across the United States.

Preparing for the Impact of COVID-19 on the Mental Health of Youth.

The COVID-19 pandemic is continuing to have long-term and global effects that the vaccine may not ease. Children and adolescents endured unprecedented periods of loneliness, social isolation, financial stressors, in-home conflicts, changes in living circumstances, and variable access to healthcare, resulting in increased mental health sequelae. Timely recognition of students' anxiety, depression, and disruptive behaviors will allow appropriate interventions to de-escalate these feelings and prevent suicidal ideations and attempts. As youth return to school, their mental health needs will not subside. School nurses and the multidisciplinary team have a vital role in impacting this population's already surging increase of mental and behavioral health disorders.

An Interprofessional Approach to Family-Centered Child Protective Services Referral: A Case Report.

BACKGROUND: Members of the trauma team often find themselves in a uniquely challenging position wherein their role on the care team may necessitate developing a working relationship with alleged or confirmed perpetrators of abuse. CASE PRESENTATION: A 9-week-old admitted to the hospital with hyponatremia and evaluation for suspected child physical abuse. Specific details of the case were a barrier to communication and interactions between the patient's mother and the trauma nurse. This report will provide a discussion of takeaway lessons to support communication with this patient population. CONCLUSION: Peplau's Theory of Interpersonal Relations is utilized as a framework for engaging in therapeutic communication with a family that is part of a child protective services evaluation. The mnemonic, A-TEAM (Aware, Transparent, Empathetic, A nonjudgmental approach, and Managed by an interprofessional team), is introduced as a strategy for trauma nurses and other health care team members to engage in therapeutic communication with a family that is part of a child protective services evaluation during their admission.

Moving Toward Standardized Pediatric Performance Improvement Measures in Child Physical Abuse: A Modified Delphi Approach.

BACKGROUND: Limited guidance exists for pediatric trauma centers (PTCs) regarding best practice for measuring and reviewing performance improvement (PI) in the child physical abuse population. To move PTC programs toward standardized guidelines and PI practices, current practice and points of consensus among level 1 and 2 PTCs across the United States were assessed. METHODS: Utilizing a two-round, modified Delphi methodology, electronic surveys were distributed to pediatric trauma program managers and coordinators representing 125 PTCs. Survey data included demographics, coding practices, definitions, current PI measures, prevention programs, and opinions regarding key components of child physical abuse guidelines. RESULTS: In Round 1, responses were received from 90 (72%) PTCs [47 (84%) ACS-verified level 1 PTCs; 29 (73%) ACS-verified level 2 PTCs; and 14 (48%) state PTCs]. Of the respondents, 87% agreed that establishing a national consensus for child physical abuse PI is important, and 92% agreed that their institution would benefit from standardized guidelines. Although PI process varied among PTCs in terms of measures, review, and coding practices, several points of consensus were achieved. CONCLUSION: Survey results demonstrate areas of consistency and a foundation for consensus among PTCs. Results also identify areas of practice diversity that may benefit from an attempt to standardize PI across centers.

Librarians collaborate successfully with nursing faculty and a writing centre to support nursing students doing professional doctorates.

This study explores how a three-way collaboration between a University library, writing centre and faculty created avenues of training and support for students within a Doctor of Nursing Practice (DNP) program in an American University. The role of each partner involved in the collaboration is discussed alongside the profile of the DNP students. Lesson planning and classroom techniques for DNP information literacy classes are described and feedback from the partners and the students are discussed. The study confirms that collaboration is effective in improving research and writing skills. D.I.

Igniting Change: Supporting the Well-Being of Academicians Who Practice and Teach Critical Care.

Academicians who maintain a critical care clinical practice encounter numerous stressors, especially during the COVID-19 pandemic, which can influence well-being. This article provides historical perspectives on the stressors inherent in working in the critical care environment as well as the stressors of working in the academic environment. It proposes the application of the synergy model as a framework to help improve the well-being of academicians who practice and teach critical care. The most valuable strategy to improve professional well-being is for organizations to take a systems approach. The article focuses on approaches that are potentially within each individual's control.

Recognizing Victims of a Hidden Crime: Human Trafficking Victims in Your Pediatric Trauma Bay.

Human trafficking is the second largest criminal industry in the United States and almost half of the victims are children. This crime against children is referred to as domestic minor human sex trafficking (DMHST). The majority DMHST victims access health care, often at an emergency department, at some point during their captivity. Trafficking of minors has been cited as the most underreported form of child abuse making education on this topic essential for all health care providers to help meet the needs of this population. A case study provides an illustration of a pediatric trauma patient who was a victim of DMHST and presented to an emergency department for care. As nurses who care for pediatric trauma patients in all settings strive to learn more about child abuse, topics in DMHST should also be included in these educational activities.

Prepared to Care: An Exploration of Continuing Education Trends of Nurses Caring for Injured Children.

The significance of nursing competence in the care of pediatric trauma patients has been well documented. Continuing education for trauma nurses is a critical component of maintaining competence in pediatric trauma care; yet, there is significant variability in the programs and resources used to support this goal. The purpose of this current study was to describe the educational activities that practicing registered nurses engage in to inform their care of injured children. A quantitative, descriptive nonexperimental research design was utilized to describe the educational programs that members of the Society of Trauma Nurses (STN) must complete to work in verified and designated trauma centers. Participants completed a survey instrument that included demographic questions, pediatric trauma educational programs required/offered by their employer, and feedback about pediatric trauma nursing education. A total of 266 STN members completed the electronic survey, reflecting a 9% response rate. Most of the participants reported that the verifying body required trauma nursing education hours (n = 187, 70.3%). The number of required courses ranged from 1 to 6, with 33 (12.4%) reporting this 3-course combination-emergency nursing pediatric course (ENPC), pediatric advanced life support (PALS), and trauma nursing core course (TNCC). The second most common combination of courses (n = 30; 11.3%) was required to take both PALS and TNCC. No significant relationship was found between verifying agency type and continuing education program required (p> .05). Trauma nursing core course was the most popular course (n = 208; 79%), followed by PALS (n = 194; 73%) and ENPC (n = 103; 38%). Participants also shared barriers to continuing education activities. It has been 10 years since pediatric trauma nursing course utilization was first explored in the literature. There continue to be significant opportunities to support nurses in continuing education activities related to the care of injured children. While barriers to accessing these types of activities sometimes exist, it is the responsibility of the pediatric trauma community to explore these challenges even further and collaborate with others interested in improving the care of injured children.

Determining the Education and Research Priorities in Pediatric Trauma Nursing: A Delphi Study.

Trauma has a greater impact on morbidity and mortality than all other disease processes in the pediatric population; yet, there is a gap in the literature related to the scientific basis for educating and researching future practice. The purpose of this research study was to utilize the Delphi technique to identify the current education and research priorities for pediatric trauma nursing as described by the members of the Society of Trauma Nurses. Consensus on the education and research priorities was derived from a sample (n = 25) of trauma nursing experts. The pediatric trauma nursing education priorities are the following: (1) initial resuscitation; (2) assessment; and (3) evidence-based practice. The pediatric trauma nursing research priorities are the following: (1) impact of nursing care on outcomes; (2) initial resuscitation; and (3) critical care. Future efforts in educational program development and research study should focus on these priorities.

The Cost of Caring: An Exploration of Compassion Fatigue, Compassion Satisfaction, and Job Satisfaction in Pediatric Nurses.

PURPOSE: The purpose of this study was to describe levels of compassion satisfaction, compassion fatigue, and job satisfaction among pediatric nurses in the United States and determine if there was a relationship among these constructs. DESIGN AND METHODS: All members Society of Pediatric Nurses were sent an electronic invitation to participate, and those who consented received three measures; a demographic questionnaire, the Job Satisfaction Survey (JSS) and the Professional Quality of Life (ProQOL) measure. RESULTS: Three hundred eighteen (10.6%) of members of the Society of Pediatric Nurses participated in the study: Over three quarters (245, 76%) of the sample had another career before nursing. The sample's mean job satisfaction level was 149.8 (SD=29.74), which was significantly higher than published reported means for nurses. Bivariate analyses revealed a significant relationship between gender and the compassion satisfaction, in that women were more likely to evidence compassion satisfaction than men (t=1.967, p=.05, df=298). No other significant relationships were found. CONCLUSIONS: The majority of nurses had high levels of compassion satisfaction and job satisfaction; further, female gender was associated with higher levels of compassion satisfaction. PRACTICE IMPLICATIONS: This current study had a very high response from second-career nurses (n=245, 76.8%) and overall, the sample had higher levels of compassion satisfaction. It is possible that second career nurses are better equipped in some way that helps them mediate negative responses of caring as a pediatric nurse and future research should explore this. Due to the significant financial costs to institutions of having nurses who have low levels of job satisfaction and high levels on compassion fatigue, it is imperative for hospital administrators to develop infrastructures to support employees.

An International Interprofessional Study of Mental Models and Factors Delaying Neuroimaging of Critically Head-Injured Children Presenting to Emergency Departments.

OBJECTIVES: Thousands of head-injured children are cared for by interprofessional teams in emergency departments every day. Teams must balance performing time-consuming interventions with safe transport for neuroimaging. This study aims to describe and compare providers' perspectives on the transfer of head-injured children to neuroimaging and factors contributing to delays. METHODS: Participants were interprofessional health care providers involved in the care of head-injured children at sites in the United Kingdom, the United States, and New Zealand. They first viewed a 3-minute video of a child with a severe head injury presenting to their resuscitation bay. Next, they were presented with 5 physiologically different simulated scenarios and asked to report whether interventions were required before transporting each patient to neuroimaging. Then, they reported team and system factors contributing to delays in neuroimaging. RESULTS: Two hundred forty of 296 providers completed the intervention. The percentage of providers reporting that they would directly transport to neuroimaging without intervention was 89% for "stable," 49% for "Cushing's triad," 26% for "hypoxic," 25% for "tachycardic," and 5% for "extremis." There were differences noted in responses by profession for the hypoxia and tachycardia cases. No differences were noted between trainees and attending physicians for any cases. The most frequent factors reported as delaying neuroimaging were team decision making and waiting for equipment, medications, and scanner availability. CONCLUSIONS: There is variability in providers' perspectives on the interventions required before transporting severely head-injured patients for imaging. Diverse team and system factors contribute to delays in imaging.

Technology Use and Technological Self-Efficacy Among Undergraduate Nursing Faculty.

AIM: This study explored faculty responses to a survey about using technology to teach undergraduate nursing students. BACKGROUND: Little is known regarding faculty confidence, technology use, or supports for integrating technology into nursing education. METHOD: A descriptive correlational design was utilized to explore the relationship between technology use and technological self-efficacy in faculty (N = 272) who teach at Commission on Collegiate Nursing Education-accredited nursing programs. Instruments used were a sociodemographic questionnaire, the Roney Technology Use Scale, and the Technology Self-Efficacy Scale. RESULTS: Participants who taught didactic content had moderate technology use as compared to those teaching didactic and clinical/laboratory who reported high levels of technology use. A weak relationship between age and technological self-efficacy (ρ = .127, p < .05) was also found. CONLUSION: This research was an initial step in understanding levels of technology use and responses to this challenge by undergraduate nursing faculty.

Describing clinical faculty experiences with patient safety and quality care in acute care settings: A mixed methods study.

BACKGROUND: A major safety initiative in acute care settings across the United States has been to transform hospitals into High Reliability Organizations. The initiative requires developing cognitive awareness, best practices, and infrastructure so that all healthcare providers including clinical faculty are accountable to deliver quality and safe care. OBJECTIVE: To describe the experience of baccalaureate clinical nursing faculty concerning safety and near miss events, in acute care hospital settings. METHODS: A mixed method approach was used to conduct the pilot study. Nurse faculty (n=18) completed study surveys from the Agency for Healthcare Research and Quality (AHRQ) to track patient safety concerns: Incidents; Near misses; or Unsafe conditions, during one academic semester, within 9 different acute care hospitals. Additionally, seven nurse faculty participated in end of the semester focus groups to discuss the semester long experience. RESULTS: Clinical faculty identified a total of 24 patient occurrences: 15 Incidents, 1 Near miss event, and 8 Unsafe conditions. Focus group participants (n=7) described benefits and challenges experienced by nursing clinical faculty and students in relation to the culture of safety in acute care hospital settings. Six themes resulted from the content analysis. CONCLUSIONS: Utilizing nursing clinical faculty and students may add significant value to promoting patient safety and the delivery of quality care, within acute care hospital settings.