Identification of caregiver's knowledge and perceptions of pediatric asthma management: A quality improvement initiative.

INTRODUCTION: Asthma is the most prevalent chronic disease of childhood. Caregiver knowledge is essential to optimize patient quality and safety. Asthma education is an opportunity that can lead to decreased morbidity and mortality, reduced admission rates, lower cost, and improved outcomes for a child with chronic asthma. OBJECTIVE: The purpose of this quality improvement study was to obtain information from caregivers of children with asthma to gain insight into their knowledge gaps and needs as a critical first step towards the provision of patient centered effective and efficient care. METHODS: This was a descriptive educational knowledge assessment conducted using questionnaires via a hand-held electronic device (iPad). RESULTS: All caregivers in this study reported that they desired more education. Specific knowledge deficits were identified and included: understanding the pathophysiology of asthma, mechanism of action of use of medications including both rescue and maintenance agents, and initial actions to implement during an acute asthma exacerbation. CONCLUSION: Caregivers in this sample population had a suboptimal understanding of the asthma disease process and home management strategies. PRACTICE IMPLICATIONS: To maximize education strategies and achieve symptom control and risk reduction in the care of children with asthma, it is imperative that caregivers clearly understand asthma home management and actively participate in all aspects of their child's care. The identification of specific gaps and needs in caregiver's knowledge base is a critical first step towards the provision of patient-centered effective and efficient pediatric asthma care.

Implementing Safe and Effective Pediatric Procedural Sedation in the Emergency Department.

There has been a great increase in the number of diagnostic and therapeutic procedures performed in the emergency department (ED) setting over the past several decades. Most of these procedures are unscheduled, unplanned, and much more likely to be successful and result in a positive outcome when the child's pain, fear, anxiety, and movement are controlled. To promote patient quality and safety, increase the effectiveness and efficiency of care, and improve patient and caregiver satisfaction, there has been a proportionate increase in the number of pediatric procedural sedations performed in the ED. With proper education and skills verification, pediatric procedural sedation can be safely and efficaciously performed in the ED. The purpose of this article is to present an overview of pediatric analgesia, anxiolysis, and sedation to promote compassionate, evidence-based emergency care of children and optimize procedural performance and outcomes.

Pediatric Sexual Abuse: An Interprofessional Approach to Optimizing Emergency Care.

INTRODUCTION: Pediatric sexual abuse can lead to devastating lifelong consequences for the child, their caregivers, and society at large. To achieve the goal of optimizing patient outcomes, strategies to enhance teamwork, education, and mentorship are essential. The ultimate goal of child safety and protection through an evidence-based approach will only be attained when interprofessional alignment of expertise and resources is implemented. METHODS: This project was implemented in a mixed-method design in two phases. Phase 1 was a face-to-face, evidence-based, 3.5-hour educational intervention involving members of the interprofessional emergency care team. Phase 2 consisted of focus groups to discover specific concerns emergency care providers encounter and to provide a forum for discussion on methods to improve care delivery. Data analysis was conducted to examine changes before and after education intervention and to identify themes discovered in focus groups. RESULTS: There was a significant increase in the knowledge, confidence, and self-efficacy of the interprofessional emergency care team regarding sexual abuse after the education intervention. General themes identified in the focus groups included (a) the importance of advancing one's knowledge and skill set in this specialized area, (b) the importance of interprofessional collaboration in the emergency department and with community partners, (c) implementation of evidence-based national guidelines, and (d) ideas for improved quality and safety in the care of the sexually abused child. DISCUSSION: Education and collaboration through an interprofessional approach are required for the promotion of quality and safety for the child presenting with alleged sexual abuse.

Child maltreatment: interventions to improve recognition and reporting.

Child maltreatment is a significant public health problem and described as one of the greatest threats facing the health, welfare, and social well-being of children (Centers for Disease Control and Prevention, U.S. Department of Health and Human Services, 2012). The effect of child maltreatment on the children involved, their families, and society as a whole is substantial. Despite mandatory reporting laws, the poignant reality is that child maltreatment is significantly underrecognized and underreported. Interventions must be designed, tested, and implemented to fulfill the goal of child maltreatment prevention. Forensic nurses are uniquely qualified to assume a leadership role and work collaboratively with children, their caregivers, and all members of the interdisciplinary team to ensure the safety and protection of children. The purpose of this article is to present an evidence-based discussion of the scope of the problem of child maltreatment, contributing barriers to recognition and reporting, and suggestions for interventions designed to achieve the goals of primary and secondary prevention.