ABSTRACT
BACKGROUND: Parents of hospitalized children, especially parents of children with complex and chronic health conditions, report not being adequately prepared for self-management of their child's care at home after discharge. PROBLEM: No theory-based discharge intervention exists to guide pediatric nurses' preparation of parents for discharge. PURPOSE: To develop a theory-based conversation guide to optimize nurses' preparation of parents for discharge and self-management of their child at home following hospitalization. METHODS: Two frameworks and one method influenced the development of the intervention: the Individual and Family Self-Management Theory, Tanner's Model of Clinical Judgment, and the Teach-Back method. A team of nurse scientists, nursing leaders, nurse administrators, and clinical nurses developed and field tested the electronic version of a nine-domain conversation guide for use in acute care pediatric hospitals. CONCLUSIONS: The theory-based intervention operationalized self-management concepts, added components of nursing clinical judgment, and integrated the Teach-Back method. CLINICAL RELEVANCE: Development of a theory-based intervention, the translation of theoretical knowledge to clinical innovation, is an important step toward testing the effectiveness of the theory in guiding clinical practice. Clinical nurses will establish the practice relevance through future use and refinement of the intervention.
Subject(s)
Parents/education , Patient Discharge , Patient Education as Topic/methods , Pediatric Nursing , Self Care , Child , Child, Hospitalized , Communication , Humans , Nurse-Patient Relations , Parents/psychology , Psychological TheoryABSTRACT
PURPOSE: The purpose was to explore nurses' and physicians' recognition of signs of deterioration and management of symptoms. DESIGN AND METHODS: This descriptive, cross-sectional study used an electronic survey with 35 nurses and 17 physicians. RESULTS: Nurses using the Bedside Paediatric Early Warning System (BedsidePEWS) were significantly more likely to recognize risk for deterioration and respond with appropriate interventions. Physicians incorporating BedsidePEWS were more likely to choose reliable indicators of deterioration and reported significantly more effective communication from nurses to identify deterioration. PRACTICE IMPLICATIONS: BedsidePEWS may improve nurses' and physicians' abilities to recognize early signs of patient deterioration, communicate findings to providers, and plan interventions.
Subject(s)
Clinical Alarms , Nurse's Role , Nursing Assessment/methods , Pediatric Nursing/methods , Physician's Role , Point-of-Care Systems/organization & administration , Risk Management/methods , Adult , Child , Cross-Sectional Studies , Disease Progression , Female , Humans , Interprofessional Relations , Male , Middle Aged , Population Surveillance , Practice Guidelines as TopicABSTRACT
OBJECTIVES: The objectives of this study were to: (1) identify local barriers to nursing presence on patient- and family-centered rounds (PFCR); and (2) increase nursing attendance during PFCR. METHODS: An electronic survey needs assessment was administered to nursing staff on a single acute medical care unit to identify local barriers to nursing presence on PFCR. Daily tracking of nursing presence on rounds was then performed over a 7-month period. During this time period, 2 Plan-Do-Study Act cycles were conducted. The first intervention was a workshop for nurses about PFCR. The second intervention was the development of a strategy to contact nurses by using a hands-free communication device so that nurses were notified when rounds were starting on their patients. To evaluate the impact of our interventions, a p-chart was generated for the outcome of average daily nursing attendance (%) on PFCR per week over the 7-month period. RESULTS: Two barriers identified on the survey were: (1) nurses were uncertain if physicians valued their input during PFCR; and (2) nurses were unsure when the physician team would be conducting rounds on their patients. On the p-chart, the average percentage of nursing attendance before interventions was 47%. After the nursing workshop, no change in the mean nursing attendance on PFCR was noted. After initiation of the hands-free contact strategy, nursing attendance on PFCR rose to 80%. CONCLUSIONS: A nursing contact strategy using a hands-free device led to a sustained increase in nursing attendance during PFCR.
