Examining Mental Health Disorders in Overweight and Obese Pediatric Patients.

INTRODUCTION: We investigated the frequency and variation in three mental health diagnoses among obese or overweight children and adolescents. METHOD: Logistic regression was used to examine the association between the outcome variables-anxiety, depression, and adjustment disorders-with the following covariates: overweight/obesity status, sex, age, and race. RESULTS: Findings show anxiety, depressive, and adjustment disorder diagnoses were significantly higher for overweight or obese youth in our sample. In addition, diagnosis rates for one or more of these disorders increase as children grow into adolescence. Furthermore, we found significantly higher rates of depression and significantly lower rates of anxiety among youth who live in places with higher rates of poverty. DISCUSSION: Findings indicate a target age for providers to focus on mental health screening among overweight/obese patients: (1) early adolescence (aged 11-14 years) for depressive and adjustment disorders and (2) early childhood (aged 2-4 years) for anxiety disorder.

Holistic review of BSN to DNP applicants: A step-by-step approach to implementation.

BACKGROUND: Now, more than ever, enhancement of diversity and inclusion is significant to the nursing profession. One way that nursing institutions can enrich diversity in the workforce is through enrollment of students from diverse backgrounds. PURPOSE: The overarching goal of this innovative admissions revision project was to implement and assess the process of holistic admissions in a BSN to DNP family nurse practitioner track. METHODS: Using a step-by-step approach, the authors in this paper present five key steps to implementing a holistic review of doctoral nursing applicants. These five steps are: (1) assessing fit of admissions criteria, (2) utilizing shared governance, (3) measuring admissions criteria, (4) analyzing reliability, and (5) evaluating revision outcomes. RESULTS AND CONCLUSION: The step-by-step approach to holistic admissions discussed in this paper was feasible and cost effective. The scoring tool developed for applicant videos demonstrated very good to excellent reliability among raters in two different scoring scenarios. Diversity enhancement among enrolled students was noted in gender, race, and ethnicity after a holistic review was implemented. IMPLICATIONS: Findings from this innovative admissions revision have implications for nursing education, advanced nursing practice, organizational policy, workforce diversity, and student/patient outcomes.

Teaching Nurses From a Holistic Comfort Perspective.

Nursing students in various degree programs experience an array of stressful and demanding circumstances. As such, nursing faculty have a unique opportunity to provide student-centered teaching from a holistic comfort perspective. Holistic comfort is a concept supported by evidence symbolizing more than just the relief of pain. It involves caring for the whole person. The majority of research surrounding holistic comfort has been focused on patients-but, what about students in nursing? In this article, the authors aim to explain and expand upon the role of teaching from a holistic comfort perspective. Holistic comfort has been well documented in the literature and it is delivered in one (or more) of 4 different contexts: the physical, psychospiritual, sociocultural, and/or environmental context. Implementing a program of teaching focused on comforting students has implications for nursing education, organizational policy, and nursing practice.

Piloting Virtual Clinical Site Visits in a Family Nurse Practitioner Program.

BACKGROUND: In nurse practitioner (NP) programs, NP faculty are responsible for evaluating student progress via clinical site visits. The purpose of this pilot study revolved around investigating the following aims: virtual clinical site visit feasibility, faculty perspectives related to implementing virtual and face-to-face clinical site visits, and exploration of student learning and related experiences with both virtual and face-to-face site visits. METHOD: This mixed-methods pilot study included cross-sectional assessment of faculty and preceptor perspectives, as well as an open-ended qualitative descriptive survey for students. RESULTS: Three themes of student experience were found: We Discussed Strengths and Weaknesses, I Had a Better Experience, and I Had Trouble. Faculty years in practice was significantly associated with preference of face-to-face visits and preference of observing preceptor teaching methods. CONCLUSION: Student learning needs for clinical site visits are multifactorial. Virtual site visits are feasible, cost effective, and time efficient for faculty and nursing administration needs. [J Nurs Educ. 2014;53(3):160-164.].

The Pediatric Procedural Holistic Comfort Assessment: A Feasibility Study.

INTRODUCTION: Holistic comfort is an essential component of pediatric procedural care. However, a main gap in the literature is the ability to measure this. In this study, researchers report the feasibility of implementing a newly developed psychosocial measurement instrument in clinical practice. METHOD: This mixed methods study was guided by Kolcaba's holistic comfort theory. Descriptive and inferential statistics and a qualitative descriptive approach to cognitive interviewing were used. Children aged 4 to 8 years (n = 16) experiencing a nonurgent needle procedure and registered nurses (n = 14) who administered the instrument were recruited. RESULTS: Eight qualitative themes of feasibility and comprehensibility were identified. Perspectives of children and nurses were not significantly associated with any demographic variable. The Pediatric Procedural Holistic Comfort Assessment is a feasible instrument to implement but will benefit from minor revisions. DISCUSSION: This study has implications for nursing practice, research methodology, and future research. The Pediatric Procedural Holistic Comfort Assessment can be successfully implemented by nurses in health care settings.

Exploring Holistic Comfort in Children Who Experience a Clinical Venipuncture Procedure.

PURPOSE: Children often experience the uncomfortable effects of invasive procedures as a part of primary care and during times of illness. Holistic comfort has been well documented in adult literature but little research exists on the understanding of holistic procedural comfort from the child's perspective. In this study, holistic comfort related to an invasive venipuncture procedure was explored in children age 5 to 7 years and their caregivers of all ages. DESIGN: A qualitative descriptive design described by Sandelowski was used. METHOD: The philosophical underpinnings of naturalistic inquiry of Guba and Lincoln were used. Semistructured interviews were conducted with 13 child and 15 caregiver participants. Children also drew pictures to help describe their perceptions. FINDINGS: Traditional thematic content analysis described by Hsieh and Shannon yielded four overarching themes of holistic comfort related to venipuncture procedures in children: Body Comfort, Cognitive and Emotional Comfort, Comfort in the Procedure Surroundings, and Comfort Play. CONCLUSIONS: Numerous recommendations for future research are included. Implications for nursing and related health sciences, organizational and administrative policy, invasive procedures, theory, and methods were found and are discussed. Findings from this study will assist nurses in providing procedure management for children from a holistic care perspective.

Cognitive Dissonance and Pediatric Procedural Pain Management: A Concept Clarification.

BACKGROUND: Pediatric nurses have often reported that pain management is a vital part of patient care. Evidence, however, suggests pediatric procedural pain treatments are often underused. Cognitive dissonance, the mental conflict leading to unpleasant thoughts and or feelings, may be related to this evidence-based gap found between what pediatric nurses claim about procedural pain management (that it is important) and what they actually do (underutilize pain treatments). OBJECTIVE: The purpose of this manuscript is to clarify and further develop the concept of cognitive dissonance in terms of its relationship to nurses' mental struggles with underutilization of pediatric procedural pain treatments. A more relevant and extended definition of cognitive dissonance is presented. DESIGN: The concept of cognitive dissonance was examined using Rodgers' evolutionary concept analysis approach/framework. Analysis Methods: Through a six-step process of concept identification, setting and sample identification, data collection, data analysis, and future implication discussion, a more accurate and representative definition of cognitive dissonance is described. Databases used included CINAHL, Google Scholar, PsycINFO, ERIC, and PubMed. Seminal, recent, and relevant works were included in the review to adequately develop and clarify the concept. CONCLUSIONS: Procedural pain management breech among pediatric nurses is proposed to occur before the mental conflict produced. The unpleasant mental conflict created after the breech is followed by the nurse's determination to reduce mental conflict through attitude change followed by cognition change, which more closely reflects his or her behavior.

Holistic Comfort Interventions for Pediatric Nursing Procedures: A Systematic Review.

Comfort interventions for children during invasive nursing procedures have been well documented in the literature. It is important, however, to distinguish between the provision of holistic comfort management and pain alleviation. Holistic comfort focuses on treating the child's whole procedural experience and includes more than simply reducing pain. In this literature review, 33 intervention studies were examined. These studies focused on evaluating comfort effects from nursing interventions on pain, anxiety, fear, and distress. Four themes of procedural comfort intervention emerged: music therapy, amusement and entertainment, caregiver facilitation, and a multifaceted approach. Important findings of this review, gaps in the literature, and implications for future research are discussed.

Increasing nursing treatment for pediatric procedural pain.

Procedural pain management is an underused practice in children. Despite the availability of efficacious treatments, many nurses do not provide adequate analgesia for painful interventions. Complementary therapies and nonpharmacologic interventions are additionally essential to managing pain. Owing to the increasing awareness of inadequate nursing utilization of pharmacologic measures for procedural pain, this paper focuses only on analgesic treatments. The aim of this review was to examine how varying degrees of quality improvement affect nursing utilization of treatments for routine pediatric procedural pain. A comprehensive search of databases including Cinahl, Medline/Pubmed, Web of Science, Google Scholar, Psycinfo, and Cochrane Library was performed. Sixty-two peer-reviewed research articles were examined. Ten articles focusing on quality improvement in pediatric pain management published in English from 2001 to 2011 were included. Three themes emerged: 1) increasing nursing knowledge; 2) nursing empowerment; and 3) protocol implementation. Research critique was completed with the use of guidelines and recommendations from Creswell (2009) and Garrard (2011). The literature reveals that nurses still think that pediatric pain management is essential. Quality improvement increases nursing utilization of procedural pain treatments. Although increasing nursing knowledge improves pediatric pain management, it appears that nursing empowerment and protocol implementation increase nursing compliance more than just education alone. Nurses providing pain management can enhance their individual practice with quality improvement measures that may increase nursing adherence to institutional and nationally recommended pediatric procedural pain management guidelines.