Nutritional support of the critically ill child.

There is a growing awareness that the nutrition an individual receives as a child may exert significant consequences later in life. The successful treatment of critically ill children influences their potential for full recovery and optimal outcome. This requires an understanding of how the child responds to stress and starvation. Daily energy needs of the child in the intensive care unit are highly variable. Specific knowledge of the nutritional assessment of these children, whether sustaining an acute or chronic illness, is required, as is an understanding of how the disease process affects the child. Further work needs to be done to evaluate how chronic illness affects the growth, development, and maturation of the child. Assessment parameters remain somewhat controversial, and recent studies indicate that, indeed, critically ill children may be overfed if standard equations are used to calculate needs. Poor clinical outcomes can occur if the child is underfed or overfed. The long-term results of specific diets, micronutrients, glutamine, and new access routes into the infant are not yet known. Research in these areas is rapidly growing, and the new knowledge will provide a greater ability to meet the individual needs of the critically ill child. Perhaps in the future the treatment of choice in patients with organ failure will involve specific micronutrients that influence the immune status and cellular degradation. In the meantime, critically ill children deserve to have their basic nutritional needs met, and nurses can do much to individualize the nutritional support required to produce optimal patient outcomes.

Documenting the primary nursing summary note: a leap toward professionalism.

A newly developed documentation tool greatly enhances professional nursing practice, empowerment, and interdisciplinary collaboration. The Primary Nursing Summary Note captures the essence of the nursing process, records and validates it in the interdisciplinary patient progress notes, and facilitates the provision of high quality, cost-effective health care.

Communicating the financial worth of the CNS through the use of fiscal reports.

To maintain the clinical nurse specialist's (CNS's) leading role within hospital nursing services, routine communication to hospital administration of the impact of the CNS role on the hospital's budget is imperative. The CNS group at Children's Hospital of The King's Daughters implemented a quarterly Fiscal Report to clarify the financial worth of CNS practice. The Fiscal Report presents cost savings and revenue generating activities utilizing the role components of the CNS. During fiscal year 1991, the CNS group reported a total impact of $1,600,000. This article describes in detail the use of the Fiscal Report.

Nurse self-awareness in therapeutic relationships.

Each individual comes into nursing with personal motivations, values, beliefs, and unresolved family-of-origin issues that can impact on therapeutic relationships with families that nurses care for. Possible underlying motives that may impact a nurse's ability to sustain a therapeutic relationship appropriately are described.

The role of the pediatric clinical nurse specialist in gastroenterology.

Clinical nurse specialists have been employed by hospitals for many years. However, very little published information exists specifically describing the role of the pediatric clinical nurse specialist in the field of gastroenterology. The pediatric GI staff nurse and/or GI assistant may be uncertain as how to best utilize this important nursing resource. The author discusses her own role implementation as a pediatric gastroenterology/nutrition clinical nurse specialist and highlights in particular her role as a resource to the GI nurses.