Identification and measurement of nurse sensitive outcomes in pediatric nephrology nursing.

Patient outcomes are increasingly the focus of research and are seen as primary indicators of nursing care quality. The identification and measurement of nurse-sensitive outcomes that actually reflect nursing care are more difficult than it seems. Many of the outcomes currently in use for nephrology patients are global in scope and influenced by many health professionals as well as patients and families. Further, outcomes appropriate for adult nephrology patients may need modification for pediatric patients or may not work at all. This article explores issues related to identifying outcomes related to the nursing care of pediatric nephrology patients, reviews selected outcomes, and describes measurement strategies.

Continuous venovenous hemofiltration: a cost-effective therapy for the pediatric patient.

The authors were surprised to discover that at Riley Hospital for Children the cost of continuous venovenous hemofiltration (CVVH) constitutes a small fraction of the total admission costs, even when it is performed for a large portion of inpatient stays. A reasonable treatment that gives critically ill children reasonable chances of surviving at reasonable costs, must be considered cost-effective. CVVH currently offers some pediatric patients an additional chance at survival without an extraordinary increase in total hospital bills. Further research regarding patient selection, timing of initiation of therapy, and improving outcomes is recommended.

Rehabilitation and social and adaptive development of young renal transplant recipients.

OBJECTIVE: To survey a group (n = 37) of children and adolescents, who had received renal transplants, along with a parent, to determine their rehabilitation status and social and adaptive development. Additionally, subjects were asked to identify factors perceived as interfering with development and rehabilitation. DESIGN: This primarily descriptive study used a comparative data analysis strategy. There was also an exploratory component to the study. SAMPLE/SETTING: Potential subjects included all children more than 5 and less than 21 years of age who had received at least one renal transplant at a large university medical center in the Midwest. Subjects' actual ages were 5 to 20 (mean = 13.1); 14 were female, 23 were male. Twenty-five had a functioning transplant at the time of the study. METHODS: Telephone interviews were conducted with the child and a parent. The Vineland Adaptive Behavior Subscales for communication, daily living skills and socialization were administered. RESULTS: The mean communication score was 86.5 (19th percentile), mean daily living skills score was 88.1 (21st percentile), and the mean socialization score was 89.0 (23rd percentile). There was no significant difference on any domain score by whether or not the child had a functional transplant at the time of the study. Factors reported by child and parent as interfering with age-appropriate activities were explored. CONCLUSIONS: Nurses working with children and adolescents who have received renal transplants have many opportunities to incorporate developmental assessments and interventions into their nursing care to help these children to lead fuller and more satisfying lives.

Care of the family of the child with end stage renal disease.

A major challenge for the pediatric nephrology nurse is to build a relationship with the family of the child with end stage renal disease (ESRD) that is neither intrusive nor fosters overdependence. Strategies addressed in this article include assessment, the team approach, teaching, emotional support, counseling, and coping with the health care system.

Creating a therapeutic environment in a pediatric renal unit.

Creating and maintaining a therapeutic patient environment has been the responsibility of nurses since the days of Florence Nightingale. Achieving this environment for children with renal disease and their families can, however, be a complex task. This article addresses a number of factors that must be considered in planning a new pediatric unit or renovating an established one. Useful strategies leading to a therapeutic environment in a pediatric nephrology unit are described as well.