Listening to School Nurses' Voices: A Mixed Methods Study on the Continued Impact of COVID-19 on School Nursing Practice.

School closures in March 2020 due to the COVID-19 pandemic precipitated losses of critical student resources as physical, mental, emotional, and social needs escalated. Identifying the challenges, strategies, and changes in school nurse (SN) practice in Massachusetts during this pandemic is fundamental to understanding how to manage future anticipated pandemics while protecting children, communities, and SNs. The purpose of this mixed-methods descriptive study in the second year of the global pandemic was to (a) listen to SN voices through a novel online survey including the prompts of challenges, strategies, and practice changes and (b) describe the SN experience of COVID-19 response in Massachusetts schools, including identification of intent to leave school nursing. Responses were analyzed using descriptive qualitative analysis (n = 73). The prompts each elicited subthemes that coalesced to a cohesive theme: Finding one's way required the support of others to pave untraversed roads.

Post-acute day and night non-invasive respiratory intervention use and outcome: A brief report.

OBJECTIVE: This study aimed to describe daytime and nighttime use and outcome of non-invasive respiratory intervention (NIRI) for infants born prematurely and for children with medical complexity (CMC) during a post-acute care hospital (PACH) admission. METHODS: Thirty-eight initial PACH admissions (October 2018 through September 2020) for premature infants (< 1 year; n = 19) and CMC (> 1 year; n = 19) requiring NIRI during the day and/or at night were retrospectively examined. Measures included: 1) daytime and nighttime NIRI use by type (supplemental oxygen therapy via low-flow nasal cannula or positive airway pressure [PAP] via high-flow nasal cannula, continuous positive airway pressure, or biphasic positive airway pressure at admission and discharge) and 2) daytime and nighttime NIRI outcome-reduction, increase, or no change from admission to discharge. RESULTS: For the total sample (n = 38), daytime vs nighttime NIRI use was significantly different (p < 0.001). At both admission and discharge, supplemental oxygen was the most common NIRI during the day, while PAP was most common at night. From admission to discharge, seven (18%) infants and children had a positive change (reduced NIRI) during the day, while nine (24%) had a positive change at night. At discharge, 11/38 (29%) infants and children required no daytime NIRI, while 4/38 (11%) required no day or night NIRI. CONCLUSION: NIRI use differs between day and night at PACH admission and discharge for CMC. Reductions in NIRI were achieved during the day and at night from PACH admission to discharge for both infants born prematurely and for children with varied congenital, neurological, or cardiac diagnoses.

Caregiver Engagement During Pediatric Post-Acute Care Hospitalization.

OBJECTIVES: Caregiver engagement during acute inpatient hospitalizations has been demonstrated to provide developmental and behavioral benefits for children, decrease readmissions and length of stay, and improve caregiver confidence. Caregiver engagement has been examined in acute care settings; however, there is a gap in information regarding caregiver engagement in a pediatric post-acute care hospital (pPACH). The objective of this study was to explore caregiver engagement in a pPACH. PATIENTS AND METHODS: All patients, birth to 23 years of age, in the medical service of an independent pPACH in the Northeastern United States, January 1, 2013, through December 31, 2017, were identified. Retrospective review of electronic health records for patient demographics and caregiver engagement, identified as visit(s) and telephone call(s), was conducted. Descriptive statistics and logistic regression were used to distinguish differences and measure associations of caregiver visits and calls between demographic groups. RESULTS: The primary mode of caregiver engagement for pPACH patients (n = 614) was by visits, whereas caregiver calls were less frequent. Multivariable logistic regression analysis identified significantly greater odds of caregiver visits among patients ages 1 to 17 years, with private payer, and having a single admission, whereas lower odds of visits were identified among those <1 year or ≥18 years, with ≥2 pPACH admissions, public insurance, Child Protective Services (CPS) involvement, and African American/Black, other, and unknown race/ethnicities. CONCLUSIONS: Patients who were infants, had ≥2 admissions, had CPS involvement, and were covered under public payer experienced lower caregiver visit rates. Strategies are needed to further identify and address barriers to caregiver engagement.