Indicators to measure implementation and sustainability of nursing best practice guidelines: A mixed methods analysis.

Background: The use of best practice guidelines (BPGs) has the potential to decrease the gap between best evidence and nursing and healthcare practices. We conducted an exploratory mixed method study to identify strategies, processes, and indicators relevant to the implementation and sustainability of two Registered Nurses' Association of Ontario (RNAO) BPGs at Best Practice Spotlight Organizations® (BPSOs). Methods: Our study had four phases. In Phase 1, we triangulated two qualitative studies: a) secondary analysis of 126 narrative reports detailing implementation progress from 21 BPSOs spanning four sectors to identify strategies and processes used to support the implementation and sustainability of BPGs and b) interviews with 25 guideline implementers to identify additional strategies and processes. In Phase 2, we evaluated correlations between strategies and processes identified from the narrative reports and one process and one outcome indicator for each of the guideline. In Phase 3, the results from Phases 1 and 2 informed indicator development, led by an expert panel. In Phase 4, the indicators were assessed internally by RNAO staff and externally by Ontario Health Teams. A survey was used to validate proposed indicators to determine relevance, feasibility, readability, and usability with knowledge users and BPSO leaders. Results: Triangulation of the two qualitative studies revealed 46 codes of implementation and sustainability of BPGs, classified into eight overarching themes: Stakeholder Engagement, Practice Interventions, Capacity Building, Evidence-Based Culture, Leadership, Evaluation & Monitoring, Communication, and Governance. A total of 28 structure, process, or outcome indicators were developed. End users and BPSO leaders were agreeable with the indicators according to the validation survey. Conclusions: Many processes and strategies can influence the implementation and sustainability of BPGs at BPSOs. We have developed indicators that can help BPSOs promote evidence-informed practice implementation of BPGs.

Specialized Pediatric Palliative Care in Neonates with Life-Limiting Illness: A Systematic Review.

OBJECTIVE: The aim of this study is to assess the impact of specialized pediatric palliative care (PPC) on neonates with life-limiting conditions compared to standard care. STUDY DESIGN: MEDLINE, PsycINFO, Cochrane Central Register of Controlled Trials, Web of Science, CINAHL, Scopus, and Embase databases were searched from January 2000 to September 2018. Randomized clinical trials, experimental or observational studies, and secondary administrative database analyses published in English, Spanish, French, and German were included. Two independent reviewers extracted data, and used the Newcastle-Ottawa Scale and the Cochrane Risk of Bias Tool for quality analysis. Discrepancies were resolved as a team. RESULTS: From the 37,788 records obtained, only eight articles met the inclusion criteria. A meta-analysis was not possible due to the heterogeneity in how the outcomes were defined; however, a qualitative synthesis of the results was possible; organizing outcomes into eight different categories: psychological, social and spiritual support; communication; location of care; symptom management; bereavement care; predicted versus actual neonatal outcomes; and parental coping, stress, and satisfaction. CONCLUSION: Specialized versus may have an impact on neonates with life-limiting conditions and their families. More studies that evaluate the impact of specialized versus in neonates with sound statistical analysis is warranted.

Decision aids available for parents making end-of-life or palliative care decisions for children: A scoping review.

AIM: To identify and assess the quality of decision aids that align the decision, values and information provided for parents making end-of-life or palliative care decisions for children with life-threatening conditions. METHODS: Six databases and the grey literature were searched in December 2018. Two reviewers independently reviewed database citations, and one reviewed grey literature citations. Citation chaining via Scopus was conducted. Quality was assessed using IPDAS Collaboration Criteria. RESULTS: After reviewing 18 671 database citations and 10 988 grey literature citations, 18 citations describing 11 decision aids remained. Decision aids targeted premature infants, children requiring airway management, children with cancer and children with scoliosis. Three aids underwent testing beyond initial development. Quality scores averaged 27 of 50 points. CONCLUSIONS: There are few high-quality decision aids available for use and a lack evidence of widespread clinical use. Additional research is needed to support systematic development and the use of decision aids with families.

What is known about paediatric nurse burnout: a scoping review.

Burnout in healthcare providers has impacts at the level of the individual provider, patient, and organization. While there is a substantial body of literature on burnout in healthcare providers, burnout in pediatric nurses has received less attention. This subpopulation may be unique from adult care nurses because of the specialized nature of providing care to children who are typically seen as a vulnerable population, the high potential for empathetic engagement, and the inherent complexities in the relationships with families. Thus, the aim of this scoping review was to investigate, among pediatric nurses, (i) the prevalence and/or degree of burnout, (ii) the factors related to burnout, (iii) the outcomes of burnout, and (iv) the interventions that have been applied to prevent and/or mitigate burnout. This scoping review was performed according to the PRISMA Guidelines Scoping Review Extension. CINAHL, EMBASE, MEDLINE, PsycINFO, ASSIA, and The Cochrane Library were searched on 3 November 2018 to identify relevant quantitative, qualitative, and mixed-method studies on pediatric nurse burnout. Our search identified 78 studies for inclusion in the analysis. Across the included studies, burnout was prevalent in pediatric nurses. A number of factors were identified as impacting burnout including nurse demographics, work environment, and work attitudes. Similarly, a number of outcomes of burnout were identified including nurse retention, nurse well-being, patient safety, and patient-family satisfaction. Unfortunately, there was little evidence of effective interventions to address pediatric nurse burnout. Given the prevalence and impact of burnout on a variety of important outcomes, it is imperative that nursing schools, nursing management, healthcare organizations, and nursing professional associations work to develop and test the interventions to address key attitudinal and environmental factors that are most relevant to pediatric nurses.

Impact of specialized pediatric palliative care programs on communication and decision-making.

OBJECTIVE: To summarize and analyze the impact of specialized pediatric palliative care (SPPC) programs on communication and decision-making for children with life-threatening conditions. METHODS: Our search strategy covered MEDLINE, PsycINFO, Cochrane Central Register of Controlled Trials, Web of Science, CINAHL, Scopus, and Embase through September 2018. RESULTS: We reviewed 13 studies analyzing the impact of SPPC programs on communication and decision-making using a wide range of outcome indicators. Study quality was poor in 58% of included papers. SPPC programs improved communication and decision-making between families and healthcare professionals (HCPs), within and between families, and among HCPs. CONCLUSION: SPPC programs generally support and improve communication and decision-making for children with life-threatening conditions, their families and associated HCPs. Families referred to an SPPC program had more discussions with HCPs on a broad variety of topics. However, data on communication with children, siblings, and other family members was scarce and of poor quality. PRACTICE IMPLICATIONS: More research on SPPC program efficacy is needed from the perspective of the ill child, as well as about barriers to end-of-life discussions and the specific aspects of SPPC programs responsible for improving outcomes.

Indicators Used to Assess the Impact of Specialized Pediatric Palliative Care: A Scoping Review.

BACKGROUND: Specialized pediatric palliative care programs aim to improve quality of life and ease distress of patients and their families across the illness trajectory. These programs require further development, which should be based on how they improve outcomes for patients, families, health care professionals, and the health care system. OBJECTIVE: To identify and compare definitions of indicators used to assess the impact of specialized pediatric palliative care programs. DESIGN: The scoping review protocol was prospectively registered on PROSPERO 2017 (CRD42017074090). DATE SOURCES: MEDLINE, PsycINFO, Cochrane Central Register of Controlled Trials, Web of Science, CINAHL, Scopus, and Embase databases were searched from January 2000 to September 2018. Eligible studies included randomized controlled trials, experimental studies, or observational studies that compared specialized programs with usual care. Studies were excluded if most care recipients were older than 19 years or the article was not available in English, French, German, or Spanish. RESULTS: Forty-six studies were included; one was a randomized controlled trial. We identified 82 different indicators grouped into 14 domains. The most common indicators included the following: location of death, length of stay in hospital, and number of hospital admissions. Only 22 indicators were defined identically in at least 2 studies. Only one study included children's perspectives in assessing indicators. CONCLUSIONS: Many indicators were used to assess program outcomes with little definition consensus across studies. Development of a set of agreed-upon indicators to assess program impact concurrent with family and patient input is essential to advance research and practice in pediatric palliative care.

Impactos dos hipoglicemiantes orais no desenvolvimento neuropsicomotor epondero-estatural em recém-nascidos / Impacts of oral hypoglycemics neurological development and weight-height neonatal

Avaliar comparativamente o desenvolvimento neuropsicomotor(DNPM) e pondero-estatural (PE) dos filhosde gestantes portadoras de diabete mélito gestacional(DMG) que utilizaram metformina e glibenclamida. Foirealizado um estudo prospectivo descritivo, de maio atejunho de 2011, avaliando os filhos das gestantes portadorasde DMG, que necessitaram de terapêutica complementarà dietoterapia, e utilizaram metformina (n=38)e glibenclamida (n=22). As drogas foram substituídaspor insulina quando atingida a dose máxima sem controleglicêmico. Os desfechos primários avaliados foramDNPM através do Teste de Triagem de DesenvolvimentoDenver II e PE. Não foi encontrada diferença nos doisgrupos quanto as características maternas e controleglicêmico durante a utilização das drogas, com excessãona idade materna que foi maior no grupo da metformina(34,1%vs29,5%; p=0,03). As características ao nascimentonão apresentaram diferença. Não houve diferençana idade da criança em meses no momento da avaliação(14,2%vs14,3%; p=0,82). Quanto aos desfechosavaliados, não foi encontrado diferença nos parâmetrosPE, com uma relação normal (73,7%vs63,6%; p=0,39) ecom sobrepeso (18,4%vs31,8%; p=0,16) nos grupos dametformina e glibenclamida respectivamente. No DNPMa maioria (80%) das crianças apresentaram uma avaliaçãonormal, não foi encontrado diferença entre os gruposem todos os parâmetros avaliados, e o risco de déficitde linguagem foi o mais freqüente (18,1%vs18,2%;p=0,88) nos grupos da metformina e glibenclamida respectivamente.Não foi encontrado diferença no desenvolvimentopondero-estatural e neuropsicomotor entreos filhos das gestantes portadoras de DMG que utilizarammetformina e glibenclamida.

The aim of this work is to assess comparatively neuropsychomotor(NPMD) and pondero-statural (PS) developmentin babies born to mothers with gestational diabetesmellitus (GDM) treated by metformin and glyburid. Aprospective descriptive study was held in May-June 2011,where babies born to mothers with GDM, who needed complementarytherapy to dietary therapy, and were treatedby metformin (n=38) and glyburid (n=22). The drugs werereplaced by insulin when maximum dose was achievedwithout glycemic control. The primary outcomes assessedwere NPMD through screening test of Denver II and pondero-statural developments. No difference was found betweenthe two groups when maternal characteristics and glycemiccontrol were analysed while treated with drugs, though theonly difference was the maternal age, higher in metformingroup (34,1,%vs29,9%;p=0,03). There were no differencesin childbirth features, nor in child´s age in months while theassessment was performed (14,2%vs14,3%;p=0,83). Accordingto the outcome assessed, no difference was foundin the PS parameters, with a normal ratio (73,7vs63,6%p=0,39) and with overweight (18,4vs31,8% p=0,16) in metforminand glyburid groups respectively. In NPMD most(80%) of the children presented a normal assessment, andno difference was found between groups in all parametersassessed, the language deficit risk was the most frequent(18,1vs18,2% p=0,88) in metformin and glyburid groupsrespectively. No difference was found in neuropsychomotorand pondero-statural development between childrenborn to mothers with diabetes mellitus in pregnancy whowere treated with metformin and glyburid.