Caring for a Child With an Acquired Disability: Unveiling Light From Darkness.

This study explored how parents of children with acquired disabilities transform loss into meaning when faced with traumatic experiences. This type of loss is ambiguous and different from that of the bereaved. Directed content analysis was guided by the predetermined categories of unveiling, darkness, and light. Stories from 8 parents revealed the ability to decide how they perceived their experiences, discovering meaning in caring for their child despite the suffering associated with loss. These findings offer direction for nursing research, practice, and policy on how to assist parents in overcoming these challenges and shed light on the dynamic perspectives of loss.

Community reintegration: Children with special healthcare needs in rural areas.

PURPOSE: The purpose of this study was to gather descriptions from caregivers and providers of children with special healthcare needs (CSHCN) about their experiences with community reintegration. This study focused on three community support areas: the healthcare structure, community of support, and school systems. The research question was, "How do caregivers and providers of CSHCN describe reintegration into community-based systems?" METHOD: This descriptive qualitative study used focus group design to interview caregivers and providers about their experiences. Data were analyzed using conventional content analysis with open coding, clustering into categories, and abstracting into themes. RESULTS: Eight themes were found within three categories. 1. Planning life and caregiving while fighting for everything needed, 2. Deciding to seek help while living with stigma, shame, and fear, 3. Coping with caregiving while feeling isolated, stressed, and overwhelmed, 4. Arranging transportation while living far away, 5. Underwhelming support in community and school systems, 6. Managing finances and covering expenses, 7. Improving communication of complex needs, and 8. Building a community, increasing confidence, and providing hope. CONCLUSION: Community reintegration was described by caregivers and providers as balancing responsibilities, securing resources, and facilitating collaboration, which offer guidance for future care. IMPLICATIONS: Engaging in open dialogue structured by the themes can help nurses understand the unique needs of caregivers of CSHCN. Social policy reform focused on access to care, financial resources, and school support may reduce inequities, and additional research focused on community-based systems, coping, and caregiving may identify needs based on sociodemographics and existing resources.

The Implementation and Evaluation of an Innovative Clinical Immersion Experience for Undergraduate Nursing Students.

ABSTRACT: The demand for clinical placement sites for nursing students requires the development of alternative clinical settings. This study aimed to evaluate an innovative learning experience for nursing students at the World Scout Jamboree. Nineteen students and four faculty were assigned to base camp medical facilities, providing care for more than 45,000 campers. Student pre- and posttests reported significant increases in cultural awareness, communication skills, and clinical problem-solving ability; students rated interprofessional teamwork highly. Findings reveal promising direction for use of alternative clinical sites to fill the gap in clinical placements while offering unique learning experiences.

Nurses' perception of readiness to care for parents of children with special healthcare needs.

PURPOSE: To describe pediatric nurses' perception of readiness to care for parents of children with special healthcare needs. DESIGN AND METHODS: This cross-sectional, exploratory study surveyed 56 pediatric nurses from a large tertiary care center in Appalachia. Participants completed an anonymous electronic survey aimed at evaluating perception of discharge preparation and readiness to care. Data analysis included descriptive statistics and Chi square comparisons. RESULTS: The majority of participants (80%) reported spending 12 h or less preparing parents for discharge. The domains rated lowest on readiness to care included financial, psychological, and emotional. Participants anticipate parents spending an average of 13.9 h a day serving as the child's primary caregiver in the home. CONCLUSIONS: Subjective, 'unseen' domains of readiness are often under-assessed and evaluated. Parents are often discharged with limited preparation to assume around-the-clock care for a child with special healthcare needs, specifically related to their holistic health and wellbeing. PRACTICE IMPLICATIONS: Standardization of discharge preparation and readiness evaluation should focus on overall parent preparedness, including financial, psychological, and emotional domains. Discharge preparation should begin at the time of admission to familiarize parents with care. Clear, frequent communication should be used to emphasize realistic expectations and assess unique needs. Provision of accessible community-based resources should be given early to better equip parents with supportive services once home.

Online Learning Challenges for Nursing Students in Appalachia.

ABSTRACT: It is known that nursing students in an online learning environment may experience challenges related to their quality of life and well-being. However, it is unknown what additional challenges students face in a resource-limited environment like Appalachia. This descriptive study surveyed 154 undergraduate nursing students from a single institution in the Appalachian region at the beginning of the COVID-19 pandemic. Results reveal that students experienced unique resource-related barriers specific to underserved communities that impacted their online learning experiences. Findings offer unique implications for nurse educators facilitating online learning. Specific ideas for those teaching in resource-limited areas are presented.

Relationship between negative emotions and perceived support among parents of hospitalized, critically ill children.

OBJECTIVES: The purpose of this study was to describe relationships between negative emotions and perceived emotional support in parents of children admitted to the pediatric intensive care unit (PICU). METHODS: This cross-sectional descriptive study conducted face-to-face interviews between January 2019 and January 2020. Study variables included depression (PHQ-9 Scale), anxiety (Emotional Distress-Anxiety-Short Form 8a), anger (Emotional Distress-Anger-Short Form 5a), fear (Fear-Affect Computerized Adaptive Test), somatic fear (Fear-Somatic Arousal-Fixed Form), loneliness (Revised 20-item UCLA Loneliness Scale), and perceived emotional support (Emotional Support-Fixed Form). RESULTS: Eighty parents reported symptoms of depression 8.00(4.00, 13.75), anxiety (23.43 ± 7.80), anger (13.40 ± 5.46), fear (72.81 ± 27.26), somatic fear 9.00(6.00, 12.75), loneliness (39.35 ± 12.00), and low perceived emotional support (32.14 ± 8.06). Parents who were young, single, low-income, and with limited-post secondary education reported greater loneliness and lower perceived emotional support. Fear correlated with depression (r = 0.737, P < 0.01) and anxiety (r=0.900, P < 0.01). Inverse relationships were discovered between perceived emotional support and loneliness (r = -0.767, P < 0.01), anger (r=-0.401, P < 0.01), and depression (r = -0.334, P < 0.01). CONCLUSIONS: The cluster of negative emotions identified will serve as potential targets for future interventions designed to enhance support for parents of critically ill children.

Transforming loss: A developing concept for nursing.

PURPOSE: The purpose of this paper is to describe the development of the concept transforming loss for its use in knowledge development and practice improvement. METHOD: A published 10-phase process guided development of this concept. The name and defining core qualities were constructed through a practice story and further understood through a review of the literature. A model was created to represent relationships between the core qualities, and a middle range theory lifted the concept up the ladder of abstraction. Gathering a story with parents experiencing a life changing event with their child led to the synthesis of a mini-saga to describe what is known about the concept. Finally, the development of a mini-synthesis brought the concept building process together to include a population, definition, and research direction. IMPLICATIONS: Structured by the concept transforming loss, further research will include conceptual development through a rigorous review of the literature and empirical development by gathering stories of parents who have experienced a life-altering event of their child.

Propofol Drug Shortage Associated With Worse Postoperative Nausea and Vomiting Outcomes Despite a Mitigation Strategy.

Drug shortages negatively affect patient care and outcomes. Postoperative nausea and vomiting (PONV) can be mitigated using risk assessment and prophylaxis. A 2012 propofol shortage provided an opportunity to study the impact of using prophylactic antiemetics and changing the technique from a propofol infusion to inhaled agents in an ambulatory surgery setting. We retrospectively collected data for 2,090 patients regarding PONV risk factors, anesthetic management, and PONV outcomes for periods before, during, and after the shortage. Patients during the propofol shortage experienced a higher incidence of PONV (11% vs 5% before the shortage), greater need for rescue antiemetics (3% vs 1%), and longer duration of stay (mean [SD] = 124 [115] minutes vs 118 [108] minutes). More patients in this group reported PONV at home (14% vs 7%), and 2 required unplanned admission or return to the hospital. During the shortage, patients had a 2-fold increase in the odds of PONV when adjusted for all risk factors. Antiemetics moderated the association between gender and PONV but did not change the effect of the shortage. Findings suggest that despite mitigation efforts, the inability to use propofol infusion was associated with worse PONV outcomes.