Exploring the Needs for Support of Pediatric Nurses Caring for Children with a Mental Health Disorder Hospitalized in Non-Psychiatric Units.

This qualitative study explored the experience and the needs for support of pediatric nurses caring for children with a mental health disorder hospitalized in non-psychiatric units in a health organization in Canada. Semi-structured interviews were conducted with 17 nurses. Content analysis revealed two main themes: (a) nurses are challenged by the lack of knowledge, the gap between access to mental health resources and the basic role of only ensuring safety. Amidst these barriers, nurses revealed their feelings of helplessness, frustration and injustice. (b) All participants voiced their willingness to break this powerlessness loop. They identified several strategies to support them: more training in mental health, better collaboration with the mental health team, etc. Further research is needed to evaluate the efficiency of these strategies to improve the delivery of care for children with a mental health disorder hospitalized in non-psychiatric units.

Recording practices and satisfaction of hemophiliac patients using two different data entry systems.

Record keeping is integral to home treatment for hemophilia. Identified problems with paper diaries include suboptimal compliance and questionable data validity and quality. The effects of an electronic data recording system, Advoy, on data quality, patient adherence, and satisfaction were examined. An exploratory approach was used to examine the sequential use of paper diaries and e-diaries by 38 patients. Data were obtained from paper records for the 6 months preceding the introduction of the electronic record and from the first 6 months of use of Advoy. Completion of mandatory and additional treatment details was also compared. More mandatory information (27.57%) was recorded with the e-diary. As well, the amount of completed additional fields nearly doubled (19.9%-36.5%). Patients tended to complete a greater variety of additional fields with the e-diary than with paper records. Finally, a higher percentage of survey respondents (29.4%) indicated that they were "very satisfied" with Advoy compared with paper records (6.7%). Most survey respondents (94.4%) had a previous experience with electronic programs. The use of the e-diary significantly improved patient adherence in recording mandatory treatment information; the increase in additional data provided by the patients was also found to be an added benefit of this technology.

One-on-one coaching to improve pain assessment and management practices of pediatric nurses.

Pain in children is infrequently assessed and managed by nurses. One-on-one coaching based on audit with feedback and the use of opinion leaders have been effective in changing professional health care practices. Coaching by an opinion leader for changing pediatric nurses' pain practices was tested in a clustered randomized trial in six Canadian pediatric hospitals. The rate of pain assessments, nurses' knowledge, and nonpharmacological interventions increased in the coaching group. However, there were significant site differences that could not be attributed to the coaching but to factors inherent in the sites. The context in which interventions are implemented will influence the effectiveness of individualized interventions.

Childhood chronic pain and health care professional interactions: shaping the chronic pain experiences of children.

Children with chronic pain meet numerous healthcare professionals during their search to understand their pain. Through semi-structured interviews, this qualitative study sought to understand the experiences of five children with chronic pain as they encountered healthcare professionals. In the majority of these interactions, children reported feeling misunderstood, disbelieved and abandoned. The findings of this study demonstrate that children's experiences with professionals influence their approach towards current and future healthcare encounters. All children discussed their guarded relationships with healthcare providers. Children also developed negative perceptions about their pain, in particular believing that their experience with chronic pain was life-threatening, and demanded major life adjustments. Interactions with healthcare professionals have a tremendous influence on children's perceptions and chronic pain experiences. In order to better understand and care for children with chronic pain, it is essential that healthcare professionals provide children with the opporunity to communicate their unique experiences with pain.

Follow-up phone calls after pediatric ambulatory surgery for tonsillectomy: what can we learn from families?

The purpose of this quality improvement study was to describe families' responses regarding the adequacy of the preoperative preparation provided in the Preoperative Assessment Clinic, and the necessity of two follow-up phone calls after pediatric ambulatory surgery for tonsillectomy with or without adenoidectomy (T+/-A). Using a questionnaire developed for the study, 90 families were contacted by phone on the first postoperative day and, of them, 73 were contacted a second time between the ninth and twelfth postoperative days. Families' responses were reported in four categories: (1) concerns, (2) use of resources, (3) adequacy of the preoperative teaching, and (4) necessity of the two postoperative phone calls. Results showed that, at the first phone call, a sore throat was reported as the most important concern followed by a decreased oral intake (ie, fluid, food, medicine), vomiting, and fever or "perceived fever." During the second phone call, a sore throat remained the most important concern followed by a decreased intake. Earache was the third highest concern and vomiting was then reported of concern by a minority of families. The most frequently consulted resource person for concerns was the physician on call for the otolaryngology service. Eighty-seven percent of families felt the preoperative preparation was adequate. For reasons of instructional and/or emotional support, 94% of families who responded reported that the first phone call was necessary and 68% reported that the second call was as well.

Barriers and facilitators to caring for individuals with stroke in the community: the family's experience.

PURPOSE: This project explored caregivers' perceptions regarding the barriers and facilitators to undertaking the post-stroke caregiving role, particularly as related to the health care system, with the ultimate goal of identifying potential strategies that would assist families in successfully undertaking the role. METHOD: A qualitative study consisting of focus groups and individual interviews with caregivers of persons with stroke. Participants were asked about their needs in managing the care of their family member and the factors that facilitated and/or hindered the transition to the home and influenced them in maintaining their role. RESULTS: Information from 14 caregiver participants identified the following as primary barriers to undertaking and maintaining the caregiving role: lack of collaboration with the health care team, the intensity of the caregiving role, the negative impact on the caregiver, and the lack of community support for the caregiving role. Caregivers identified the following factors as facilitative: coordination of care, progress of the patient towards normalcy, mastery of the caregiving role, supportive social environment, and accessible community resources. DISCUSSION AND CONCLUSIONS: The results indicate there are facilitators that caregivers perceive as important both to undertaking and to sustaining the caregiving role. Consideration of these results in the design of interventions may lead to more effective interventions to support caregivers in undertaking and continuing in the caregiver role.