Trauma Registry Professionals' Perspectives on the Secondary Traumatic Stress Component of Compassion Fatigue: A Qualitative Study.

BACKGROUND: Secondary traumatic stress and compassion fatigue have been studied among trauma clinicians yet have not been explored in trauma registry professionals (TRPs). OBJECTIVE: The purpose of this study is to describe the secondary traumatic stress component of compassion fatigue among TRPs. METHODS: A qualitative, phenomenological study was conducted to examine TRPs' experiences with the secondary traumatic stress component of compassion fatigue. The primary investigator assembled a multidisciplinary team of researchers, including nursing leadership, registry educators, mental health experts, and qualitative researchers. Two focus groups were held virtually in January 2021, using an interview guide designed by the research team. Participants were recruited via an email sent to a list of colleagues known to the research team from training classes held nationally and selected for their diverse clinical experiences, years in the role, demographic background, and trauma center representation. The recorded sessions were independently transcribed and analyzed by a five-member subgroup of the research team; the analysis concluded in December 2022. RESULTS: Nine TRPs participated in the focus groups. Participants came from Level I, II, and III adult and pediatric trauma centers and military centers. Four themes emerged from the data: disquieting and rewarding work, reactions and emotional responses, the influence of personal histories and background, and coping strategies. CONCLUSION: A qualitative analysis of focus group discussions revealed the secondary traumatic stress component of compassion fatigue is present in the TRP.

The Feasibility of a School Nurse-Led Mindfulness Program.

The purpose of this study was to evaluate the feasibility of a school nurse-led mindfulness program in a public school. Elementary students in an urban public school system are exposed to many stressors including poverty, family disturbances, and mental health conflicts. Previous research suggests that mindfulness interventions given by teachers promote prosocial behavior and stress reduction; however, there are no studies that have determined whether the school nurse could lead the program. A pre- to posttest design was employed using school-aged children enrolled in the fourth grade who were administered a mindfulness program. The participants were assessed for emotional states before and after the intervention. A total of 12 students completed the intervention. Students found the mindfulness program to be helpful, and the school nurse may be able to successfully complete the intervention. With appropriate planning, school nurses may be able to successfully implement the mindfulness curriculum in an urban public school.

The Feasibility of Kangaroo Care and the Effect on Maternal Attachment for Neonates in a Pediatric Cardiac Intensive Care Unit.

BACKGROUND: As survival rates in neonates with congenital heart disease have improved, research has shown they are at an increased risk for brain injury and neurodevelopmental delay. One intervention shown to have a positive impact on the development in premature and full-term newborns, as well as a positive impact on mother-infant relationship, is kangaroo care (KC). There is limited evidence to support the use of KC in infants with congenital heart disease, some of who may also be premature. PURPOSE: The purpose of this study was to examine the safety and feasibility of introducing KC for neonates with congenital heart disease in the pediatric cardiac intensive care unit. METHODS: A descriptive observational feasibility study was employed to evaluate the safety and efficacy of KC for this population. RESULTS: There were 25 neonates included with 60 sessions of KC. There were no adverse events including line and tube dislodgments and physiological instability related to the use of KC. IMPLICATIONS FOR PRACTICE: This study found KC to be safe and feasible for neonates with KC. IMPLICATIONS FOR RESEARCH: This is the first study examining the feasibility and safety of KC in this vulnerable population of neonates. Further research should be conducted using a quasi-experimental design to investigate neurodevelopmental outcomes with a larger sample of patients.

A Randomized Controlled Trial Comparing Flat Times Versus Standard Care in Pediatric Patients Post Cardiac Catheterization.

BACKGROUND: Pediatric patients undergoing cardiac catheterization procedures are required to lie flat for 4 hours for femoral venous access and 6 hours for femoral arterial access. Authors of research in adults suggest the flat time for the same access can be safely reduced to 1.5 to 2 hours post procedure. No literature was found that flat times could be safely reduced for pediatric patients. OBJECTIVE: The purpose of this study was to determine whether decreased flat time for the post-cardiac catheterization pediatric patient would impact the incidence of site bleeding, additional sedation, and the need for a critical care admission. METHODS: A randomized controlled trial was designed and participants were randomly assigned to experimental or control group. The experimental group reduced flat times to 2 hours for venous and 4 hours for arterial. The control group was standard care of 4 hours for venous and 6 hours for arterial. RESULTS: A total of 119 participants were enrolled, 60 in the experimental group and 59 in the control group. Results suggest no difference in the incidence of site bleeding (P = .999), additional sedation (P = .653), or need for a critical care admission. CONCLUSIONS: For pediatric patients undergoing arterial or venous cardiac catheterizations, flat times can safely be reduced without increasing site bleeding, additional sedation, or critical care admissions.

Pain Control and Positioning in Children Following Selective Dorsal Rhizotomy Surgery.

BACKGROUND: A practice was changed to elevate the head of bed from day 1 to day 3 on children after selective dorsal rhizotomy (SDR) surgery to improve pain control. Multiple methods to address pain post SDR include a continuous epidural infusion, medication administration, and repositioning/distraction. The length of time for the patient to remain flat was increased to potentially improve pain management. However, no studies in the literature were found to support the practice change. Nurses inquired whether this change resulted in optimal pain control. The primary research aim was to determine whether the change in positioning resulted in a difference in pain control. METHODS: A retrospective cohort design was used to compare pain medication administered before and after the practice change. Patients between the ages of 2 and 15 years and admitted to the neuroscience unit after SDR surgery were included. Data were electronically retrieved to record the amount of medications given for pain. Descriptive and univariate statistics were used to detect differences. RESULTS: The retrospective component of the study analyzed a total of 385 patients. There were no statistically significant differences between the number of intermittent doses of medication administered for pain between the 2 groups (P = .661). DISCUSSION: Results support return to practice of 1 day of flat time. Nurses perceive that lying flat contributes to child and parent anxiety and limits options for distraction; therefore, decreasing flat time may lower anxiety without affecting pain control. These results are limited to postsurgical SDR patients but have implications for postoperative positioning and pain management. On the basis of these results, the neurosurgeon changed practice to zero days of flat time.

A Randomized Controlled Trial to Compare Pain Medications in Children Undergoing Strabismus Surgery.

PURPOSE: The purpose of this study was to investigate optimal intraoperative combinations of analgesia for children undergoing strabismus surgery. DESIGN: A randomized controlled trial was employed to compare the difference in pain after administration of hydromorphone versus fentanyl. METHODS: Participants were randomly assigned to either arm of the study. Pain was measured by the revised Faces, Legs, Activity, Cry, and Consolability Scale (rFLACC) tool postoperatively, and the parent was asked about the presence or absence of pain after discharge. FINDINGS: A total of 135 children were included in the study. The rFLACC pain score was found to be significantly higher postoperatively among patients receiving fentanyl (P = .011). Pain after discharge was reported more often among patients who received fentanyl (P < .001). CONCLUSIONS: Results of this study can be used to change practice to minimize the pain levels both postoperatively and after discharge for children undergoing strabismus surgery.

Improving the Discharge to Home Experience for Pediatric Heart Center Patients and Families.

PURPOSE: The purpose of this study was to determine if implementation of the discharge specialist role improves family perception of discharge readiness and determines whether the use of the role decreases the number of tasks needing completion on the day of discharge. DESIGN AND METHODS: A prospective descriptive study was designed to compare parent readiness for discharge from two groups of participants. One group had a discharge specialist the day of discharge. The other group did not have the assistance of the discharge specialist on the day of discharge. Participants were contacted after discharge and surveyed on their perception of readiness for discharge based on a modified version of the Care Transitions Method Survey. Patient responses were either Strongly Agree or Less than Strongly Agree. RESULTS: A total of 60 patients (30 in each group) were analyzed. There were no statistically significant differences in demographic variables between the two groups. The overall average score of the composite proportion responding with Strongly Agree was higher among caregivers using a discharge specialist (Mean = 88.2) as compared to those without (Mean = 55.9, U = 157.0, p < .001). CONCLUSION: The use of a discharge specialist on the day of discharge resulted in a higher parent perception of discharge readiness in this sample of children with complex cardiac diagnosis. PRACTICE IMPLICATIONS: The use of a discharge specialist in the heart center can assist with the successful transition from hospital to home. Future research should examine the effect of the discharge specialist on hospital re-admission rates and clinical outcomes.

Maternity Leave Length and Workplace Policies' Impact on the Sustainment of Breastfeeding: Global Perspectives.

BACKGROUND: Breastfeeding is a global initiative of the World Health Organization and the U.S. domestic health agenda, Healthy People 2020; both recommend exclusive breastfeeding, defined as providing breast milk only via breast or bottle, through the first 6 months of an infant's life. Previous literature has shown the correlation between socioeconomic status and breastfeeding, with higher maternal education and income as predictors of sustained breastfeeding. This same population of women is more likely to be employed outside the home. METHODS: PubMed and the Cochrane Database of Systematic Reviews were searched using inclusion and exclusion criteria to identify the effect of maternity leave length and workplace policies on the sustainment of breastfeeding for employed mothers. RESULTS: Common facilitators to sustainment of breastfeeding included longer length of maternity leave as well as adequate time and space for the pumping of breast milk once the mother returned to the workplace. Barriers included inconsistency in policy and the lack of enforcement of policies in different countries. CONCLUSIONS: There is a lack of consistency globally on maternity leave length and workplace policy as determinants of sustained breastfeeding for employed mothers. A consistent approach is needed to achieve the goal of exclusive breastfeeding for infants.

Psychosocial outcomes of a summer overnight recreational experience for children with heart disease.

Children with chronic heart disease (CHD) are often turned away from recreational summer overnight experiences because of complicated medical histories and medication regimens. The purpose of this qualitative study was to evaluate the psychosocial impact of a five-day overnight recreational experience for children with CHD and their parents. Thirty-six children with CHD between the age of 8 and 15 years and their parents participated in the study. Data were collected from the children using photovoice interviews. Parent data were collected using a post camp survey. Results included the following external outcome themes: inclusion in a peer group and the importance of friendship, fun, and safety. Internal or personal outcome themes included counselor as a role model, increased self-confidence, and the realization of life's possibilities. Parent themes included increased child independence, increased child confidence, and child feelings of normalcy related to belonging to a peer group. Findings from this study can be used to encourage families of children with CHD to allow participation in a well-supervised overnight recreational experience. Such an experience can foster the child's overall development, provide peer group support, and reduce parent anxiety about overnight separation from the child.

An evidence-based practice scholars program: one institution's journey toward excellence.

The concept of evidence-based practice (EBP) has continued to evolve in the nursing profession as the basis for clinical decision-making. Despite the evidence to support this practice, few nurses at the bedside have received instruction in how to develop a clinical practice question using EBP skills. The EBP Scholars Program was designed at a Midwest pediatric academic hospital to teach EBP skills to enable staff to conduct extensive evaluations of existing literature to improve pediatric patient care. The program provides a comprehensive overview of EBP and the essential components necessary for implementation of EBP in a clinical setting. The development and implementation of an innovative EBP program designed to empower nurses to improve patient outcomes, as well as the lessons learned, are described.

Adverse effects of pediatric emergency sedation after discharge.

PURPOSE: Sedation is commonly performed in children in the emergency department. However, little is known about adverse events that may occur after discharge. This study was conducted to evaluate adverse effects occurring after discharge in children following sedation in the emergency department. METHODS: Parents of 547 children receiving sedation in the emergency department of a pediatric, academic hospital were called A approximately 24 hours af t er discharge a nd asked to complete a telephone questionnaire. Data were analyzed using descriptive statistics. RESULTS: At least one adverse effect was reported in 42% of participants after discharge. This included lethargy (12%), vomiting (7%), behavioral changes (7%), headache (6%), balance/gait disturbances (5%), nausea (4%), sleep disturbances (4%), nightmares (4%), hallucinations (2%), and ear pain (0.2%). CONCLUSIONS: Children experience minor adverse effects from sedation after discharge from the emergency department. Anticipatory guidance about these adverse effects should be given to parents and caregivers prior to discharge.