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Kim EN, Moss WD, Rosales MN, Lyon N, Lotz A, Yamashiro DK, Gociman BR, Siddiqi FA, Johns DN. Multidisciplinary Presurgical Education: Clinical Impact on Children With Orofacial Clefts Undergoing Maxillary Distraction via Rigid External Distraction. Cleft Palate Craniofac J 2023; 60:75-81. [PMID: 34730019 DOI: 10.1177/10556656211055411] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVE Treatment of severe maxillary hypoplasia is commonly addressed via distraction osteogenesis with a rigid external device (RED). While effective, this method can be socially stigmatizing in an already vulnerable patient population. To prepare children and their caregivers for life with a RED and decrease peri-operative anxiety, we instituted a multidisciplinary pre-surgical education session (MPES). This educational team involves our cleft care coordinator, child life specialist, orthodontist and plastic surgeon 2 weeks prior to surgery. We reviewed the impact of this intervention by examining clinical outcomes before and after its implementation. DESIGN From February 2017 to February 2020, a retrospective chart review was performed to include patients with orofacial clefts and maxillary hypoplasia who underwent maxillary distraction osteogenesis with RED at our center before (28 patients) and after (29 patients) the implementation of MPES. RESULTS MPES was associated with a significantly shorter length of stay compared to controls who did not receive MPES (3.6 vs 3.1 days, p < 0.03) and significantly decreased usage of inpatient narcotic pain medication compared to controls (16.8 morphine equivalents vs 31.8 morphine equivalents, p < 0.02). Our intervention also demonstrated a trend towards decrease in minor complications but did not achieve statistical significance p = 0.32). CONCLUSIONS Multidisciplinary presurgical education is a beneficial adjunct in the care of patients with orofacial clefts and maxillary hypoplasia undergoing maxillary advancement with a RED.
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Affiliation(s)
- Erinn N Kim
- University of Utah Division of Plastic Surgery, 114380University of Utah Hospital, Salt Lake City, Utah, USA
| | - Whitney D Moss
- University of Utah Division of Plastic Surgery, 114380University of Utah Hospital, Salt Lake City, Utah, USA
| | - Megan N Rosales
- Biostatistician. University of Utah Study Design and Biostatistics Center, University of Utah, Salt Lake City, Utah, USA
| | - Natalee Lyon
- RN Cleft Care Coordinator, 23188Primary Children's Hospital, Salt Lake City, Utah, USA
| | - Analise Lotz
- Certified Child Life Specialist, 23188Primary Children's Hospital, Salt Lake City, Utah, USA
| | - Duane K Yamashiro
- University of Utah Division of Plastic Surgery, 114380University of Utah Hospital and 23188Primary Children's Hospital, Salt Lake City, Utah, USA
| | - Barbu R Gociman
- University of Utah Division of Plastic Surgery, 114380University of Utah Hospital, Salt Lake City, Utah, USA
| | - Faizi A Siddiqi
- University of Utah Division of Plastic Surgery, 114380University of Utah Hospital, Salt Lake City, Utah, USA
| | - Dana N Johns
- University of Utah Division of Plastic Surgery, 114380University of Utah Hospital, Salt Lake City, Utah, USA
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Kouo JL, Kouo TS, Gallogly J. Brief Report: The Experiences of Families of Children with an Autism Spectrum Disorder When Seeking Patient-and Family-Centered Care. J Autism Dev Disord 2021; 52:4172-4180. [PMID: 34499274 DOI: 10.1007/s10803-021-05272-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/02/2021] [Indexed: 10/20/2022]
Abstract
Patient-and family-centered care (PFCC) is a partnership among healthcare professionals, patients, and families that is grounded in mutual respect and is an approach that impacts delivery of care, decision-making, and information sharing. PFCC should be implemented for all, including individuals with Autism Spectrum Disorders (ASD), who experience adverse medical encounters despite increased prevalence and healthcare utilization. Insights into the experiences of families during medical experiences can inform clinical practice by increasing healthcare professionals' understanding of the population. Using a mixed-methods approach, the perspectives of 40 families were analyzed. The themes include barriers and opportunities to improve upon the delivery of PFCC, which help to advance healthcare interactions and inform solution-based initiatives to facilitate medical visits that may benefit all patients.
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Affiliation(s)
- Jennifer L Kouo
- The Institute for Innovation in Development, Engagement, and Learning Systems (IDEALS), Johns Hopkins University School of Education, 2800 North Charles Street, Baltimore, MD, 21218, USA.
| | - Theodore S Kouo
- Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD, 21287, USA
| | - Jillian Gallogly
- The Institute for Innovation in Development, Engagement, and Learning Systems (IDEALS), Johns Hopkins University School of Education, 2800 North Charles Street, Baltimore, MD, 21218, USA
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Brescia AA, Piazza JR, Jenkins JN, Heering LK, Ivacko AJ, Piazza JC, Dwyer-White MC, Peters SL, Cepero J, Brown BH, Longi FN, Monaghan KP, Bauer FW, Kathawate VG, Jafri SM, Webster MC, Kasperek AM, Garvey NL, Schwenzer C, Wu X, Lagisetty KH, Osborne NH, Waljee JF, Riba M, Likosky DS, Byrnes ME, Deeb GM. The Impact of Nonpharmacological Interventions on Patient Experience, Opioid Use, and Health Care Utilization in Adult Cardiac Surgery Patients: Protocol for a Mixed Methods Study. JMIR Res Protoc 2021; 10:e21350. [PMID: 33591291 PMCID: PMC7925147 DOI: 10.2196/21350] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Revised: 11/13/2020] [Accepted: 11/17/2020] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Despite pharmacological treatments, patients undergoing cardiac surgery experience severe anxiety and pain, which adversely affect outcomes. Previous work examining pediatric and nonsurgical adult patients has documented the effectiveness of inexpensive, nonpharmacological techniques to reduce anxiety and pain as well as health care costs and length of hospitalization. However, the impact of nonpharmacological interventions administered by a dedicated comfort coach has not been evaluated in an adult surgical setting. OBJECTIVE This trial aims to assess whether nonpharmacological interventions administered by a trained comfort coach affect patient experience, opioid use, and health care utilization compared with usual care in adult cardiac surgery patients. This study has 3 specific aims: assess the effect of a comfort coach on patient experience, measure differences in inpatient and outpatient opioid use and postoperative health care utilization, and qualitatively evaluate the comfort coach intervention. METHODS To address these aims, we will perform a prospective, randomized controlled trial of 154 adult cardiac surgery patients at Michigan Medicine. Opioid-naive patients undergoing first-time, elective cardiac surgery via sternotomy will be randomized to undergo targeted interventions from a comfort coach (intervention) versus usual care (control). The individualized comfort coach interventions will be administered at 6 points: preoperative outpatient clinic, preoperative care unit on the day of surgery, extubation, chest tube removal, hospital discharge, and 30-day clinic follow-up. To address aim 1, we will examine the effect of a comfort coach on perioperative anxiety, self-reported pain, functional status, and patient satisfaction through validated surveys administered at preoperative outpatient clinic, discharge, 30-day follow-up, and 90-day follow-up. For aim 2, we will record inpatient opioid use and collect postdischarge opioid use and pain-related outcomes through an 11-item questionnaire administered at the 30-day follow-up. Hospital length of stay, readmission, number of days in an extended care facility, emergency room, urgent care, and an unplanned doctor's office visit will be recorded as the primary composite endpoint defined as total days spent at home within the first 30 days after surgery. For aim 3, we will perform semistructured interviews with patients in the intervention arm to understand the comfort coach intervention through a thematic analysis. RESULTS This trial, funded by Blue Cross Blue Shield of Michigan Foundation in 2019, is presently enrolling patients with anticipated manuscript submissions from our primary aims targeted for the end of 2020. CONCLUSIONS Data generated from this mixed methods study will highlight effective nonpharmacological techniques and support a multidisciplinary approach to perioperative care during the adult cardiac surgery patient experience. This study's findings may serve as the foundation for a subsequent multicenter trial and broader dissemination of these techniques to other types of surgery. TRIAL REGISTRATION ClinicalTrials.gov NCT04051021; https://clinicaltrials.gov/ct2/show/NCT04051021. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/21350.
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Affiliation(s)
- Alexander A Brescia
- Department of Cardiac Surgery, Michigan Medicine, University of Michigan, Ann Arbor, MI, United States
- Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor, MI, United States
| | - Julie R Piazza
- Office of Patient Experience, Michigan Medicine, University of Michigan, Ann Arbor, MI, United States
| | - Jessica N Jenkins
- Department of Child and Family Life, CS Mott Children's Hospital, Michigan Medicine, Ann Arbor, MI, United States
| | - Lindsay K Heering
- Department of Child and Family Life, CS Mott Children's Hospital, Michigan Medicine, Ann Arbor, MI, United States
| | - Alexander J Ivacko
- Department of Cardiac Surgery, Michigan Medicine, University of Michigan, Ann Arbor, MI, United States
| | - James C Piazza
- Department of Cardiac Surgery, Michigan Medicine, University of Michigan, Ann Arbor, MI, United States
| | - Molly C Dwyer-White
- Office of Patient Experience, Michigan Medicine, University of Michigan, Ann Arbor, MI, United States
| | - Stefanie L Peters
- Frankel Cardiovascular Center, Michigan Medicine, Ann Arbor, MI, United States
| | - Jesus Cepero
- Children and Women's Hospital, Michigan Medicine, Ann Arbor, MI, United States
| | - Bailey H Brown
- Department of Cardiac Surgery, Michigan Medicine, University of Michigan, Ann Arbor, MI, United States
| | - Faraz N Longi
- Department of Cardiac Surgery, Michigan Medicine, University of Michigan, Ann Arbor, MI, United States
| | - Katelyn P Monaghan
- Department of Cardiac Surgery, Michigan Medicine, University of Michigan, Ann Arbor, MI, United States
| | - Frederick W Bauer
- Department of Cardiac Surgery, Michigan Medicine, University of Michigan, Ann Arbor, MI, United States
| | - Varun G Kathawate
- Department of Cardiac Surgery, Michigan Medicine, University of Michigan, Ann Arbor, MI, United States
| | - Sara M Jafri
- Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor, MI, United States
| | - Melissa C Webster
- Department of Psychiatry, Michigan Medicine, University of Michigan, Ann Arbor, MI, United States
| | - Amanda M Kasperek
- Department of Cardiac Surgery, Michigan Medicine, University of Michigan, Ann Arbor, MI, United States
| | - Nickole L Garvey
- Department of Cardiac Surgery, Michigan Medicine, University of Michigan, Ann Arbor, MI, United States
| | - Claudia Schwenzer
- Office of Patient Experience, Michigan Medicine, University of Michigan, Ann Arbor, MI, United States
| | - Xiaoting Wu
- Department of Cardiac Surgery, Michigan Medicine, University of Michigan, Ann Arbor, MI, United States
| | - Kiran H Lagisetty
- Department of Surgery, Michigan Medicine, University of Michigan, Ann Arbor, MI, United States
| | - Nicholas H Osborne
- Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor, MI, United States
- Department of Surgery, Michigan Medicine, University of Michigan, Ann Arbor, MI, United States
| | - Jennifer F Waljee
- Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor, MI, United States
- Department of Surgery, Michigan Medicine, University of Michigan, Ann Arbor, MI, United States
| | - Michelle Riba
- Department of Psychiatry, Michigan Medicine, University of Michigan, Ann Arbor, MI, United States
| | - Donald S Likosky
- Department of Cardiac Surgery, Michigan Medicine, University of Michigan, Ann Arbor, MI, United States
- Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor, MI, United States
| | - Mary E Byrnes
- Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor, MI, United States
- Department of Surgery, Michigan Medicine, University of Michigan, Ann Arbor, MI, United States
| | - G Michael Deeb
- Department of Cardiac Surgery, Michigan Medicine, University of Michigan, Ann Arbor, MI, United States
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Abstract
Child life programs are an important component of pediatric hospital-based care; they address the psychosocial concerns that accompany hospitalization and other health care experiences. Child life specialists focus on the optimal development and well-being of infants, children, adolescents, and young adults while promoting coping skills and minimizing the adverse effects of hospitalization, health care encounters, and/or other potentially stressful experiences. In collaboration with the entire health care team and family, child life specialists provide interventions that include therapeutic play, expressive modalities, and psychological preparation to facilitate coping and normalization at times and under circumstances that might otherwise prove overwhelming for the child. Play and developmentally appropriate communication are used to (1) promote optimal development, (2) educate children and families about health conditions, (3) prepare children and partner with families for medical events or procedures, (4) plan and rehearse useful coping and pain-management strategies with patients and families, (5) help children work through feelings about past or impending experiences, and (6) partner with families to establish therapeutic relationships between patients, siblings, and caregivers. Child life specialists collaborate with the entire interdisciplinary team to promote coping and enhance the overall health care experience for patients and families.
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Affiliation(s)
- Barbara Romito
- Child Life Program, The Bristol-Myers Squibb Children's Hospital at Robert Wood Johnson University Hospital, New Brunswick, New Jersey; and
| | - Jennifer Jewell
- The Barbara Bush Children's Hospital at Maine Medical Center, Portland, Maine
| | - Meredith Jackson
- The Barbara Bush Children's Hospital at Maine Medical Center, Portland, Maine
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Effectiveness of Adaptive Care Plans for Children with Developmental Disabilities During Outpatient Clinic Appointments. J Autism Dev Disord 2020; 51:3028-3038. [PMID: 33118074 DOI: 10.1007/s10803-020-04764-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/14/2020] [Indexed: 10/23/2022]
Abstract
Children with developmental disabilities require more medical experiences than typically-developing children and struggle to cooperate with healthcare encounters. Adaptive care plans, delivered by child life specialists, are individualized patient-centered plans created to address the challenges that children with developmental disabilities experience. The current study evaluated if adaptive care plans affect the psychosocial outcomes of children with ASD compared to those with other developmental disabilities. One-hundred and sixty children between 3 and 18 years of age (child's Mage = 8.10, SD = 3.75) participated. Although children with developmental disabilities who had adaptive care plans did not generally experience less psychosocial distress; children with ASD who had adaptive care plans experienced fewer challenges with anxiety and coping compared to children with ASD who did not have adaptive care plans.
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Ludmir J, Small AJ. The Challenge of Identifying and Addressing Psychological Comorbidities. J Am Coll Cardiol 2019; 71:1590-1593. [PMID: 29622167 DOI: 10.1016/j.jacc.2018.02.042] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Affiliation(s)
- Jonathan Ludmir
- Division of Cardiovascular Medicine, University of Maryland School of Medicine, Baltimore, Maryland.
| | - Adam J Small
- Department of Medicine, Division of Cardiology, David Geffen School of Medicine at UCLA, Los Angeles, California
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Diener ML, Lofgren AO, Isabella RA, Magana S, Choi C, Gourley C. Children’s distress during intravenous placement: The role of child life specialists. CHILDRENS HEALTH CARE 2018. [DOI: 10.1080/02739615.2018.1492410] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Marissa L. Diener
- Department of Family & Consumer Studies, University of Utah, Salt Lake City, UT, USA
| | - Abigail Owens Lofgren
- Patient and Family Support Services, Primary Children’s Medical Center, Salt Lake City, UT, USA
| | - Russell A. Isabella
- Department of Family & Consumer Studies, University of Utah, Salt Lake City, UT, USA
| | | | - Chansong Choi
- School of Medicine, University of Utah, Salt Lake City, UT, USA
| | - Chelsea Gourley
- Patient and Family Support Services, Primary Children’s Medical Center, Salt Lake City, UT, USA
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Coats H, Bourget E, Starks H, Lindhorst T, Saiki-Craighill S, Curtis JR, Hays R, Doorenbos A. Nurses' Reflections on Benefits and Challenges of Implementing Family-Centered Care in Pediatric Intensive Care Units. Am J Crit Care 2018; 27:52-58. [PMID: 29292276 DOI: 10.4037/ajcc2018353] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND Family-centered care is a proposed way of supporting family involvement with a child's care and decreasing distress associated with a child's critical illness by improving communication, helping manage stress and coping, and decreasing conflicts. Nurses are critical to successful implementation of family-centered care. OBJECTIVES To describe nurses' perceptions of the benefits and challenges of providing family-centered care in pediatric intensive care units. METHODS Semistructured interviews of 10 bedside and charge nurses in pediatric, cardiac, and neonatal intensive care units. Questions were related to 4 domains: the intensive care unit environment and its relationship to the structure and delivery of critical care, stressors for nurses and families, communication challenges and strategies, and involvement of families in care and decision-making. RESULTS The main thematic finding was the nurses' descriptions of a "balancing act" to provide quality family-centered care. The balancing act was characterized by the interaction between 2 types of changes: (1) intensive care unit policies related to visitation hours and family presence at the bedside and (2) physical transformations in the intensive care unit from shared open space to individual private rooms. CONCLUSIONS All of the nurses viewed the transition to family-centered care as having benefits for families. They also described how changes had created new challenges for the delivery of nursing care in intensive care units, particularly regarding mentorship and the safety of patients and staff.
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Affiliation(s)
- Heather Coats
- Heather Coats is an assistant professor of research, University of Colorado College of Nursing, Denver, Colorado. Erica Bourget is a research assistant at the Center for Child Health, Behavior and Development, Seattle Children's Research Institute, Seattle, Washington. Helene Starks is an associate professor, Department of Bioethics and Humanities, University of Washington School of Medicine, Seattle, Washington. Taryn Lindhorst is a professor, University of Washington School of Social Work, Seattle, Washington. Shigeko Saiki-Craighill is a professor, Faculty of Nursing and Medical Care, Keio University, Tokyo, Japan. J. Randall Curtis is a professor, Department of Medicine, Division of Pulmonary and Critical Care Medicine, University of Washington School of Medicine. Ross Hays is a professor in the Center for Child Health, Behavior and Development, Seattle Children's Research Institute, and in the Department of Rehabilitative Medicine, University of Washington School of Medicine. Ardith Doorenbos is a professor in the Department of Biobehavioral Nursing and Health Systems, University of Washington School of Nursing; the Department of Bioethics and Humanities, University of Washington School of Medicine; and the Department of Anesthesiology and Pain Medicine, University of Washington School of Medicine
| | - Erica Bourget
- Heather Coats is an assistant professor of research, University of Colorado College of Nursing, Denver, Colorado. Erica Bourget is a research assistant at the Center for Child Health, Behavior and Development, Seattle Children's Research Institute, Seattle, Washington. Helene Starks is an associate professor, Department of Bioethics and Humanities, University of Washington School of Medicine, Seattle, Washington. Taryn Lindhorst is a professor, University of Washington School of Social Work, Seattle, Washington. Shigeko Saiki-Craighill is a professor, Faculty of Nursing and Medical Care, Keio University, Tokyo, Japan. J. Randall Curtis is a professor, Department of Medicine, Division of Pulmonary and Critical Care Medicine, University of Washington School of Medicine. Ross Hays is a professor in the Center for Child Health, Behavior and Development, Seattle Children's Research Institute, and in the Department of Rehabilitative Medicine, University of Washington School of Medicine. Ardith Doorenbos is a professor in the Department of Biobehavioral Nursing and Health Systems, University of Washington School of Nursing; the Department of Bioethics and Humanities, University of Washington School of Medicine; and the Department of Anesthesiology and Pain Medicine, University of Washington School of Medicine
| | - Helene Starks
- Heather Coats is an assistant professor of research, University of Colorado College of Nursing, Denver, Colorado. Erica Bourget is a research assistant at the Center for Child Health, Behavior and Development, Seattle Children's Research Institute, Seattle, Washington. Helene Starks is an associate professor, Department of Bioethics and Humanities, University of Washington School of Medicine, Seattle, Washington. Taryn Lindhorst is a professor, University of Washington School of Social Work, Seattle, Washington. Shigeko Saiki-Craighill is a professor, Faculty of Nursing and Medical Care, Keio University, Tokyo, Japan. J. Randall Curtis is a professor, Department of Medicine, Division of Pulmonary and Critical Care Medicine, University of Washington School of Medicine. Ross Hays is a professor in the Center for Child Health, Behavior and Development, Seattle Children's Research Institute, and in the Department of Rehabilitative Medicine, University of Washington School of Medicine. Ardith Doorenbos is a professor in the Department of Biobehavioral Nursing and Health Systems, University of Washington School of Nursing; the Department of Bioethics and Humanities, University of Washington School of Medicine; and the Department of Anesthesiology and Pain Medicine, University of Washington School of Medicine
| | - Taryn Lindhorst
- Heather Coats is an assistant professor of research, University of Colorado College of Nursing, Denver, Colorado. Erica Bourget is a research assistant at the Center for Child Health, Behavior and Development, Seattle Children's Research Institute, Seattle, Washington. Helene Starks is an associate professor, Department of Bioethics and Humanities, University of Washington School of Medicine, Seattle, Washington. Taryn Lindhorst is a professor, University of Washington School of Social Work, Seattle, Washington. Shigeko Saiki-Craighill is a professor, Faculty of Nursing and Medical Care, Keio University, Tokyo, Japan. J. Randall Curtis is a professor, Department of Medicine, Division of Pulmonary and Critical Care Medicine, University of Washington School of Medicine. Ross Hays is a professor in the Center for Child Health, Behavior and Development, Seattle Children's Research Institute, and in the Department of Rehabilitative Medicine, University of Washington School of Medicine. Ardith Doorenbos is a professor in the Department of Biobehavioral Nursing and Health Systems, University of Washington School of Nursing; the Department of Bioethics and Humanities, University of Washington School of Medicine; and the Department of Anesthesiology and Pain Medicine, University of Washington School of Medicine
| | - Shigeko Saiki-Craighill
- Heather Coats is an assistant professor of research, University of Colorado College of Nursing, Denver, Colorado. Erica Bourget is a research assistant at the Center for Child Health, Behavior and Development, Seattle Children's Research Institute, Seattle, Washington. Helene Starks is an associate professor, Department of Bioethics and Humanities, University of Washington School of Medicine, Seattle, Washington. Taryn Lindhorst is a professor, University of Washington School of Social Work, Seattle, Washington. Shigeko Saiki-Craighill is a professor, Faculty of Nursing and Medical Care, Keio University, Tokyo, Japan. J. Randall Curtis is a professor, Department of Medicine, Division of Pulmonary and Critical Care Medicine, University of Washington School of Medicine. Ross Hays is a professor in the Center for Child Health, Behavior and Development, Seattle Children's Research Institute, and in the Department of Rehabilitative Medicine, University of Washington School of Medicine. Ardith Doorenbos is a professor in the Department of Biobehavioral Nursing and Health Systems, University of Washington School of Nursing; the Department of Bioethics and Humanities, University of Washington School of Medicine; and the Department of Anesthesiology and Pain Medicine, University of Washington School of Medicine
| | - J Randall Curtis
- Heather Coats is an assistant professor of research, University of Colorado College of Nursing, Denver, Colorado. Erica Bourget is a research assistant at the Center for Child Health, Behavior and Development, Seattle Children's Research Institute, Seattle, Washington. Helene Starks is an associate professor, Department of Bioethics and Humanities, University of Washington School of Medicine, Seattle, Washington. Taryn Lindhorst is a professor, University of Washington School of Social Work, Seattle, Washington. Shigeko Saiki-Craighill is a professor, Faculty of Nursing and Medical Care, Keio University, Tokyo, Japan. J. Randall Curtis is a professor, Department of Medicine, Division of Pulmonary and Critical Care Medicine, University of Washington School of Medicine. Ross Hays is a professor in the Center for Child Health, Behavior and Development, Seattle Children's Research Institute, and in the Department of Rehabilitative Medicine, University of Washington School of Medicine. Ardith Doorenbos is a professor in the Department of Biobehavioral Nursing and Health Systems, University of Washington School of Nursing; the Department of Bioethics and Humanities, University of Washington School of Medicine; and the Department of Anesthesiology and Pain Medicine, University of Washington School of Medicine
| | - Ross Hays
- Heather Coats is an assistant professor of research, University of Colorado College of Nursing, Denver, Colorado. Erica Bourget is a research assistant at the Center for Child Health, Behavior and Development, Seattle Children's Research Institute, Seattle, Washington. Helene Starks is an associate professor, Department of Bioethics and Humanities, University of Washington School of Medicine, Seattle, Washington. Taryn Lindhorst is a professor, University of Washington School of Social Work, Seattle, Washington. Shigeko Saiki-Craighill is a professor, Faculty of Nursing and Medical Care, Keio University, Tokyo, Japan. J. Randall Curtis is a professor, Department of Medicine, Division of Pulmonary and Critical Care Medicine, University of Washington School of Medicine. Ross Hays is a professor in the Center for Child Health, Behavior and Development, Seattle Children's Research Institute, and in the Department of Rehabilitative Medicine, University of Washington School of Medicine. Ardith Doorenbos is a professor in the Department of Biobehavioral Nursing and Health Systems, University of Washington School of Nursing; the Department of Bioethics and Humanities, University of Washington School of Medicine; and the Department of Anesthesiology and Pain Medicine, University of Washington School of Medicine
| | - Ardith Doorenbos
- Heather Coats is an assistant professor of research, University of Colorado College of Nursing, Denver, Colorado. Erica Bourget is a research assistant at the Center for Child Health, Behavior and Development, Seattle Children's Research Institute, Seattle, Washington. Helene Starks is an associate professor, Department of Bioethics and Humanities, University of Washington School of Medicine, Seattle, Washington. Taryn Lindhorst is a professor, University of Washington School of Social Work, Seattle, Washington. Shigeko Saiki-Craighill is a professor, Faculty of Nursing and Medical Care, Keio University, Tokyo, Japan. J. Randall Curtis is a professor, Department of Medicine, Division of Pulmonary and Critical Care Medicine, University of Washington School of Medicine. Ross Hays is a professor in the Center for Child Health, Behavior and Development, Seattle Children's Research Institute, and in the Department of Rehabilitative Medicine, University of Washington School of Medicine. Ardith Doorenbos is a professor in the Department of Biobehavioral Nursing and Health Systems, University of Washington School of Nursing; the Department of Bioethics and Humanities, University of Washington School of Medicine; and the Department of Anesthesiology and Pain Medicine, University of Washington School of Medicine.
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Brynes N, Lee H, Ren D, Beach M. Improvement of Patient- and Family-Specific Care for Children with Special Behavioral Needs in the Emergency Setting: A Behavioral Needs Education. J Emerg Nurs 2016; 43:202-207. [PMID: 27597721 DOI: 10.1016/j.jen.2016.07.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2016] [Revised: 06/24/2016] [Accepted: 07/25/2016] [Indexed: 11/29/2022]
Abstract
Improvements in staff training, identification, and treatment planning for children with special health care needs who have behavioral issues are routinely recommended, but a literature review revealed no coherent plans targeted specifically toward pediatric ED staff. METHODS An educational module was delivered to emergency staff along with a survey before and after and 1 month after the intervention to examine comfort in working with children with behavioral special needs and the ability to deliver specialized care. Child life consultations in the pediatric emergency department were measured 3 months before and 3 months after the education was provided. RESULTS A total of 122 staff participated and reported clinically significant improvements across all areas of care that were maintained at 1 month. IMPLICATIONS FOR PRACTICE To the best of our knowledge, this project represents the first quality improvement project offering behavioral needs education to emergency staff at a large pediatric hospital with an examination of its impact on staff competence, comfort, and outcomes. A large-scale educational module is a practical option for improvement in pediatric ED staff competence in caring for patients with behavioral special needs.
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Hill JA, Kimani K, White A, Barasa F, Livingstone M, Gallie BL, Dimaras H. Achieving optimal cancer outcomes in East Africa through multidisciplinary partnership: a case study of the Kenyan National Retinoblastoma Strategy group. Global Health 2016; 12:23. [PMID: 27229322 PMCID: PMC4882853 DOI: 10.1186/s12992-016-0160-1] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2015] [Accepted: 05/07/2016] [Indexed: 11/23/2022] Open
Abstract
Background Strategic, interdisciplinary partnerships are essential to addressing the complex drivers of health inequities that result in survival disparities worldwide. Take for example the aggressive early childhood eye cancer retinoblastoma, where survival reaches 97 % in resource-rich countries, but is as low 30 % in some resource-limited nations, where 92 % of the burden lies. This suggests a need for a multifaceted approach to achieve a tangible and sustainable increase in survival. Methods We assembled the history the Kenyan National Retinoblastoma Strategy (KNRbS), using information documented in NGO reports, grant applications, news articles, meeting agendas and summaries. We evaluated the KNRbS using the principles found in the guide for transboundary research partnerships developed by the Swiss Commission for Research Partnerships with Developing Countries. Results A nationally co-ordinated approach drawing input and expertise from multiple disciplines and sectors presented opportunities to optimise cure of children with retinoblastoma. Annual meetings were key to achieving the over 40 major outputs of the group’s efforts, related to Awareness, Medical Care, Family Support and Resource Mobilization. Three features were found to be critical to the KNRbS success: multidisciplinarity, consistency and flexibility. Conclusion The KNRbS has achieved a number of key outputs with limited financial investment. As a partnership, the KNRbS meets most of the criteria identified for success. Challenges remain in securing the long-term sustainability of its achievements. Elements of the Kenyan National Retinoblastoma Strategy may be useful to other developing countries struggling with limited survival of retinoblastoma and other cancers or rare diseases. Electronic supplementary material The online version of this article (doi:10.1186/s12992-016-0160-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Jessica A Hill
- Department of Ophthalmology and Vision Sciences, The Hospital for Sick Children, 555 University Ave., Room 7265, Toronto, ON, M5G 1X8, Canada
| | - Kahaki Kimani
- Department of Ophthalmology, University of Nairobi, Nairobi, Kenya
| | - Abby White
- World Eye Cancer Hope (formerly Daisy's Eye Cancer Fund - International)
| | | | - Morgan Livingstone
- World Eye Cancer Hope (formerly Daisy's Eye Cancer Fund - International)
| | - Brenda L Gallie
- Department of Ophthalmology and Vision Sciences, The Hospital for Sick Children, 555 University Ave., Room 7265, Toronto, ON, M5G 1X8, Canada.,Department of Ophthalmology & Vision Sciences, Faculty of Medicine & Division of Clinical Public Health, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Helen Dimaras
- Department of Ophthalmology and Vision Sciences, The Hospital for Sick Children, 555 University Ave., Room 7265, Toronto, ON, M5G 1X8, Canada. .,Department of Ophthalmology & Vision Sciences, Faculty of Medicine & Division of Clinical Public Health, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada. .,Division of Clinical Public Health, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada. .,Department of Human Pathology, University of Nairobi, Nairobi, Kenya.
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11
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Tyson ME, Bohl DD, Blickman JG. A randomized controlled trial: child life services in pediatric imaging. Pediatr Radiol 2014; 44:1426-32. [PMID: 24801818 DOI: 10.1007/s00247-014-3005-1] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2013] [Revised: 02/24/2014] [Accepted: 04/10/2014] [Indexed: 11/25/2022]
Abstract
BACKGROUND Children undergoing procedures in pediatric health care facilities and their families have been shown to benefit from psychosocial services and interventions such as those provided by a Certified Child Life Specialist (CCLS). The comprehensive impact of a CCLS in a pediatric imaging department is well recognized anecdotally but has not been examined in a prospective or randomized controlled fashion. OBJECTIVE We prospectively assessed the impact of a CCLS on parent satisfaction, staff satisfaction, child satisfaction, and parent and staff perceptions of child pain and distress in a pediatric imaging department. MATERIALS AND METHODS Eligible children between 1 and 12 years of age (n = 137) presenting to the pediatric imaging department for an imaging procedure were randomly assigned to an intervention or control arm. Those assigned to the intervention received the comprehensive services of a CCLS. The control group received standard of care, which did not include any child life services. Quantitative measures of satisfaction and perception of child pain and distress were assessed by parents and staff using a written 5-point Likert scale questionnaire after the imaging procedure. Children 4 and older were asked to answer 3 questions on a 3-point scale. RESULTS Statistically significant differences between the intervention and control groups were found in 19 out of 24 measures. Parents in the intervention group indicated higher satisfaction and a lower perception of their child's pain and distress. Staff in the intervention group indicated greater child cooperation and a lower perception of the child's pain and distress. Children in the intervention group indicated a better overall experience and less fear than those in the control group. CONCLUSION Child life specialists have a quantifiably positive impact on the care of children in imaging departments. Measures of parent satisfaction, staff satisfaction, child satisfaction, child pain and child distress are shown to be positively impacted by the services of a CCLS. These results have significant implications for hospitals striving to increase satisfaction, decrease costs and improve quality of care. In a health care landscape that is changing quickly and increasingly focused on the cost of care, future research should assess whether the core tenants of the child life profession support and contribute quantifiably to high-quality, cost-effective practices in health care.
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Affiliation(s)
- Mary E Tyson
- Pediatric Imaging Sciences, Golisano Children's Hospital at the University of Rochester Medical Center, Rochester, NY, USA,
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12
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Abstract
Child life programs are an important component of pediatric hospital-based care to address the psychosocial concerns that accompany hospitalization and other health care experiences. Child life specialists focus on the optimal development and well-being of infants, children, adolescents, and young adults while promoting coping skills and minimizing the adverse effects of hospitalization, health care, and/or other potentially stressful experiences. Using therapeutic play, expressive modalities, and psychological preparation as primary tools, in collaboration with the entire health care team and family, child life interventions facilitate coping and adjustment at times and under circumstances that might otherwise prove overwhelming for the child. Play and developmentally appropriate communication are used to: (1) promote optimal development; (2) educate children and families about health conditions; (3) prepare children and families for medical events or procedures; (4) plan and rehearse useful coping and pain management strategies; (5) help children work through feelings about past or impending experiences; and (6) establish therapeutic relationships with patients, siblings, and parents to support family involvement in each child's care.
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A Noncategorical Approach to the Psychosocial Care of Persons with DSD and Their Families. GENDER DYSPHORIA AND DISORDERS OF SEX DEVELOPMENT 2014. [DOI: 10.1007/978-1-4614-7441-8_5] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
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Mann KJ, Hoffman A, Miller D, Chadwick S, Bratcher D. The effect of a patient- and family-centered care curriculum on pediatrics residents' patient-centeredness. J Grad Med Educ 2013; 5:36-40. [PMID: 24404224 PMCID: PMC3613315 DOI: 10.4300/jgme-d-11-00254.1] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2011] [Revised: 04/02/2012] [Accepted: 06/03/2012] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Patient- and family-centered care (PFCC) approaches to care are important in enhancing the patient-centeredness of the health care experience, yet little is known about the effectiveness of formal approaches for teaching patient-centeredness in residency. INTERVENTION We developed and implemented a PFCC curriculum and assessed its impact on residents' self-perceptions of patient-centered behavior and practices. METHODS We used a quasi-experimental, nonrandomized approach with a pretest-posttest design. An experimental group of 24 interns filled out the Patient Practitioner Orientation Scale (PPOS) before residency, and a control group of 18 graduating residents who had not been exposed to a PFCC curriculum also completed the PPOS. After 2 years of residency and exposure to a PFCC curriculum, interns in the experimental group repeated the PPOS. We compared mean total and subscale PPOS scores. RESULTS There was no difference in baseline total or subscale PPOS scores between the experimental and control group. The mean total PPOS score for the experimental group after exposure to the curriculum was 4.55 (P = .45), reflecting no change in patient-centeredness. The 17 female interns in the intervention group were more patient centered (4.8 ± 0.36) than the 6 male interns (4.2 ± 0.38) (P = .005), scoring significantly higher (4.6 ± 0.39 versus 4.0 ± 0.38) in the sharing domain (P = .001). CONCLUSION Interns' exposure to a PFCC curriculum did not result in a change in their perceived patient-centeredness. Most pediatrics residents at our children's hospital perceive themselves as patient and family centered at the start of residency and remain so throughout.
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Sutter C, Reid T. How do we talk to the children? Child life consultation to support the children of seriously ill adult inpatients. J Palliat Med 2012; 15:1362-8. [PMID: 22978620 DOI: 10.1089/jpm.2012.0019] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Abstract
BACKGROUND Families with young children often struggle to talk about and cope with a parent's life-threatening illness and potential death. Adult interdisciplinary palliative medicine teams often feel unprepared to facilitate the open communication with these children that has been shown to reduce anxiety, depression, and other behavioral problems. In pediatric settings, child life specialists routinely provide this support to hospitalized children as well as their siblings and parents. Although these services are the standard of care in pediatrics, no research reports their use in the care of children of adults with serious illness. OBJECTIVE Our aim is to describe a pilot child life consultation service for the children of seriously ill adult inpatients. DESIGN We summarize the support needs of these children, their families, and the medical staff caring for them and report our experience with developing a child life consultation service to meet these needs. SETTING/SUBJECTS Our service assists seriously ill adult inpatients and their families in a university medical center. RESULTS Informal feedback from families and staff was uniformly positive. During consultations, family and child coping mechanisms were assessed and supported. Interventions were chosen to enhance the children's processing and self-expression and to facilitate family communication. CONCLUSION All hospitals should consider providing broad-based in-service training enabling their staff to improve the support they offer to the children of seriously ill parents. Medical centers with access to child life services should consider developing a child life consultation service to further enhance this support. More research is needed to evaluate both the short- and long-term clinical impact of these interventions.
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Affiliation(s)
- Camilla Sutter
- Newton-Wellesley Hospital, Newton, Massachusetts 02445, USA.
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16
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Abstract
Drawing on several decades of work with families, pediatricians, other health care professionals, and policy makers, the American Academy of Pediatrics provides a definition of patient- and family-centered care. In pediatrics, patient- and family-centered care is based on the understanding that the family is the child's primary source of strength and support. Further, this approach to care recognizes that the perspectives and information provided by families, children, and young adults are essential components of high-quality clinical decision-making, and that patients and family are integral partners with the health care team. This policy statement outlines the core principles of patient- and family-centered care, summarizes some of the recent literature linking patient- and family-centered care to improved health outcomes, and lists various other benefits to be expected when engaging in patient- and family-centered pediatric practice. The statement concludes with specific recommendations for how pediatricians can integrate patient- and family-centered care in hospitals, clinics, and community settings, and in broader systems of care, as well.
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Crissman HP, Warner L, Gardner M, Carr M, Schast A, Quittner AL, Kogan B, Sandberg DE. Children with disorders of sex development: A qualitative study of early parental experience. INTERNATIONAL JOURNAL OF PEDIATRIC ENDOCRINOLOGY 2011; 2011:10. [PMID: 21992519 PMCID: PMC3223129 DOI: 10.1186/1687-9856-2011-10] [Citation(s) in RCA: 82] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/17/2011] [Accepted: 10/12/2011] [Indexed: 11/10/2022]
Abstract
BACKGROUND Clinical research on psychological aspects of disorders of sex development (DSD) has focused on psychosexual differentiation with relatively little attention directed toward parents' experiences of early clinical management and their influence on patient and family psychosocial adaptation. OBJECTIVES To characterize parental experiences in the early clinical care of children born with DSD. STUDY DESIGN Content analysis of interviews with parents (n = 41) of 28 children, newborn to 6 years, with DSD. RESULTS Four major domains emerged as salient to parents: (1) the gender assignment process, (2) decisions regarding genital surgery, (3) disclosing information about their child's DSD, and (4) interacting with healthcare providers. Findings suggested discordance between scientific and parental understandings of the determinants of "sex" and "gender." Parents' expectations regarding the benefits of genital surgery appear largely met; however, parents still had concerns about their child's future physical, social and sexual development. Two areas experienced by many parents as particularly stressful were: (1) uncertainties regarding diagnosis and optimal management, and (2) conflicts between maintaining privacy versus disclosing the condition to access social support. CONCLUSIONS Parents' experiences and gaps in understanding can be used to inform the clinical care of patients with DSD and their families. Improving communication between parents and providers (and between parents and their support providers) throughout the early clinical management process may be important in decreasing stress and improving outcomes for families of children with DSD.
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Affiliation(s)
- Halley P Crissman
- Department of Pediatrics & Communicable Diseases Division of Child Behavioral Health University of Michigan Medical School 1500 East Medical Center Drive, SPC 5318 Ann Arbor, Michigan 48109-5318 USA
| | - Lauren Warner
- Department of Pediatrics & Communicable Diseases Division of Child Behavioral Health University of Michigan Medical School 1500 East Medical Center Drive, SPC 5318 Ann Arbor, Michigan 48109-5318 USA
| | - Melissa Gardner
- Department of Pediatrics & Communicable Diseases Division of Child Behavioral Health University of Michigan Medical School 1500 East Medical Center Drive, SPC 5318 Ann Arbor, Michigan 48109-5318 USA
| | - Meagan Carr
- Department of Pediatrics & Communicable Diseases Division of Child Behavioral Health University of Michigan Medical School 1500 East Medical Center Drive, SPC 5318 Ann Arbor, Michigan 48109-5318 USA
| | - Aileen Schast
- Division of Urology The Children's Hospital of Philadelphia Richard D Wood Center, 3rd Floor 34th Street and Civic Center Boulevard Philadelphia, Pennsylvania 19104 USA
| | - Alexandra L Quittner
- Departments of Psychology & Pediatrics University of Miami 5665 Ponce de Leon Blvd. Coral Gables, Florida 33146-2070 USA
| | - Barry Kogan
- Division of Urology Department of Surgery Albany Medical College 23 Hackett Boulevard Albany, New York 12208 USA
| | - David E Sandberg
- Department of Pediatrics & Communicable Diseases Division of Child Behavioral Health University of Michigan Medical School 1500 East Medical Center Drive, SPC 5318 Ann Arbor, Michigan 48109-5318 USA
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Using a Collaborative Child Life Approach for Continuous Surgical Preparation. AORN J 2009; 90:557-66. [DOI: 10.1016/j.aorn.2009.06.033] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2009] [Revised: 05/06/2009] [Accepted: 06/03/2009] [Indexed: 11/22/2022]
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Stevenson MD, Bivins CM, O'Brien K, Gonzalez del Rey JA. Child life intervention during angiocatheter insertion in the pediatric emergency department. Pediatr Emerg Care 2005; 21:712-8. [PMID: 16280943 DOI: 10.1097/01.pec.0000186423.84764.5a] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Current literature is deficient regarding the scope of procedures for which certified child life specialist (CCLS) services are effective in the pediatric emergency department. The purpose of this study is to analyze the effect of CCLS intervention during routine peripheral venous angiocatheter insertion on child procedure-related distress. METHODS Eligible children were aged 2 to 16 years. Subjects were randomly assigned to CCLS intervention or standard care. The Observation Scale of Behavior Distress-revised (OSBD-r) [J Pediatr Psychol 12 (1987) 543] was recorded during the procedure. Secondary outcomes included child and parent State Trait Anxiety Inventories [Manual for the State-Trait Anxiety Inventory (1973) and Manual for the State-Trait Anxiety Inventory for Children (1973)] and an adapted parent customer satisfaction survey [Eval Program Plann 5 (1982) 233; Eval Program Plann 6 (1983) 299; and J Paediatr Child Health 31 (1995) 435]. Explanatory and intention-to-treat analyses were performed. RESULTS One hundred forty-nine children completed the study. Although there was no statistical difference in mean total OSBD-r in the intention-to-treat analysis, the mean difference of 0.61 OSBD units (95% confidence interval, 0.04-1.19) in the anticipation phase in the 4- to 7-year age group was statistically significant. When the patients with only 1 insertion attempt were analyzed (n = 121), the total OSBD-r, anticipation, and preparation phase differences were statistically significant in the intention-to-treat analysis. In the explanatory analysis (n = 138), a mean significant difference in total OSBD-r score of 1.80 (95% confidence interval, 0.19-3.42) was found. There were no significant differences in child or parent anxiety or customer satisfaction between groups. CONCLUSIONS CCLS intervention may reduce the behavioral stress associated with angiocatheter insertion, especially in children aged 4 to 7 years. These data further support the role of the CCLS as a patient and family advocate during routine procedures.
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Affiliation(s)
- Michelle D Stevenson
- Division of Emergency Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
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Abstract
This evidence-based practice (EBP) article begins with a case study background. Case studies can be used to illustrate the unfolding of the nursing process, from assessment to reassessment, for particular patient care situations. The evidence-based process, and its importance for successful clinical outcomes, is explicated after the case study presentation. This is an example of how EBP is an integral part of what we do as healthcare professionals: When we are faced with clinical dilemmas, evidence-based tools are there to guide us to solutions. In this example, Child Life and Nursing worked collaboratively to identify key clinical issues. They consulted with clinical experts within the hospital, and they used scientific rationale to select therapeutic interventions to support a patient and her family through several crisis situations. The EBP tools, seeking clinical expertise and applying research-based interventions, resulted in successful outcomes for a complex patient care situation.
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Cole W, Diener M, Wright C, Gaynard L. Health Care Professionals' Perceptions of Child Life Specialists. CHILDRENS HEALTH CARE 2001. [DOI: 10.1207/s15326888chc3001_1] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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Abstract
There has been a tremendous amount of progress in the perioperative approach to the child since Levy wrote "Psychic trauma of operations in children and a note on combat neurosis" nearly 50 years ago. Recognition of prolonged behavioral derangements following the anesthetic-surgical-hospital experience and the prominent role that the parent and physician play in modifying these have dramatically changed the contemporary pediatric perioperative care. Of paramount importance is the psychological preparation of family and child. With increasing outpatient or same-day admission surgery and free-standing surgical centers, preoperative preparation will, of necessity, increasingly become the responsibility of the pediatrician.
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Affiliation(s)
- A L Zuckerberg
- Department of Anesthesia and Critical Care Medicine, Johns Hopkins Hospital, Baltimore, Maryland
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Abstract
The purpose of this naturalistic study was to describe the play of children in hospital playrooms and to determine whether the type of child life program focus (i.e., playroom/group vs. nonplayroom/individual) impacts on the frequency and types of play behaviors exhibited. Despite differences in hours of availability, length of experience of staff, complexity of play spaces, and number of activities, the type of program focus was not found to affect significantly play frequency or type. There were, however, trends for more educative and therapeutic play to occur in the playroom-focused setting. Instead, child variables of gender and length of hospitalization were related to types of play exhibited, and the type of illness and whether the child was previously hospitalized were related to certain nonplay behaviors. Implications are drawn for additional study of play in child life contexts.
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Abstract
Medical play and preparation have become increasingly visible components of psychosocial programming for children in health care settings. Each strategy varies to the extent to which adults structure and direct, which may influence children's responses and posthospital adjustment. Medical play and preparation represent different philosophies and theories on children's learning, adaptation, and development. The ever-changing medical environment may currently favor adult-directed experiences over those that are spontaneous or child initiated, with potentially differing impacts on children. Issues are raised regarding the potential impact as well as that of programs with various combinations of adult- versus child-structured experiences.
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Affiliation(s)
- R Bolig
- Ohio State University, Columbus
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McClowry SG. Behavioral disturbances among medically hospitalized school-age children. JOURNAL OF CHILD AND ADOLESCENT PSYCHIATRIC AND MENTAL HEALTH NURSING 1991; 4:62-7. [PMID: 2019976 DOI: 10.1111/j.1744-6171.1991.tb00491.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
The purpose of this study was to examine the behavioral disturbances of medically hospitalized school-age children. Seventy-six school-age children, between the ages of 8 and 12, were the subjects. The children's usual prehospital behavior was reported by their mothers who completed the Child Behavior Checklist (CBCL). The hospitalized children were compared with the standardized nonclinical norms on the CBCL. Fifty-one percent of the children scored in the clinical range on one or both of the broad bands measuring behavioral disturbances: 21% on externalizing symptoms and 47% on internalizing symptoms. Total behavior problems and externalizing behavior were slightly associated with low socioeconomic status but not with the number of previous hospitalizations. Internalizing problems were not related to socioeconomic status nor the number of previous hospitalizations. The need for specialized mental health services to this population is discussed.
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