1
|
Sullivan AHT, Healy HM, DeGrazia M, Toole C, Hansen A, Leeman KT. The 21st Century Cures Act: Perspectives of Clinicians in a Level-IV Neonatal Intensive Care Unit. Am J Perinatol 2024; 41:511-514. [PMID: 36130671 DOI: 10.1055/a-1948-7471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
OBJECTIVE Our objective is to describe the implications, anticipated and perceived, by providers in a level-IV neonatal intensive care unit (NICU) with immediate patient access to inpatient notes and test results in the wake of the 21st Century Cures Act (CCA). STUDY DESIGN Using a mixed-method approach in February 2021, a preimplementation survey of neonatologists, neonatal fellows, nurse practitioners, and neonatal nurses reported their perspectives on the new 21st CCA and how they anticipated that it would change their practices, and the experience of families in the NICU. In the follow-up to implementation, a postsurvey was completed by staff reporting their experiences in July 2021. Thematic analysis was performed. RESULTS In the preimplementation survey, staff reported the greatest perceived benefits of the changes to be an increase in families' ability to be part of the care team and prepare questions, and faster discussion of results by the care team. Also, staff's highest concerns were that family members may incorrectly interpret results delivered electronically without the context provided by the care team and be overwhelmed by the amount of information available. In the postimplementation survey, staff reported that the Act had less impact on their practice than they had anticipated preimplementation. CONCLUSION To maximize benefits and limit burdens to families and staff, care teams should consider a thoughtful approach to information sharing with family members in compliance with the 21st CCA. KEY POINTS · The impact of the 21 CCA on the NICU has not been studied.. · NICU staff have significant concerns related to the release of results to families.. · This study highlights the need to set expectations and provide family-centered care..
Collapse
Affiliation(s)
- Anne H T Sullivan
- Division of Newborn Medicine, Boston Children's Hospital, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
| | - Helen M Healy
- Harvard Medical School, Boston, Massachusetts
- Department of Neonatology, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Michele DeGrazia
- Division of Newborn Medicine, Boston Children's Hospital, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
| | - Cheryl Toole
- Division of Newborn Medicine, Boston Children's Hospital, Boston, Massachusetts
| | - Anne Hansen
- Division of Newborn Medicine, Boston Children's Hospital, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
| | - Kristen T Leeman
- Division of Newborn Medicine, Boston Children's Hospital, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
| |
Collapse
|
2
|
Toole C, DeGrazia M, Andrews TM, Bouve ME, Pezanowski R, Cole A, Kourembanas S, Hickey PA. No Place Like Home: Improving the Transition From NICU to Home Through the NICU to Nursery Program. Adv Neonatal Care 2024; 24:46-57. [PMID: 38215025 DOI: 10.1097/anc.0000000000001134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2024]
Abstract
BACKGROUND Boston Children's Hospital's Level IV Neonatal Intensive Care Unit (NICU) discharges about a third of its medically complex infants home. Parental feedback indicated a need for more education and training in discharge preparation. PURPOSE The NICU to Nursery (N2N) program was created to better prepare parents to care for their medically complex infants following Level IV NICU discharge. The goals were to (1) mitigate safety risks, (2) assess parent satisfaction, (3) assess pediatric primary care providers' (PCPs') satisfaction, (4) assess community visiting nurses' and PCPs' knowledge deficits, and (5) develop educational materials. METHODS The N2N program provided parents with pre- and postdischarge assessments with an experienced nurse. Parents completed a survey following assessments to measure satisfaction. To enhance PCPs' knowledge, they were sent summary reports and asked for feedback. PCP feedback, along with a needs assessment of community visiting nurses, guided the development of free Web-based educational videos. RESULTS One hundred and fifty-five parents participated in the N2N program. Parents' educational needs included medication education, safe sleep, and well-infant care, with some requiring significant nursing interventions for safety risk mitigation. Most PCPs found the home visit reports helpful. Knowledge deficits identified among PCPs and community visiting nurses included management of tubes and drains, growth and nutrition, and emergency response. More than 100,000 providers viewed the 3 Web-based educational videos developed. IMPLICATIONS FOR PRACTICE AND RESEARCH The N2N program fills a crucial gap in the transition of medically complex infants discharged home. The next steps are developing best practices for virtual in-home assessments.
Collapse
Affiliation(s)
- Cheryl Toole
- Neonatal Intensive Care Unit, Boston Children's Hospital, Massachusetts (Mss Toole, Andrews, Bouve, and Pezanowski and Drs DeGrazia and Kourembanas); Harvard Medical School, Boston, Massachusetts (Drs DeGrazia, Kourembanas, and Hickey); and Department of Nursing and Patient Care Operations, Boston Children's Hospital, Massachusetts (Ms Cole and Dr Hickey)
| | | | | | | | | | | | | | | |
Collapse
|
3
|
Kennedy HM, Cole A, Berbert L, Schenkel SR, DeGrazia M. An examination of characteristics, social supports, caregiver resilience and hospital readmissions of children with medical complexity. Child Care Health Dev 2024; 50:e13206. [PMID: 38123168 DOI: 10.1111/cch.13206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 08/18/2023] [Accepted: 11/19/2023] [Indexed: 12/23/2023]
Abstract
BACKGROUND Children with medical complexity (CMC) account for 1% of children in the United States. These children experience frequent hospital readmissions, high healthcare costs and poor health outcomes. A link between CMC caregiver social support, resilience and hospital readmissions has never been fully investigated. This study examines the feasibility of a prospective, descriptive, repeated measures research design to characterize CMC and their caregivers, social supports, caregiver resilience and hospital readmissions to inform a larger prospective investigation. METHODS Caregivers of CMC with unplanned hospitalizations completed surveys at the index hospitalization and 30 and 60 days after discharge. CMC caregiver and child characteristics, social supports and hospital readmissions were examined using an investigator-developed survey. Resilience was measured using the Resilience Scale-14© (7-Point Likert Scale, score range 14-98), and feasibility was measured by calculating enrolment, attrition, survey completion and item response. Analysis included descriptive statistics and qualitative data visualization. RESULTS Of caregivers who were approached for participation, 81.1% consented and completed 76 surveys. Attrition was 31%. Item response rates were ≥ 90% for all but one item. A total of 62.1% of children had hospital readmissions within 90 days and 37.9% within 30 days. Additionally, 70% of caregivers had home care nursing, but the approved hours were only partially filled. More than 70% of caregiver resilience scores were moderate to high (score range 74-98) and were stable across repeated measures and hospital readmissions. Open-ended question responses revealed the following five categories: All-consuming, Family Reliance, Impact of Covid, Taking Action and Broken System. CONCLUSIONS Studying CMC caregiver social supports and resilience using repeated measures is feasible. CMC caregivers reported stressors including coordinating their child's substantial healthcare needs and managing partially filled home care nursing hours. Caregiver resilience remained stable over time, amidst frequent CMC hospital readmissions. Findings can inform future research priorities and power analyses for CMC caregiver resilience.
Collapse
Affiliation(s)
- Heather M Kennedy
- Department of Nursing Patient Care Services, Boston Children's Hospital, Boston, MA, USA
- Department of Neurology and Neurosurgery, Boston Children's Hospital, Boston, MA
| | - Alexandra Cole
- Cardiovascular and Critical Care Services, Boston Children's Hospital, Boston, MA, USA
| | - Laura Berbert
- Biostatistics and Research Design Center, Boston Children's Hospital, Boston, MA, USA
| | | | - Michele DeGrazia
- Department of Nursing Patient Care Services, Boston Children's Hospital, Boston, MA, USA
- Division of Newborn Medicine, Boston Children's Hospital, Boston, MA, USA
- Department of Pediatrics, Harvard Medical School, Boston, MA, USA
| |
Collapse
|
4
|
Armstrong A, Engstrand S, Kunz S, Cole A, Schenkel S, Kucharski K, Toole C, DeGrazia M. Transferring With TACT: A Novel Tool to Standardize Transfer Decisions From a Level IV NICU. Adv Neonatal Care 2022; 22:E217-E228. [PMID: 36170747 DOI: 10.1097/anc.0000000000001030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Neonatal patients who no longer require level IV neonatal intensive care unit care are transferred to less acute levels of care. Standardized assessment tools have been shown to be beneficial in the transfer of patient care. However, no standardized tools were available to assist neonatal providers in the assessment and communication of the infants needs at transfer. PURPOSE The purpose was to develop a Transfer Assessment and Communication Tool (TACT) that guides provider decision making in the transfer of infants from a level IV neonatal intensive care unit to a less acute level of care within a regionalized healthcare system. METHODS Phase 1 included developing the first draft of the TACT using retrospective data, known variables from published literature, and study team expertise. In phase 2, the final draft of the TACT was created through feedback from expert neonatal providers in the regionalized care system using e-Delphi methodology. RESULTS The first draft of the TACT, developed in phase 1, included 36 characteristics. In phase 2, nurses, nurse practitioners, and physician experts representing all levels of newborn care participated in 4 e-Delphi surveys to develop the final draft of the TACT, which included 74 weighted characteristics. IMPLICATIONS FOR PRACTICE AND RESEARCH Potential benefits of the TACT include improved communication across healthcare teams, reduced risk for readmission, and increased caregiver visitation. The next steps are to validate the TACT for use either retrospectively or in real time, including characteristic weights, before implementation of this tool in the clinical setting.
Collapse
Affiliation(s)
- Alexandra Armstrong
- Neonatal Intensive Care Unit (Mss Armstrong, Kucharski, and Toole and Dr DeGrazia) and Cardiovascular and Critical Care (Mss Armstrong, Engstrand, Cole, Kucharski, and Toole and Dr DeGrazia), Boston Children's Hospital, Boston, Massachusetts; Division of Newborn Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts (Dr Kunz); Department of Pediatrics, Harvard Medical School, Boston, Massachusetts (Drs Kunz and DeGrazia); and Division of Pediatric Global Health, Massachusetts General Hospital, Boston, Massachusetts (Ms Schenkel)
| | | | | | | | | | | | | | | |
Collapse
|
5
|
Gilmore M, Cole A, DeGrazia M. Evidence-based review of chlorhexidine gluconate and iodine in the preoperative skin preparation of young infants. J SPEC PEDIATR NURS 2022; 27:e12393. [PMID: 35932169 DOI: 10.1111/jspn.12393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Revised: 06/22/2022] [Accepted: 07/27/2022] [Indexed: 11/27/2022]
Abstract
PURPOSE The preoperative preparation of young infants' skin requires special considerations. Commonly used solutions for preparing the skin preoperatively include chlorhexidine (CHG) and iodine. The Centers for Disease Control and Prevention (CDC) has recommendations for preparing skin for surgery and other invasive procedures for adults, but they do not have recommendations for young infants' skin. The purpose of this evidence-based literature review is to synthesize the literature, compare, and inform healthcare providers about the safety and efficacy of CHG and iodine as preoperative preparation solutions for young infants' skin. For this project young infants is defined as infants less than 48 weeks' postmenstrual age and those born prematurely and less than 28 days old. CONCLUSIONS We analyze 19 articles that met the inclusion criteria. Three discussion themes emerge: systemic absorption, dermatologic burns, and CHG and iodine efficacy. PRACTICE IMPLICATIONS We need more research regarding the safety and efficacy of CHG and iodine solutions for preoperative preparation of young infants' skin. Findings suggest the cautious use of CHG and iodine solutions on patients born at or before 28 weeks' postmenstrual age, especially those less than 28 days postnatal age.
Collapse
Affiliation(s)
- Molly Gilmore
- Acute Cardiac Care Unit, Boston Children's Hospital, Boston, Massachusetts, USA.,Boston Children's Hospital, Boston, Massachusetts, USA
| | | | - Michele DeGrazia
- Boston Children's Hospital, Boston, Massachusetts, USA.,Neonatal Intensive Care Unit, Boston Children's Hospital, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA
| |
Collapse
|
6
|
Getchell, K, McCowan, K, Whooley, E, Dumais, C, Rosenstock, A, Cole A, DeGrazia M. Child Life Specialists Decrease Procedure Time, Improve Experience, and Reduce Fear in an Outpatient Blood Drawing Lab (CLS Decrease Procedure Time). J Patient Exp 2022; 9:23743735221105679. [PMID: 35694015 PMCID: PMC9174556 DOI: 10.1177/23743735221105679] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Children can experience extreme fear when undergoing medical procedures,
including blood draws. A growing body of evidence points to the benefits of
Child Life Specialists supporting children throughout medical procedures in
various medical settings. This prospective cohort study aimed to describe the
impact of Child Life Specialist facilitated play on children's fear and
caregiver satisfaction in an outpatient blood drawing lab. A nonrandomized
convenience sample of 150 children and their caregivers were enrolled.
Seventy-five patients received the Child Life Specialist intervention during
their blood draw, while the remaining 75 patients were enrolled as controls.
Children and caregivers in the intervention group spent less time in the
procedure room, with a median time of 3 min (interquartile range: 2-5) as
compared to 5 min (interquartile range: 5-6; P < .001) for
the control group. Caregivers in the intervention group reported the atmosphere
(P = .032) and experience (P < .001)
more positively, and children reported lower fear scores
(P = .007) as compared to the control group. The findings of
this study suggest that Child Life Specialist interventions in pediatric
outpatient blood drawing labs improve satisfaction and reduce fear.
Collapse
Affiliation(s)
| | | | | | | | | | | | - Michele DeGrazia
- Neonatal Intensive Care Unit, Boston Children’s Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| |
Collapse
|
7
|
Roy KL, Fisk A, Forbes P, Holland CC, Schenkel SR, Vitali S, DeGrazia M. Inadequate Oxygen Delivery Dose and Major Adverse Events in Critically Ill Children With Sepsis. Am J Crit Care 2022; 31:220-228. [PMID: 35466350 DOI: 10.4037/ajcc2022125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
BACKGROUND The inadequate oxygen delivery (IDo2) index is used to estimate the probability that a patient is experiencing inadequate systemic delivery of oxygen. Its utility in the care of critically ill children with sepsis is unknown. OBJECTIVE To evaluate the relationship between IDo2 dose and major adverse events, illness severity metrics, and outcomes among critically ill children with sepsis. METHODS Clinical and IDo2 data were retrospectively collected from the records of 102 critically ill children with sepsis, weighing >2 kg, without preexisting cardiac dysfunction. Descriptive, nonparametric, odds ratio, and correlational statistics were used for data analysis. RESULTS Inadequate oxygen delivery doses were significantly higher in patients who experienced major adverse events (n = 13) than in those who did not (n = 89) during the time intervals of 0 to 12 hours (P < .001), 12 to 24 hours (P = .01), 0 to 24 hours (P < .001), 0 to 36 hours (P < .001), and 0 to 48 hours (P < .001). Patients with an IDo2 dose at 0 to 12 hours at or above the 80th percentile had the highest odds of a major adverse event (odds ratio, 23.6; 95% CI, 5.6-99.4). Significant correlations were observed between IDo2 dose at 0 to 12 hours and day 2 maximum vasoactive inotropic score (ρ = 0.27, P = .006), day 1 Pediatric Logistic Organ Dysfunction (PELOD-2) score (ρ = 0.41, P < .001), day 2 PELOD-2 score (ρ = 0.44, P < .001), intensive care unit length of stay (ρ = 0.35, P < .001), days receiving invasive ventilation (ρ = 0.42, P < .001), and age (ρ = -0.47, P < .001). CONCLUSIONS Routine IDo2 monitoring may identify critically ill children with sepsis who are at the highest risk of adverse events and poor outcomes.
Collapse
Affiliation(s)
- Katie L. Roy
- Katie L. Roy is a nurse practitioner in the medical-surgical intensive care unit (ICU), Cardiovascular and Critical Care Services, Boston Children’s Hospital, and a DNP graduate, Northeastern University, Boston, Massachusetts
| | - Anna Fisk
- Anna Fisk is a clinical coordinator in the cardiovascular ICU, Cardiovascular and Critical Care Services, Boston Children’s Hospital
| | - Peter Forbes
- Peter Forbes is a senior biostatistician, Institutional Centers for Clinical and Translational Research, Boston Children’s Hospital
| | - Conor C. Holland
- Conor C. Holland is a research engineer, Etiometry Inc, Boston, Massachusetts
| | - Sara R. Schenkel
- Sara R. Schenkel is a clinical research program manager, Massachusetts General Hospital, Boston
| | - Sally Vitali
- Sally Vitali is a senior associate in critical care medicine, Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children’s Hospital, and an assistant professor of anesthesia, Harvard Medical School, Boston, Massachusetts
| | - Michele DeGrazia
- Michele DeGrazia is director of nursing research, neonatal ICU, Cardiovascular and Critical Care Services, Boston Children’s Hospital, and an assistant professor of pediatrics, Harvard Medical School
| |
Collapse
|
8
|
Haley J, Engstrand SL, Cole A, Schenkel S, Hinsley K, Brawn B, Esch J, Ibla J, DeGrazia M. Safety and feasibility of the paediatric post-cardiac catheterisation Wrap: a pilot study. Cardiol Young 2022; 33:1-10. [PMID: 35105395 DOI: 10.1017/s1047951122000178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE The paediatric post-cardiac catheterisation Wrap (Wrap), an innovative medical safety device, swaddles young paediatric patients in a supine position aiding in immobilisation post-cardiac catheterisation. This pilot study investigated the feasibility and safety of using the Wrap on young paediatric patients during their bed rest period following cardiac catheterisation with femoral access. SETTING Boston Children's Hospital Cardiac Catheterization Lab. PARTICIPANTS 20 patients, ages 1-5 years and weighing 3-25 kg. METHODS Investigator-developed tools used to collect data included the Demographic and Outcome Measures Data Tool, the Parent/Caregiver Satisfaction, and Provider Ease of Use tools. They measured:1.The feasibility of using the Wrap2.Wrap ease of use from the nurse providers' perspective3.Parent satisfaction related to the Wrap4.Frequency of Wrap non-bleeding-related adverse events5.Frequency of rebleeding at femoral groin access sites. RESULTS The Wrap was feasible and safe; increased nurse provider satisfaction by allowing visualisation of the groin access sites while minimising the need for hands-on care; and increased parent satisfaction by allowing parents to hold and provide comfort while their child was on bed rest. IMPLICATIONS FOR RESEARCH The Wrap is a safe alternative to the current practice of swaddling with a bath blanket. Further studies are warranted to assess the Wrap's effectiveness in reducing the incidence of rebleeding events in the post-cardiac catheterisation period and explore clinical use outside of the Cardiac Catheterization Lab.
Collapse
Affiliation(s)
- Jennifer Haley
- Cardiac Catheterization Lab, Boston Children's Hospital, Boston, MA, USA
| | - Shannon L Engstrand
- Cardiovascular and Critical Care, Boston Children's Hospital, Boston, MA, USA
| | - Alexandra Cole
- Cardiovascular and Critical Care, Boston Children's Hospital, Boston, MA, USA
| | - Sara Schenkel
- Division of Pediatric Global Health, Massachusetts General Hospital, Boston, MA, USA
| | - Karen Hinsley
- Cardiac Catheterization Lab, Boston Children's Hospital, Boston, MA, USA
| | - Brenda Brawn
- Cardiac Catheterization Lab, Boston Children's Hospital, Boston, MA, USA
| | - Jesse Esch
- Cardiac Catheterization Lab, Boston Children's Hospital, Boston, MA, USA
| | - Juan Ibla
- Cardiac Catheterization Lab, Boston Children's Hospital, Boston, MA, USA
| | - Michele DeGrazia
- Cardiovascular and Critical Care, Boston Children's Hospital, Boston, MA, USA
| |
Collapse
|
9
|
Hillier MM, DeGrazia M, Mott S, Taylor M, Manning MJ, O'Brien M, Schenkel SR, Cole A, Hickey PA. Utilizing high-fidelity simulation to improve newly licensed pediatric intensive care unit nurses' experiences with end-of-life care. J SPEC PEDIATR NURS 2022; 27:e12360. [PMID: 34599640 DOI: 10.1111/jspn.12360] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Revised: 07/23/2021] [Accepted: 09/13/2021] [Indexed: 12/11/2022]
Abstract
PURPOSE New pediatric intensive care unit (PICU) nurses face distinct challenges in transitioning from the protected world of academia to postlicensure clinical practice; one of their greatest challenges is how to support children and their caregivers at the end-of-life (EOL). The purpose of this quality improvement project was to create, implement, and assess the efficacy of a high-fidelity EOL simulation, utilizing the "Debriefing with Good Judgment" debriefing model. DESIGN AND METHODS Participants were nurses with 4 years or less of PICU experience from a 404-bed quaternary care, free-standing children's hospital in the northeastern United States. Data were collected with the Simulation Effectiveness Tool-Modified (SET-M) and the PICU EOL Simulation Evaluation Survey. RESULTS Twenty-four nurses participated; the majority (54%) were 25-29 years of age. The SET-M results indicate that the EOL simulation was beneficial to their learning and increased nurse confidence in delivering EOL care. Responding to the EOL Simulation Survey, participants rated high levels of confidence with tasks such as utilizing unit and hospital-based supports, self-care, ability to listen and support families, and medicating their patients at the EOL. PRACTICE IMPLICATIONS This high-fidelity EOL simulation is a robust teaching tool that serves to support the unmet needs of the PICU nurses who care for dying children. Nurse participants had a unique opportunity to practice procedural and communication skills without risk for patient or family harm. Findings from this project can serve to guide curriculum changes at the undergraduate level as well as provide direction for new nurse orientation classes.
Collapse
Affiliation(s)
- Maureen M Hillier
- Medical Surgical Intensive Care Unit, Boston Children's Hospital, Boston, Massachusetts, USA.,MGH Institute of Health Professions, Boston, Massachusetts, USA
| | - Michele DeGrazia
- Neonatal Intensive Care Unit, Boston Children's Hospital, Boston, Massachusetts, USA.,Division of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA
| | - Sandra Mott
- Boston Children's Hospital, Boston, Massachusetts, USA
| | - Matthew Taylor
- Boston Children's Hospital Simulator Program, Boston, Massachusetts, USA
| | - Mary J Manning
- Medical Surgical Intensive Care Unit, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Mary O'Brien
- Medical Surgical Intensive Care Unit, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Sara R Schenkel
- Division of Pediatric Global Health, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Alexandra Cole
- Cardiovascular and Critical Care Services, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Patricia A Hickey
- Division of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA.,Cardiovascular and Critical Care Services, Boston Children's Hospital, Boston, Massachusetts, USA
| |
Collapse
|
10
|
DeGrazia M, Porter C, Sheehan A, Whitamore S, White D, Nuttall PW, Blanchard T, Davis N, Steadman J, Hickey P. Building Moral Resiliency Through the Nurse Education and Support Team Initiative. Am J Crit Care 2021; 30:95-102. [PMID: 33644802 DOI: 10.4037/ajcc2021534] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
BACKGROUND Findings from 3 nurse-led research studies conducted in a large pediatric institution resulted in a call to action to support intensive and progressive care nurses experiencing moral and ethical challenges. OBJECTIVE To evaluate the feasibility of and satisfaction with implementation of a Nurse Education and Support Team (NEST) coach role. METHODS An interdisciplinary work group identified solutions for just-in-time support, including a new NEST coach role. This role was implemented in January 2017 to provide peer-to-peer support for nurses. The NEST coaches provide coverage 5 days per week in 4 intensive care units and 1 progressive care unit. Feasibility of the role was evaluated by assessing the number, type, length, and outcome of NEST coach consultations. Staff satisfaction was evaluated 6 months and 1.5 years after implementation. RESULTS A total of 6262 NEST coach consultations occurred across the units from January 2017 through November 2019. At both evaluation periods, more than 85% of respondents indicated that they were satisfied with their interactions with the NEST coach and nearly 80% indicated that they would seek consultation again. CONCLUSIONS Pediatric intensive and progressive care nurses experience many challenges in their practice environments. The innovative NEST coach role enabled access to just-in-time support and guidance through morally and ethically challenging situations. As evidenced by the number of consultations and the positive staff response, intensive and progressive care nurses have embraced and integrated the NEST coach role into their culture and practice.
Collapse
Affiliation(s)
- Michele DeGrazia
- Michele DeGrazia is director of nursing research in the neonatal intensive care unit, Boston Children’s Hospital, Boston, Massachusetts, and an assistant professor in the Department of Pediatrics, Harvard Medical School, Boston
| | - Courtney Porter
- Courtney Porter is a program administrative manager III in Cardiovascular and Critical Care Nursing Patient Services, Boston Children’s Hospital
| | - Anne Sheehan
- Anne Sheehan is a staff nurse II in the cardiac progressive care unit, Boston Children’s Hospital
| | - Stephanie Whitamore
- Stephanie Whitamore is a staff nurse II in the cardiac intensive care unit, Boston Children’s Hospital
| | - Deborah White
- Deborah White is a staff nurse II in the neonatal intensive care unit, Boston Children’s Hospital
| | - Penny Winter Nuttall
- Penny Winter Nuttall is a staff nurse II in the cardiac intensive care unit, Boston Children’s Hospital
| | - Tyler Blanchard
- Tyler Blanchard is a staff nurse I in the medical-surgical intensive care unit, Boston Children’s Hospital
| | - Norah Davis
- Norah Davis is a staff nurse I in the medical intensive care unit, Boston Children’s Hospital
| | - Jennifer Steadman
- Jennifer Steadman is a clinical coordinator in the medical intensive care unit, Boston Children’s Hospital
| | - Patricia Hickey
- Patricia Hickey is vice president and associate chief nurse in Cardiovascular and Critical Care Nursing Patient Services, Boston Children’s Hospital and an assistant professor in the Department of Pediatrics, Harvard Medical School
| |
Collapse
|
11
|
Schuler E, Mott S, Forbes PW, Schmid A, Atkinson C, DeGrazia M. Evaluation of an evidence-based practice mentorship programme in a paediatric quaternary care setting. J Res Nurs 2021; 26:149-165. [PMID: 35251236 DOI: 10.1177/1744987121991417] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Evidence-based practice (EBP) is essential for clinical decision-making, improving care, reducing costs and achieving optimal patient outcomes. The Evidence-based Practice Mentorship Program (EBPMP) is a flexible, self-directed programme whereby participants carry out EBP projects guided by expert mentors. AIMS To evaluate EBPMP effectiveness and participant experience. METHODS To evaluate effectiveness, as measured by changes in EBP value, knowledge and implementation, participants completed pre- and post-EBPMP Quick-EBP-Value, Implementation and Knowledge (VIK) surveys. To understand participants' experiences individual and group interviews were conducted at the end of the programme and analysed using qualitative content analysis. RESULTS Most participants were over 50 years old, Caucasian, inpatient staff nurses, baccalaureate prepared, with over 11 years' experience. Statistically significant improvements were observed in the post Quick-EBP-VIK knowledge and implementation domains. Individual and group participant interviews revealed four categories of importance to the experience: 1. perceived benefits of EBP, 2. time as a barrier to EBP, 3. desire for more cohort interaction and 4. positive mentee-mentor experience. CONCLUSIONS EBPMP can improve participants' knowledge and implementation of EBP in an environment that values EBP; however, opportunities exist to implement programme modifications that address barriers identified by participants including project time and increased participant interactions.
Collapse
Affiliation(s)
- Ethan Schuler
- Pediatric Nurse Practitioner II, Cardiovascular and Critical Care Nursing Patient Services, Boston Children's Hospital, USA
| | - Sandra Mott
- Nurse Scientist, Cardiovascular and Critical Care Nursing Patient Services, Boston Children's Hospital, USA
| | - Peter W Forbes
- Senior Biostatistician, Clinical Research Program, Boston Children's Hospital, USA
| | - Alexis Schmid
- Staff Nurse, Emergency Department, Boston Children's Hospital, USA
| | - Carole Atkinson
- Nurse Practice Specialist II, Neuroscience Programs, Boston Children's Hospital, USA
| | - Michele DeGrazia
- Director of Nursing Research for the Neonatal Intensive Care Unit, Cardiovascular and Critical Care Nursing Patient Services, Boston Children's Hospital, USA. Harvard Medical School, USA
| |
Collapse
|
12
|
Abecassis L, Gaffin JM, Forbes PW, Schenkel SR, McBride S, DeGrazia M. Validation of the Hospital Asthma Severity Score (HASS) in children ages 2-18 years old. J Asthma 2020; 59:315-324. [PMID: 33198536 DOI: 10.1080/02770903.2020.1852414] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
INTRODUCTION The Hospital Asthma Severity Score (HASS) was developed to communicate inpatient asthma severity between providers. The purpose of this prospective study was to validate the HASS against the Pediatric Respiratory Assessment Measure (PRAM) and spirometry for assessment of inpatient asthma exacerbation severity in patients 2-18 years old, at a single point-in-time. METHODS This study was registered with clinicaltrials.gov (NCT02782065). Children admitted to a tertiary care, free-standing children's hospital were assessed for asthma severity using the HASS, PRAM, and pulmonary function by spirometry. Inter-rater agreement of HASS and PRAM scores was assessed between two blinded clinician raters. Spirometry results were obtained by a certified pulmonary laboratory technician and correlated with HASS and PRAM scores. RESULTS The sample included 58 subjects. Allowing for a one-point difference in continuous HASS and PRAM scores, inter-rater agreement was 79% for the HASS and 60% for the PRAM. When the scores were categorized as mild, moderate, and severe, inter-rater agreement was 62% for the HASS and 93% for the PRAM (p < .0001). Additionally, intra-rater agreement between HASS and PRAM severity categories was 71% for Rater 1 and 64% for Rater 2. A weak correlation was noted between both the HASS and FEV1 (r = -0.31; p = 0.11), and PRAM and FEV1 (r = -0.30; p = 0.11) for the 29 subjects with acceptable spirometry results. CONCLUSIONS The HASS and PRAM have acceptable inter-rater and intra-rater agreement. These results support validation of the HASS for managing hospitalized patients during asthma exacerbations.
Collapse
Affiliation(s)
- Leah Abecassis
- Cardiovascular and Critical Care Services, Boston Children's Hospital, Boston, MA, USA
| | - Jonathan M Gaffin
- Division of Pulmonary Medicine, Boston Children's Hospital, Boston, MA, USA.,Department of Medicine, Harvard Medical School, Boston, MA, USA
| | - Peter W Forbes
- Clinical Research Center, Boston Children's Hospital, Boston, MA, USA
| | - Sara R Schenkel
- Division of Pediatric Global Health, Massachusetts General Hospital, Boston, MA, USA
| | - Sarah McBride
- Division of General Pediatrics, Boston Children's Hospital, Boston, MA, USA
| | - Michele DeGrazia
- Cardiovascular and Critical Care Services, Boston Children's Hospital, Boston, MA, USA.,Department of Medicine, Harvard Medical School, Boston, MA, USA
| |
Collapse
|
13
|
Schmid A, DeGrazia M, Mott S, Schuler E, Schenkel SR, Niescierenko M, Hickey PA. Pediatric nurses' perceptions of preparedness for global health fieldwork. J SPEC PEDIATR NURS 2020; 25:e12304. [PMID: 32692485 DOI: 10.1111/jspn.12304] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Revised: 05/08/2020] [Accepted: 07/09/2020] [Indexed: 11/30/2022]
Abstract
OBJECTIVES The purpose of this qualitative descriptive research study was to understand the current state, perceived content, and experiential needs of pediatric nurses preparing for global health (GH) fieldwork experience. This study aimed to inform stakeholders about the standard and unique preparation needs of pediatric GH nurses. STUDY DESIGN AND METHODS One group and five individual interviews were held with nurses from a large pediatric quaternary care facility in the Northeast United States. Data from the interviews were transcribed verbatim, eliminating personal data. Only deidentified transcripts were used for data analysis. Members of the study team used content analysis to systematically code and analyze the data. RESULTS Qualitative content analysis revealed five categories: (1) identifying clear objectives, (2) understanding the practice environment, (3) self-assessment of clinical skills, cultural competencies, and adaptability, (4) safety and logistics planning, and (5) psychological self-care and reentry anticipatory guidance. CONCLUSIONS Findings can provide a basis for program planning to prepare pediatric nurses for GH fieldwork. Program planning must account for the unique features of the site and situation. Organizational and personal preparation can influence the perceived success of the GH experience.
Collapse
Affiliation(s)
- Alexis Schmid
- Department of Emergency Medicine, Boston Children's Hospital, Boston, Massachusetts, USA.,Global Health Program, Boston Children's Hospital, Boston, Massachusetts, USA.,Northeastern University, Boston, Massachusetts, USA
| | - Michele DeGrazia
- Cardiovascular and Critical Care Services, Boston Children's Hospital, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA
| | - Sandra Mott
- Cardiovascular and Critical Care Services, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Ethan Schuler
- Cardiovascular and Critical Care Services, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Sara R Schenkel
- Cardiovascular and Critical Care Services, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Michelle Niescierenko
- Department of Emergency Medicine, Boston Children's Hospital, Boston, Massachusetts, USA.,Global Health Program, Boston Children's Hospital, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA
| | - Patricia A Hickey
- Cardiovascular and Critical Care Services, Boston Children's Hospital, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA
| |
Collapse
|
14
|
DeGrazia M, Ahtam B, Rogers-Vizena CR, Proctor M, Porter C, Vyas R, Laurentys CT, Bergling E, McLaughlin K, Grant PE. Brain Characteristics Noted Prior to and Following Cranial Orthotic Treatment. Child Neurol Open 2020; 7:2329048X20949769. [PMID: 32884966 PMCID: PMC7440724 DOI: 10.1177/2329048x20949769] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Objective: This case report aims to assess a potential association between cranial asymmetry, brain deformation, and associated developmental delay. Study Design: Two infants born at ≥37 weeks pursuing cranial orthotic treatment for severe Deformational Plagiocephaly (DP) (cranial vault asymmetry index >8.75%) underwent developmental assessment using Mullen Scales of Early Learning (MSEL) and non-sedated brain structural and diffusion magnetic resonance imaging (MRI) prior to and following cranial orthotic treatment. Results: In both infants with DP, tractography results revealed alterations in the white matter pathways of the brain. Both infants also had low to low/normal visual receptivity and fine motor skills. After cranial orthotic treatment, cranial asymmetry improved but did not completely resolve, tractography demonstrated a change toward normalized white matter pathways, and visual receptivity and fine motor skills improved. Conclusions: These preliminary findings suggest a potential link between DP, altered brain structures, and developmental assessment. Further investigation with a larger sample is warranted.
Collapse
Affiliation(s)
- Michele DeGrazia
- Cardiovascular and Critical Care, Boston Children's Hospital, Boston, MA, USA.,Department of Pediatrics, Harvard Medical School, Boston, MA, USA.,Division of Newborn Medicine, Boston Children's Hospital, Boston, MA, USA
| | - Banu Ahtam
- Department of Pediatrics, Harvard Medical School, Boston, MA, USA.,Division of Newborn Medicine, Boston Children's Hospital, Boston, MA, USA.,Fetal-Neonatal Neuroimaging and Developmental Science Center, Boston Children's Hospital, Boston, MA, USA
| | - Carolyn R Rogers-Vizena
- Department of Plastic and Oral Surgery, Boston Children's Hospital, Boston, MA, USA.,Department of Surgery, Harvard Medical School, Boston, MA, USA
| | - Mark Proctor
- Department of Neurosurgery, Boston Children's Hospital, Boston, MA, USA.,Department of Neurosurgery, Harvard Medical School, Boston, MA, USA
| | - Courtney Porter
- Cardiovascular and Critical Care, Boston Children's Hospital, Boston, MA, USA
| | - Rutvi Vyas
- Department of Pediatrics, Harvard Medical School, Boston, MA, USA.,Division of Newborn Medicine, Boston Children's Hospital, Boston, MA, USA.,Fetal-Neonatal Neuroimaging and Developmental Science Center, Boston Children's Hospital, Boston, MA, USA
| | - Cynthia T Laurentys
- Department of Pediatrics, Harvard Medical School, Boston, MA, USA.,Division of Newborn Medicine, Boston Children's Hospital, Boston, MA, USA.,Fetal-Neonatal Neuroimaging and Developmental Science Center, Boston Children's Hospital, Boston, MA, USA
| | - Emily Bergling
- Cardiovascular and Critical Care, Boston Children's Hospital, Boston, MA, USA
| | | | - Patricia Ellen Grant
- Department of Pediatrics, Harvard Medical School, Boston, MA, USA.,Division of Newborn Medicine, Boston Children's Hospital, Boston, MA, USA.,Fetal-Neonatal Neuroimaging and Developmental Science Center, Boston Children's Hospital, Boston, MA, USA
| |
Collapse
|
15
|
Connor JA, Mott S, DeGrazia M, Lajoie D, Dwyer P, Reed MP, Porter C, Hickey PA. Nursing science fellowship at Boston Children's Hospital. Appl Nurs Res 2020; 55:151292. [PMID: 32873423 DOI: 10.1016/j.apnr.2020.151292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Revised: 03/06/2020] [Accepted: 05/07/2020] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Clinical inquiry is vital to safeguard nursing practice and ensure optimal outcomes for our patients and families. The innovative Nursing Science Fellowship (NSF) was developed to provide structured mentorship for pediatric nurses by nurse scientists to design and conduct clinical inquiry generated from their practice. METHODS Each fellow is paired with a nurse scientist mentor to receive support for timely project completion. Dedicated mentors guide the immersion of fellows in nursing science by providing them with didactic content detailing the process of clinical inquiry and bi-monthly one-on-one mentorship sessions. Throughout their journey, fellows learn the appropriate method by which to address their clinical inquiry question and complete a scholarly project that contributes to the science of nursing. On a quarterly basis, fellows share their progress and achievements with peers, mentors, and senior leadership. RESULTS Since 2011, 84 fellows have enrolled in this two-year program. Sixty-two nurses have graduated from the NSF and 22 fellows are currently active. Collectively, the fellows have received 46 grants to support their projects. Twenty-one fellows have received promotions and 22 fellows have furthered their education in a masters, clinical or research doctorate program. There have been 78 external disseminations highlighting their clinical inquiry work, including poster and podium presentations and peer-reviewed published manuscripts. Lastly, there have been 26 new or updated clinical practices implemented across the enterprise as a result of completed projects. CONCLUSIONS Combined these efforts have ensured a sustained commitment to advancing the science and practice of pediatric nursing.
Collapse
Affiliation(s)
- Jean A Connor
- Cardiovascular and Critical Care Nursing Patient Services, Boston Children's Hospital, Boston, MA, United States of America; Harvard Medical School, Boston, MA, United States of America.
| | - Sandra Mott
- Cardiovascular and Critical Care Nursing Patient Services, Boston Children's Hospital, Boston, MA, United States of America
| | - Michele DeGrazia
- Harvard Medical School, Boston, MA, United States of America; Neonatal Intensive Care Unit, Boston Children's Hospital, Boston, MA, United States of America
| | - Debra Lajoie
- Surgical Programs, Boston Children's Hospital, Boston, MA, United States of America
| | - Patricia Dwyer
- Satellite Clinical Operations, Boston Children's Hospital, Boston, MA, United States of America
| | - Mary Poyner Reed
- Medicine Patient Services, Boston Children's Hospital, Boston, MA, United States of America
| | - Courtney Porter
- Cardiovascular and Critical Care Patient Services, Boston Children's Hospital, Boston, MA, United States of America
| | - Patricia A Hickey
- Harvard Medical School, Boston, MA, United States of America; Cardiovascular and Critical Care Nursing Patient Services, Boston Children's Hospital, Boston, MA, United States of America
| |
Collapse
|
16
|
Chandonnet CJ, Toole C, Young V, Feldman HA, Kellogg M, Kim J, Scoville M, Porter C, Weekes M, Wild S, DeGrazia M. Safety of Biweekly Chlorhexidine Gluconate Bathing in Infants 36 To 48 Weeks' Postmenstrual Age. Am J Crit Care 2019; 28:451-459. [PMID: 31676520 DOI: 10.4037/ajcc2019967] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
BACKGROUND Little evidence supports use of chlorhexidine gluconate (CHG) baths to reduce health care-associated infections, including central catheter-associated bloodstream infections in infants less than 2 months old. OBJECTIVE To describe the safety of biweekly CHG baths in infants less than 2 months old by measuring blood levels of CHG, liver and renal function, skin reactions, and adverse events. METHODS Study participants received twice-weekly 2% CHG baths, weekly blood tests, and twice-daily skin assessments. Adverse events were monitored. RESULTS Ten infants 36 to 48 weeks' postmenstrual age with central venous catheters admitted to the neonatal or cardiac intensive care unit were enrolled before the study was closed by the Food and Drug Administration. The 9 patients contributing data had 83 CHG exposures; 31 CHG levels were analyzed. All patients had evidence of CHG absorption. Seven patients had CHG levels of 100 ng/mL or greater. Findings did not support accumulation of CHG but did show evidence of higher absorption than previously reported. Results of liver and renal function studies remained within reference limits. No patient had any adverse events, including skin reactions. CONCLUSIONS Although no adverse events were observed, our patients had evidence of CHG absorption. The effects of this absorption remain unknown. More research is needed to determine safe blood levels of CHG in infants less than 2 months of age.
Collapse
Affiliation(s)
- Celeste J Chandonnet
- Celeste J. Chandonnet is an infection preventionist at Boston Children's Hospital, Boston, Massachusetts. Cheryl Toole is director of nursing patient services and Stephanie Wild is a staff nurse II in the neonatal intensive care unit, Cardiovascular and Critical Care Nursing Patient Services, Boston Children's Hospital. Vanessa Young is a clinical coordinator in the Division of Newborn Medicine, Boston Children's Hospital. Henry A. Feldman is principal biostatistician in the Institutional Centers for Clinical and Translational Research, Boston Children's Hospital, and an associate professor of pediatrics at Harvard Medical School, Boston, Massachusetts. Mark Kellogg is associate director of chemistry in the Department of Laboratory Medicine, Boston Children's Hospital and an assistant professor of pathology at Harvard Medical School. Jenny Kim is a clinical pharmacist and Michael Scoville is lead pharmacy technician for the investigational drug service in the Department of Pharmacy, Boston Children's Hospital. Courtney Porter is a program administrative manager III in Cardiovascular and Critical Care Nursing Patient Services, Boston Children's Hospital. Malika Weekes is a staff nurse I in the cardiac intensive care unit, Cardiovascular and Critical Care Nursing Patient Services, Boston Children's Hospital. Michele DeGrazia is director of nursing research in the neonatal intensive care unit, Cardiovascular and Critical Care Nursing Patient Services, Boston Children's Hospital, and an assistant professor of pediatrics at Harvard Medical School.
| | - Cheryl Toole
- Celeste J. Chandonnet is an infection preventionist at Boston Children's Hospital, Boston, Massachusetts. Cheryl Toole is director of nursing patient services and Stephanie Wild is a staff nurse II in the neonatal intensive care unit, Cardiovascular and Critical Care Nursing Patient Services, Boston Children's Hospital. Vanessa Young is a clinical coordinator in the Division of Newborn Medicine, Boston Children's Hospital. Henry A. Feldman is principal biostatistician in the Institutional Centers for Clinical and Translational Research, Boston Children's Hospital, and an associate professor of pediatrics at Harvard Medical School, Boston, Massachusetts. Mark Kellogg is associate director of chemistry in the Department of Laboratory Medicine, Boston Children's Hospital and an assistant professor of pathology at Harvard Medical School. Jenny Kim is a clinical pharmacist and Michael Scoville is lead pharmacy technician for the investigational drug service in the Department of Pharmacy, Boston Children's Hospital. Courtney Porter is a program administrative manager III in Cardiovascular and Critical Care Nursing Patient Services, Boston Children's Hospital. Malika Weekes is a staff nurse I in the cardiac intensive care unit, Cardiovascular and Critical Care Nursing Patient Services, Boston Children's Hospital. Michele DeGrazia is director of nursing research in the neonatal intensive care unit, Cardiovascular and Critical Care Nursing Patient Services, Boston Children's Hospital, and an assistant professor of pediatrics at Harvard Medical School
| | - Vanessa Young
- Celeste J. Chandonnet is an infection preventionist at Boston Children's Hospital, Boston, Massachusetts. Cheryl Toole is director of nursing patient services and Stephanie Wild is a staff nurse II in the neonatal intensive care unit, Cardiovascular and Critical Care Nursing Patient Services, Boston Children's Hospital. Vanessa Young is a clinical coordinator in the Division of Newborn Medicine, Boston Children's Hospital. Henry A. Feldman is principal biostatistician in the Institutional Centers for Clinical and Translational Research, Boston Children's Hospital, and an associate professor of pediatrics at Harvard Medical School, Boston, Massachusetts. Mark Kellogg is associate director of chemistry in the Department of Laboratory Medicine, Boston Children's Hospital and an assistant professor of pathology at Harvard Medical School. Jenny Kim is a clinical pharmacist and Michael Scoville is lead pharmacy technician for the investigational drug service in the Department of Pharmacy, Boston Children's Hospital. Courtney Porter is a program administrative manager III in Cardiovascular and Critical Care Nursing Patient Services, Boston Children's Hospital. Malika Weekes is a staff nurse I in the cardiac intensive care unit, Cardiovascular and Critical Care Nursing Patient Services, Boston Children's Hospital. Michele DeGrazia is director of nursing research in the neonatal intensive care unit, Cardiovascular and Critical Care Nursing Patient Services, Boston Children's Hospital, and an assistant professor of pediatrics at Harvard Medical School
| | - Henry A Feldman
- Celeste J. Chandonnet is an infection preventionist at Boston Children's Hospital, Boston, Massachusetts. Cheryl Toole is director of nursing patient services and Stephanie Wild is a staff nurse II in the neonatal intensive care unit, Cardiovascular and Critical Care Nursing Patient Services, Boston Children's Hospital. Vanessa Young is a clinical coordinator in the Division of Newborn Medicine, Boston Children's Hospital. Henry A. Feldman is principal biostatistician in the Institutional Centers for Clinical and Translational Research, Boston Children's Hospital, and an associate professor of pediatrics at Harvard Medical School, Boston, Massachusetts. Mark Kellogg is associate director of chemistry in the Department of Laboratory Medicine, Boston Children's Hospital and an assistant professor of pathology at Harvard Medical School. Jenny Kim is a clinical pharmacist and Michael Scoville is lead pharmacy technician for the investigational drug service in the Department of Pharmacy, Boston Children's Hospital. Courtney Porter is a program administrative manager III in Cardiovascular and Critical Care Nursing Patient Services, Boston Children's Hospital. Malika Weekes is a staff nurse I in the cardiac intensive care unit, Cardiovascular and Critical Care Nursing Patient Services, Boston Children's Hospital. Michele DeGrazia is director of nursing research in the neonatal intensive care unit, Cardiovascular and Critical Care Nursing Patient Services, Boston Children's Hospital, and an assistant professor of pediatrics at Harvard Medical School
| | - Mark Kellogg
- Celeste J. Chandonnet is an infection preventionist at Boston Children's Hospital, Boston, Massachusetts. Cheryl Toole is director of nursing patient services and Stephanie Wild is a staff nurse II in the neonatal intensive care unit, Cardiovascular and Critical Care Nursing Patient Services, Boston Children's Hospital. Vanessa Young is a clinical coordinator in the Division of Newborn Medicine, Boston Children's Hospital. Henry A. Feldman is principal biostatistician in the Institutional Centers for Clinical and Translational Research, Boston Children's Hospital, and an associate professor of pediatrics at Harvard Medical School, Boston, Massachusetts. Mark Kellogg is associate director of chemistry in the Department of Laboratory Medicine, Boston Children's Hospital and an assistant professor of pathology at Harvard Medical School. Jenny Kim is a clinical pharmacist and Michael Scoville is lead pharmacy technician for the investigational drug service in the Department of Pharmacy, Boston Children's Hospital. Courtney Porter is a program administrative manager III in Cardiovascular and Critical Care Nursing Patient Services, Boston Children's Hospital. Malika Weekes is a staff nurse I in the cardiac intensive care unit, Cardiovascular and Critical Care Nursing Patient Services, Boston Children's Hospital. Michele DeGrazia is director of nursing research in the neonatal intensive care unit, Cardiovascular and Critical Care Nursing Patient Services, Boston Children's Hospital, and an assistant professor of pediatrics at Harvard Medical School
| | - Jenny Kim
- Celeste J. Chandonnet is an infection preventionist at Boston Children's Hospital, Boston, Massachusetts. Cheryl Toole is director of nursing patient services and Stephanie Wild is a staff nurse II in the neonatal intensive care unit, Cardiovascular and Critical Care Nursing Patient Services, Boston Children's Hospital. Vanessa Young is a clinical coordinator in the Division of Newborn Medicine, Boston Children's Hospital. Henry A. Feldman is principal biostatistician in the Institutional Centers for Clinical and Translational Research, Boston Children's Hospital, and an associate professor of pediatrics at Harvard Medical School, Boston, Massachusetts. Mark Kellogg is associate director of chemistry in the Department of Laboratory Medicine, Boston Children's Hospital and an assistant professor of pathology at Harvard Medical School. Jenny Kim is a clinical pharmacist and Michael Scoville is lead pharmacy technician for the investigational drug service in the Department of Pharmacy, Boston Children's Hospital. Courtney Porter is a program administrative manager III in Cardiovascular and Critical Care Nursing Patient Services, Boston Children's Hospital. Malika Weekes is a staff nurse I in the cardiac intensive care unit, Cardiovascular and Critical Care Nursing Patient Services, Boston Children's Hospital. Michele DeGrazia is director of nursing research in the neonatal intensive care unit, Cardiovascular and Critical Care Nursing Patient Services, Boston Children's Hospital, and an assistant professor of pediatrics at Harvard Medical School
| | - Michael Scoville
- Celeste J. Chandonnet is an infection preventionist at Boston Children's Hospital, Boston, Massachusetts. Cheryl Toole is director of nursing patient services and Stephanie Wild is a staff nurse II in the neonatal intensive care unit, Cardiovascular and Critical Care Nursing Patient Services, Boston Children's Hospital. Vanessa Young is a clinical coordinator in the Division of Newborn Medicine, Boston Children's Hospital. Henry A. Feldman is principal biostatistician in the Institutional Centers for Clinical and Translational Research, Boston Children's Hospital, and an associate professor of pediatrics at Harvard Medical School, Boston, Massachusetts. Mark Kellogg is associate director of chemistry in the Department of Laboratory Medicine, Boston Children's Hospital and an assistant professor of pathology at Harvard Medical School. Jenny Kim is a clinical pharmacist and Michael Scoville is lead pharmacy technician for the investigational drug service in the Department of Pharmacy, Boston Children's Hospital. Courtney Porter is a program administrative manager III in Cardiovascular and Critical Care Nursing Patient Services, Boston Children's Hospital. Malika Weekes is a staff nurse I in the cardiac intensive care unit, Cardiovascular and Critical Care Nursing Patient Services, Boston Children's Hospital. Michele DeGrazia is director of nursing research in the neonatal intensive care unit, Cardiovascular and Critical Care Nursing Patient Services, Boston Children's Hospital, and an assistant professor of pediatrics at Harvard Medical School
| | - Courtney Porter
- Celeste J. Chandonnet is an infection preventionist at Boston Children's Hospital, Boston, Massachusetts. Cheryl Toole is director of nursing patient services and Stephanie Wild is a staff nurse II in the neonatal intensive care unit, Cardiovascular and Critical Care Nursing Patient Services, Boston Children's Hospital. Vanessa Young is a clinical coordinator in the Division of Newborn Medicine, Boston Children's Hospital. Henry A. Feldman is principal biostatistician in the Institutional Centers for Clinical and Translational Research, Boston Children's Hospital, and an associate professor of pediatrics at Harvard Medical School, Boston, Massachusetts. Mark Kellogg is associate director of chemistry in the Department of Laboratory Medicine, Boston Children's Hospital and an assistant professor of pathology at Harvard Medical School. Jenny Kim is a clinical pharmacist and Michael Scoville is lead pharmacy technician for the investigational drug service in the Department of Pharmacy, Boston Children's Hospital. Courtney Porter is a program administrative manager III in Cardiovascular and Critical Care Nursing Patient Services, Boston Children's Hospital. Malika Weekes is a staff nurse I in the cardiac intensive care unit, Cardiovascular and Critical Care Nursing Patient Services, Boston Children's Hospital. Michele DeGrazia is director of nursing research in the neonatal intensive care unit, Cardiovascular and Critical Care Nursing Patient Services, Boston Children's Hospital, and an assistant professor of pediatrics at Harvard Medical School
| | - Malika Weekes
- Celeste J. Chandonnet is an infection preventionist at Boston Children's Hospital, Boston, Massachusetts. Cheryl Toole is director of nursing patient services and Stephanie Wild is a staff nurse II in the neonatal intensive care unit, Cardiovascular and Critical Care Nursing Patient Services, Boston Children's Hospital. Vanessa Young is a clinical coordinator in the Division of Newborn Medicine, Boston Children's Hospital. Henry A. Feldman is principal biostatistician in the Institutional Centers for Clinical and Translational Research, Boston Children's Hospital, and an associate professor of pediatrics at Harvard Medical School, Boston, Massachusetts. Mark Kellogg is associate director of chemistry in the Department of Laboratory Medicine, Boston Children's Hospital and an assistant professor of pathology at Harvard Medical School. Jenny Kim is a clinical pharmacist and Michael Scoville is lead pharmacy technician for the investigational drug service in the Department of Pharmacy, Boston Children's Hospital. Courtney Porter is a program administrative manager III in Cardiovascular and Critical Care Nursing Patient Services, Boston Children's Hospital. Malika Weekes is a staff nurse I in the cardiac intensive care unit, Cardiovascular and Critical Care Nursing Patient Services, Boston Children's Hospital. Michele DeGrazia is director of nursing research in the neonatal intensive care unit, Cardiovascular and Critical Care Nursing Patient Services, Boston Children's Hospital, and an assistant professor of pediatrics at Harvard Medical School
| | - Stephanie Wild
- Celeste J. Chandonnet is an infection preventionist at Boston Children's Hospital, Boston, Massachusetts. Cheryl Toole is director of nursing patient services and Stephanie Wild is a staff nurse II in the neonatal intensive care unit, Cardiovascular and Critical Care Nursing Patient Services, Boston Children's Hospital. Vanessa Young is a clinical coordinator in the Division of Newborn Medicine, Boston Children's Hospital. Henry A. Feldman is principal biostatistician in the Institutional Centers for Clinical and Translational Research, Boston Children's Hospital, and an associate professor of pediatrics at Harvard Medical School, Boston, Massachusetts. Mark Kellogg is associate director of chemistry in the Department of Laboratory Medicine, Boston Children's Hospital and an assistant professor of pathology at Harvard Medical School. Jenny Kim is a clinical pharmacist and Michael Scoville is lead pharmacy technician for the investigational drug service in the Department of Pharmacy, Boston Children's Hospital. Courtney Porter is a program administrative manager III in Cardiovascular and Critical Care Nursing Patient Services, Boston Children's Hospital. Malika Weekes is a staff nurse I in the cardiac intensive care unit, Cardiovascular and Critical Care Nursing Patient Services, Boston Children's Hospital. Michele DeGrazia is director of nursing research in the neonatal intensive care unit, Cardiovascular and Critical Care Nursing Patient Services, Boston Children's Hospital, and an assistant professor of pediatrics at Harvard Medical School
| | - Michele DeGrazia
- Celeste J. Chandonnet is an infection preventionist at Boston Children's Hospital, Boston, Massachusetts. Cheryl Toole is director of nursing patient services and Stephanie Wild is a staff nurse II in the neonatal intensive care unit, Cardiovascular and Critical Care Nursing Patient Services, Boston Children's Hospital. Vanessa Young is a clinical coordinator in the Division of Newborn Medicine, Boston Children's Hospital. Henry A. Feldman is principal biostatistician in the Institutional Centers for Clinical and Translational Research, Boston Children's Hospital, and an associate professor of pediatrics at Harvard Medical School, Boston, Massachusetts. Mark Kellogg is associate director of chemistry in the Department of Laboratory Medicine, Boston Children's Hospital and an assistant professor of pathology at Harvard Medical School. Jenny Kim is a clinical pharmacist and Michael Scoville is lead pharmacy technician for the investigational drug service in the Department of Pharmacy, Boston Children's Hospital. Courtney Porter is a program administrative manager III in Cardiovascular and Critical Care Nursing Patient Services, Boston Children's Hospital. Malika Weekes is a staff nurse I in the cardiac intensive care unit, Cardiovascular and Critical Care Nursing Patient Services, Boston Children's Hospital. Michele DeGrazia is director of nursing research in the neonatal intensive care unit, Cardiovascular and Critical Care Nursing Patient Services, Boston Children's Hospital, and an assistant professor of pediatrics at Harvard Medical School
| |
Collapse
|
17
|
Reither M, Germano E, DeGrazia M. Midwifery Management of Pregnant Women Who Are Obese. J Midwifery Womens Health 2018; 63:273-282. [PMID: 29778087 DOI: 10.1111/jmwh.12760] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2016] [Revised: 03/08/2018] [Accepted: 03/10/2018] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Obesity is associated with increased risks for adverse health outcomes during and after pregnancy in both the woman with obesity and her infant. This study was designed to investigate midwifery management of pregnant women with obesity. METHODS Certified midwives and certified nurse-midwives who were members of the American College of Nurse-Midwives were sent a survey. The survey instrument was divided into 4 sections: demographic characteristics; practice guidelines and protocols; the role of the 2015 Levels of Maternal Care guidelines for referral, including transfer to a higher level of care; and factors that influence management of pregnant women with obesity. Descriptive statistics were used to analyze data. RESULTS In a sample of 546 midwives, 87% of respondents reported observing an increase in perinatal complications associated with obesity. Midwives reported increasing discomfort with the care of pregnant women with obesity as body mass index (BMI) increased. For pregnant women with extreme obesity, the respondents reported less frequent use of physiologic birth guidelines only and increased use of interventions, referral to physician care, and transfer to a higher level of care. Approximately half (270, 49.5%) reported having a guideline that addressed the care of women with obesity. Of these, 145 midwives (53.7%) reported that extreme obesity was the BMI threshold for identifying an increased or high risk for perinatal complications. Sixty percent (339) of midwives who participated requested guidance for management of laboring women who are obese. DISCUSSION This study provides a greater understanding of midwifery management practices when caring for women with obesity and opportunities to improve care. The results suggest that midwifery management alters with increased BMI, specifically in the care of women with extreme obesity. Suggestions for future study include research on management of pregnant women with obesity and extreme obesity with outcome data examining management strategies that provide safe, satisfying care.
Collapse
|
18
|
Sakakeeny KH, Connor JA, Del Nido PJ, Odegard K, DeGrazia M. Heat retention head wrap for rewarming infants undergoing cardiopulmonary bypass surgery. Am J Crit Care 2015; 24:141-7. [PMID: 25727274 DOI: 10.4037/ajcc2015939] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
BACKGROUND A major postoperative problem for infants undergoing cardiopulmonary bypass surgery is hypothermia. OBJECTIVE To determine the safety and feasibility of a newly designed Heat Retention Head Wrap on infants during the rewarming period of cardiopulmonary bypass surgery. METHODS A sample of 10 infants was recruited into this descriptive pilot study. The health care providers completed ease-of-use questionnaires to describe the feasibility of the head wrap. Interval body temperatures were recorded to characterize temperature progression from onset of rewarming to arrival in the cardiac intensive care unit (ICU) and were compared with the temperature progression of a similar group of nonparticipants. Adverse events were recorded on the basis of perioperative body temperatures and skin assessments. RESULTS The head wrap was easily applied to the infant's head and was removed without difficulty. A steady increase in median body temperature from (1) the onset of rewarming (28°C), to (2) removal of bypass cannulas (28.9°C), to (3) removal of the rectal temperature probe before transfer from the operating room to the cardiac ICU (34.5°C), and (4) upon arrival in the cardiac ICU (36.0°C) was observed. No skin lesions or temperature-related adverse events were observed. CONCLUSIONS The newly designed Heat Retention Head Wrap was associated with a gradual normalization of temperature during rewarming and did not interfere with routine perioperative care of infants undergoing bypass surgery. This pilot study indicates that the head wrap is both safe and feasible for use in infants undergoing cardiopulmonary bypass surgery.
Collapse
Affiliation(s)
- Karen H Sakakeeny
- Karen H. Sakakeeny is a staff nurse in the main operating room at Boston Children's Hospital, Boston, Massachusetts. Jean Anne Connor is director of nursing research in the cardiovascular program at Boston Children's Hospital and an instructor of pediatrics at Harvard Medical School in Boston, Massachusetts. Pedro J. del Nido is chief of cardiac surgery at Boston Children's Hospital and a professor of surgery at Harvard Medical School. Kirsten Odegard is a cardiac anesthesiologist at Boston Children's Hospital and an associate professor of anesthesiology at Harvard Medical School. Michele DeGrazia is director of nursing research in the neonatal intensive care unit at Boston Children's Hospital and an instructor of pediatrics at Harvard Medical School.
| | - Jean Anne Connor
- Karen H. Sakakeeny is a staff nurse in the main operating room at Boston Children's Hospital, Boston, Massachusetts. Jean Anne Connor is director of nursing research in the cardiovascular program at Boston Children's Hospital and an instructor of pediatrics at Harvard Medical School in Boston, Massachusetts. Pedro J. del Nido is chief of cardiac surgery at Boston Children's Hospital and a professor of surgery at Harvard Medical School. Kirsten Odegard is a cardiac anesthesiologist at Boston Children's Hospital and an associate professor of anesthesiology at Harvard Medical School. Michele DeGrazia is director of nursing research in the neonatal intensive care unit at Boston Children's Hospital and an instructor of pediatrics at Harvard Medical School
| | - Pedro J Del Nido
- Karen H. Sakakeeny is a staff nurse in the main operating room at Boston Children's Hospital, Boston, Massachusetts. Jean Anne Connor is director of nursing research in the cardiovascular program at Boston Children's Hospital and an instructor of pediatrics at Harvard Medical School in Boston, Massachusetts. Pedro J. del Nido is chief of cardiac surgery at Boston Children's Hospital and a professor of surgery at Harvard Medical School. Kirsten Odegard is a cardiac anesthesiologist at Boston Children's Hospital and an associate professor of anesthesiology at Harvard Medical School. Michele DeGrazia is director of nursing research in the neonatal intensive care unit at Boston Children's Hospital and an instructor of pediatrics at Harvard Medical School
| | - Kirsten Odegard
- Karen H. Sakakeeny is a staff nurse in the main operating room at Boston Children's Hospital, Boston, Massachusetts. Jean Anne Connor is director of nursing research in the cardiovascular program at Boston Children's Hospital and an instructor of pediatrics at Harvard Medical School in Boston, Massachusetts. Pedro J. del Nido is chief of cardiac surgery at Boston Children's Hospital and a professor of surgery at Harvard Medical School. Kirsten Odegard is a cardiac anesthesiologist at Boston Children's Hospital and an associate professor of anesthesiology at Harvard Medical School. Michele DeGrazia is director of nursing research in the neonatal intensive care unit at Boston Children's Hospital and an instructor of pediatrics at Harvard Medical School
| | - Michele DeGrazia
- Karen H. Sakakeeny is a staff nurse in the main operating room at Boston Children's Hospital, Boston, Massachusetts. Jean Anne Connor is director of nursing research in the cardiovascular program at Boston Children's Hospital and an instructor of pediatrics at Harvard Medical School in Boston, Massachusetts. Pedro J. del Nido is chief of cardiac surgery at Boston Children's Hospital and a professor of surgery at Harvard Medical School. Kirsten Odegard is a cardiac anesthesiologist at Boston Children's Hospital and an associate professor of anesthesiology at Harvard Medical School. Michele DeGrazia is director of nursing research in the neonatal intensive care unit at Boston Children's Hospital and an instructor of pediatrics at Harvard Medical School
| |
Collapse
|
19
|
DeGrazia M, Giambanco D, Hamn G, Ditzel A, Tucker L, Gauvreau K. Prevention of Deformational Plagiocephaly in Hospitalized Infants Using a New Orthotic Device. J Obstet Gynecol Neonatal Nurs 2015; 44:28-41. [DOI: 10.1111/1552-6909.12523] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
|
20
|
Aslam M, DeGrazia M, Hossain T. Congenital nephrotic syndrome masquerading as respiratory illness. Am J Perinatol 2008; 25:601-4. [PMID: 18841537 DOI: 10.1055/s-0028-1090589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Congenital nephrotic syndrome is rare and is often found incidentally while investigating other disorders. The diagnosis is made by typical clinical features and laboratory tests in infants < 3 months of age. It may be inherited, sporadic, acquired, or associated with a syndrome. We present the case of a former premature infant with respiratory distress at 3 months of age who was subsequently diagnosed with Finnish-type congenital nephrotic syndrome resulting from an unusual mode of inheritance.
Collapse
|
21
|
Abstract
We present the case of a premature infant noted to have massive abdominal distension at birth. Obstetric ultrasound at delivery was significant for abdominal distension, oligohydramnios, and restricted chest wall motion. He was diagnosed to have posterior urethral valves with intraperitoneal rupture of the bladder. We present this case with a brief review of the literature.
Collapse
Affiliation(s)
- Muhammad Aslam
- Neonatal Intensive Care Unit, Children's Hospital Boston, Boston, Massachusetts 02115, USA
| | | | | |
Collapse
|
22
|
Abstract
OBJECTIVES To explore the stability of the one-point Infant Car Seat Challenge and risk factors that may be associated with oxygen desaturation events. DESIGN, SETTING, AND PARTICIPANTS This descriptive, nonexperimental, observational study examined the responses of 49 premature infants during two 90-minute Infant Car Seat Challenges at a tertiary health care institution. MAIN OUTCOME MEASURES Three Infant Car Seat Challenge outcomes were explored: (a) pass/fail rates following two Infant Car Seat Challenge observation periods, (b) oxygen saturation and desaturation patterns during two Infant Car Seat Challenges, and (c) the association between oxygen desaturation events and infants' chronological, gestational, and corrected gestational ages. RESULTS The findings indicated that 86% of premature infants had stable results, 8% passed Infant Car Seat Challenge 1 but not Infant Car Seat Challenge 2, and 6% failed Infant Car Seat Challenge 1 and passed Infant Car Seat Challenge 2. In addition, the odds for oxygen desaturation events increased for infants born at less than or equal to 34 weeks gestation and hospitalized longer than 7 days. CONCLUSIONS The Infant Car Seat Challenge success rate for identifying infants at risk for oxygen desaturation events was equal to or better than that of other screening tests for newborn medical conditions. The findings of this study will assist neonatal health care providers in making appropriate recommendations for infants' safe travel at discharge.
Collapse
Affiliation(s)
- Michele DeGrazia
- Newborn Medicine Nursing, Children's Hospital Boston, Boston, MA 02347, USA.
| |
Collapse
|