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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.
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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
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Moschovis PP, Lombay J, Rooney J, Schenkel SR, Singh D, Rezaei SJ, Salo N, Gong A, Yonker LM, Shah J, Hayden D, Hibberd PL, Demokritou P, Kinane TB. The effect of activity and face masks on exhaled particles in children. Pediatr Investig 2023; 7:75-85. [PMID: 37324601 PMCID: PMC10262878 DOI: 10.1002/ped4.12376] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2022] [Accepted: 01/29/2023] [Indexed: 06/17/2023] Open
Abstract
Importance Despite the high burden of respiratory infections among children, the production of exhaled particles during common activities and the efficacy of face masks in children have not been sufficiently studied. Objective To determine the effect of type of activity and mask usage on exhaled particle production in children. Methods Healthy children were asked to perform activities that ranged in intensity (breathing quietly, speaking, singing, coughing, and sneezing) while wearing no mask, a cloth mask, or a surgical mask. The concentration and size of exhaled particles were assessed during each activity. Results Twenty-three children were enrolled in the study. Average exhaled particle concentration increased by intensity of activity, with the lowest particle concentration during tidal breathing (1.285 particles/cm3 [95% CI 0.943, 1.627]) and highest particle concentration during sneezing (5.183 particles/cm3 [95% CI 1.911, 8.455]). High-intensity activities were associated with an increase primarily in the respirable size (≤ 5 µm) particle fraction. Surgical and cloth masks were associated with lower average particle concentration compared to no mask (P = 0.026 for sneezing). Surgical masks outperformed cloth masks across all activities, especially within the respirable size fraction. In a multivariable linear regression model, we observed significant effect modification of activity by age and by mask type. Interpretation Similar to adults, children produce exhaled particles that vary in size and concentration across a range of activities. Production of respirable size fraction particles (≤ 5 µm), the dominant mode of transmission of many respiratory viruses, increases significantly with coughing and sneezing and is most effectively reduced by wearing surgical face masks.
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Affiliation(s)
- Peter P. Moschovis
- Department of PediatricsMassachusetts General Hospital and Harvard Medical SchoolBostonMassachusettsUSA
| | - Jesiel Lombay
- Department of PediatricsMassachusetts General Hospital and Harvard Medical SchoolBostonMassachusettsUSA
| | - Jennifer Rooney
- Department of PediatricsMassachusetts General Hospital and Harvard Medical SchoolBostonMassachusettsUSA
| | - Sara R. Schenkel
- Department of PediatricsMassachusetts General Hospital and Harvard Medical SchoolBostonMassachusettsUSA
| | - Dilpreet Singh
- Department of Environmental HealthHarvard T. H. Chan School of Public HealthBostonMassachusettsUSA
- Department of Mechanical and Aerospace EngineeringRutgers University School of Public HealthNew BrunswickNew JerseyUSA
| | - Shawheen J. Rezaei
- Department of PediatricsMassachusetts General Hospital and Harvard Medical SchoolBostonMassachusettsUSA
| | - Nora Salo
- Department of PediatricsMassachusetts General Hospital and Harvard Medical SchoolBostonMassachusettsUSA
| | - Amanda Gong
- David Geffen School of Medicinethe University of California Los AngelesLos AngelesCaliforniaUSA
| | - Lael M. Yonker
- Department of PediatricsMassachusetts General Hospital and Harvard Medical SchoolBostonMassachusettsUSA
| | - Jhill Shah
- Department of PediatricsMassachusetts General Hospital and Harvard Medical SchoolBostonMassachusettsUSA
| | - Douglas Hayden
- Department of PediatricsMassachusetts General Hospital and Harvard Medical SchoolBostonMassachusettsUSA
| | - Patricia L. Hibberd
- Department of Global HealthBoston University School of Public HealthBostonMassachusettsUSA
| | - Philip Demokritou
- Department of Environmental HealthHarvard T. H. Chan School of Public HealthBostonMassachusettsUSA
- Department of Mechanical and Aerospace EngineeringRutgers University School of Public HealthNew BrunswickNew JerseyUSA
| | - T. Bernard Kinane
- Department of PediatricsMassachusetts General Hospital and Harvard Medical SchoolBostonMassachusettsUSA
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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.
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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
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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.
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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
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Chisti MJ, Harris JB, Carroll RW, Shahunja KM, Shahid ASMSB, Moschovis PP, Schenkel SR, Hasibur Rahman ASMM, Shahrin L, Faruk T, Kabir F, Ahmed D, Ahmed T. Antibiotic-Resistant Bacteremia in Young Children Hospitalized With Pneumonia in Bangladesh Is Associated With a High Mortality Rate. Open Forum Infect Dis 2021; 8:ofab260. [PMID: 34277885 PMCID: PMC8280371 DOI: 10.1093/ofid/ofab260] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Accepted: 05/20/2021] [Indexed: 12/29/2022] Open
Abstract
Background Pneumonia is a leading cause of sepsis and mortality in children under 5 years. However, our understanding of the causes of bacteremia in children with pneumonia is limited. Methods We characterized risk factors for bacteremia and death in a cohort of children admitted to the Dhaka Hospital of the International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b) between 2014 and 2017 with radiographically confirmed pneumonia. Results A total of 4007 young children were hospitalized with pneumonia over the study period. A total of 1814 (45%) had blood cultures obtained. Of those, 108 (6%) were positive. Gram-negative pathogens predominated, accounting for 83 (77%) of positive cultures. These included Pseudomonas (N = 22), Escherichia coli (N = 17), Salmonella enterica (N = 14, including 11 Salmonella Typhi), and Klebsiella pneumoniae (N = 11). Gram-positive pathogens included Pneumococcus (N = 7) and Staphylococcus aureus (N = 6). Resistance to all routinely used empiric antibiotics (ampicillin, gentamicin, ciprofloxacin, and ceftriaxone) for children with pneumonia at the icddr,b was observed in 20 of the 108 isolates. Thirty-one of 108 (29%) children with bacteremia died, compared to 124 of 1706 (7%) who underwent culture without bacteremia (odds ratio [OR], 5.1; 95% confidence interval [CI], 3.3–8.1; P < .001). Children infected with bacteria resistant to all routinely used empiric antibiotics were at greater risk of death compared to children without bacteremia (OR, 17.3; 95% CI, 7.0–43.1; P < .001). Conclusions Antibiotic-resistant Gram-negative bacteremia in young children with pneumonia in Dhaka, Bangladesh was associated with a high mortality rate. The pandemic of antibiotic resistance is shortening the lives of young children in Bangladesh, and new approaches to prevent and treat these infections are desperately needed.
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Affiliation(s)
- Mohammod Jobayer Chisti
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Jason B Harris
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, Massachusetts, USA.,Division of Pediatric Global Health, Massachusetts General Hospital, Boston, Massachusetts, USA.,Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA
| | - Ryan W Carroll
- Division of Pediatric Global Health, Massachusetts General Hospital, Boston, Massachusetts, USA.,Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA.,Division of Pediatric Critical Care Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - K M Shahunja
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Abu S M S B Shahid
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Peter P Moschovis
- Division of Pediatric Global Health, Massachusetts General Hospital, Boston, Massachusetts, USA.,Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA.,Division of Pediatric Pulmonology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Sara R Schenkel
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, Massachusetts, USA
| | | | - Lubaba Shahrin
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Tanveer Faruk
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Farhad Kabir
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Dilruba Ahmed
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Tahmeed Ahmed
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
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Srouji R, Schenkel SR, Forbes P, Cahill JE. Dihydroergotamine infusion for pediatric refractory headache: A retrospective chart review. Headache 2021; 61:777-789. [PMID: 34105158 DOI: 10.1111/head.14117] [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] [Received: 07/25/2020] [Revised: 03/07/2021] [Accepted: 03/19/2021] [Indexed: 01/01/2023]
Abstract
BACKGROUND Headaches are a common symptom in children. Children with refractory headaches may be admitted for inpatient treatment with intravenous dihydroergotamine mesylate (DHE). However, very few studies have characterized these patients and their treatment outcomes using validated, self-reported, pain scales. OBJECTIVE The objective of this study was to describe demographic and clinical characteristics of children admitted for DHE infusion, determine DHE treatment outcomes by means of numeric pain scale ratings, and explore associations between treatment outcomes and clinical characteristics. METHODS Retrospective chart review was completed in patients ages 5-21 admitted for DHE infusion from January 2013 to July 2018 at a large, pediatric academic medical center and community-based satellite center. All primary headache types were included. RESULTS A total of 200 unique admissions for DHE were available for analysis. Overall, patients were predominantly White (87.5%, 175/200) and female (80.0%, 160/200) with an average age of 15.4 years (SD 2.3). Common comorbidities included obesity (42.0%, 81/193), anxiety (41.0%, 82/200), and depression (20.0%, 40/200). The mean length of stay was 2.4 days (SD 1.10; range 1-8 days). Most headaches (65.0%, 130/200) met the International Classification of Headache Disorders, 3rd edition criteria for migraine, followed by new daily persistent headache (25.5%, 51/200). Mean DHE maximum dose was 5.3 (SD 2.17; range 0.5-14.5 mg) with most patients requiring 3.5-6.5 mg. DHE was typically terminated at six doses (range 1-15). The most frequently reported adverse event was nausea (5.5%, 11/200). There was no difference in pain severity at admission across headache types, with an average baseline pain score of 8.1 (SD 1.6). Posttreatment reduction in pain score was statistically significant (range: -3.2 to -4.9; each p < 0.001) across all headache types. Overall, 84.0% (168/200) of the patients had some improvement in pain. More than half of the patients (53.5%, 107/200) showed at least moderate improvement (≥50.0% reduction in pain score), and 18.0% (36/200) had full headache resolution. Limited patients (16.0%, 32/200) experienced no improvement in pain. CONCLUSIONS Treatment with DHE resulted in at least some improvement for most patients regardless of headache type or number of doses. Clinical trials stratified by headache type and comorbid factors could help clarify treatment algorithms to optimize patient outcomes.
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Affiliation(s)
- Rasha Srouji
- Department of Neurology, Boston Children's Hospital, Boston, MA, USA
| | - Sara R Schenkel
- Division of Pediatric Global Health, Massachusetts General Hospital, Boston, MA, USA
| | - Peter Forbes
- Institutional Centers for Clinical and Translational Research, Boston Children's Hospital, Boston, MA, USA
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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.
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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
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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.
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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
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