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Medicine Jan 2020Sedoanalgesia secondary iatrogenic withdrawal syndrome (IWS) in paediatric intensive units is frequent and its assessment is complex. Therapies are heterogeneous, and...
BACKGROUND
Sedoanalgesia secondary iatrogenic withdrawal syndrome (IWS) in paediatric intensive units is frequent and its assessment is complex. Therapies are heterogeneous, and there is currently no gold standard method for diagnosis. In addition, the assessment scales validated in children are scarce. This paper aims to identify and describe both the paediatric diagnostic and assessment tools for the IWS and the treatments for the IWS in critically ill paediatric patients.
METHODS
A systematic review was conducted according to the PRISMA guidelines. This review included descriptive and observational studies published since 2000 that analyzed paediatric scales for the evaluation of the iatrogenic withdrawal syndrome and its treatments. The eligibility criteria included neonates, newborns, infants, pre-schoolers, and adolescents, up to age 18, who were admitted to the paediatric intensive care units with continuous infusion of hypnotics and/or opioid analgesics, and who presented signs or symptoms of deprivation related to withdrawal and prolonged infusion of sedoanalgesia.
RESULTS
Three assessment scales were identified: Withdrawal Assessment Tool-1, Sophia Observation Withdrawal Symptoms, and Opioid and Benzodiazepine Withdrawal Score. Dexmedetomidine, methadone and clonidine were revealed as options for the treatment and prevention of the iatrogenic withdrawal syndrome. Finally, the use of phenobarbital suppressed symptoms of deprivation that are resistant to other drugs.
CONCLUSIONS
The reviewed scales facilitate the assessment of the iatrogenic withdrawal syndrome and have a high diagnostic quality. However, its clinical use is very rare. The treatments identified in this review prevent and effectively treat this syndrome. The use of validated iatrogenic withdrawal syndrome assessment scales in paediatrics clinical practice facilitates assessment, have a high diagnostic quality, and should be encouraged, also ensuring nurses' training in their usage.
Topics: Child; Humans; Iatrogenic Disease; Intensive Care Units, Pediatric; Substance Withdrawal Syndrome
PubMed: 32000360
DOI: 10.1097/MD.0000000000018502 -
International Journal of Stroke :... Aug 2023Despite its importance in being among the top 10 causes of childhood death, there is limited data on the incidence of stroke in children and whether this has changed... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Despite its importance in being among the top 10 causes of childhood death, there is limited data on the incidence of stroke in children and whether this has changed over time.
AIMS
We performed a systematic review and meta-analysis to estimate the worldwide incidence rate of pediatric ischemic stroke, identify population differences, and assess trends in incidence.
METHODS
We screened three databases (Medline, Embase, and Cumulative Index of Nursing and Allied Health Literature (CINAHL)) and a Google Search was performed up to October 2021. The protocol was pre-registered: PROSPERO: CRD42021273749. Data extraction and quality assessment were independently undertaken by two reviewers. A random-effects model was used for meta-analysis using Stata SE17 to calculate the overall incidence rate. Heterogeneity was assessed using I. Meta-regression and assessment for bias were performed.
RESULTS
Out of 4166 records identified, 39 studies were included in the qualitative synthesis and the quantitative meta-analysis. The incidence rate for all ischemic strokes varied from 0.9 to 7.9 per 100,000 person-years, with a pooled incidence of 2.09 (95% confidence interval (CI): 1.57-2.76). The pooled incidence was 1.28 (95% CI: 0.75-2.19) per 100,000 person-years for arterial ischemic stroke, and 0.56 (95% CI: 0.31-1.02) per 100,000 person-years for cerebral venous sinus thrombosis. The incidence of arterial ischemic stroke was high in neonates, less than 28 days old (18.51, 95% CI: 12.70-26.97). Significant heterogeneity was observed in the initial analyses of stroke incidence estimates, and geographical region, cohort age upper limit, length of study, study quality, and study design could not explain this. The incidence rate of childhood stroke appeared remained relatively stable over time.
CONCLUSION
Our review provides estimates of global stroke incidence, including stroke subtypes, in children. It demonstrates a particularly high stroke incidence in neonates.
Topics: Infant, Newborn; Humans; Child; Stroke; Ischemic Stroke; Incidence; Research Design; Time
PubMed: 36691675
DOI: 10.1177/17474930231155336 -
Hospital Pediatrics Jun 2021Pediatric family-centered rounds (FCRs) have been shown to have benefits in staff satisfaction, teaching, and rounding efficiency, but no systematic review has been... (Meta-Analysis)
Meta-Analysis
CONTEXT
Pediatric family-centered rounds (FCRs) have been shown to have benefits in staff satisfaction, teaching, and rounding efficiency, but no systematic review has been conducted to explicitly examine the humanistic impact of FCRs.
OBJECTIVE
The objective with this review is to determine if FCRs promote the core values of humanism in medicine by answering the question, "Do FCRs promote humanistic pediatric care?"
DATA SOURCES
Using Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, we conducted a search of PubMed, Web of Science, Cumulative Index of Nursing and Allied Health Literature, and Dissertation Abstracts for peer-reviewed pediatric studies through January 1, 2020. We used search terms including FCRs, communication, humanism, and the specific descriptors in the Gold Foundation's definition of humanism.
STUDY SELECTION
Abstracts ( = 1003) were assessed for 5 primary outcomes: empathy, enhanced communication, partnership, respect, and satisfaction and service. We evaluated 158 full-text articles for inclusion, reconciling discrepancies through an iterative process.
DATA EXTRACTION
Data abstraction, thematic analysis, and conceptual synthesis were conducted on 29 studies.
RESULTS
Pediatric family-centered rounds (FCRs) improved humanistic outcomes within all 5 identified themes. Not all studies revealed improvement within every category. The humanistic benefits of FCRs are enhanced through interventions targeted toward provider-family barriers, such as health literacy. Patients with limited English proficiency or disabilities or who were receiving intensive care gained additional benefits.
CONCLUSIONS
Pediatric FCRs promote humanistic outcomes including increased empathy, partnership, respect, service, and communication. Limitations included difficulty in defining humanism, variable implementation, and inconsistent reporting of humanistic outcomes. Future efforts should include highlighting FCR's humanistic benefits, universal implementation, and adapting FCRs to pandemics such as coronavirus disease 2019.
Topics: Attitude of Health Personnel; Child; Child, Hospitalized; Communication; Empathy; Humanism; Humans; Pediatrics; Professional-Family Relations; Teaching Rounds
PubMed: 34021029
DOI: 10.1542/hpeds.2020-000240 -
Nursing & Health Sciences Dec 2023The aim of this systematic review was to examine the association of nursing workload on patient outcomes in intensive care units. The primary outcome measure was patient... (Review)
Review
The aim of this systematic review was to examine the association of nursing workload on patient outcomes in intensive care units. The primary outcome measure was patient mortality, with adverse events (AE), the secondary outcome measures. Electronic search of databases including MEDLINE, CINAHL, Cochrane, EMCARE, Scopus, and Web of Science were performed. Studies were excluded if they were in non-ICU settings, pediatric, neonatal populations, or if the abstract/full text was unavailable. Risk of bias was assessed by the ROBINS-I tool. After screening 4129 articles, 32 studies were identified as meeting inclusion criteria. The majority of included studies were assessed as having a moderate risk of bias. The nursing activities score (NAS) was the most frequently used tool to assess nursing workload. Our systematic review identified that higher nursing workload was associated with patient-focused outcomes, including increased mortality and AE in the intensive care setting. The varied approaches of measuring and reporting nursing workload make it difficult to translate the findings of the impact of nursing workload on patient outcomes in intensive care settings.
Topics: Infant, Newborn; Humans; Child; Workload; Critical Care; Nursing Care; Intensive Care Units; Outcome Assessment, Health Care
PubMed: 37784243
DOI: 10.1111/nhs.13052 -
International Nursing Review Jun 2023Nurse-sensitive outcomes are measures for improvement and evaluation of the quality of nursing care delivered. The specific outcomes that need to be measured will be... (Review)
Review
BACKGROUND
Nurse-sensitive outcomes are measures for improvement and evaluation of the quality of nursing care delivered. The specific outcomes that need to be measured will be determined by the patient population, as well as the field and scope of practice, in which nursing care is being delivered. Currently, there is no internationally agreed upon set of nurse-sensitive outcomes for pediatric nursing, which provides specialist care to infants, children, and young people.
AIM
To identify and evaluate nurse-sensitive outcomes for pediatric nursing.
METHODS
A systematic review was conducted. Five electronic databases (British Nursing Index, CINAHL, EMBASE, MEDLINE, and EMCARE) were searched in the period up to February 2022. Studies were selected for inclusion using title and abstract screening using predetermined criteria. The Critical Appraisal Skills Programme tool was used for quality assessment. A narrative synthesis of the results was performed.
RESULTS
A total of 633 studies were identified from online searches, with 14 studies meeting the inclusion criteria. All studies had moderate to high methodological strength. A total of 57 nurse-sensitive outcomes were identified from all included studies. Using the nurse-sensitive outcome conceptual analysis framework, 25 (45%) of the items were classified as outcome attributes, 20 (35%) as process attributes, and 13 (23%) as structure attributes. The most frequently reported nurse-sensitive outcomes included pressure ulcers, nosocomial infections, hospital-acquired infections, peripheral intravenous infiltration, failure to rescue, and staffing levels.
CONCLUSIONS
This review provides an up-to-date and comprehensive list of nurse-sensitive outcomes for use in pediatric nursing and describes their frequency of use. However, further work is required to achieve consensus for an international core nurse-sensitive outcome set for pediatric nursing with policy recommendations to ensure agreed-upon minimum standards.
IMPLICATIONS FOR NURSING AND HEALTH POLICY
Policy initiatives and guideline recommendations on nurse-sensitive outcome frameworks as part of patient safety should be a part of key priorities for policy makers. The commonly reported nurse-sensitive outcomes should be incorporated into daily bedside pediatric clinical nursing practice as a mechanism to evaluate and improve the quality of care, enhancement of patient safety, and better outcomes.
Topics: Infant; Humans; Child; Adolescent; Pediatric Nursing; Nurses, Pediatric
PubMed: 36274192
DOI: 10.1111/inr.12805 -
International Emergency Nursing Jul 2022Resuscitation of a child is one of the most critical times that parents need support, and parental support is fundamental to providing family-centered care in high... (Review)
Review
BACKGROUND
Resuscitation of a child is one of the most critical times that parents need support, and parental support is fundamental to providing family-centered care in high acuity settings. The aim of this systematic review was to appraise and synthesize studies conducted to examine the support needs of parents during resuscitation of their child from their own perspective.
METHOD
The PRISMA model guided the systematic literature search of Google Scholar, PubMed, Cochrane, Scopus, and Ovid for studies published until the end of 2020. Keywords used were: family support, family-centered care, family needs, resuscitation, CPR, children, neonatal, pediatric, family presence, family-witnessed, and parents.
RESULTS
There were 787 articles located. After reviewing for relevancy, 21 articles met criteria and were included in this review. Findings indicate the needs of parents during resuscitation of their child include: Spiritual and cultural support; Communication with the child before and after resuscitation; Professional behavior from staff; Receiving information; Presence at resuscitation; Trust in the resuscitation team; and Having physical and mental needs met.
CONCLUSION
Parents have differing support needs when their child is resuscitated in the hospital, and meeting these needs is critical for providing family-centered care.
Topics: Child; Communication; Family; Humans; Infant, Newborn; Parents; Resuscitation
PubMed: 35580428
DOI: 10.1016/j.ienj.2022.101173 -
Nurse Education Today May 2022End-of-Life care and experiencing death of infants, children, and teenagers remain one of the most difficult and traumatic events for nurses and nursing students,...
BACKGROUND
End-of-Life care and experiencing death of infants, children, and teenagers remain one of the most difficult and traumatic events for nurses and nursing students, potentially leading to personal and professional distress. Although efforts have been made to alleviate stressors in these settings, improvements remain slow. Understanding nurses and nursing students' experiences of pediatric End-of-Life care and death in multiple care settings may direct interventions to better support quality of care and healthcare professionals in these areas.
OBJECTIVE
This review aimed to qualitatively synthesize existing literature to examine the nurses and nursing students' experiences of providing End-of-Life care to children and the death of pediatric patients.
DESIGN
The qualitative systematic review was conducted using Sandelowski and Barroso's guidelines. The included studies were appraised using the Critical Appraisal Skill Program.
DATA SOURCES
This qualitative systematic review was registered with the International Prospective Register of Systematic Reviews. Six electronic databases (Cumulative Index of Nursing and Allied Health Literature, PubMed, Embase, PsychINFO, Scopus, and Mednar) were searched from the database inception date through May 2021.
RESULTS
Thirty articles were included to form three key themes: (1) Emotional impact of pediatric End-of-Life care and death, (2) Perspective of delivering optimal care: What works and what does not, and (3) The complex role of nurses in pediatric End-of-Life care. Overall, the findings suggested that in an emotionally taxing environment, clinical and emotional support were paramount. Furthermore, there is a need to examine nurses' role in End-of-Life decision making and provide more discussion on professional boundaries.
CONCLUSION
This review offered nurses' and nursing students' perceptions of pediatric End-of Life care and death in the nursing profession. Findings can provide useful insights towards the planning of educational programs and institutional changes that supports nurses and nursing students in these settings.
Topics: Adolescent; Child; Health Personnel; Humans; Infant; Qualitative Research; Students, Nursing; Terminal Care
PubMed: 35334222
DOI: 10.1016/j.nedt.2022.105332 -
Pediatric Critical Care Medicine : a... Jul 2015To identify and prioritize research questions of concern to the practice of pediatric critical care nursing practice.
OBJECTIVE
To identify and prioritize research questions of concern to the practice of pediatric critical care nursing practice.
DESIGN
One-day consensus conference. By using a conceptual framework by Benner et al describing domains of practice in critical care nursing, nine international nurse researchers presented state-of-the-art lectures. Each identified knowledge gaps in their assigned practice domain and then poised three research questions to fill that gap. Then, meeting participants prioritized the proposed research questions using an interactive multivoting process.
SETTING
Seventh World Congress on Pediatric Intensive and Critical Care in Istanbul, Turkey.
PARTICIPANTS
Pediatric critical care nurses and nurse scientists attending the open consensus meeting.
INTERVENTIONS
Systematic review, gap analysis, and interactive multivoting.
MEASUREMENTS AND MAIN RESULTS
The participants prioritized 27 nursing research questions in nine content domains. The top four research questions were 1) identifying nursing interventions that directly impact the child and family's experience during the withdrawal of life support, 2) evaluating the long-term psychosocial impact of a child's critical illness on family outcomes, 3) articulating core nursing competencies that prevent unstable situations from deteriorating into crises, and 4) describing the level of nursing education and experience in pediatric critical care that has a protective effect on the mortality and morbidity of critically ill children.
CONCLUSIONS
The consensus meeting was effective in organizing pediatric critical care nursing knowledge, identifying knowledge gaps and in prioritizing nursing research initiatives that could be used to advance nursing science across world regions.
Topics: Critical Care Nursing; Critical Illness; Health Priorities; Humans; Intensive Care Units, Pediatric; International Cooperation; Life Support Care; Nurse's Role; Nursing Research; Patient Safety; Pediatric Nursing; Professional-Family Relations; Terminal Care; Withholding Treatment
PubMed: 25905492
DOI: 10.1097/PCC.0000000000000446 -
Journal of Advanced Nursing Jun 2021To identify and critically appraise the available evidence on paediatric nurses' clinical competencies performed autonomously regarding disease prevention and health... (Review)
Review
AIMS
To identify and critically appraise the available evidence on paediatric nurses' clinical competencies performed autonomously regarding disease prevention and health promotion activities for children and adolescents in primary healthcare worldwide.
DESIGN
A systematic review design in accordance with the Preferred Reporting Items Systematic Reviews and Meta-Analyses statement.
DATA SOURCES
The search was conducted through MEDLINE (PubMed), Cumulative Index to Nursing and Allied Health Literature, SCOPUS, The Cochrane Library, Scientific Electronic Library Online, Web of Science and The Joanna Briggs Institute EBP (Ovid) databases. The grey literature was reviewed at OpenGrey. Additional studies were located through a references list of selected studies identified on first search.
REVIEW METHODS
Database search employed MeSH terms: (paediatric nursing) AND (primary healthcare) AND ((clinical skills) OR (clinical competences)). Studies published from inception to October 2019 exploring paediatric nurses' clinical competencies in primary healthcare were eligible for inclusion. No language restrictions were applied in the main search. Selection was made by two reviewers independently. Three independent reviewers assessed the methodological quality of included studies.
RESULTS
Eighteen studies were included from six countries. The most common nursing competencies independently performed identified and described in studies were Health education and advice, Child and adolescent health and development assessment, Immunizations and Child health checks.
CONCLUSION
Studies describe clinical competencies of nurses in children care. No consistent scientific evidence is available about clinical competencies of paediatric nurses performed autonomously in primary care.
IMPACT
Few scientific studies identifying and assessing nurses' child primary healthcare skills were found and therefore recorded. Studies describe nurses' clinical skills in childhood, but results do not show firm consistency assessing their practice scope. Health policy-makers should encourage the development of nurses' competencies if they wish to preserve quality and equity of healthcare services to children. Therefore, the first step is to identify the autonomous competencies of paediatric nurses in primary care.
Topics: Adolescent; Child; Clinical Competence; Delivery of Health Care; Humans; Pediatric Nursing; Primary Health Care
PubMed: 33594748
DOI: 10.1111/jan.14768 -
Nursing Open Dec 2023Nursing competencies are crucial indicators for providing quality and safe care. The lack of international agreement in this field has caused problems in the... (Review)
Review
AIM
Nursing competencies are crucial indicators for providing quality and safe care. The lack of international agreement in this field has caused problems in the generalization and application of findings. The purpose of this review is to identify the core competencies necessary for undergraduate nursing students to enter nursing work.
DATA SOURCES
We conducted a structured search using Scopus, MEDLINE (PubMed), Science Direct, CINAHL, Web of Science, and Google Scholar.
REVIEW METHODS
We conducted a scoping review using the methodology recommended by the Joanna Briggs Institute, supported by the PAGER framework, and guided by the PRISMA-ScR Checklist. Inclusion criteria included full-text articles in English, quantitative and qualitative research related to competencies for undergraduate students or newly graduated nurses, competency assessment, and tool development from 1970 to 2022. We excluded articles related to specific nursing roles, specific contexts, Master's and Ph.D. curricula, hospital work environment competencies, and editorial.
RESULTS
Out of 15,875 articles, we selected 43 studies, and data analysis with summative content analysis identified five themes named individualized care, professional nursing process, nursing administration, readiness, and professional development.
CONCLUSION
Considering the dynamics of competencies and their change with time, experience, and setting, it is necessary to update, localize, and levelling of the proposed competencies based on the culture of each country.
IMPACT
These competencies provide a guide for undergraduate nursing curriculum development and offer a framework for both clinical instruction and the evaluation of nursing students.
Topics: Humans; Education, Nursing, Baccalaureate; Students, Nursing; Curriculum; Qualitative Research; Generalization, Psychological
PubMed: 37817394
DOI: 10.1002/nop2.2020