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Demers LA, Wright NM, Kopstick AJ, Niehaus CE, Hall TA, Williams CN, Riley AR. Is Pediatric Intensive Care Trauma-Informed? A Review of Principles and Evidence. CHILDREN (BASEL, SWITZERLAND) 2022; 9:children9101575. [PMID: 36291511 PMCID: PMC9600460 DOI: 10.3390/children9101575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Revised: 10/03/2022] [Accepted: 10/10/2022] [Indexed: 11/23/2022]
Abstract
Pediatric critical illness and injury, along with the experience of recovering from critical illness are among the most potentially traumatic experiences for children and their families. Additionally, children often come to the Pediatric Intensive Care Unit (PICU) with pre-existing trauma that may sensitize them to PICU-related distress. Trauma-informed care (TIC) in the PICU, while under-examined, has the potential to enhance quality of care, mitigate trauma-related symptoms, encourage positive coping, and provide anticipatory guidance for the recovery process. This narrative review paper first describes the need for TIC in the PICU and then introduces the principles of TIC as outlined by the American Academy of Pediatrics: awareness, readiness, detection and assessment, management, and integration. Current clinical practices within PICU settings are reviewed according to each TIC principle. Discussion about opportunities for further development of TIC programs to improve patient care and advance knowledge is also included.
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Affiliation(s)
- Lauren A. Demers
- Pediatric Critical Care and Neurotrauma Recovery Program, Oregon Health & Science University, Portland, OR 97239, USA
- Division of Pediatric Psychology, Department of Pediatrics, Oregon Health & Science University, Portland, OR 97239, USA
| | - Naomi M. Wright
- Division of Pediatric Psychology, Department of Pediatrics, Oregon Health & Science University, Portland, OR 97239, USA
- Department of Psychology, University of Denver, Denver, CO 80208, USA
| | - Avi J. Kopstick
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, Texas Tech University Health Science Center El Paso, El Paso, TX 97705, USA
| | - Claire E. Niehaus
- Division of Psychology and Psychiatry, University of Louisville School of Medicine, Louisville, KY 40202, USA
| | - Trevor A. Hall
- Pediatric Critical Care and Neurotrauma Recovery Program, Oregon Health & Science University, Portland, OR 97239, USA
- Division of Pediatric Psychology, Department of Pediatrics, Oregon Health & Science University, Portland, OR 97239, USA
- Correspondence: ; Tel.: +1-503-418-2134
| | - Cydni N. Williams
- Pediatric Critical Care and Neurotrauma Recovery Program, Oregon Health & Science University, Portland, OR 97239, USA
- Division of Pediatric Psychology, Department of Pediatrics, Oregon Health & Science University, Portland, OR 97239, USA
- Division of Pediatric Critical Care, Department of Pediatrics, Oregon Health & Science University, Portland, OR 97239, USA
| | - Andrew R. Riley
- Division of Pediatric Psychology, Department of Pediatrics, Oregon Health & Science University, Portland, OR 97239, USA
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Tamher SD, Rachmawaty R, Erika KA. The effectiveness of Plan Do Check Act (PDCA) method implementation in improving nursing care quality: A systematic review. ENFERMERIA CLINICA 2021. [DOI: 10.1016/j.enfcli.2021.07.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
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Kong X, Zhu X, Zhang Y, Wu J. The application of plan, do, check, act (PDCA) quality management in reducing nosocomial infections in endoscopy rooms: It does work. Int J Clin Pract 2021; 75:e14351. [PMID: 33973325 DOI: 10.1111/ijcp.14351] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Accepted: 05/07/2021] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND The role of plan, do, check, act (PDCA) cycle quality management in reducing nosocomial infections in endoscopy rooms remains unclear; we aimed to evaluate the effects of PDCA in the nosocomial infections control of endoscopy rooms. METHODS This present study was a before and after design. The patients treated in our endoscopy room from 1 January 2019 to 31 December 2019 were included in the control group, which were managed according to current department practice. The patients from 1 January 2020 to 31 December 2020 were included in the PDCA group, which were managed according to PDCA cycle quality management including formulation of cleaning and disinfection process, establishment of an infection control team and improvement of inspection standards. The nosocomial infections of patients, the pass rate of medical staff's knowledge on the nosocomial infection and hand hygiene, the pass rate of disinfection of endoscope cavity and surface, the incidence of sharp injury and biological pollution were compared between two groups. RESULTS A total of 1020 patients were included, with 512 patients in PDCA group and 508 patients in the control group. The incidence of nosocomial infections in PDCA group was significantly lower than that of control group (0.98% vs. 2.76%, P = .002). The pass rate of medical staff's knowledge on the nosocomial infection and hand hygiene was significantly higher than that of control group (all P < .05). The pass rate of disinfection of endoscope cavity in PDCA group was significantly higher than that of control group (P = .037). The incidence of sharp injury and biological pollution in PDCA group were significantly lower than that of control group (all P < .05). CONCLUSIONS PDCA cycle management is beneficial to reduce the risk of nosocomial infection, enhance the awareness of infection control and reduce the risk of occupational exposure of medical staff in the endoscopy room.
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Affiliation(s)
- Xiaoming Kong
- Department of Infection Management, People's Hospital of Liyang, Changzhou, China
| | - Xiaolu Zhu
- Department of Infection Management, People's Hospital of Liyang, Changzhou, China
| | - Yidan Zhang
- Department of Infection Management, People's Hospital of Liyang, Changzhou, China
| | - Jie Wu
- Department of Infection Management, People's Hospital of Liyang, Changzhou, China
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Kaur J, Ghosh S, Sahani AK, Sinha JK. Mental Imagery as a Rehabilitative Therapy for Neuropathic Pain in People With Spinal Cord Injury: A Randomized Controlled Trial. Neurorehabil Neural Repair 2020; 34:1038-1049. [PMID: 33040678 DOI: 10.1177/1545968320962498] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Pain of neuropathic origin in spinal cord injury (SCI) is unbearable and challenging to treat. Research studies conducted in the past have shown that mental imagery (MI) techniques have a significant impact on the reduction of symptoms of central neuropathic pain in people with SCI. OBJECTIVES The objective of this study was to evaluate the effect of MI training on pain intensity, neuropathic pain symptoms, and interference of pain with function in SCI. METHODS A total of 42 SCI participants with central neuropathic pain (duration 6-12 months) were recruited and randomly allocated to MI or control groups. A MI training protocol was administered to MI group and for 30 min/d for 5 days. Outcome measures were assessed at baseline and at the end of 4 weeks. RESULTS There was significant reduction in differences of mean [95% CI] scores of numeric rating scale (-2.1 [CI -2.78 to -1.41]; P < .001) between groups. Mean [95% CI] total scores of Neuropathic Pain Symptom Inventory declined in MI group as compared with control group (-4.52 [CI -5.86 to -3.18]; P < .001). Similarly, Brief Pain Inventory interference scale total dropped significantly (P < .001) in MI group. Majority of participants in the MI group (55%) reported improvement in scores of Patients' Global Impression of Change scale as compared with control group where most of the participants (52%) reported no change. CONCLUSIONS This study shows the effectiveness of the MI protocol developed as a rehabilitative approach in improving central neuropathic pain in SCI. Trial Registration. Clinical Trials Registry-India under Indian Council of Medical Research; CTRI/2018/07/014884. Registered July 16, 2018.
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Affiliation(s)
| | - Shampa Ghosh
- Indian Council of Medical Research-National Institute of Nutrition, Hyderabad, Telangana, India
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Luo L, Li L, Guo M, Chen X, Lin Y, Wu D. Genetic variation in NRG 1 gene and risk of post-traumatic stress disorders in patients with hepatocellular carcinoma. J Clin Lab Anal 2020; 34:e23187. [PMID: 31944381 PMCID: PMC7246357 DOI: 10.1002/jcla.23187] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Revised: 11/12/2019] [Accepted: 12/11/2019] [Indexed: 12/15/2022] Open
Abstract
Objective Neuregulin 1 (NRG1) was proved to play an important role in numerous neurodevelopmental processes. In our study, we aimed to investigate the relationship between the NRG1 gene polymorphism and the cognitive function of patients with hepatocellular carcinoma (HCC) complicated with post‐traumatic stress disorders (PTSD) before and after the psychological intervention. Methods Mini‐mental State Examination (MMSE), Montreal Cognitive Assessment (MoCA), and Loewenstein Occupational Therapy Cognitive Assessment (LOTCA) were used for cognitive function assessment. Serum level of NRG1 was detected by ELISA, and the correlation between NRG1 level and cognitive function was analyzed. The difference of cognitive function score of patients with HCC complicated with PTSD before and after psychological intervention was compared, and the relationship between rs35753505 and rs3924999 polymorphism with the score was analyzed. Results Patients with HCC complicated with PTSD showed decreased serum NRG1 level. NRG1 levels of patients in the HCC + PTSD group were positively correlated with MMSE, MoCA, and LOTCA scores. In rs35753505, the CC genotype was a risk factor for the occurrence of PTSD in patients with HCC, while in rs3924999, the GG genotype was a risk factor for the occurrence of PTSD in patients with HCC. After psychological intervention, the CC genotype at rs35753505 and the GG genotype at rs3924999 were susceptible genotypes. Conclusion CC genotype at rs35753505 and GG genotype at rs3924999 of NRG1 gene increased the risk of PTSD in patients with HCC. CC and GG genotypes were susceptible after psychological intervention.
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Affiliation(s)
- Liumei Luo
- Xiangya Nursing College, Central South University, Changsha, China.,Department of science and education, Hainan General Hospital, Haikou, China
| | - Li Li
- Department of nursing, Xiangya Medical College of Central South University, Changsha, China
| | - Min Guo
- Department of science and education, Hainan General Hospital, Haikou, China
| | - Xi Chen
- Xiangya Nursing College, Central South University, Changsha, China
| | - Yuzhu Lin
- Department of science and education, Hainan General Hospital, Haikou, China
| | - Dingyin Wu
- Department of science and education, Hainan General Hospital, Haikou, China
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Ismail A, Forgeron P, Polomeno V, Gharaibeh H, Dagg W, Harrison D. Pain management interventions in the Paediatric Intensive Care Unit: A scoping review. Intensive Crit Care Nurs 2019; 54:96-105. [DOI: 10.1016/j.iccn.2019.05.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2018] [Revised: 05/13/2019] [Accepted: 05/18/2019] [Indexed: 01/18/2023]
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Patricolo GE, LaVoie A, Slavin B, Richards NL, Jagow D, Armstrong K. Beneficial Effects of Guided Imagery or Clinical Massage on the Status of Patients in a Progressive Care Unit. Crit Care Nurse 2018; 37:62-69. [PMID: 28148616 DOI: 10.4037/ccn2017282] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
BACKGROUND Patients in the progressive care unit typically experience high levels of pain and anxiety and exhibit difficulty sleeping. OBJECTIVE To determine whether either clinical massage or guided imagery could reduce pain and anxiety and improve sleep. METHODS This study included 288 inpatients on 2 floors of a progressive care unit. On 1 floor, each patient was offered daily a 15-minute complimentary clinical massage, whereas the patients on the other floor were provided access to a 30-minute guided-imagery recording. Patients were asked to rate their pain and anxiety levels immediately before and after the massage intervention or were asked whether the guided-imagery intervention was helpful for pain, anxiety, or insomnia. RESULTS The massage intervention showed an immediate and significant reduction in self-reported pain and anxiety (P < .001); likewise, a significant number of patients self-reported that guided imagery helped alleviate pain, anxiety, and insomnia (P < .001). CONCLUSION The results of this study indicate that clinical massage and guided imagery can benefit patients in the progressive care unit.
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Affiliation(s)
- Gail Elliott Patricolo
- Gail Elliott Patricolo is director of integrative medicine, Beaumont Health System, Royal Oak, Michigan. .,Amanda LaVoie is a registered dietitian with an interest in integrative medicine and improving patients' health care experiences. She is director of service excellence and environmental services, Beaumont Health System, Troy, Michigan. .,Barbara Slavin is an administrative manager in a progressive care unit in the Beaumont Health System-Troy. She has more than 30 years experience in critical care nursing and nursing leadership. .,Nancy L. Richards is a clinical nurse specialist for progressive care, Beaumont Health System, Troy, Michigan. .,Deborah Jagow is a registered nurse and nurse manager of a surgical progressive care unit, Beaumont Health System, Troy, Michigan. .,Karen Armstrong is manager of clinical massage and instructor of Beaumont's oncology and hospital massage, Beaumont Health System, Royal Oak, Michigan.
| | - Amanda LaVoie
- Gail Elliott Patricolo is director of integrative medicine, Beaumont Health System, Royal Oak, Michigan.,Amanda LaVoie is a registered dietitian with an interest in integrative medicine and improving patients' health care experiences. She is director of service excellence and environmental services, Beaumont Health System, Troy, Michigan.,Barbara Slavin is an administrative manager in a progressive care unit in the Beaumont Health System-Troy. She has more than 30 years experience in critical care nursing and nursing leadership.,Nancy L. Richards is a clinical nurse specialist for progressive care, Beaumont Health System, Troy, Michigan.,Deborah Jagow is a registered nurse and nurse manager of a surgical progressive care unit, Beaumont Health System, Troy, Michigan.,Karen Armstrong is manager of clinical massage and instructor of Beaumont's oncology and hospital massage, Beaumont Health System, Royal Oak, Michigan
| | - Barbara Slavin
- Gail Elliott Patricolo is director of integrative medicine, Beaumont Health System, Royal Oak, Michigan.,Amanda LaVoie is a registered dietitian with an interest in integrative medicine and improving patients' health care experiences. She is director of service excellence and environmental services, Beaumont Health System, Troy, Michigan.,Barbara Slavin is an administrative manager in a progressive care unit in the Beaumont Health System-Troy. She has more than 30 years experience in critical care nursing and nursing leadership.,Nancy L. Richards is a clinical nurse specialist for progressive care, Beaumont Health System, Troy, Michigan.,Deborah Jagow is a registered nurse and nurse manager of a surgical progressive care unit, Beaumont Health System, Troy, Michigan.,Karen Armstrong is manager of clinical massage and instructor of Beaumont's oncology and hospital massage, Beaumont Health System, Royal Oak, Michigan
| | - Nancy L Richards
- Gail Elliott Patricolo is director of integrative medicine, Beaumont Health System, Royal Oak, Michigan.,Amanda LaVoie is a registered dietitian with an interest in integrative medicine and improving patients' health care experiences. She is director of service excellence and environmental services, Beaumont Health System, Troy, Michigan.,Barbara Slavin is an administrative manager in a progressive care unit in the Beaumont Health System-Troy. She has more than 30 years experience in critical care nursing and nursing leadership.,Nancy L. Richards is a clinical nurse specialist for progressive care, Beaumont Health System, Troy, Michigan.,Deborah Jagow is a registered nurse and nurse manager of a surgical progressive care unit, Beaumont Health System, Troy, Michigan.,Karen Armstrong is manager of clinical massage and instructor of Beaumont's oncology and hospital massage, Beaumont Health System, Royal Oak, Michigan
| | - Deborah Jagow
- Gail Elliott Patricolo is director of integrative medicine, Beaumont Health System, Royal Oak, Michigan.,Amanda LaVoie is a registered dietitian with an interest in integrative medicine and improving patients' health care experiences. She is director of service excellence and environmental services, Beaumont Health System, Troy, Michigan.,Barbara Slavin is an administrative manager in a progressive care unit in the Beaumont Health System-Troy. She has more than 30 years experience in critical care nursing and nursing leadership.,Nancy L. Richards is a clinical nurse specialist for progressive care, Beaumont Health System, Troy, Michigan.,Deborah Jagow is a registered nurse and nurse manager of a surgical progressive care unit, Beaumont Health System, Troy, Michigan.,Karen Armstrong is manager of clinical massage and instructor of Beaumont's oncology and hospital massage, Beaumont Health System, Royal Oak, Michigan
| | - Karen Armstrong
- Gail Elliott Patricolo is director of integrative medicine, Beaumont Health System, Royal Oak, Michigan.,Amanda LaVoie is a registered dietitian with an interest in integrative medicine and improving patients' health care experiences. She is director of service excellence and environmental services, Beaumont Health System, Troy, Michigan.,Barbara Slavin is an administrative manager in a progressive care unit in the Beaumont Health System-Troy. She has more than 30 years experience in critical care nursing and nursing leadership.,Nancy L. Richards is a clinical nurse specialist for progressive care, Beaumont Health System, Troy, Michigan.,Deborah Jagow is a registered nurse and nurse manager of a surgical progressive care unit, Beaumont Health System, Troy, Michigan.,Karen Armstrong is manager of clinical massage and instructor of Beaumont's oncology and hospital massage, Beaumont Health System, Royal Oak, Michigan
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Brenner M, Drennan J, Treacy MP, Fealy GM. An exploration of the practice of restricting a child's movement in hospital: a factorial survey. J Clin Nurs 2014; 24:1189-98. [PMID: 25041376 DOI: 10.1111/jocn.12650] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/24/2014] [Indexed: 11/30/2022]
Abstract
AIMS AND OBJECTIVES To identify the reported predictors of the practice of restricting a child for a clinical procedure in hospital. BACKGROUND Previous work in this area is dominated by discussion papers and suggestions for addressing the issue of restriction. This is the first study to explore reported predictors of this practice with a view to implementing change based on research findings. DESIGN A factorial survey was developed, which incorporated the use of vignettes with various scenarios. The factorial design enabled exploration of the interaction of multiple factors on the practice of restriction. METHODS One hundred and sixty-six nurses caring for children were each sent 10 vignettes and asked to rate their likelihood to restrict a child based on the vignettes. A total of 105 nurses responded to the survey, representing a response rate of 63%. Hierarchical linear regression was used to identify reported predictors of restriction. RESULTS Nurses were more likely to restrict a child if they had prior instruction on safe holding, if there was no play therapist available, if the nurse was a registered general nurse with no other registration qualification, if the child required cannulation or if the child was less than five years of age. CONCLUSION This study identified predictors of restriction from the perspective of practicing nurses; the evidence needs to be used in developing clinical guidelines and in multidisciplinary education. RELEVANCE TO CLINICAL PRACTICE There is a need to move from any presumption of restriction towards more critical consideration of the individual requirements of the child. There is a need to increase the numbers of nurses receiving specialist training on the care of a child in hospital. The importance of a well-resourced play therapy service is supported, and there is a need for multidisciplinary work to explore alternatives to restriction.
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Affiliation(s)
- Maria Brenner
- School of Nursing, Midwifery & Health Systems, University College Dublin, Dublin, Ireland
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Abstract
Health care quality and value are leading issues in medicine today for patients, health care professionals, and policy makers. Outcome, safety, and service-the components of quality-have been used to define value when placed in the context of cost. Health care organizations and professionals are faced with the challenge of improving quality while reducing health care related costs to improve value. Measurement of quality is essential for assessing what is effective and what is not when working toward improving quality and value. However, there are few tools currently for assessing quality of care, and clinicians often lack the resources and skills required to conduct quality improvement work. In this article, we provide a brief review of quality improvement as a discipline and describe these efforts within pediatric anesthesiology.
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Johnston CC, Rennick JE, Filion F, Campbell-Yeo M, Goulet C, Bell L, Tucci M, Ranger M. Maternal touch and talk for invasive procedures in infants and toddlers in the pediatric intensive care unit. J Pediatr Nurs 2012; 27:144-53. [PMID: 22341193 DOI: 10.1016/j.pedn.2010.12.016] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2010] [Revised: 12/21/2010] [Accepted: 12/22/2010] [Indexed: 11/24/2022]
Abstract
The aim of this single-blind, randomized, crossover trial was to test the effect of Touch & Talk (T&T) for infants and toddlers less than 36 months of age (N = 65) in the pediatric intensive care unit on their physiological stability and recovery to an invasive procedure. In the T&T condition, mothers touched, sang, or told stories or rhymes to their child during an invasive procedure. In the control condition, the mothers did not have contact with their child. Physiological measures included heart rate, heart rate variability, and oxygen saturation range during the procedure and change from baseline. Time from the end of the procedure until the heart rate returned to baseline levels gave the recovery time. Analysis was conducted using repeated-measures analysis of covariance. There were no significant differences on any of the physiological parameters by condition during the procedure. However, when controlling for severity of illness, recovery was faster with mothers.
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Eldridge C, Kennedy R. Nonpharmacologic Techniques for Distress Reduction During Emergency Medical Care: A Review. CLINICAL PEDIATRIC EMERGENCY MEDICINE 2010. [DOI: 10.1016/j.cpem.2010.09.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
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