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Bergman CM, Thomas C, Clapper T, Nellis M, Yuen A, Gerber L, Ching K. Sim-Based Home Tracheostomy Care: A Mixed Methods Study on Outcomes and Parental Preparedness. Hosp Pediatr 2024; 14:251-257. [PMID: 38545677 DOI: 10.1542/hpeds.2023-007539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/18/2024] [Indexed: 04/02/2024]
Abstract
OBJECTIVES To assess effects of a Simulation-Based Discharge Education Program (SDP) on long-term caregiver-reported satisfaction and to compare clinical outcomes for children with new tracheostomies whose caregivers completed SDP versus controls. METHODS The study employed a mixed methods approach: (1) a qualitative analysis of feedback from caregivers who previously completed SDP, and (2) a quantitative retrospective case-control study comparing outcomes between children with new tracheostomies whose caregivers completed SDP versus controls, matched on discharge disposition and age. The primary outcome was emergency department visits for tracheostomy-related issues within 1 year of discharge. RESULTS Feedback from 18 interviews was coded into 5 themes: knowledge acquisition, active learning, comfort and preparedness, home application of skills, and overall assessment. Caregivers of 27 children (median age 26 months [interquartile range (IQR) 5.5 months-11 years]) underwent SDP training. Clinical outcomes of these children were compared with 27 matched children in the non-SDP group (median age 16 months [IQR 3.5 months-10 years]). There was no significant difference in ED visits for tracheostomy-related complications within 1 year of discharge between the SDP group and non-SDP group (2 [IQR 0-2] vs 1 [IQR 0-2], P = .2). CONCLUSIONS Caregivers reported overwhelmingly positive experiences with SDP that persisted even 4 years after training. Caregiver participation in SDP did not yield a significant difference in ED visits within 1 year of discharge for tracheostomy-related complications compared with control counterparts. Future steps will identify more effective methods for comparing and analyzing clinical outcomes to further validate impacts of simulation-based programs.
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Affiliation(s)
- Charles M Bergman
- Department of Pediatrics, NewYork-Presbyterian Hospital/Weill Cornell Medical Center, New York, New York
| | - Charlene Thomas
- Department of Pediatrics, NewYork-Presbyterian Hospital/Weill Cornell Medical Center, New York, New York
| | - Timothy Clapper
- Department of Pediatrics, NewYork-Presbyterian Hospital/Weill Cornell Medical Center, New York, New York
| | - Marianne Nellis
- Department of Pediatrics, NewYork-Presbyterian Hospital/Weill Cornell Medical Center, New York, New York
| | - Anthony Yuen
- Department of Pediatrics, NewYork-Presbyterian Hospital/Weill Cornell Medical Center, New York, New York
| | - Linda Gerber
- Department of Pediatrics, NewYork-Presbyterian Hospital/Weill Cornell Medical Center, New York, New York
| | - Kevin Ching
- Department of Pediatrics, NewYork-Presbyterian Hospital/Weill Cornell Medical Center, New York, New York
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Borges LADC, Almeida RGDS, Barboza ES, Arruda GOD. Simulation training of caregivers at hospital discharge of patients with chronic diseases: an integrative review. Rev Bras Enferm 2023; 76:e20230043. [PMID: 38055488 DOI: 10.1590/0034-7167-2023-0043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Accepted: 08/11/2023] [Indexed: 12/08/2023] Open
Abstract
OBJECTIVE to identify evidence about the use and effects of clinical simulation for preparing caregivers for discharging patients with chronic conditions. METHODS an integrative peer review in the Scopus, PubMed, Web of Science, Cumulative Index to Nursing and Allied Health Literature, ScienceDirect and Virtual Health Library databases, from July to September 2022. RESULTS 3,218 studies were identified, with a final sample consisting of four national and two international articles. Using simulation as an educational technology contributed to caregiver preparation in home care. In most studies, using clinical simulation included using other strategies to complement training: expository dialogued class, conversation circle and audiovisual resources. FINAL CONSIDERATIONS simulation proved to be efficient for training caregivers, with the active participation of family members and nurses in health education actions.
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Affiliation(s)
| | | | - Elton Santo Barboza
- Universidade Federal de Mato Grosso do Sul. Campo Grande, Mato Grosso do Sul, Brazil
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Seltzer RR, Watson BD, Donohue PK. Delays in Hospital Discharge for Children in Foster Care: Reasons and Recommendations From a Multisite Study. Acad Pediatr 2022; 22:1452-1458. [PMID: 35835376 DOI: 10.1016/j.acap.2022.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Revised: 06/27/2022] [Accepted: 07/02/2022] [Indexed: 01/18/2023]
Abstract
OBJECTIVE To elucidate challenges to timely hospital discharge of children in foster care (CFC). METHODS Inpatient providers with prior experience caring for CFC were recruited from 6 mid-Atlantic hospitals. Semi-structured interviews were conducted to explore provider experience discharging CFC. Conventional content analysis was applied to interview transcripts with Dedoose software. RESULTS Interviews were completed with 15 MDs/NPs, 11 RNs, 10 social workers, and 2 case managers. Participants explained that delayed discharge is the norm for CFC, especially for those entering new foster care placements. Participants detailed challenges to efficiently discharging CFC, which were categorized into 3 themes: 1) Waiting for discharge disposition: Providers' ability to proceed with discharge planning is contingent on procedural steps (eg, court decisions) needed to determine disposition (eg, entering new foster care placement); 2) Medically cleared, but no place to go: Participants report placement searches are often not initiated by child welfare until the child is medically cleared. Lack of available, appropriate foster care placements delays discharge, particularly for children with complex medical or behavioral diagnoses; 3) Coordinating for a safe discharge: Establishing a safe discharge for CFC involves meticulous discharge planning, foster parent training, and multidisciplinary team communication/coordination. CONCLUSION Delayed discharge for CFC is multifactorial, yet often predictable. There are modifiable factors identified that can be addressed to promote timely hospital discharge and prevent medically unnecessary hospital days, benefitting patients in foster care and the hospital system.
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Affiliation(s)
- Rebecca R Seltzer
- Johns Hopkins University School of Medicine (R Seltzer and PK Donohue), Baltimore, Md; Berman Institute of Bioethics (R Seltzer), Baltimore, Md; Johns Hopkins Bloomberg School of Public Health (R Seltzer, BD Watson, and PK Donohue), Baltimore, Md.
| | - Breanna D Watson
- Johns Hopkins Bloomberg School of Public Health (R Seltzer, BD Watson, and PK Donohue), Baltimore, Md
| | - Pamela K Donohue
- Johns Hopkins University School of Medicine (R Seltzer and PK Donohue), Baltimore, Md; Johns Hopkins Bloomberg School of Public Health (R Seltzer, BD Watson, and PK Donohue), Baltimore, Md
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Michel J, Ilg T, Neunhoeffer F, Hofbeck M, Heimberg E. Implementation and Evaluation of Resuscitation Training for Childcare Workers. Front Pediatr 2022; 10:824673. [PMID: 35295697 PMCID: PMC8918630 DOI: 10.3389/fped.2022.824673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Accepted: 02/04/2022] [Indexed: 11/16/2022] Open
Abstract
Background and Objective Children spend a large amount of time in daycare centers or schools. Therefore, it makes sense to train caregivers well in first-aid measures in children. The aim of this study is to evaluate whether a multimodal resuscitation training for childcare workers can teach adherence to resuscitation guidelines in a sustainable way. Materials and Methods Caregivers at a daycare center who had previously completed a first-aid course received a newly developed multimodal resuscitation training in small groups of 7-8 participants by 3 AHA certified PALS instructors and providers. The 4-h focused retraining consisted of a theoretical component, expert modeling, resuscitation exercises on pediatric manikins (Laerdal Resusci Baby QCPR), and simulated emergency scenarios. Adherence to resuscitation guidelines was compared before retraining, immediately after training, and after 6 months. This included evaluation of chest compressions per round, chest compression rate, compression depth, full chest recoil, no-flow time, and success of rescue breaths. For better comparability and interpretation of the results, the parameters were evaluated both separately and summarized in a resuscitation score reflecting the overall adherence to the guidelines. Results A total of 101 simulated cardiopulmonary resuscitations were evaluated in 39 participants. In comparison to pre-retraining, chest compressions per round (15.0 [10.0-29.0] vs. 30.0 [30.0-30.0], p < 0.001), chest compression rate (100.0 [75.0-120.0] vs. 112.5 [105-120.0], p < 0.001), correct compression depth (6.7% [0.0-100.0] vs. 100.0% [100.0-100.0], p < 0.001), no-flow time (7.0 s. [5.0-9.0] vs. 4.0 s. [3.0-5.0], p < 0.001), success of rescue breaths (0.0% [0.0-0.0] vs. 100.0% [100.0-100.0], p < 0.001), and resuscitation score were significantly improved immediately after training (3.9 [3.2-4.9] vs. 6.3 [5.6-6.7], p < 0.001). At follow-up, there was no significant change in chest compression rate and success of rescue breaths. Chest compressions per round (30.0 [15.0-30.0], p < 0.001), no-flow time (5.0 s. [4.0-8.0], p < 0.001), compression depths (100.0% [96.7-100.0], p < 0.001), and resuscitation score worsened again after 6 months (5.7 [4.7-6.4], p = 0.03). However, the results were still significantly better compared to pre-retraining. Conclusion Our multimodal cardiopulmonary resuscitation training program for caregivers is effective to increase the resuscitation performance immediately after training. Although the effect diminishes after 6 months, adherence to resuscitation guidelines was significantly better than before retraining.
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Affiliation(s)
- Jörg Michel
- Department of Pediatric Cardiology, Pulmonology and Pediatric Intensive Care Medicine, University Children’s Hospital Tübingen, Tübingen, Germany
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Taha AA, Stephen JM, Brennan A, Stamp V, Green A, Walls C, Baird J, Van Allen K, Dorrington M. Stop, look, and listen: SPN's diversity, equity, and inclusion progress report. J Pediatr Nurs 2021; 61:439-448. [PMID: 34840036 DOI: 10.1016/j.pedn.2021.08.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Asma A Taha
- Oregon Health & Science University, Portland, OR, USA
| | | | | | - Victoria Stamp
- SSM Health Cardinal Glennon Children's Hospital, St. Louis, MO, USA
| | - Angela Green
- Johns Hopkins All Children's Hospital, St. Petersburg, FL, USA
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Harness J, Pierce J, Malas N. Psychiatric Evaluation and Management in Pediatric Spinal Cord Injuries: a Review. Curr Psychiatry Rep 2021; 23:40. [PMID: 33974153 DOI: 10.1007/s11920-021-01256-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/19/2021] [Indexed: 12/17/2022]
Abstract
PURPOSE OF REVIEW To summarize current key recommendations in the evaluation and management of mental health disorders associated with spinal cord injuries (SCI) among pediatric patients, based on a review of recent evidence-based literature and clinical experience. RECENT FINDINGS Anticipating potential mental health risks among youth with SCI and implementing early multidisciplinary management improves physical and mental health outcomes. When caregivers of youth with SCI model healthy coping strategies, it promotes healthy coping strategies in patients themselves. Peer mentor programs can be instrumental in patient adjustment, improve mental health, and aid in recovery. Pediatric SCI is particularly impactful on a child's development and individuation. Early involvement of a mental health team while in the hospital can help with the initial adjustment period and address psychiatric concerns that might interfere with recovery. The transition from the hospital to home is a period of vulnerability for individuals with SCI.
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Affiliation(s)
- Jane Harness
- Department of Psychiatry, Division of Child and Adolescent Psychiatry, University of Michigan, Ann Arbor, USA.
| | - Jessica Pierce
- Department of Psychiatry, Division of Child and Adolescent Psychiatry and Department of Pediatrics, C.S. Mott Children's Hospital, University of Michigan Hospital Systems, Ann Arbor, MI, USA
| | - Nasuh Malas
- Department of Psychiatry, Division of Child and Adolescent Psychiatry and Department of Pediatrics, C.S. Mott Children's Hospital, University of Michigan Hospital Systems, Ann Arbor, MI, USA.,Department of Psychiatry and Pediatrics, C.S. Mott Children's Hospital, University of Michigan Health System, Ann Arbor, MI, USA
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Diaz MCG, Arnold JL. Advocating for Your Patients and Families: Simulation as an Educational Tool for Home Caregivers of Children with Chronic Conditions. Pediatr Ann 2021; 50:e39-e43. [PMID: 33450038 DOI: 10.3928/19382359-20201215-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Simulation-based education for home caregivers of children with chronic conditions provides hands-on training set in a safe, confidential, supportive learning environment that is founded on the principles of patient-and family-centered care. This type of education and approach has been favored over traditional educational methods and may also improve caregivers' comfort, confidence, knowledge, skills, and ability to manage their child's routine and emergent care at home. Pediatricians play a vital role in this type of education as an advocate for their patients and families and as key stakeholders and collaborators in the process. Open collaboration and information sharing among home caregivers, simulation experts, pediatricians, and the rest of the medical team can lead to the development and implementation of successful simulation curricula. This in turn has the potential to lead to improved patient safety, quality of care, and patient outcomes. [Pediatr Ann. 2021;50(1):e39-e43.].
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Abstract
PURPOSE OF REVIEW This review highlights the emerging fields of simulation research by tying innovation into principles of learning and process improvement. RECENT FINDINGS Advances have been made in both educational simulation and simulation for quality improvement, allowing this versatile modality to be more broadly applied to healthcare and systems. SUMMARY Simulation in pediatric critical care medicine continues to evolve. Although the majority of simulation is focused on learner education, emerging research has broadened to focus on patient- and system-centered outcomes, leading to improvement in the quality of care delivered in the ICU.
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Affiliation(s)
- Ilana Harwayne-Gidansky
- Division of Critical Care, Stony Brook Children’s Hospital, Renaissance School of Medicine, Stony Brook, NY USA
| | - Rahul Panesar
- Division of Critical Care, Stony Brook Children’s Hospital, Renaissance School of Medicine, Stony Brook, NY USA
| | - Tensing Maa
- Division of Pediatric Critical Care Medicine, Nationwide Children’s Hospital, Ohio State University College of Medicine, Columbus, OH USA
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Evaluation of a Multimodal Resuscitation Program and Comparison of Mouth-to-Mouth and Bag-Mask Ventilation by Relatives of Children With Chronic Diseases. Pediatr Crit Care Med 2020; 21:e114-e120. [PMID: 31834244 DOI: 10.1097/pcc.0000000000002204] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Children with chronic critical illness are at higher risk for cardiopulmonary arrests. Before chronically ill children are discharged from hospital, family members receive training in basic life support at many institutions. We evaluated whether a multimodal training program is able to teach adherence to current resuscitation guidelines and whether laypersons can be trained to perform both bag-mask ventilation and mouth-to-mouth ventilation equally effective in infants. DESIGN Prospective observational study. SETTING Pediatric critical care unit of a tertiary referral center. SUBJECTS Relatives of children with chronic illness prior to discharge from hospital. INTERVENTIONS Multimodal emergency and cardiopulmonary resuscitation training program. MEASUREMENTS AND MAIN RESULTS Following participation in our cardiopulmonary resuscitation training program 56 participants performed 112 simulated cardiopulmonary resuscitations (56 with mouth-to-mouth ventilation, 56 with bag-mask ventilation). Nearly all participants checked for consciousness and breathing. Shouting for help and activation of the emergency response system was only performed in half of the cases. There was almost full adherence to the resuscitation guidelines regarding number of chest compressions, chest compression rate, compression depth, full chest recoil, and duration of interruption of chest compression for rescue breaths. The comparison of mouth-to-mouth ventilation and bag-mask ventilation revealed no significant differences regarding the rate of successful ventilation (mouth-to-mouth ventilation: 77.1% ± 39.6%, bag-mask ventilation: 80.4% ± 38.0%; p = 0.39) and the cardiopulmonary resuscitation performance. CONCLUSIONS A standardized multimodal cardiopulmonary resuscitation training program for family members of chronically ill children is effective to teach good cardiopulmonary resuscitation performance and adherence to resuscitation guidelines. Laypersons could be successfully trained to equally perform mouth-to-mouth and bag-mask ventilation technique.
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Estrem B, Wall J, Paitich L, Maynard R. The Ventilator-Dependent Child: Best Practices for Educating Home Care Nurses. Home Healthc Now 2020; 38:75-79. [PMID: 32134814 DOI: 10.1097/nhh.0000000000000852] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Pediatric Home Service (PHS) in Roseville, Minnesota, has provided home care for children with medical complexity for over 30 years. This article describes the PHS program for educating and training home care nurses (HCNs). Since the inception of the company, advanced training for family and professional caregivers of ventilator-dependent children has been an important focus. The current program for HCN has three components and incorporates simulation and in-home training. Standardizing educational requirements and competencies for pediatric HCNs across nursing agencies has the potential to improve outcomes for children with medical complexity receiving home healthcare services.
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Affiliation(s)
- Bruce Estrem
- Bruce Estrem, BA, RRT-NPS, is a Manager of Clinical Education, Pediatric Home Service, Roseville, Minnesota. Jill Wall, BSN, CRNI, is a Nurse Educator, Pediatric Home Service, Roseville, Minnesota. Lindsey Paitich, BSN, RN, is Director of Home Care Nursing, Pediatric Home Service, Roseville, Minnesota. Roy Maynard, MD, FAAP, is Medical Director, Pediatric Home Service, Roseville, Minnesota, and Committee Member, Section on Home Care, American Academy of Pediatrics
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There Is No Place Like Home: Simulation Training for Caregivers of Critically Ill Children. Pediatr Crit Care Med 2019; 20:396-397. [PMID: 30950998 DOI: 10.1097/pcc.0000000000001902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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