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Hasanah I, Nursalam N, Krisnana I, Arief YS, Qur'aniati N, Haikal Z, Sulistyawati RA, Rohita T. Non-Pharmacological Pain and Stress Management (N-PPSM) in Pediatric Wards: A Nurses' Perspective. Pain Manag Nurs 2024:S1524-9042(24)00216-9. [PMID: 39142917 DOI: 10.1016/j.pmn.2024.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Revised: 05/10/2024] [Accepted: 07/11/2024] [Indexed: 08/16/2024]
Abstract
PURPOSE To describe the nurses' use of non-pharmacological pain and stress management (N-PPSM) in pediatric wards and their perceptions of the benefits and perceived barriers that encourage and limited their use of these methods. METHODS This was a descriptive cross-sectional study involving 125 nurses working in the pediatric ward of an Indonesian hospital. Data collection utilized modified non-pharmacological method questionnaires, and data analysis involved t-tests and ANOVA. RESULTS The most widely used N-PPSM by nurses are cognitive methods such as providing education (48%), physical methods by positioning (40%), emotional support (36%), environmental support (45%), and family support (60%). Nurses stated that N-PPSM had few side effects (50.4%), were inexpensive (49.6%), could be performed independently (51.2%), and were easy to use (52.8%). However, during its implementation, there were several obstacles including lack of experience (42.4%), lack of training (48%), lack of equipment (45.6%), nurse belief (36.8%), lack of time (44%), patient unwilling (47.2%), and patient belief (41.6%). Work experience influences the overall utilization of N-PPSM (p-value = .043). CONCLUSION The findings from this research emphasize the significance of enhanced training for nurses working in the utilization of N-PPSM in pediatric wards. CLINICAL IMPLICATIONS Findings from this study can enhance nurses' knowledge and competence in using N-PPSM in pediatric wards, thus improving patient care. Hospitals may consider implementing new policies, education, training, and infrastructure to support N-PPSM. Educational institutions can also incorporate these methods into nursing curricula, increasing nurses' awareness and skills in using N-PPSM in pediatric patients.
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Affiliation(s)
- Idyatul Hasanah
- Nursing Department, STIKES Yarsi Mataram, Mataram, Indonesia.
| | | | - Ilya Krisnana
- Faculty of Nursing, Airlangga University, Surabaya, Indonesia
| | | | | | - Zikrul Haikal
- Faculty of Medicine, Universitas Mataram, Mataram, Indonesia
| | | | - Tita Rohita
- Nursing Department, Faculty of Health Sciences, Galuh University, Ciamis, Indonesia
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van der Perk CJ, Burger P, Maaskant J, Gemke RJBJ. Parents' Experiences and Perspectives of Their Child's Sleep Quality During Hospitalization. Clin Pediatr (Phila) 2024; 63:755-763. [PMID: 37496367 PMCID: PMC11103915 DOI: 10.1177/00099228231188223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/28/2023]
Abstract
Sleep is essential for maintenance and restoration of health, yet studies exploring this in hospitalized children are scarce. In a qualitative study, we assessed the perceived quality of sleep, factors affecting sleep, and the role of health care professionals in the sleep environment for hospitalized children aged 1 to 12 years. Data were obtained from 11 semi-structured, audio-recorded, and verbatim-transcribed interviews with parents, and analyzed using a systematic thematic analysis. The interviews were coded based on iterative assessment of transcripts. Subsequently, categories and interpretative main themes were identified. Four themes emerged: (1) being informed, keeping informed; (2) coordination of care; (3) parents as main advocates for their child's sleep; and (4) environmental disturbers. Parents reported differences in their child's sleep quality during hospital compared with home. Sleep is substantially affected during hospitalization, prompting the need for interventions to improve the quality of sleep of children. Parents provided valuable suggestions for improvements.
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Affiliation(s)
- Cor-Jan van der Perk
- Emma Children’s Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Pia Burger
- Emma Children’s Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Jolanda Maaskant
- Emma Children’s Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
- Department of Internal Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Reinoud J. B. J. Gemke
- Emma Children’s Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
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Akdeniz Kudubes A, Bektas M, Gerceker GÖ. The Predictive Power of Pain Characteristics and Sleep Quality on Fatigue in Adolescents With Cancer. J Pediatr Hematol Oncol 2023; 45:301-308. [PMID: 37494606 DOI: 10.1097/mph.0000000000002707] [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] [Received: 04/13/2022] [Accepted: 05/15/2023] [Indexed: 07/28/2023]
Abstract
This study was conducted as descriptive, methodological, and cross-sectional research to determine the predictive power of pain characteristics and sleep quality on fatigue in adolescents with cancer. The study was conducted between November 2020 and April 2021 with 139 adolescents with cancer who reported pain. The study data were collected via an AdolescentInformation Form, the Adolescent Pediatric Pain Tool, the Scale For The Assessment Of Fatigue in Pediatric Oncology Patients Aged 13-18, and the Sleep Assessment Scale for Children with Cancer-Adolescent Form. Mean values, percentage calculations, Pearson correlation analysis, and linear regression analysis were used in the analysis of the data. There was a high level and negative correlation between pain characteristics (pain location, severity, and quality) of the adolescents participating in the study and their mean scores from the overall fatigue scale and its subdimensions and a high level and positive correlation with their mean scores from the overall sleep quality scale. Pain characteristics and sleep quality of adolescents with cancer explained 74% of fatigue. Pain, sleep quality, and fatigue are symptoms that should be closely addressed in adolescents with cancer.
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Affiliation(s)
- Asli Akdeniz Kudubes
- Department of Pediatric Nursing, Bilecik Şeyh Edebali University Faculty of Health, Bilecik
| | - Murat Bektas
- Dokuz Eylul University Faculty of Nursing, Izmir, Turkey
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Burger P, Van den Ende E, Lukman W, Burchell GL, Steur LM, Merten H, Nanayakkara PW, Gemke RJ. Sleep in hospitalized pediatric and adult patients – A systematic review and meta-analysis. Sleep Med X 2022; 4:100059. [PMID: 36406659 PMCID: PMC9672415 DOI: 10.1016/j.sleepx.2022.100059] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Revised: 10/24/2022] [Accepted: 10/28/2022] [Indexed: 11/07/2022] Open
Abstract
Background Sleep is essential for recovery from illness. As a result, researchers have shown a growing interest in the sleep of hospitalized patients. Although many studies have been conducted over the past years, an up to date systematic review of the results is missing. Objective The objective of this systematic review was to assess sleep quality and quantity of hospitalized patients and sleep disturbing factors. Methods A systematic literature search was conducted within four scientific databases. The search focused on synonyms of 'sleep’ and 'hospitalization’. Papers written in English or Dutch from inception to April 25th,2022 were included for hospitalized patients >1 year of age. Papers exclusively reporting about patients receiving palliative, obstetric or psychiatric care were excluded, as well as patients in rehabilitation and intensive care settings, and long-term hospitalized geriatric patients. This review was performed in accordance with the PRISMA guidelines. Results Out of 542 full text studies assessed for eligibility, 203 were included, describing sleep quality and/or quantity of 17,964 patients. The median sample size of the studies was 51 patients (IQR 67, range 6–1472). An exploratory meta-analysis of the Total Sleep Time showed an average of 7.2 h (95%-CI 4.3, 10.2) in hospitalized children, 5.7 h (95%-CI 4.8, 6.7) in adults and 5.8 h (95%-CI 5.3, 6.4) in older patients (>60y). In addition, a meta-analysis of the Wake After Sleep Onset (WASO) showed a combined high average of 1.8 h (95%-CI 0.7, 2.9). Overall sleep quality was poor, also due to nocturnal awakenings. The most frequently cited external factors for poor sleep were noise and number of patients in the room. Among the variety of internal/disease-related factors, pain and anxiety were most frequently mentioned to be associated with poor sleep. Conclusion Of all studies, 76% reported poor sleep quality and insufficient sleep duration in hospitalized patients. Children sleep on average 0.7–3.8 h less in the hospital than recommended. Hospitalized adults sleep 1.3–3.2 h less than recommended for healthy people. This underscores the need for interventions to improve sleep during hospitalization to support recovery. An overview of the magnitude of sleep deprivation in hospitalized patients. A meta-analysis of studies reporting on some of the main sleep outcomes. An overview of internal and external factors affecting sleep in hospitalized patients. Guidance for potential interventions to improve sleep during clinical admission. Uncovers a knowledge gap regarding the sleep quality of hospitalized children and daytime sleep of hospitalized adults.
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Topsakal S, Ekici B. Effect of illuminated musical mobile on sleep quality of children hospitalized in pediatric emergency departments. J Pediatr Nurs 2022; 67:e156-e164. [PMID: 35973878 DOI: 10.1016/j.pedn.2022.08.004] [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: 03/06/2022] [Revised: 07/27/2022] [Accepted: 08/06/2022] [Indexed: 11/15/2022]
Abstract
PURPOSE The aim of this study is to evaluate the effect of an illuminated musical mobile on the sleep quality of children hospitalized in a pediatric emergency department. DESIGN AND METHODS In this randomized controlled study, 124 children presenting to a pediatric emergency department who met the inclusion criteria were included in the study. Patients were randomized into two equal groups. In the intervention group, an illuminated musical mobile was used to help facilitate sleep. In the control group, routine sleep routines were continued. Groups were compared according to sleep quality as evaluated by mothers' observations. Evaluation was performed twice (before intervention - 1st day of hospitalization and on the intervention day - 2nd day of hospitalization). RESULTS Average age of children was 1.86 ± 0.78 years. On the intervention day, nighttime sleep duration was longer in the intervention group (p < .0001). Also, the frequency of spontaneous awakening (p < .0001), time to fall asleep after spontaneous awakening (p < .0001) and sleep time problems (p < .0001) were less in the intervention group. CONCLUSıONS: An illuminated musical mobile was used for the first time in the pediatric emergency department and was found to be effective in improving the sleep quality of hospitalized children aged between 1 and 3 years. PRACTICE IMPLICATIONS During hospitalization, children's sleep quality can be increased by using methods and objects suitable for the child's developmental level.
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Affiliation(s)
- Sinem Topsakal
- Istanbul Ministry of Health Marmara University Pendik Training and Research Hospital, Pediatric Emergency Clinic, Istanbul, Turkey
| | - Behice Ekici
- Maltepe University, School of Nursing, Pediatric Nursing Department, Istanbul, Turkey.
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Fidler AL, Voorhees S, Zhou ES, Stacciarini JM, Fedele DA. A systematic review and proposed conceptual model of sleep disturbances during pediatric hospitalizations. Sleep 2022; 45:zsac038. [PMID: 35554575 DOI: 10.1093/sleep/zsac038] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Revised: 01/19/2022] [Indexed: 09/21/2023] Open
Abstract
STUDY OBJECTIVES The current review aims to examine factors that influence pediatric inpatient sleep and determine the effectiveness of sleep promotion interventions among hospitalized children. METHODS A systematic literature search was conducted across PubMed, PsycINFO, CINAHL, Cochrane Central, Web of Science, Embase, and Scopus databases. Studies included children with a mean age between 1 and 18 years old that either described factors affecting the sleep of children who are hospitalized on a non-intensive care unit or reported on sleep-related intervention outcomes. We conducted separate narrative reviews for each of the two aims and then synthesized findings from quantitative and qualitative studies across both aims. RESULTS Forty-five articles were included for review. Despite most sleep disturbances being attributed to environmental disruptions (e.g. noise, staff interruptions), most interventions targeted the child level using relaxation techniques. Although the majority of interventions were small pilot studies, preliminary findings appear to positively impact sleep duration. The Pediatric Inpatient Sleep Model was proposed to illustrate connections between sleep disturbances, factors influencing sleep, and existing intervention components. CONCLUSIONS Replication studies are needed, including larger-scale sleep promotion interventions among hospitalized children. Given the identification of environmental factors as the main cause of night wakings, environmental modifications are crucial. Additional research examining contributors to intraindividual variability in disrupted sleep patterns during hospitalizations as well as the consequences of these disturbances is warranted.
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Affiliation(s)
- Andrea L Fidler
- Department of Clinical and Health Psychology, University of Florida, Gainesville, FL, USA
| | - Sara Voorhees
- Department of Clinical and Health Psychology, University of Florida, Gainesville, FL, USA
| | - Eric S Zhou
- Dana-Farber Cancer Institute, Boston, MA, USA
- Division of Sleep Medicine, Harvard Medical School, Boston, MA, USA
| | | | - David A Fedele
- Department of Clinical and Health Psychology, University of Florida, Gainesville, FL, USA
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Sleep in hospitalized children and adolescents: A scoping review. Sleep Med Rev 2021; 59:101496. [PMID: 33984632 DOI: 10.1016/j.smrv.2021.101496] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Revised: 04/01/2021] [Accepted: 04/18/2021] [Indexed: 11/20/2022]
Abstract
Hospitalized children and adolescents are at risk of short sleep and subsequent adverse health effects, but little is known about actual sleep duration, the factors that cause sleep disturbances in an inpatient pediatric setting, and what has been done to promote sleep in this population. The aim of this review was to systematically identify, categorize, and synthesize the literature on sleep in children and adolescents in an inpatient setting. We searched five electronic databases (PubMed, CENTRAL, CINAHL, PsycINFO, and Scopus) and of the 3770 references identified, 28 were eligible for inclusion. From studies reporting age-specific sleep durations, we found that four out of nineteen fell within the National Sleep Foundations recommendations for age-specific sleep durations. Reported causes of sleep disturbances were primarily related to modifiable, external factors, e.g., nursing care activities and noise from equipment and other patients. Sleep-promoting interventions seemed acceptable to patients, parents, and healthcare professionals. However, the literature in this area is heterogeneous regarding methodology, reporting, and population characteristics. Our findings underline the importance of prioritizing and optimizing sleep in hospitalized pediatric patients and highlight the need for standardization in the planning and reporting of studies within this field.
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Berger J, Zaidi M, Halferty I, Kudchadkar S. Sleep in the Hospitalized Child: A Contemporary Review. Chest 2021; 160:1064-1074. [PMID: 33895129 DOI: 10.1016/j.chest.2021.04.024] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2020] [Revised: 04/13/2021] [Accepted: 04/17/2021] [Indexed: 11/17/2022] Open
Abstract
Acute illness and hospitalization introduce several risk factors for sleep disruption in children that can negatively affect recovery and healing and potentially compromise long-term cognition and executive function. The hospital setting is not optimized for pediatric sleep promotion, and many of the pharmacologic interventions intended to promote sleep in the hospital actually may have deleterious effects on sleep quality and quantity. To date, evidence to support pharmacologic sleep promotion in the pediatric inpatient setting is sparse. Therefore, nonpharmacologic interventions to optimize sleep-wake patterns are of highest yield in a vulnerable population of patients undergoing active neurocognitive development. In this review, we briefly examine what is known about healthy sleep in children and describe risk factors for sleep disturbances, available sleep measurement tools, and potential interventions for sleep promotion in the pediatric inpatient setting.
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Affiliation(s)
- Jessica Berger
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins School of Medicine, Baltimore, MD
| | - Munfarid Zaidi
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins School of Medicine, Baltimore, MD
| | | | - Sapna Kudchadkar
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins School of Medicine, Baltimore, MD; Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, MD; Department of Physical Medicine and Rehabilitation, Johns Hopkins School of Medicine, Baltimore, MD.
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Mozer CL, Bhagat PH, Seward SA, Mason NR, Anderson SL, Byron M, Peirce LB, Konold V, Kumar M, Arora VM, Orlov NM. Optimizing Oral Medication Schedules for Inpatient Sleep: A Quality Improvement Intervention. Hosp Pediatr 2021; 11:327-333. [PMID: 33731336 DOI: 10.1542/hpeds.2020-002261] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
OBJECTIVES Hospitalized children experience frequent nighttime awakenings. Oral medications are commonly administered around the clock despite the comparable efficacy of daytime administration schedules, which promote sleep. With this study, we evaluated the effectiveness of a quality improvement initiative to increase the proportion of sleep-friendly antibiotic administration schedules. METHODS Interprofessional stakeholders modified computerized provider order entry defaults for 4 oral antibiotic medications, from around the clock to administration occurring exclusively during waking hours. Additionally, care-team members received targeted education. Outcome measures included the proportion of sleep-friendly administration schedules and patient caregiver-reported disruptions to sleep. Pre- and posteducation surveys were used to evaluate education effectiveness. Balancing measures were missed antibiotic doses and related escalations of care. RESULTS Interrupted time series analysis revealed a 72% increase (interceptpre: 18%; interceptpost: 90%; 95% confidence interval: 65%-79%; P < .001) in intercept for percentage of orders with sleep-friendly administration schedules (orders: n pre = 1014 and n post = 649). Compared with preeducation surveys, care-team members posteducation were more likely to agree that oral medications scheduled around the clock cause sleep disruption (resident: 71% pre, 90% post [P = .01]; nurse: 63% pre, 79% post [P = .03]). Although sleep-friendly orders increased, patient caregivers reported an increase in sleep disruption due to medications (pre 28%, post 46%; P < .001). CONCLUSIONS A simple, low-cost intervention of computerized provider order entry default modifications and education can increase the proportion of sleep-friendly oral antibiotic administration schedules for hospitalized children. Patient perception of sleep is impacted by multiple factors and often does not align with objective data. An increased focus on improving sleep during hospitalization may result in heightened awareness of disruptions.
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Affiliation(s)
- Christine L Mozer
- Pritzker School of Medicine, The University of Chicago, Chicago, Illinois
| | | | - Sarah A Seward
- IS Technology and Applications, Children's Wisconsin, West Allis, Wisconsin
| | - Noah R Mason
- Pritzker School of Medicine, The University of Chicago, Chicago, Illinois
| | | | - Maxx Byron
- Section of General Internal Medicine, Department of Medicine
| | - Leah B Peirce
- Department of Pediatrics, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois; and
| | - Victoria Konold
- Infectious Diseases and Virology, Seattle Children's Hospital, Seattle, Washington
| | - Madan Kumar
- Pritzker School of Medicine, The University of Chicago, Chicago, Illinois.,Sections of Infectious Diseases and
| | - Vineet M Arora
- Pritzker School of Medicine, The University of Chicago, Chicago, Illinois.,Section of General Internal Medicine, Department of Medicine
| | - Nicola M Orlov
- Pritzker School of Medicine, The University of Chicago, Chicago, Illinois; .,Pediatric Hospital Medicine, Department of Pediatrics and
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Coe M, Gruhler H, Schefft M, Williford D, Burger B, Crain E, Mihalek AJ, Santos M, Cotter JM, Trowbridge G, Kessenich J, Nolan M, Tchou MJ. Learning from Each Other: A Multisite Collaborative to Reduce Electrolyte Testing. Pediatr Qual Saf 2020; 5:e351. [PMID: 33134756 PMCID: PMC7591129 DOI: 10.1097/pq9.0000000000000351] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Accepted: 07/23/2020] [Indexed: 12/27/2022] Open
Abstract
Inpatient electrolyte testing rates vary significantly across pediatric hospitals. Despite evidence that unnecessary testing exists, providers still struggle with reducing electrolyte laboratory testing. We aimed to reduce serum electrolyte testing among pediatric inpatients by 20% across 5 sites within 6 months. METHODS A national quality improvement collaborative evaluated standardized interventions for reducing inpatient serum electrolyte testing at 5 large tertiary and quaternary children's hospitals. The outcome measure was the rate of electrolyte laboratory tests per 10 patient-days. The interventions were adapted from a previous single-site improvement project and included cost card reminders, automated laboratory plans via electronic medical record, structured rounds discussions, and continued education. The collaborative utilized weekly conference calls to discuss Plan, Do, Study, Act cycles, and barriers to implementation efforts. RESULTS The study included 17,149 patient-days across 5 hospitals. The baseline preintervention electrolyte laboratory testing rate mean was 4.82 laboratory tests per 10 patient-days. Postimplementation, special cause variation in testing rates shifted the mean to 4.19 laboratory tests per 10 patient-days, a 13% reduction. There was a wide variation in preintervention electrolyte testing rates and the effectiveness of interventions between the hospitals participating in the collaborative. CONCLUSIONS This multisite improvement collaborative was able to rapidly disseminate and implement value improvement interventions leading to a reduction in electrolyte testing; however, we did not meet our goal of 20% testing reduction across all sites. Quality improvement collaboratives must consider variation in context when adapting previously successful single-center interventions to a wide variety of sites.
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Affiliation(s)
- Megan Coe
- From the Division of Hospital Medicine, Department of Pediatrics, Children’s Hospital of Richmond at Virginia Commonwealth University, Richmond, Virginia
| | | | - Matthew Schefft
- From the Division of Hospital Medicine, Department of Pediatrics, Children’s Hospital of Richmond at Virginia Commonwealth University, Richmond, Virginia
| | - Dustin Williford
- Section of Pediatric Hospital Medicine, Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Barrett Burger
- Section of Pediatric Hospital Medicine, Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Emily Crain
- Section of Pediatric Hospital Medicine, Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Alexandra J. Mihalek
- Division of Hospital Medicine, Department of Pediatrics, Children’s Hospital Los Angeles; Keck School of Medicine of the University of Southern California, Los Angeles, California
| | - Maria Santos
- Division of Hospital Medicine, Department of Pediatrics, Children’s Hospital Los Angeles; Keck School of Medicine of the University of Southern California, Los Angeles, California
| | - Jillian M. Cotter
- Section of Hospital Medicine, Department of Pediatrics, Children’s Hospital Colorado and University of Colorado School of Medicine, Aurora, Colorado
| | - Gregory Trowbridge
- Pediatric Hospital Medicine, Spectrum Health Medical Group/Helen DeVos Children’s Hospital, Grand Rapids, Mich
| | - Jeri Kessenich
- Pediatric Hospital Medicine, Spectrum Health Medical Group/Helen DeVos Children’s Hospital, Grand Rapids, Mich
| | - Mark Nolan
- Pediatric Hospital Medicine, Spectrum Health Medical Group/Helen DeVos Children’s Hospital, Grand Rapids, Mich
| | - Michael J. Tchou
- Section of Hospital Medicine, Department of Pediatrics, Children’s Hospital Colorado and University of Colorado School of Medicine, Aurora, Colorado
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Cook DJ, Arora VM, Chamberlain M, Anderson S, Peirce L, Erondu A, Ahmed F, Kilaru M, Edstrom E, Gonzalez M, Ridgeway R, Stanly S, LaFond C, Fromme HB, Clardy C, Orlov NM. Improving Hospitalized Children's Sleep by Reducing Excessive Overnight Blood Pressure Monitoring. Pediatrics 2020; 146:peds.2019-2217. [PMID: 32817268 PMCID: PMC7461242 DOI: 10.1542/peds.2019-2217] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/23/2020] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Although required for healing, sleep is often disrupted during hospitalization. Blood pressure (BP) monitoring can be especially disruptive for pediatric inpatients and has few clinical indications. Our aim in this pilot study was to reduce unnecessary overnight BP monitoring and improve sleep for pediatric inpatients. METHODS The intervention in June 2018 involved clinician education sessions and updated electronic health record (EHR) orders that enabled the forgoing of overnight BP checks. The postintervention period from July 2018 to May 2019 examined patient-caregiver surveys as outcome measures. These surveys measured inpatient sleep and overnight disruptions and were adopted from validated surveys: the Patient Sleep Questionnaire, expanded Brief Infant Sleep Questionnaire, and Potential Hospital Sleep Disruptions and Noises Questionnaire. Uptake of new sleep-friendly EHR orders was a process measure. Reported patient care escalations served as a balancing measure. RESULTS Interrupted time series analysis of EHR orders (npre = 493; npost = 1472) showed an increase in intercept for the proportion of patients forgoing overnight BP postintervention (+50.7%; 95% confidence interval 41.2% to 60.3%; P < .001) and a subsequent decrease in slope each week (-0.16%; 95% confidence interval -0.32% to -0.01%; P = .037). Statistical process control of surveys (npre = 263; npost = 131) showed a significant increase in sleep duration for patients older than 2, and nighttime disruptions by clinicians decreased by 19% (P < .001). Annual estimated cost savings were $15 842.01. No major adverse events in patients forgoing BP were reported. CONCLUSIONS A pilot study combining EHR changes and clinician education safely decreased overnight BP checks, increased pediatric inpatient sleep duration, and reduced nighttime disruptions by clinicians.
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Affiliation(s)
- David J. Cook
- Pritzker School of Medicine, The University of Chicago, Chicago, Illinois; and
| | - Vineet M. Arora
- Departments of Medicine and,Pritzker School of Medicine, The University of Chicago, Chicago, Illinois; and
| | - Michael Chamberlain
- Pritzker School of Medicine, The University of Chicago, Chicago, Illinois; and
| | | | - Leah Peirce
- Pritzker School of Medicine, The University of Chicago, Chicago, Illinois; and
| | - Amarachi Erondu
- Pritzker School of Medicine, The University of Chicago, Chicago, Illinois; and
| | - Farah Ahmed
- Center for Healthcare Delivery Sciences and Innovation and
| | - Megha Kilaru
- Center for Healthcare Delivery Sciences and Innovation and
| | - Eve Edstrom
- Center for Healthcare Delivery Sciences and Innovation and
| | - Monica Gonzalez
- Comer Children’s Hospital, University of Chicago Medicine, Chicago, Illinois
| | - Rachel Ridgeway
- Comer Children’s Hospital, University of Chicago Medicine, Chicago, Illinois
| | - Suja Stanly
- Comer Children’s Hospital, University of Chicago Medicine, Chicago, Illinois
| | - Cynthia LaFond
- Pediatrics and,Center for Healthcare Delivery Sciences and Innovation and
| | - H. Barrett Fromme
- Pediatrics and,Pritzker School of Medicine, The University of Chicago, Chicago, Illinois; and
| | | | - Nicola M. Orlov
- Pediatrics and,Pritzker School of Medicine, The University of Chicago, Chicago, Illinois; and
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12
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Hooke MC, Linder LA. Symptoms in Children Receiving Treatment for Cancer-Part I: Fatigue, Sleep Disturbance, and Nausea/Vomiting. J Pediatr Oncol Nurs 2020; 36:244-261. [PMID: 31307321 PMCID: PMC7197223 DOI: 10.1177/1043454219849576] [Citation(s) in RCA: 51] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
Children and adolescents with cancer often undergo intensive chemotherapy treatment to obtain remission and long-term survival. The pursuit of successful treatment outcomes may lead to high levels of symptom distress related to treatment side effects and toxicities. The Children's Oncology Group Nursing Discipline held a State of the Science Symposium "Symptom Assessment During Childhood Cancer Treatment" in 2018 that included reviews of evidence regarding key symptoms. The purpose of this review is to summarize and synthesize the evidence presented about the prevalence, relationships, trajectories, and associated biomarkers of selected symptoms experienced by children and adolescents during cancer treatment. Five symptoms were selected, with the focus on fatigue, sleep disturbance, and nausea/vomiting and included in Part I of the review. Using Ovid-Medline, studies published between 2008 and 2018 that focused on these specific symptoms during active chemotherapy treatment were selected. Fatigue interferes with normal developmental activities and is associated with sleep disturbances, and its pattern changes within a cycle of chemotherapy as well as across the treatment trajectory. Sleep is disrupted by the hospital environment, treatment medications, and changes in normal childhood and schedules. Disturbances of sleep persist during treatment, preventing recovery from poor quality sleep. Although pharmacologic interventions have advanced for treatment of nausea and vomiting, children and adolescents continue to struggle with this symptom. Its trajectory changes with the intensity of treatment, and over half of the patients report that they experience nausea and/or vomiting. Future research is needed to advance identification of biologic risk factors for symptoms and test effectiveness of symptom-related interventions.
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Affiliation(s)
- Mary C Hooke
- 1 University of Minnesota School of Nursing, Minneapolis, MN, USA
- 2 Children's Minnesota, Minneapolis, MN, USA
| | - Lauri A Linder
- 3 University of Utah College of Nursing, Salt Lake City, UT, USA
- 4 Primary Children's Hospital, Salt Lake City, UT, USA
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Bevan R, Grantham-Hill S, Bowen R, Clayton E, Grice H, Venditti HC, Stickland A, Hill CM. Sleep quality and noise: comparisons between hospital and home settings. Arch Dis Child 2019; 104:147-151. [PMID: 30018067 DOI: 10.1136/archdischild-2018-315168] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Accepted: 06/09/2018] [Indexed: 11/03/2022]
Abstract
BACKGROUND Children and their parents report poor sleep in hospital and complain about noise. OBJECTIVE To measure sleep quality and noise levels in hospital and compare these with the home environment. DESIGN Observational within case-controlled study. SETTING Paediatric medical wards at Southampton Children's Hospital and bedrooms at home. PARTICIPANTS AND METHODS Participants were children aged 3-16 years and their co-sleeping parents. Sleep quality was measured using actigraphy for a maximum of 5 nights in each setting. Median sound levels at the bedside were monitored overnight in a subgroup in both settings. MAIN OUTCOME MEASURES Total sleep time, sleep efficiency, median sound levels overnight. RESULTS 40 children and 16 mothers completed actigraphy in both settings. Children had on average 62.9 min, and parents 72.8 min, per night less sleep in hospital than at home. Both children and parents had poorer sleep quality in hospital than at home: mean sleep efficiency 77.0% vs 83.2% for children and 77.1% vs 88.9% for parents, respectively. Median sound levels in hospital measured in 8 children averaged 48.6 dBA compared with 34.7 dBA at home and exceeded World Health Organization recommendations of 30 dB. CONCLUSIONS Children and their mothers have poor quality sleep in paediatric wards. This may affect the child's behaviour, recovery and pain tolerance. Sleep deprivation adds to parental burden and stress. Sound levels are significantly raised in hospital and may contribute to poor sleep. Reduction in the level of noise might lead to an improvement in sleep, affecting the quality of stay of both parent and child.
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Affiliation(s)
- Rosanna Bevan
- Division of Clinical Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Sarah Grantham-Hill
- Division of Clinical Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Ruth Bowen
- Division of Clinical Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Esther Clayton
- Division of Clinical Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Helen Grice
- Division of Clinical Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Holly Caroline Venditti
- Division of Clinical Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Alice Stickland
- Division of Clinical Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Catherine Mary Hill
- Division of Clinical Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK.,Southampton Children's Hospital, Southampton, UK
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15
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Tchou MJ, Tang Girdwood S, Wormser B, Poole M, Davis-Rodriguez S, Caldwell JT, Shannon L, Hagedorn PA, Biondi E, Simmons J, Anderson J, Brady PW. Reducing Electrolyte Testing in Hospitalized Children by Using Quality Improvement Methods. Pediatrics 2018; 141:peds.2017-3187. [PMID: 29618583 PMCID: PMC7008632 DOI: 10.1542/peds.2017-3187] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/18/2017] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Despite studies indicating a high rate of overuse, electrolyte testing remains common in pediatric inpatient care. Frequently repeated electrolyte tests often return normal results and can lead to patient harm and increased cost. We aimed to reduce electrolyte testing within a hospital medicine service by >25% within 6 months. METHODS We conducted an improvement project in which we targeted 6 hospital medicine teams at a large academic children's hospital system by using the Model for Improvement. Interventions included standardizing communication about the electrolyte testing plan and education about the costs and risks associated with overuse of electrolyte testing. Our primary outcome measure was the number of electrolyte tests per patient day. Secondary measures included testing charges and usage rates of specific high-charge panels. We tracked medical emergency team calls and readmission rates as balancing measures. RESULTS The mean baseline rate of electrolyte testing was 2.0 laboratory draws per 10 patient days, and this rate decreased by 35% after 1 month of initial educational interventions to 1.3 electrolyte laboratory draws per 10 patient days. This change has been sustained for 9 months and could save an estimated $292 000 in patient-level charges over the course of a year. Use of our highest-charge electrolyte panel decreased from 67% to 22% of testing. No change in rates of medical emergency team calls or readmission were found. CONCLUSIONS Our improvement intervention was associated with significant and rapid reduction in electrolyte testing and has not been associated with unintended adverse events.
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Affiliation(s)
- Michael J. Tchou
- Division of Hospital Medicine, Department of Pediatrics, Cincinnati, Ohio;,James M. Anderson Center for Health Systems Excellence, Cincinnati, Ohio
| | | | | | - Meifawn Poole
- Pediatric Residency Training Program, Cincinnati, Ohio
| | | | | | - Lauren Shannon
- Division of Hospital Medicine, Department of Pediatrics, Cincinnati, Ohio
| | - Philip A. Hagedorn
- Division of Hospital Medicine, Department of Pediatrics, Cincinnati, Ohio
| | - Eric Biondi
- Department of Pediatrics, Johns Hopkins Children’s Center, Baltimore, Maryland
| | - Jeffrey Simmons
- Division of Hospital Medicine, Department of Pediatrics, Cincinnati, Ohio;,James M. Anderson Center for Health Systems Excellence, Cincinnati, Ohio
| | - Jeffrey Anderson
- James M. Anderson Center for Health Systems Excellence, Cincinnati, Ohio;,Heart Institute, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
| | - Patrick W. Brady
- Division of Hospital Medicine, Department of Pediatrics, Cincinnati, Ohio;,James M. Anderson Center for Health Systems Excellence, Cincinnati, Ohio
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16
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17
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Abstract
Increased incidence of children diagnosed with cancer and survivors was an impact on changes in pediatric hemato-oncology nursing care. In this review article, it is aimed to investigate the new trends and recent care approaches in pediatric oncology nursing. The recent care topics were common in the literature as family-centered care, technology-based care, program development, primary care of child, health-care provider, survivors and home care, and nonpharmacological care. All of the topics contribute to perform evidence-based care for health promotion and well-being in pediatric hemato-oncology nursing. Research reviews showed that many current topics for the care of children and their parents have entered in the literature. There is a need for more randomized controlled studies to improve the level of evidence of new nursing approaches.
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Affiliation(s)
| | - Naime Altay
- Department of Nursing, Faculty of Health Sciences, Gazi University, Ankara, Turkey
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18
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Andrade SRD, Ruoff AB, Piccoli T, Schmitt MD, Ferreira A, Xavier ACA. O ESTUDO DE CASO COMO MÉTODO DE PESQUISA EM ENFERMAGEM: UMA REVISÃO INTEGRATIVA. TEXTO & CONTEXTO ENFERMAGEM 2017. [DOI: 10.1590/0104-07072017005360016] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
RESUMO Objetivo: analisar a aplicação do estudo de caso como método de pesquisa pela enfermagem nas publicações científicas nacionais e internacionais. Método: revisão integrativa de literatura realizada nas bases bibliográficas eletrônicas PubMed, CINAHL, LILACS e SciELO, utilizando os descritores estudo de caso, pesquisa e enfermagem. Foram incluídos artigos originais disponíveis na íntegra no formato on-line, nos idiomas português, inglês ou espanhol, no recorte temporal de 2010 a 2015. Resultados: foram encontrados 624 estudos, dos quais 50 atenderam ao objetivo. Os autores Yin e Stake foram os pesquisadores cujos referenciais metodológicos de estudo de caso se destacaram no contexto da pesquisa na área da enfermagem. A aplicação do método abrangeu os diferentes campos de atuação da profissão: educação, assistência/cuidado e gestão/administração. Conclusão: o estudo de caso como método de pesquisa mostrou-se uma importante metodologia que pode ser amplamente utilizada pela enfermagem nos seus diversos campos de atuação ao buscar compreender fenômenos relacionados a indivíduos, grupos ou organizações.
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19
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Merz EL, Tomfohr-Madsen L. Sleep Disruption in Pediatric Cancer Survivors: Conceptual Framework and Opportunities for Clinical Assessment and Behavioral Treatment. Am J Lifestyle Med 2016; 12:311-323. [PMID: 32063816 DOI: 10.1177/1559827616681725] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2016] [Revised: 10/31/2016] [Accepted: 11/09/2016] [Indexed: 12/18/2022] Open
Abstract
Sleep disruption is a commonly reported consequence of cancer and its treatment in pediatric patients and survivors. This review summarizes common sleep concerns in this population and introduces a multidimensional framework of risk factors specific to childhood cancer that may interact to develop and maintain disrupted sleep. Based on the extant literature, parameters of the cancer and its treatment, physical and social environmental conditions both during and after treatment, changes to family behavior and norms, psychological factors and traumatic stress, and reduced physical activity are hypothesized to be the most pertinent risk factors for disrupted sleep in this population. Potential clinical assessment strategies and behavioral interventions relevant to these considerations are discussed, with reference to the behavioral model of insomnia. The review concludes by offering directions for research and clinical practice, including developing and testing comprehensive assessment tools, intervention effectiveness studies in both oncology and primary care clinics, and efforts to increase patient-provider communication about sleep in pediatric oncology.
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Affiliation(s)
- Erin L Merz
- Department of Psychology, California State University, Dominguez Hills, Carson, California (ELM).,Department of Psychology, University of Calgary and Department of Pediatrics, Alberta Children's Hospital Research Institute, Calgary, Alberta, Canada (LTM)
| | - Lianne Tomfohr-Madsen
- Department of Psychology, California State University, Dominguez Hills, Carson, California (ELM).,Department of Psychology, University of Calgary and Department of Pediatrics, Alberta Children's Hospital Research Institute, Calgary, Alberta, Canada (LTM)
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20
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Linder LA, Seitz M. Through Their Words: Sources of Bother for Hospitalized Children and Adolescents With Cancer. J Pediatr Oncol Nurs 2016; 34:51-64. [PMID: 26902500 DOI: 10.1177/1043454216631308] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
An increased intensity of inpatient treatment, hospital-based routines, and separation from the familiar home environment may collectively increase the burden of the pediatric cancer experience. This study explored children and adolescents' perceived sources of bother related to hospitalization using two questions: (1) What bothered you the most about the hospital or hospital environment? and (2) What do you think could improve the hospital or hospital environment? Fifty children and adolescents (mean age 12.6 years) responded to these questions during each shift of a 3-day/3-night data collection period. Responses were analyzed using content analysis and chi-square analyses. Themes related to sources of bother included (1) "nothing/don't know," (2) "treatment and its consequences," (3) "isolation and loneliness," (4) "imposed bother," (5) "negative environment," and (6) "staff behaviors." Themes related to improving the hospital environment included (1) "nothing/don't know," (2) "normalizing activities," (3) "quality of the hospital environment," (4) "decrease burden of cancer and its treatment," and (5) "patient care issues." Participants' responses to these questions provide a foundation for actionable change to alleviate the burden associated with hospitalization.
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Affiliation(s)
- Lauri A Linder
- 1 University of Utah College of Nursing, Salt Lake City, UT, USA
| | - Marie Seitz
- 2 University of Utah College of Nursing, Salt Lake City, UT, USA
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21
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Lee S, Narendran G, Tomfohr-Madsen L, Schulte F. A systematic review of sleep in hospitalized pediatric cancer patients. Psychooncology 2016; 26:1059-1069. [DOI: 10.1002/pon.4149] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2015] [Revised: 02/07/2016] [Accepted: 03/30/2016] [Indexed: 11/08/2022]
Affiliation(s)
- Soeun Lee
- Department of Psychology; University of Guelph; Guelph ON Canada
| | - Gaya Narendran
- Cumming School of Medicine; University of Calgary; Calgary AB Canada
| | - Lianne Tomfohr-Madsen
- Department of Psychology; University of Calgary; Calgary AB Canada
- Alberta Children's Hospital Research Institute; Calgary AB Canada
| | - Fiona Schulte
- Alberta Children's Hospital Research Institute; Calgary AB Canada
- Haemotology, Oncology, and Blood and Marrow Transplant Program; Alberta Children's Hospital; Calgary AB Canada
- Department of Paediatrics; University of Calgary; Calgary AB Canada
- Department of Oncology; University of Calgary; Calgary AB Canada
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22
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Camargo-Sanchez A, Niño CL, Sánchez L, Echeverri S, Gutiérrez DP, Duque AF, Pianeta O, Jaramillo-Gómez JA, Pilonieta MA, Cataño N, Arboleda H, Agostino PV, Alvarez-Baron CP, Vargas R. Theory of Inpatient Circadian Care (TICC): A Proposal for a Middle-Range Theory. Open Nurs J 2015; 9:1-9. [PMID: 25767632 PMCID: PMC4353124 DOI: 10.2174/1874434601509010001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2014] [Revised: 12/22/2014] [Accepted: 01/05/2015] [Indexed: 11/30/2022] Open
Abstract
The circadian system controls the daily rhythms of a variety of physiological processes. Most organisms show physiological, metabolic and behavioral rhythms that are coupled to environmental signals. In humans, the main synchronizer is the light/dark cycle, although non-photic cues such as food availability, noise, and work schedules are also involved. In a continuously operating hospital, the lack of rhythmicity in these elements can alter the patient’s biological rhythms and resilience. This paper presents a Theory of Inpatient Circadian Care (TICC) grounded in circadian principles. We conducted a literature search on biological rhythms, chronobiology, nursing care, and middle-range theories in the databases PubMed, SciELO Public Health, and Google Scholar. The search was performed considering a period of 6 decades from 1950 to 2013. Information was analyzed to look for links between chronobiology concepts and characteristics of inpatient care. TICC aims to integrate multidisciplinary knowledge of biomedical sciences and apply it to clinical practice in a formal way. The conceptual points of this theory are supported by abundant literature related to disease and altered biological rhythms. Our theory will be able to enrich current and future professional practice.
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Affiliation(s)
- Andrés Camargo-Sanchez
- Nursing School at the Universidad de Ciencias Aplicadas y Ambientales (U.D.C.A), Bogotá, Colombia
| | - Carmen L Niño
- Nursing School at the Universidad de Ciencias Aplicadas y Ambientales (U.D.C.A), Bogotá, Colombia
| | - Leonardo Sánchez
- Nursing School at the Universidad de Ciencias Aplicadas y Ambientales (U.D.C.A), Bogotá, Colombia
| | - Sonia Echeverri
- Nursing Department at Fundación Santa Fe de Bogotá University Hospital, Bogotá, Colombia
| | - Diana P Gutiérrez
- Division of Internal Medicine at Fundación Santa Fe de Bogotá University Hospital, Bogotá, Colombia
| | | | - Oscar Pianeta
- School of Medicine at the Universidad de Ciencias Aplicadas y Ambientales (U.D.C.A), Bogotá, Colombia
| | - Jenny A Jaramillo-Gómez
- Cell Death Group, School of Medicine and Institute of Genetics at the Universidad Nacional de Colombia, Bogotá, Colombia
| | - Martin A Pilonieta
- School of Medicine at the Universidad Nacional de Colombia, Bogotá, Colombia
| | - Nhora Cataño
- School of Nursing at the Universidad Nacional de Colombia, Bogotá, Colombia
| | - Humberto Arboleda
- Neurosciences Research Group, School of Medicine and Institute of Genetics at the Universidad Nacional de Colombia, Bogotá, Colombia
| | - Patricia V Agostino
- Laboratorio de Cronobiología, Departamento de Ciencia y Tecnología, Universidad Nacional de Quilmes/CONICET, Buenos Aires, Argentina
| | | | - Rafael Vargas
- School of Medicine at the Pontificia Universidad Javeriana, Bogotá, Colombia
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23
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Abstract
There are many ways to add to children's quality of life within the hospital environment. Inpatient settings offer both opportunities and challenges with respect to providing care to children with life-threatening illnesses. The barriers to pediatric palliative care (PPC) on hospital wards, as with those in other settings, frequently stem from misconceptions. However, some barriers are intensified by characteristics of acute inpatient centers. Yet some characteristics of the inpatient setting, including the availability of human resources and unique interventions, offer creative ways to ease distress and improve quality of life for children and their families.
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Affiliation(s)
- Adam Rapoport
- Paediatric Advanced Care Team (PACT), The Hospital for Sick Children, 555 University Avenue, Toronto, Ontario M5G 1X8, Canada.
| | - Kevin Weingarten
- Paediatric Advanced Care Team (PACT), The Hospital for Sick Children, 555 University Avenue, Toronto, Ontario M5G 1X8, Canada
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24
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Herbert AR, de Lima J, Fitzgerald DA, Seton C, Waters KA, Collins JJ. Exploratory study of sleeping patterns in children admitted to hospital. J Paediatr Child Health 2014; 50:632-8. [PMID: 24893889 DOI: 10.1111/jpc.12617] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/02/2014] [Indexed: 11/27/2022]
Abstract
AIMS Sleep is considered an important time of healing and restoration during illness. The primary aim of this study was to determine the prevalence of self-reported sleep disturbance in children admitted to a tertiary children's hospital with a variety of medical diagnoses. METHODS Parents of children admitted to the hospital, aged between 1 and 18 years, were asked to complete a sleep diary during one night of their child's hospital stay. Children older than 12 years were asked to complete a diary independently. Descriptive statistics were used to summarise the data. RESULTS Overall, 107 children were surveyed for one hospital inpatient night. The overall prevalence of poor sleep was 52.3%. The wide age range and variety of diagnosis limited further detailed analysis of specific causes of this problem. Poor sleep prior to admission was the strongest predictor of poor sleep in hospital suggesting that these children already had an underlying sleep problem. Unprompted awakenings were predominantly due to toileting (17.8%) or were spontaneous (17.8%). Factors specific to the hospital environment that woke children were nursing cares (25.2%), alarms (12.1%) and pain (12.1%). CONCLUSIONS Children admitted to hospital have a higher prevalence of poor sleep compared with healthy children in the community. Children were woken frequently by both external noise and attention provided by hospital staff. Education of hospital staff about the importance of sleep for children and factors that affect children's sleep may reduce the negative impact of hospitalisation on children's sleep.
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Affiliation(s)
- Anthony R Herbert
- Paediatric Palliative Care Service, Division of Oncology, Royal Children's Hospital, Brisbane, Queensland, Australia; Discipline of Paediatrics and Child Health, School of Medicine, University of Queensland, Brisbane, Queensland, Australia; Department of Pain Medicine and Palliative Care, The Children's Hospital at Westmead, Sydney, New South Wales, Australia
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