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Dryden-Palmer K, Shinewald A, O'Leary K. Supporting siblings during the critical illness hospitalization of a child: learning from experience. Front Pediatr 2024; 12:1337491. [PMID: 39252752 PMCID: PMC11381246 DOI: 10.3389/fped.2024.1337491] [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: 11/13/2023] [Accepted: 07/30/2024] [Indexed: 09/11/2024] Open
Abstract
Introduction Childhood critical illness impacts the entire family of the critically ill patient. Disruptions to usual family rhythms and routines, established relationships, physical relocations or shifts in caregivers, and the uncertainty about the patient's well-being can have significant impacts on siblings and other connected children in the family. Promoting and facilitating family interactions and engaging younger family members in the hospital experience have been shown to reduce patient and family anxiety, enhance family adaptation, and improve child and family outcomes. The critical care team can implement evidence-informed approaches to address and mitigate challenges for families and provide developmentally aligned support to impacted siblings. Aim This conceptual paper describes the potential impacts of a critical illness hospitalization on siblings, approaches to supporting siblings, and practical interventions drawn from a synthesis of the current literature and the author's practice experience caring for critically ill children and their families. Data sources A traditional review and narrative analysis moderated by the authors and supported by lived experience. Conclusions There is a range of impacts of a critical illness hospitalization on siblings and young family members of the patient. Providing consistent, transparent, and supportive child, sibling, and whole family-centered care can improve the experience and outcomes for the child and family.
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Affiliation(s)
- Karen Dryden-Palmer
- Paediatric Intensive Care Unit, The Hospital for Sick Children, Toronto, ON, Canada
- Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, ON, Canada
| | - Alexis Shinewald
- Paediatric Intensive Care Unit, The Hospital for Sick Children, Toronto, ON, Canada
- Child Life Program, The Hospital for Sick Children, Toronto, ON, Canada
| | - Kimberly O'Leary
- Child Life Program, The Hospital for Sick Children, Toronto, ON, Canada
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Munshi FM, Desai PP, Azizi B, Alabdulkarim SO, Mujlli GA, Alaskary HA, McIntire CR, Alhegelan RS, Yaqinuddin A, Izquierdo JP. The imperative of the child life profession in KSA in transforming the quality of pediatric healthcare. J Taibah Univ Med Sci 2024; 19:790-799. [PMID: 39135962 PMCID: PMC11318472 DOI: 10.1016/j.jtumed.2024.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2024] [Revised: 05/08/2024] [Accepted: 06/05/2024] [Indexed: 08/15/2024] Open
Abstract
Saudi Arabia has made substantial advancements in its pediatric healthcare infrastructure. However, substantial gaps persist in addressing hospitalized children's emotional safety, and psychosocial and developmental needs. Internationally, the child life profession has evolved over decades to specifically address these needs, through interventions such as therapeutic play, age-appropriate patient education, and family support. This article evaluates the imperative for integrating the child life profession into healthcare services in Saudi Arabia to transform the quality of pediatric healthcare. An analysis of the current landscape revealed gaps in pediatric psychosocial care. These gaps are listed as national priorities in the health transformation program aimed at improving healthcare quality and enhancing well-being. Integrating the child life profession can help achieve these objectives for children and families in Saudi Arabia. This article highlights the multifaceted benefits of the child life profession in improving patient experiences, healthcare delivery efficiency, pediatric healthcare quality, and the overall well-being of children and families. Strategies for phased implementation, involving healthcare institutions, academic partners, relevant non-profit partners, and policymakers, are proposed.
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Affiliation(s)
| | | | | | | | - Gadah A Mujlli
- Princess Nourah Bint Abdulrahman University, Riyadh, KSA
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George M, Keller B, Goldstein E, Grissim L, Boles J. Pawsitive Pediatrics: Hospital Facility Dogs at Work. Hosp Pediatr 2024; 14:e326-e329. [PMID: 38903054 DOI: 10.1542/hpeds.2023-007555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Revised: 03/08/2024] [Accepted: 03/18/2024] [Indexed: 06/22/2024]
Affiliation(s)
- Meredith George
- Monroe Carell Jr Children's Hospital at Vanderbilt, Nashville, Tennessee
| | - Briana Keller
- Monroe Carell Jr Children's Hospital at Vanderbilt, Nashville, Tennessee
- Vanderbilt University, Nashville, Tennessee
| | | | - Leslie Grissim
- Monroe Carell Jr Children's Hospital at Vanderbilt, Nashville, Tennessee
| | - Jessika Boles
- Monroe Carell Jr Children's Hospital at Vanderbilt, Nashville, Tennessee
- Vanderbilt University, Nashville, Tennessee
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Carvalhais MD, Oliveira ARM, Fontoura PCF, Soares CS, Pinho BFC, Fernandes ACLB, Azevedo VS, Santos SCS, Fernandes MIT, Oliveira IDJ. Children's satisfaction with nursing care during hospitalization: A cross-sectional study. J Pediatr Nurs 2024; 77:e270-e275. [PMID: 38653665 DOI: 10.1016/j.pedn.2024.04.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2023] [Revised: 03/22/2024] [Accepted: 04/12/2024] [Indexed: 04/25/2024]
Abstract
PURPOSE To assess hospitalized children's satisfaction with nursing care. DESIGN AND METHODS Cross-sectional study using the "Children Care Quality at Hospital" questionnaire. 61 children admitted to the Pediatrics Department of a hospital in the Northern Region of Portugal were enrolled. RESULTS The ranged age of the participants was 6 to 15 (10,61 ± 2,66 years), and most were male (52.46%; n = 32). The mean score in the three domains was 128 (77.11%), reflecting children's high satisfaction with the nursing care provided during hospitalization. The domain most valued was Nurse Characteristics, while the least valued was Nursing Environment. CONCLUSION Results provide essential input for the dimensions to be considered when planning nursing care for children, managing care, and the physical environment in the wards. IMPLICATIONS FOR PRACTICE These results highlight the need to hear children's voices. This must encourage nurses to reflect on how children evaluate nursing care and, by doing so, to increase the quality of nursing care provided in Pediatrics settings.
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Affiliation(s)
- Maribel Domingues Carvalhais
- Portuguese Red Cross Northern Health School, Rua da Cruz Vermelha, Cidacos, 3720-126, Oliveira de Azeméis, Portugal.
| | - Andrea Raquel Melo Oliveira
- Centro Hospitalar de Entre o Douro e Vouga, Rua Dr. Cândido Pinho 5, 4520-211 Santa Maria da Feira, Portugal
| | | | - Catarina Sousa Soares
- Santa Casa da Misericórdia de Vale de Cambra, Rua do hospital s/n, Vila Chã, Vale de Cambra, Portugal
| | | | | | - Vanessa Silva Azevedo
- Red Cross Northern Health School, Rua da Cruz Vermelha, Cidacos, 3720-126, Oliveira de Azeméis, Portugal
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Hinton T, Burns-Nader S. "They Did Not Understand": Exploring Adult Survivors of Childhood Cancer's Memories of Their Experiences With Peers. JOURNAL OF PEDIATRIC HEMATOLOGY/ONCOLOGY NURSING 2024; 41:276-282. [PMID: 39169722 DOI: 10.1177/27527530241245657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/23/2024]
Abstract
Background: Peer relationships are impacted by the diagnosis of childhood cancer. Children with cancer can feel isolation, such as bullying and lack of engagement, from their peers. As the rates of survival increase, one way to further learn about the experiences of childhood cancer is to reflect on the memories of adult survivors. This study examines adult survivors of childhood cancer's memories of their experiences with peers during their cancer. Method: Twenty-seven adult survivors (15 male, 12 female) of childhood cancer were recruited from Amazon Mechanical Turk, a crowdsourcing marketplace for survey distribution, and surveyed about their experiences with peers during childhood cancer. Using inductive thematic analysis, open-ended survey questions were analyzed. Results: Five main themes emerged, including age, perceptions of cancer, acts of kindness, peer responses, and limited peer engagement. Participants' memories included peers' lack of understanding about their diagnosis, prognosis, and treatment, positive and negative responses to their cancer diagnosis, acts of services and gifts from peers, and feelings of isolation during the cancer experience. Discussion: In the current study, adult survivors of childhood cancer had specific memories about how cancer impacted peer relationships. Such findings contribute to the evidence that children with cancer could benefit from psychosocial interventions, including education to peers about the diagnosis and the impact of diagnosis on peer relationships, peer engagement activities, and peer support groups.
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Wells J, Shah A, Gillis H, Gustafson S, Powell C, Krasaelap A, Hanna S, Hoefert JA, Bigelow A, Sherwin J, Lewis EC, Bline KE. Tiny patients, huge impact: a call to action. Front Public Health 2024; 12:1423736. [PMID: 38952729 PMCID: PMC11215126 DOI: 10.3389/fpubh.2024.1423736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2024] [Accepted: 06/06/2024] [Indexed: 07/03/2024] Open
Abstract
The continuation of high-quality care is under threat for the over 70 million children in the United States. Inequities between Medicaid and Medicare payments and the current procedural-based reimbursement model have resulted in the undervaluing of pediatric medical care and lack of prioritization of children's health by institutions. The number of pediatricians, including pediatric subspecialists, and pediatric healthcare centers are declining due to mounting financial obstacles and this crucial healthcare supply is no longer able to keep up with demand. The reasons contributing to these inequities are clear and rational: Medicaid has significantly lower rates of reimbursement compared to Medicare, yet Medicaid covers almost half of children in the United States and creates the natural incentive for medical institutions to prioritize the care of adults. Additionally, certain aspects of children's healthcare are unique from adults and are not adequately covered in the current payment model. The result of decades of devaluing children's healthcare has led to a substantial decrease in the availability of services, medications, and equipment needed to provide healthcare to children across the nation. Fortunately, the solution is just as clear as the problem: we must value the healthcare of children as much as that of adults by increasing Medicaid funding to be on par with Medicare and appreciate the complexities of care beyond procedures. If these changes are not made, the high-quality care for children in the US will continue to decline and increase strain on the overall healthcare system as these children age into adulthood.
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Affiliation(s)
- Jordee Wells
- Department of Pediatrics, Division of Emergency Medicine, Nationwide Children’s Hospital, The Ohio State University College of Medicine, Columbus, OH, United States
| | - Anita Shah
- Division of Hospital Medicine, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, United States
| | - Holly Gillis
- Department of Anesthesiology, Division of Pediatric Anesthestiology, University of Minnesota, Minneapolis, MN, United States
| | - Sarah Gustafson
- Division of Pediatric Hospital Medicine, Harbor-UCLA Medical Center, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States
| | - Carmin Powell
- Division of Pediatric Hospital Medicine, Stanford University School of Medicine, Stanford, CA, United States
| | - Amornluck Krasaelap
- Department of Gastroenterology and Hepatology, SeattleChildren’s Hospital, Seattle, WA, United States
| | - Samantha Hanna
- Saint Louis University School of Medicine, SSM Health Cardinal Glennon Children's Hospital, St. Louis, MO, United States
| | - Jennifer A. Hoefert
- Saint Louis University School of Medicine, SSM Health Cardinal Glennon Children's Hospital, St. Louis, MO, United States
| | - Amee Bigelow
- The Heart Center, Nationwide Children’s Hospital, Columbus, OH, United States
| | - Jennifer Sherwin
- Division of Cardiovascular and Thoracic Surgery,Duke University Medical Center, Durham, NC, United States
| | - Emilee C. Lewis
- Division of Hospital Pediatrics, Department of Pediatrics,University of North Carolina School of Medicine, Chapel Hill, NC, United States
| | - Katherine E. Bline
- Division of Critical Care Medicine, Department of Pediatrics, Nationwide Children’s Hospital, The Ohio State University College of Medicine, Columbus, OH, United States
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Tillhof K, Krawzak K, Batza J, Feltman DM. Bereavement Support for Siblings after Neonatal Loss: an Online Survey of U.S. Training Centers. Am J Perinatol 2024; 41:1086-1093. [PMID: 35533680 DOI: 10.1055/s-0042-1748162] [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: 11/01/2022]
Abstract
OBJECTIVE The aim of this study was to examine bereavement support for siblings of patients who die in the neonatal intensive care unit (NICU) given the adverse effects of unprocessed grief and the paucity of information on children whose newborn siblings die STUDY DESIGN: This was an anonymous online original survey assessing pre-COVID-19 pandemic bereavement services for NICU families, clinicians' attitudes toward support interventions, challenges, and center characteristics. In spring 2020, nurse managers at 81 U.S. centers with neonatology and maternal-fetal medicine fellowship programs were asked to identify the individual most knowledgeable in their NICU's bereavement support services; these individuals were invited by email to complete an original online survey. Chi testing and odds ratios (ORs) compared responses from centers reporting involvement of palliative care teams (PCT) in NICU sibling bereavement versus no PCT. RESULTS Fifty-six percent (45 of 80) of invitees responded. Most (77%) NICUs permitted perimortem sibling visitation. Challenges included sparse community resources and limited direct sibling contact. Sixty-nine percent (n = 31) of centers were grouped as PCT. PCT respondents reported eightfold higher chances of providing direct education to the sibling (OR, 7.7; 95% confidence interval, 1.7-34; p = 0.01). Views on appropriateness of sharing educational information with extended family, babysitters, and teachers did not differ. While notifying pediatricians of families experiencing NICU death was more common in PCT (p = 0.02), most respondents reported having "no individual responsible for such communications" (52% PCT vs. 100%, p = 0.001). CONCLUSION Despite limited direct contact with siblings of NICU patients who die, efforts are made to involve them in bereavement activities. Opportunities to support these children were identified. Where available, palliative care teams can help provide bereaved siblings with direct education. We recommend formalizing communication mechanisms to ensure that if a NICU patient dies and has surviving siblings, the outpatient physicians caring for these siblings are informed. KEY POINTS · Palliative care enhanced sibling support.. · Resource and visitation limits hinder support.. · Teams sporadically briefed siblings' physicians..
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Affiliation(s)
- Katie Tillhof
- Evanston Hospital, NorthShore University HealthSystem, Evanston, Illinois
| | - Katie Krawzak
- Advocate Children's Hospital, Advocate Lutheran General Hospital, Park Ridge, Illinois
| | - Jennifer Batza
- Evanston Hospital, NorthShore University HealthSystem, Evanston, Illinois
| | - Dalia M Feltman
- Evanston Hospital, NorthShore University HealthSystem, Evanston, Illinois
- Pritzker School of Medicine, University of Chicago, Chicago, Illinois
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Killian HJ, Deacy A, Edmundson E, Raab L, Schurman JV. If we know better, why don't we do better? A rapid quality improvement project to increase utilization of comfort measures to reduce pain and distress in children in a COVID-19 mass vaccination clinic. J Pediatr Nurs 2024; 76:e93-e100. [PMID: 38307756 DOI: 10.1016/j.pedn.2024.01.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 01/21/2024] [Accepted: 01/21/2024] [Indexed: 02/04/2024]
Abstract
INTRODUCTION Many evidence-based tools exist to address pain and distress associated with injections; however, there remains a large gap between the knowledge of these tools and their utilization. Our hospital began a quality improvement (QI) project prior to COVID-19, with the goal of increasing the utilization of Comfort Promise measures during needle procedures. When COVID-19 vaccinations were approved, our mass vaccination clinics provided an opportunity to rapidly increase utilization across the institution. The primary aim was to increase the percentage of comfort measures (CM) offered with COVID-19 vaccinations. METHODS Through this QI project, nurses and other professionals implemented CMs during COVID mass vaccination clinics. Clinics occurred in 3 age-based waves. Waves served as Plan-Do-Study-Act (PDSA) cycles. Families completed post-vaccination surveys to determine what CMs were offered and intention for future use with vaccinations. RESULTS Uptake of CMs (PainEase, ShotBlockers, Comfort Positioning, Alternative Focus, Topical Lidocaine, and Breastfeeding/Sucrose) throughout the waves increased and generally remained stable. CMs also seemed to decrease pain/distress with vaccinations (70.5 to 88.7%), and children/caregivers intended to use some combination for future vaccinations (82.5 to 98.5%). CONCLUSIONS Fast-paced mass vaccination clinics provided an ideal opportunity to significantly increase utilization of CMs. Across age groups CMs yielded high satisfaction and interest in future utilization. Clinic nurses returned to their own sub-specialties and became change agents. IMPLICATIONS If all healthcare providers can work together to achieve consensus while incorporating comfort measures into daily practice, sustained change with incorporation of these evidence-based tools can be achieved. Future directions are discussed.
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Affiliation(s)
- Haley J Killian
- Children's Mercy Hospital, 2401 Gillham Rd, Kansas City, MO, USA; University of Missouri Kansas City, School of Medicine, 2411 Holmes St, Kansas City, MO, USA.
| | - Amanda Deacy
- Children's Mercy Hospital, 2401 Gillham Rd, Kansas City, MO, USA; University of Missouri Kansas City, School of Medicine, 2411 Holmes St, Kansas City, MO, USA.
| | | | - Lucy Raab
- Children's Mercy Hospital, 2401 Gillham Rd, Kansas City, MO, USA.
| | - Jennifer V Schurman
- Children's Mercy Hospital, 2401 Gillham Rd, Kansas City, MO, USA; University of Missouri Kansas City, School of Medicine, 2411 Holmes St, Kansas City, MO, USA.
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Peterson R, Bruti C, Doraiswamy V, Hall AM. Improving the adult hospital experience: Reducing trauma with pediatric pearls. J Hosp Med 2024; 19:421-423. [PMID: 37661588 DOI: 10.1002/jhm.13196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Revised: 08/11/2023] [Accepted: 08/21/2023] [Indexed: 09/05/2023]
Affiliation(s)
- Rachel Peterson
- Departments of Internal Medicine and Pediatrics, University of Cincinnati, Cincinnati, Ohio, USA
| | - Christopher Bruti
- Departments of Internal Medicine and Pediatrics, Rush Medical College, Chicago, Illinois, USA
| | - Vignesh Doraiswamy
- Department of Internal Medicine and Pediatrics, The Ohio State University College of Medicine, Columbus, Ohio, USA
| | - Alan M Hall
- Departments of Internal Medicine and Pediatrics, University of Kentucky College of Medicine in Lexington, Lexington, Kentucky, USA
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Pérez-Duarte Mendiola P. How to communicate with children, according to Health Play Specialists in the United Kingdom: A qualitative study. J Child Health Care 2024; 28:166-180. [PMID: 35723213 DOI: 10.1177/13674935221109113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Child-focused anthropologists have described how sick-children utilise 'Play' and 'imagination' as a tool to cope and make-meaning of their illness-experiences. Health Play Specialists (HPS) are professional healthcare-workers who advocate for children and use 'playful' methods to improve communication with, and the lived-experience of, children in hospital. The research aim of this study was to identify strategies and methods employed by HPS to effectively communicate with children. The research methodology comprises interviews conducted with HPS and utilises a qualitative data-analysis model. The main findings include: the importance of 'Play' for chronically ill children; how HPS utilise material-resources to explain illnesses and procedures to children; structural challenges HPS face as a profession; and applicable advice for paediatric-healthcare-workers. This research highlights the importance of introducing a 'pro-play' mindset to healthcare-workers, in order to facilitate children's basic human-rights in hospital. It seeks to advocate for the potential of 'Play' and the value of HPS within paediatric-healthcare-settings, as well as the need for further recognition and multidisciplinary research in this area.
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11
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Flynn TB, Goble PM, Bishop NJ, Weimer AA. Early childhood hospitalization and problematic behaviors: A propensity score analysis. J Child Health Care 2024; 28:86-103. [PMID: 35582834 DOI: 10.1177/13674935221102707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Existing research suggests that children who experience poverty and hospitalization in early childhood are at risk of developing behavior problems. We examined whether the association between early childhood hospitalization and children's internalizing and externalizing behaviors were moderated by family poverty status and child sex. Participants included 224 children from the National Institute of Child Health and Human Development Study of Early Child Care and Youth Development. There was no direct association between hospitalization and problematic behaviors. Poverty status during early childhood, but not child sex, significantly moderated the association between hospitalization and externalizing problems. Findings support the need for community programs that promote an integrative approach to healthcare for families experiencing poverty.
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Affiliation(s)
- Toria B Flynn
- Human Development & Family Sciences, Texas State University, San Marcos, TX, USA
| | - Priscilla M Goble
- Human Development & Family Sciences, Texas State University, San Marcos, TX, USA
| | - Nicholas J Bishop
- Human Development & Family Sciences, Texas State University, San Marcos, TX, USA
| | - Amy A Weimer
- Human Development & Family Sciences, Texas State University, San Marcos, TX, USA
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Johnson E, van Zijl K, Kuyler A. Pain communication in children with autism spectrum disorder: A scoping review. PAEDIATRIC & NEONATAL PAIN 2023; 5:127-141. [PMID: 38149220 PMCID: PMC10749405 DOI: 10.1002/pne2.12115] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Revised: 08/29/2023] [Accepted: 09/11/2023] [Indexed: 12/28/2023]
Abstract
Children with autism spectrum disorder (ASD) experience social interaction and communication challenges and often display repetitive, restricted patterns of behavior, activities, and interests. The concept of pain is regarded as one of the most complex human stressors due to its subjective and personal nature and the influences of multiple internal and external factors. Due to the complexity of this disorder, it remains concerning how children with ASD communicate their pain and how observers (i.e., parents, carers, and health care practitioners) respond to these children's pain communication. This scoping review aimed to identify how children with ASD communicate or express their pain. Ten studies met the inclusion criteria for further data extraction. Through reflexive thematic analysis, two main themes were identified: verbal and nonverbal responses used by children with ASD to communicate their pain that could influence pain assessment and management strategies. This review highlighted that children with ASD utilized various verbal and nonverbal methods to communicate their pain experiences and that these methods differed compared to children without disabilities. Furthermore, this review emphasizes the importance of holistic pain assessment strategies as well as additional pictorial support for children with ASD. This review recommends that future research should focus on understanding how the inclusion of different stakeholders in pain assessment for children with ASD, can contribute to holistic pain assessment.
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Affiliation(s)
- Ensa Johnson
- Department of Inclusive Education, College of EducationUniversity of South AfricaPretoriaSouth Africa
| | - Karen van Zijl
- School of the Arts: Visual ArtsUniversity of South AfricaPretoriaSouth Africa
| | - Ariné Kuyler
- Department of Inclusive Education, College of EducationUniversity of South AfricaPretoriaSouth Africa
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Abramsohn EM, De Ornelas M, Borson S, Frazier CRM, Fuller CM, Grana M, Huang ES, Jagai JS, Makelarski JA, Miller D, Schulman-Green D, Shiu E, Thompson K, Winslow V, Wroblewski K, Lindau ST. CommunityRx, a social care assistance intervention for family and friend caregivers delivered at the point of care: two concurrent blinded randomized controlled trials. Trials 2023; 24:681. [PMID: 37864258 PMCID: PMC10624358 DOI: 10.1186/s13063-023-07697-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Accepted: 10/03/2023] [Indexed: 10/22/2023] Open
Abstract
BACKGROUND CommunityRx is an evidence-based social care intervention delivered to family and friend caregivers ("caregivers") at the point of healthcare to address health-related social risks (HRSRs). Two CommunityRx randomized controlled trials (RCTs) are being fielded concurrently on Chicago's South Side, a predominantly African American/Black community. CommunityRx-Hunger is a double-blind RCT enrolling caregivers of hospitalized children. CommunityRx-Dementia is a single-blind RCT enrolling caregivers of community-residing people with dementia. RCTs with caregivers face recruitment barriers, including caregiver burden and lack of systematic strategies to identify caregivers in clinical settings. COVID-19 pandemic-related visitor restrictions exacerbated these barriers and prompted the need for iteration of the protocols from in-person to remote operations. This study describes these protocols and methods used for successful iteration to overcome barriers. METHODS AND FINDINGS CommunityRx uses individual-level data to generate personalized, local community resource referrals for basic, health and caregiving needs. In early 2020, two in-person RCT protocols were pre-tested. In March 2020, when pandemic conditions prohibited face-to-face clinical enrollment, both protocols were iterated to efficient, caregiver-centered remote operations. Iterations were enabled in part by the Automated Randomized Controlled Trial Information-Communication System (ARCTICS), a trial management system innovation engineered to integrate the data collection database (REDCap) with community resource referral (NowPow) and SMS texting (Mosio) platforms. Enabled by engaged Community Advisory Boards and ARCTICS, both RCTs quickly adapted to remote operations. To accommodate these adaptations, launch was delayed until November (CommunityRx-Hunger) and December (CommunityRx-Dementia) 2020. Despite the delay, 65% of all planned participants (CommunityRx-Hunger n = 417/640; CommunityRx-Dementia n = 222/344) were enrolled by December 2021, halfway through our projected enrollment timeline. Both trials enrolled 13% more participants in the first 12 months than originally projected for in-person enrollment. DISCUSSION Our asset-based, community-engaged approach combined with widely accessible institutional and commercial information technologies facilitated rapid migration of in-person trials to remote operations. Remote or hybrid RCT designs for social care interventions may be a viable, scalable alternative to in-person recruitment and intervention delivery protocols, particularly for caregivers and other groups that are under-represented in traditional health services research. TRIAL REGISTRATION ClinicalTrials.gov: CommunityRx-Hunger (NCT04171999, 11/21/2019); CommunityRx for Caregivers (NCT04146545, 10/31/2019).
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Affiliation(s)
- Emily M Abramsohn
- University of Chicago, 5841 S. Maryland Ave., MC 2050, Chicago, IL, 60637, USA.
| | | | - Soo Borson
- University of Southern California, 1975 Zonal Ave, Los Angeles, CA, 90033, USA
| | | | - Charles M Fuller
- University of Chicago, 5841 S. Maryland Ave., MC 2050, Chicago, IL, 60637, USA
| | - Mellissa Grana
- University of Chicago, 5841 S. Maryland Ave., MC 2050, Chicago, IL, 60637, USA
| | - Elbert S Huang
- University of Chicago, 5841 S. Maryland Ave., MC 2050, Chicago, IL, 60637, USA
| | - Jyotsna S Jagai
- University of Chicago, 5841 S. Maryland Ave., MC 2050, Chicago, IL, 60637, USA
| | | | - Doriane Miller
- University of Chicago, 5841 S. Maryland Ave., MC 2050, Chicago, IL, 60637, USA
| | | | - Eva Shiu
- University of Chicago, 5841 S. Maryland Ave., MC 2050, Chicago, IL, 60637, USA
| | - Katherine Thompson
- University of Chicago, 5841 S. Maryland Ave., MC 2050, Chicago, IL, 60637, USA
| | - Victoria Winslow
- University of Chicago, 5841 S. Maryland Ave., MC 2050, Chicago, IL, 60637, USA
| | - Kristen Wroblewski
- University of Chicago, 5841 S. Maryland Ave., MC 2050, Chicago, IL, 60637, USA
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Gregory SW, Aul AJ, Lodermeier TM, Rodemeyer JL, Weaver AL, Lynch BA. The certified child life specialist: A novel resource in the pediatric primary care clinic for managing children's pain during routine immunizations. PAEDIATRIC & NEONATAL PAIN 2023; 5:66-75. [PMID: 37744282 PMCID: PMC10514778 DOI: 10.1002/pne2.12101] [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: 03/20/2022] [Revised: 01/12/2023] [Accepted: 02/13/2023] [Indexed: 09/26/2023]
Abstract
This study evaluated the effect of the Certified Child Life Specialist (CCLS) on pediatric pain and pain management during routine immunization administration in the pediatric primary care clinic. Children 4-12 years of age (n = 125) presenting for a well child physical examination at a rural primary care clinic were selected to receive standard nursing care or standard nursing care plus CCLS support during routine immunization administration. Patient reported pain was measured using the Faces Pain Scale-Revised (FPS-R), and patient behavioral responses were measured during immunization administration using the Children's Emotional Manifestation Scale (CEMS). The performance of psychosocial interventions and administration of topical pain-relieving interventions were measured between both groups. CCLS support was associated with fewer negative emotional behaviors during immunization administration among 7- to 12-year-old children and a significantly higher provision of psychosocial interventions and topical pain-relieving interventions among all ages. This study demonstrates that the presence of a CCLS can increase the provision of psychosocial and pain-relieving interventions and reduce distress during immunization administration in a busy pediatric primary care clinic.
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Affiliation(s)
- Seth W. Gregory
- Department of Pediatric and Adolescent MedicineMayo Clinic Health SystemRed WingMinnesotaUSA
- Department of Pediatric and Adolescent MedicineMayo ClinicRochesterMinnesotaUSA
| | - Andrea J. Aul
- Department of Pediatric and Adolescent MedicineMayo ClinicRochesterMinnesotaUSA
| | - Tara M. Lodermeier
- Department of Nursing, Child Life ProgramMayo ClinicRochesterMinnesotaUSA
| | | | - Amy L. Weaver
- Department of Quantitative Health SciencesMayo ClinicRochesterMinnesotaUSA
| | - Brian A. Lynch
- Department of Pediatric and Adolescent MedicineMayo ClinicRochesterMinnesotaUSA
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15
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Mathew M, Stahl U, Soffer GK. The emerging role of child life specialists in the pediatric food allergy clinic. Ann Allergy Asthma Immunol 2023; 131:296-297. [PMID: 37209837 DOI: 10.1016/j.anai.2023.05.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 05/04/2023] [Accepted: 05/06/2023] [Indexed: 05/22/2023]
Affiliation(s)
- Mehr Mathew
- Department of Pediatrics, Yale School of Medicine, New Haven, Connecticut
| | - Ursula Stahl
- Department of Child Life, Yale New Haven Children's Hospital, New Haven, Connecticut
| | - Gary K Soffer
- Section of Allergy and Immunology, Department of Pediatrics, Yale School of Medicine, New Haven, Connecticut; Department of Integrative Medicine, Smilow Cancer Center, Yale School of Medicine, New Haven, Connecticut.
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16
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Schenk K, Weimer AA, Warnell KR. Assessing Child Life Specialists' Management of Challenging Behaviors in Autistic Pediatric Patients. J Autism Dev Disord 2023:10.1007/s10803-023-06032-4. [PMID: 37421588 DOI: 10.1007/s10803-023-06032-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/30/2023] [Indexed: 07/10/2023]
Abstract
Given that autistic children are hospitalized at higher rates than neurotypical peers, it is important to understand the autism-specific preparedness of healthcare providers. Certified Child Life Specialists (CCLSs) play a crucial role in pediatric hospitalizations by providing socioemotional support and coping strategies. The present study assessed perceived competency and comfort levels among 131 CCLSs regarding the management of challenging behaviors exhibited by autistic pediatric patients, including aggression and self-injury. All participants reported experiences providing care to autistic children who exhibited challenging behaviors, but very few reported both high perceived competency and high comfort in managing these behaviors. Autism-specific training positively correlated with perceived competency and comfort. These results have implications for providing autistic children high quality hospital care.
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Affiliation(s)
- Kaitlyn Schenk
- School of Family and Consumer Sciences, Texas State University, San Marcos, TX, 78666, USA
| | - Amy A Weimer
- School of Family and Consumer Sciences, Texas State University, San Marcos, TX, 78666, USA
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17
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Mikuluk B, Guttoo P, Anderson A, Skeens M. Certified Child Life Specialist role in implementation of individualized coping plans for children receiving botulinum toxin injections. J SPEC PEDIATR NURS 2023:e12413. [PMID: 37354039 DOI: 10.1111/jspn.12413] [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: 07/01/2022] [Revised: 12/28/2022] [Accepted: 06/12/2023] [Indexed: 06/26/2023]
Abstract
PURPOSE The purpose of this paper is to describe the implementation of evidence-based, individualized coping plans and to compare the rates of child anxiety, child cooperation, and parent anxiety before and after implementation of these coping plans for children receiving recurring BoNT-A injections emphasizing the role of Certified Child Life Specialists (CCLSs) within the interdisciplinary team approach. DESIGN AND METHODS A retrospective chart review was conducted for children receiving BoNT-A injections at a Physical Medicine clinic pre- and post-implementation of the coping plan. Descriptive statistics were used to evaluate care plan implementation, child cooperation, child anxiety, and parent anxiety. RESULTS Post-implementation of coping care plans, children experienced improved cooperation during BoNT-A injections. Parental anxiety decreased once coping plans were implemented. Documentation improved after the implementation of coping plans specific to areas involving cooperation, child's anxiety and distress, and parental anxiety and distress. It was also noted that there was an increase in child anxiety assessments within documentation. PRACTICE IMPLICATIONS CCLS were able to utilize their expertise to collaboratively create individualized coping care plans to increase child's cooperation and decrease parental anxiety during BoNT-A injections.
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Affiliation(s)
- Brittany Mikuluk
- Department of Family and Volunteer Services, Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Parishma Guttoo
- The Center for Biobehavioral Health, Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Avery Anderson
- Professional Development, Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Micah Skeens
- The Center for Biobehavioral Health, Nationwide Children's Hospital, Columbus, Ohio, USA
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18
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Venkatesh RD, Leinwand K, Nguyen N. Pediatric Unsedated Transnasal Endoscopy. Gastrointest Endosc Clin N Am 2023; 33:309-321. [PMID: 36948748 DOI: 10.1016/j.giec.2022.10.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/24/2023]
Abstract
Unsedated transnasal endoscopy (TNE) is a feasible, safe, and cost-effective procedure for pediatric patients. TNE provides direct visualization of the esophagus and enables acquisition of biopsy samples while eliminating the risks associated with sedation and anesthesia. TNE should be considered in the evaluation and monitoring of disorders of the upper gastrointestinal tract, particularly in diseases such as eosinophilic esophagitis that often require repeated endoscopy. Setting up a TNE program requires a thorough business plan as well as training of staff and endoscopists.
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Affiliation(s)
- Rajitha D Venkatesh
- Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Nationwide Children's Hospital, 700 Childrens Drive, Columbus, OH 43205, USA; Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH, USA.
| | - Kristina Leinwand
- Section of Pediatric Gastroenterology, Hepatology and Nutrition, Northwest Permanente, Portland, OR, USA; Department of Pediatric Gastroenterology, Hepatology, and Nutrition, Doernbecher Children's Hospital at Oregon Health and Science University, Portland, OR, USA
| | - Nathalie Nguyen
- Gastrointestinal Eosinophilic Diseases Program, Section of Pediatric Gastroenterology, Hepatology and Nutrition, Children's Hospital of Colorado, Digestive Health Institute, Children's Hospital Colorado, University of Colorado School of Medicine
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19
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Desai P, Kazmi SH, Schneider S, Angert R. Virtual Care Across the Neonatal Intensive Care Continuum. Cureus 2023; 15:e35183. [PMID: 36960267 PMCID: PMC10029832 DOI: 10.7759/cureus.35183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/19/2023] [Indexed: 02/21/2023] Open
Abstract
The ongoing coronavirus disease 2019 (COVID-19) pandemic has highlighted the need for establishing effective parent and family engagement throughout all aspects of medicine. Though there has been some discussion in the literature regarding the transition from typical outpatient visits to telehealth visits, there has been less written about the inpatient approach to family inclusion. Here, we seek to describe our institution's experience with implementing virtual medicine across the full continuum of the neonatal intensive care unit (NICU) experience, including inpatient rounding, child life family visits, and outpatient high-risk developmental follow-up after discharge.
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Affiliation(s)
- Purnahamsi Desai
- Pediatrics, New York University (NYU) Grossman School of Medicine, New York, USA
| | - Sadaf H Kazmi
- Pediatrics, New York University (NYU) Grossman School of Medicine, New York, USA
| | - Stacey Schneider
- Child Life, New York University (NYU) Langone Health, New York, USA
| | - Robert Angert
- Pediatrics, New York University (NYU) Grossman School of Medicine, New York, USA
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Breuner CC, Alderman EM, Jewell JA. The Hospitalized Adolescent. Pediatrics 2023; 151:190499. [PMID: 36995186 DOI: 10.1542/peds.2022-060646] [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: 01/24/2023] Open
Abstract
This policy statement is the first published statement in the United States on this topic and the authors aim to provide pediatricians with evidence-based information on the unique aspects required to care for hospitalized adolescents. Included in this policy statement is a description of the possible effects hospitalization may have on the developmental and emotional progress of adolescence, the role of the hospital setting, the importance of confidentiality, and issues related to legal/ethical matters and bias and institutional and systemic racism that may occur during hospitalization.
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Affiliation(s)
- Cora C Breuner
- Division of Adolescent Medicine, Departments of Pediatrics and Orthopedics and Sports Medicine, University of Washington and Seattle Children's Hospital, Seattle, Washington
| | - Elizabeth M Alderman
- Division of Adolescent Medicine, Department of Pediatrics, Albert Einstein College of Medicine and The Children's Hospital at Montefiore, Bronx, New York
| | - Jennifer A Jewell
- The Barbara Bush Children's Hospital at Maine Medical Center, MaineHealth, Portland, Maine
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21
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Jenkins C, Geisthardt C, Day JK. Supporting Children and Families in Medical Settings: Insights from Child Life Specialists During the COVID-19 Pandemic. JOURNAL OF CHILD AND FAMILY STUDIES 2023; 32:1599-1616. [PMID: 36714377 PMCID: PMC9860232 DOI: 10.1007/s10826-023-02537-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 01/04/2023] [Indexed: 06/11/2023]
Abstract
Medical settings can be frightening and stressful places for pediatric patients and their families. During the COVID-19 pandemic fear and anxiety associated with receiving medical care increased as medical facilities dramatically altered the way they functioned in attempts to stop the spread of the virus. Certified Child Life Specialists (CCLSs) are medical professionals who provide psychosocial support for pediatric patients and their families by helping them understand and cope with medical procedures and the medical environment. In this role, CCLSs are likely to have important insights into the experiences and needs of pediatric patients and their families during COVID-19. Using a mixed-methods design, 101 CCLSs completed an online survey and 15 participated in follow-up interviews examining their experiences with and observations of children and families in medical environments during the pandemic. Participants emphasized a need to maintain a focus on child- and family-centered care for the well-being of patients and their families. While recognizing the need to socially distance to limit the spread of COVID, participants expressed concern about restrictive policies that did not balance the physical and mental health needs of patients and families. Participants also discussed the important role of child life services during the pandemic and the unique and multifaceted contributions CCLSs made to support patients, families, other medical professionals, and communities. Recommendations for supporting children and families in medical environments moving forward are discussed in light of lessons learned during the pandemic.
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Affiliation(s)
- Carly Jenkins
- Department of Human Development and Family Studies, Central Michigan University, 228 Education and Human Services, Mt. Pleasant, MI 48858 USA
| | - Cheryl Geisthardt
- Department of Human Development and Family Studies, Central Michigan University, 228 Education and Human Services, Mt. Pleasant, MI 48858 USA
| | - Jack K. Day
- Department of Human Development and Family Studies, Central Michigan University, 228 Education and Human Services, Mt. Pleasant, MI 48858 USA
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22
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Hitching R, Hoffman HG, Garcia-Palacios A, Adamson MM, Madrigal E, Alhalabi W, Alhudali A, Sampaio M, Peterson B, Fontenot MR, Mason KP. The Emerging Role of Virtual Reality as an Adjunct to Procedural Sedation and Anesthesia: A Narrative Review. J Clin Med 2023; 12:843. [PMID: 36769490 PMCID: PMC9917582 DOI: 10.3390/jcm12030843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 01/03/2023] [Accepted: 01/08/2023] [Indexed: 01/24/2023] Open
Abstract
Over the past 20 years, there has been a significant reduction in the incidence of adverse events associated with sedation outside of the operating room. Non-pharmacologic techniques are increasingly being used as peri-operative adjuncts to facilitate and promote anxiolysis, analgesia and sedation, and to reduce adverse events. This narrative review will briefly explore the emerging role of immersive reality in the peri-procedural care of surgical patients. Immersive virtual reality (VR) is intended to distract patients with the illusion of "being present" inside the computer-generated world, drawing attention away from their anxiety, pain, and discomfort. VR has been described for a variety of procedures that include colonoscopies, venipuncture, dental procedures, and burn wound care. As VR technology develops and the production costs decrease, the role and application of VR in clinical practice will expand. It is important for medical professionals to understand that VR is now available for prime-time use and to be aware of the growing body in the literature that supports VR.
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Affiliation(s)
- Rita Hitching
- School of Medicine and Public Health, University of Newcastle, Newcastle, NSW 2308, Australia
| | - Hunter G. Hoffman
- Department of Mechanical Engineering HPL, University of Washington, Seattle, WA 98195, USA
- Department of Computer Science, Faculty of Computing and Information Technology, King Abdulaziz University, Jeddah 21589, Saudi Arabia
| | - Azucena Garcia-Palacios
- Department of Basic Psychology, Clinic and Psychobiology, Jaume I University, 12071 Castellon de la Plana, Spain
| | - Maheen M. Adamson
- WRIISC-WOMEN and Rehabilitation Service, Veterans Affairs Palo Alto Health Care System, Palo Alto, CA 94304, USA
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - Esmeralda Madrigal
- Rehabilitation Service, Veterans Affairs Palo Alto Health Care System, Palo Alto, CA 94304, USA
| | - Wadee Alhalabi
- Department of Computer Science, Faculty of Computing and Information Technology, King Abdulaziz University, Jeddah 21589, Saudi Arabia
- Immersive Virtual Reality Research Group, King Abdulaziz University, Jeddah 21589, Saudi Arabia
- Department of Computer Science, School of Engineering, Computing and Informatics, Dar Al-Hekma University, Jeddah 21589, Saudi Arabia
| | - Ahad Alhudali
- Immersive Virtual Reality Research Group, King Abdulaziz University, Jeddah 21589, Saudi Arabia
| | - Mariana Sampaio
- Department of Psychology, University of Coimbra, 3000-115 Coimbra, Portugal
- Department of Social Work, Catholic University of Portugal, 1649-023 Lisbon, Portugal
| | | | - Miles R. Fontenot
- Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, WA 98195, USA
| | - Keira P. Mason
- Department of Anesthesiology, Critical Care and Pain Medicine, Harvard Medical School, Boston Children’s Hospital, Boston, MA 02115, USA
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23
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Kim EN, Moss WD, Rosales MN, Lyon N, Lotz A, Yamashiro DK, Gociman BR, Siddiqi FA, Johns DN. Multidisciplinary Presurgical Education: Clinical Impact on Children With Orofacial Clefts Undergoing Maxillary Distraction via Rigid External Distraction. Cleft Palate Craniofac J 2023; 60:75-81. [PMID: 34730019 DOI: 10.1177/10556656211055411] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVE Treatment of severe maxillary hypoplasia is commonly addressed via distraction osteogenesis with a rigid external device (RED). While effective, this method can be socially stigmatizing in an already vulnerable patient population. To prepare children and their caregivers for life with a RED and decrease peri-operative anxiety, we instituted a multidisciplinary pre-surgical education session (MPES). This educational team involves our cleft care coordinator, child life specialist, orthodontist and plastic surgeon 2 weeks prior to surgery. We reviewed the impact of this intervention by examining clinical outcomes before and after its implementation. DESIGN From February 2017 to February 2020, a retrospective chart review was performed to include patients with orofacial clefts and maxillary hypoplasia who underwent maxillary distraction osteogenesis with RED at our center before (28 patients) and after (29 patients) the implementation of MPES. RESULTS MPES was associated with a significantly shorter length of stay compared to controls who did not receive MPES (3.6 vs 3.1 days, p < 0.03) and significantly decreased usage of inpatient narcotic pain medication compared to controls (16.8 morphine equivalents vs 31.8 morphine equivalents, p < 0.02). Our intervention also demonstrated a trend towards decrease in minor complications but did not achieve statistical significance p = 0.32). CONCLUSIONS Multidisciplinary presurgical education is a beneficial adjunct in the care of patients with orofacial clefts and maxillary hypoplasia undergoing maxillary advancement with a RED.
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Affiliation(s)
- Erinn N Kim
- University of Utah Division of Plastic Surgery, 114380University of Utah Hospital, Salt Lake City, Utah, USA
| | - Whitney D Moss
- University of Utah Division of Plastic Surgery, 114380University of Utah Hospital, Salt Lake City, Utah, USA
| | - Megan N Rosales
- Biostatistician. University of Utah Study Design and Biostatistics Center, University of Utah, Salt Lake City, Utah, USA
| | - Natalee Lyon
- RN Cleft Care Coordinator, 23188Primary Children's Hospital, Salt Lake City, Utah, USA
| | - Analise Lotz
- Certified Child Life Specialist, 23188Primary Children's Hospital, Salt Lake City, Utah, USA
| | - Duane K Yamashiro
- University of Utah Division of Plastic Surgery, 114380University of Utah Hospital and 23188Primary Children's Hospital, Salt Lake City, Utah, USA
| | - Barbu R Gociman
- University of Utah Division of Plastic Surgery, 114380University of Utah Hospital, Salt Lake City, Utah, USA
| | - Faizi A Siddiqi
- University of Utah Division of Plastic Surgery, 114380University of Utah Hospital, Salt Lake City, Utah, USA
| | - Dana N Johns
- University of Utah Division of Plastic Surgery, 114380University of Utah Hospital, Salt Lake City, Utah, USA
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24
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Joseph MM, Mahajan P, Snow SK, Ku BC, Saidinejad M. Optimizing Pediatric Patient Safety in the Emergency Care Setting. Pediatrics 2022; 150:189658. [PMID: 36189487 DOI: 10.1542/peds.2022-059674] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/26/2022] [Indexed: 02/25/2023] Open
Abstract
Patient safety is the foundation of high-quality health care and remains a critical priority for all clinicians caring for children. There are numerous aspects of pediatric care that increase the risk of patient harm, including but not limited to risk from medication errors attributable to weight-dependent dosing and need for appropriate equipment and training. Of note, the majority of children who are ill and injured are brought to community hospital emergency departments. It is, therefore, imperative that all emergency departments practice patient safety principles, support a culture of safety, and adopt best practices to improve safety for all children seeking emergency care. This technical report outlined the challenges and resources necessary to minimize pediatric medical errors and to provide safe medical care for children of all ages in emergency care settings.
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Affiliation(s)
- Madeline M Joseph
- Division of Pediatric Emergency Medicine, Department of Emergency Medicine, University of Florida College of Medicine-Jacksonville, University of Florida Health Sciences Center-Jacksonville, Jacksonville, Florida
| | - Prashant Mahajan
- Departments of Pediatrics and Emergency Medicine, University of Michigan Medical School, Ann Arbor, Michigan
| | - Sally K Snow
- Independent Consultant in Pediatric Emergency and Trauma Nursing; Graham, Texas
| | - Brandon C Ku
- Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Mohsen Saidinejad
- The Lundquist Institute for Biomedical Innovation at Harbor-University of California Los Angeles, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, California
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25
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Wong BJ, Lee RJ, Saragossi J, Post SG, Glaubach T. Inpatient Care Team Views on Child Life Services: A Scoping Review. Hosp Pediatr 2022; 12:e400-e415. [PMID: 36239095 DOI: 10.1542/hpeds.2022-006651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
CONTEXT The utilization of Child Life Services is influenced by interprofessional collaboration and perceptions of other members of the medical team. OBJECTIVES To summarize studies which address pediatric health care team perspectives on Child Life Services and their utilization in the hospital setting. DATA SOURCES A comprehensive literature search was conducted with controlled vocabularies and key terms in MEDLINE, Embase, CINAHL, PsycInfo, and Web of Science. STUDY SELECTION Primary studies published before November 2021 were screened using a predetermined set of inclusion and exclusion criteria. DATA CHARTING Data charting was performed by 2 independent reviewers. Data extracted include baseline study characteristics, common themes, main outcomes, strengths, and limitations. Because this is not a systematic review, data from included studies was not quantitatively analyzed, but carefully summarized in the manner of a standard scoping review. RESULTS Nine studies met criteria for inclusion. Common qualitative themes on certified child life specialists include: (1) their broad responsibilities, (2) their positive impact on patients and families, (3) challenges with interprofessional collaboration and integration, and (4) the value of educating others on their roles and responsibilities. CONCLUSIONS Medical subject headings, controlled vocabulary, or other standardized subject headings that index literature on Child Life Services is limited. However, the existing body of literature supports the positive impact certified child life specialists have on patients and families, despite challenges with complete integration into the interdisciplinary care team. Additional research is required to fully understand and overcome these challenges in continued efforts to further drive patient and family-centered care.
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Affiliation(s)
| | | | | | - Stephen G Post
- Center for Medical Humanities, Compassionate Care, and Bioethics
| | - Taly Glaubach
- Renaissance School of Medicine
- Stony Brook Children's Hospital, Stony Brook University, Stony Brook, New York
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26
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Integration of child life services in the delivery of multi-disciplinary differences in Sexual Development (DSD) and Congenital Adrenal Hyperplasia (CAH) care. J Pediatr Urol 2022; 18:612.e1-612.e6. [PMID: 36031554 DOI: 10.1016/j.jpurol.2022.08.001] [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: 11/17/2021] [Revised: 04/25/2022] [Accepted: 08/02/2022] [Indexed: 12/14/2022]
Abstract
INTRODUCTION Multiple studies have demonstrated the benefit of incorporating certified child life specialist (CCLS) services in various aspects of pediatric care. Although the significance of psychosocial support of patients with Disorders of Sexual Development (DSD) and Congenital Adrenal Hyperplasia (CAH) is increasingly recognized, the involvement of CCLS services into the DSD and CAH multidisciplinary care model has yet to be described. OBJECTIVE To evaluate the feasibility, acceptability, and patient and family experience of routinely incorporating CCLS services into the multidisciplinary DSD and CAH care model. STUDY DESIGN As part of a quality improvement initiative, CCLS services were routinely incorporated in the multidisciplinary DSD and CAH clinics at our institution. Encounters for patients seen in clinic between July 2018 through October 2019 were reviewed for demographic information, DSD diagnosis classification, CCLS documentation, and whether an exam under anesthesia (EUA) was required due to an incomplete clinical exam. CCLS documentation was reviewed for assessments, interventions, whether patients tolerated their physical exams, time of CCLS services, and additional CCLS support beyond the physical exam. All patients were limited to one physical exam per clinic visit. RESULTS Out of the 45 encounters with CCLS involvement, 42 (93.3%) exams were well-tolerated. CCLS assessments considered patient development, communication considerations, temperament, medical stressors, coping preferences, and patient preferences for activities and distractions. Interventions included preparing patients for their physical exams, encouragement before and during exams, addressing patient stressors, distractions and coping mechanisms, and advocating for the patient. No patients required an EUA. DISCUSSION The CCLS aimed to provide families with a sense of control during clinic visits and teach them to advocate for themselves. The CCLS helped prepare and distract patients for their clinic visit and addressed the sensitive nature of the physical exam by focusing on the emotional and development needs of patients. CCLS contributions to a positive patient experience are consistent with multiple studies demonstrating the benefit of CCLS services for pediatric care. This quality improvement initiative ultimately helped to create a positive experience for patients and families. CONCLUSION This study demonstrates the feasibility, acceptability, and positive impact of CCLS services in the delivery of patient and family-centered care for patients with DSD and CAH as part of the multidisciplinary team model.
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Hayes LC, Meers A, Tulley K, Sable PE, Castagno S, Cilento BG. Interdisciplinary Collaboration in a Pediatric Urology Outpatient Clinic at a Tertiary Children's Hospital: A Case Series. Urology 2022; 169:191-195. [DOI: 10.1016/j.urology.2022.07.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Revised: 07/20/2022] [Accepted: 07/24/2022] [Indexed: 10/16/2022]
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What Makes a Trauma Patient “Pediatric”? Survey of Providers' Admission Decision Making for Pediatric Trauma Patients. J Trauma Nurs 2022; 29:170-180. [DOI: 10.1097/jtn.0000000000000659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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29
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Belzer LT, Wright SM, Goodwin EJ, Singh MN, Carter BS. Psychosocial Considerations for the Child with Rare Disease: A Review with Recommendations and Calls to Action. CHILDREN (BASEL, SWITZERLAND) 2022; 9:933. [PMID: 35883917 PMCID: PMC9325007 DOI: 10.3390/children9070933] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Revised: 06/10/2022] [Accepted: 06/11/2022] [Indexed: 01/07/2023]
Abstract
Rare diseases (RD) affect children, adolescents, and their families infrequently, but with a significant impact. The diagnostic odyssey undertaken as part of having a child with RD is immense and carries with it practical, emotional, relational, and contextual issues that are not well understood. Children with RD often have chronic and complex medical conditions requiring a complicated milieu of care by numerous clinical caregivers. They may feel isolated and may feel stigmas in settings of education, employment, and the workplace, or a lack a social support or understanding. Some parents report facing similar loneliness amidst a veritable medicalization of their homes and family lives. We searched the literature on psychosocial considerations for children with rare diseases in PubMed and Google Scholar in English until 15 April 2022, excluding publications unavailable in full text. The results examine RD and their psychosocial ramifications for children, families, and the healthcare system. The domains of the home, school, community, and medical care are addressed, as are the implications of RD management as children transition to adulthood. Matters of relevant healthcare, public policies, and more sophisticated translational research that addresses the intersectionality of identities among RD are proposed. Recommendations for interventions and supportive care in the aforementioned domains are provided while emphasizing calls to action for families, clinicians, investigators, and advocacy agents as we work toward establishing evidence-based care for children with RD.
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Affiliation(s)
- Leslee T. Belzer
- Division of Developmental and Behavioral Health, Section of Pediatric Psychology, Children’s Mercy Kansas City, Kansas City, MO 64108, USA
- Department of Pediatrics, School of Medicine, University of Missouri-Kansas City, Kansas City, MO 64108, USA; (S.M.W.); (E.J.G.); (B.S.C.)
- Division of General Academic Pediatrics, The Beacon Program, Children’s Mercy Kansas City, Kansas City, MO 64111, USA
| | - S. Margaret Wright
- Department of Pediatrics, School of Medicine, University of Missouri-Kansas City, Kansas City, MO 64108, USA; (S.M.W.); (E.J.G.); (B.S.C.)
- Division of General Academic Pediatrics, The Beacon Program, Children’s Mercy Kansas City, Kansas City, MO 64111, USA
- School of Medicine, University of Kansas, Kansas City, KS 66160, USA
| | - Emily J. Goodwin
- Department of Pediatrics, School of Medicine, University of Missouri-Kansas City, Kansas City, MO 64108, USA; (S.M.W.); (E.J.G.); (B.S.C.)
- Division of General Academic Pediatrics, The Beacon Program, Children’s Mercy Kansas City, Kansas City, MO 64111, USA
- School of Medicine, University of Kansas, Kansas City, KS 66160, USA
| | - Mehar N. Singh
- Department of Psychology, Clinical Child Psychology Program, University of Kansas, Lawrence, KS 66045, USA;
| | - Brian S. Carter
- Department of Pediatrics, School of Medicine, University of Missouri-Kansas City, Kansas City, MO 64108, USA; (S.M.W.); (E.J.G.); (B.S.C.)
- Department of Medical Humanities & Bioethics, University of Missouri-Kansas City, Kansas City, MO 64108, USA
- Bioethics Center, Children’s Mercy Kansas City, Kansas City, MO 64108, USA
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Getchell, K, McCowan, K, Whooley, E, Dumais, C, Rosenstock, A, Cole A, DeGrazia M. Child Life Specialists Decrease Procedure Time, Improve Experience, and Reduce Fear in an Outpatient Blood Drawing Lab (CLS Decrease Procedure Time). J Patient Exp 2022; 9:23743735221105679. [PMID: 35694015 PMCID: PMC9174556 DOI: 10.1177/23743735221105679] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Children can experience extreme fear when undergoing medical procedures,
including blood draws. A growing body of evidence points to the benefits of
Child Life Specialists supporting children throughout medical procedures in
various medical settings. This prospective cohort study aimed to describe the
impact of Child Life Specialist facilitated play on children's fear and
caregiver satisfaction in an outpatient blood drawing lab. A nonrandomized
convenience sample of 150 children and their caregivers were enrolled.
Seventy-five patients received the Child Life Specialist intervention during
their blood draw, while the remaining 75 patients were enrolled as controls.
Children and caregivers in the intervention group spent less time in the
procedure room, with a median time of 3 min (interquartile range: 2-5) as
compared to 5 min (interquartile range: 5-6; P < .001) for
the control group. Caregivers in the intervention group reported the atmosphere
(P = .032) and experience (P < .001)
more positively, and children reported lower fear scores
(P = .007) as compared to the control group. The findings of
this study suggest that Child Life Specialist interventions in pediatric
outpatient blood drawing labs improve satisfaction and reduce fear.
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Affiliation(s)
| | | | | | | | | | | | - Michele DeGrazia
- Neonatal Intensive Care Unit, Boston Children’s Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
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31
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Lukas M, Avery G, Burns-Nader S, Goldstein E, Schmitz A. Exploring child life specialists’ perspective on the role and benefits of child life in pediatric sexual assault forensic examinations. CHILDRENS HEALTH CARE 2022. [DOI: 10.1080/02739615.2022.2079511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
- Molly Lukas
- Department of Human Development and Family Studies, The University of Alabama, Tuscaloosa, AL, USA
| | - Gracie Avery
- Department of Human Development and Family Studies, The University of Alabama, Tuscaloosa, AL, USA
| | - Sherwood Burns-Nader
- Department of Human Development and Family Studies, The University of Alabama, Tuscaloosa, AL, USA
| | - Emily Goldstein
- Department of Human Development and Family Studies, The University of Alabama, Tuscaloosa, AL, USA
| | - Anna Schmitz
- Department of Human Development and Family Studies, The University of Alabama, Tuscaloosa, AL, USA
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32
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Meyer R, Wang K, Yearley A, Grob S, Zeitlin J, Bloomfeld J, You M, Lee D, Bonner M, Shah N, Page K. Usability and Acceptability of the QuestLeukemia Mobile Application: A Pilot Study for An Educational and Psychological Intervention for Children with Chronic Illnesses. JOURNAL OF PEDIATRIC HEMATOLOGY/ONCOLOGY NURSING 2022; 39:137-142. [PMID: 35467435 DOI: 10.1177/27527530221068422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
It is widely accepted that educational interventions benefit children with chronic diseases (disease awareness and autonomy) or those undergoing medical procedures (decreased anxiety and improved satisfaction). Hematopoietic cell transplantation (HCT) is an intensive procedure to treat life-threatening diseases but is associated with multiple adverse medical experiences. QuestLeukemia (QuestED, Durham, NC) is a mobile app designed to educate pediatric patients preparing for HCT through age-appropriate videos and quizzes. Here we describe the results of the initial pilot study assessing acceptability and feasibility of QuestLeukemia app. Eligible participants were selected from a convenience sample (inpatient HCT unit and outpatient clinic). Participants spent 30-60 min using the app then completed a survey assessing the app for usability, accessibility, and user satisfaction. Participants identified the app as a useful tool for gaining disease-related knowledge and reported greater autonomy over their disease process. On average, patients indicated that the app was easy to use (M = 4.93), enjoyable (M = 4.79), and comprehensive (M = 4.71). Parents followed similar trends of satisfaction with the app. Pediatric HCT providers likewise reported that the app was easy to use (M = 4.22), enjoyable (M = 4.85), and educationally comprehensive (M = 4.77). The QuestLeukemia mobile application prototype provides an easy, enjoyable, and educational tool for pediatric patients undergoing HCT. This application was well received by patients, parents, and providers. These findings will be used to design future iterations of the game in clinical care.
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Affiliation(s)
| | - Kira Wang
- 3065Duke University, Durham, NC, USA
| | - Alexander Yearley
- 3065Duke University, Durham, NC, USA
- 1812Harvard Medical School, Durham, NC, USA
| | | | | | | | | | - Diane Lee
- 3065Duke University, Durham, NC, USA
| | - Melanie Bonner
- 213852Duke University Hospital, Durham, NC, USA
- 3065Duke University, Durham, NC, USA
| | - Nirmish Shah
- 213852Duke University Hospital, Durham, NC, USA
- 3065Duke University, Durham, NC, USA
| | - Kristin Page
- 213852Duke University Hospital, Durham, NC, USA
- 3065Duke University, Durham, NC, USA
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33
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Miller TA, Elhoff JJ, Alexander NM, Butler SC, Uzark KC, Glotzbach KL, Mahle WT, Lisanti AJ. Developmental Care Practice and Documentation Variability in the Cardiac ICU. Pediatr Crit Care Med 2022; 23:e180-e185. [PMID: 34982760 PMCID: PMC8944887 DOI: 10.1097/pcc.0000000000002881] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVES Describe variability in developmental care practices, as documented in the electronic health record, for infants undergoing congenital heart surgery. DESIGN Multicenter, retrospective, cohort study. SETTING Six pediatric cardiac centers. PATIENTS One hundred eighty-two infants undergoing one of three index operations: Norwood palliation, aortic arch reconstruction with ventricular septal defect closure, or arterial switch. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Core domains of developmental care encompassing pain assessment, feeding, infant holding, caregiver involvement, therapy, and psychosocial services were reviewed. Practices varied across individuals, institutions, and the hospital stay. At five of six sites, greater than 90% of individuals had physical or occupational therapy services as part of their care, but the day of first evaluation ranged from day of admission to postoperative day 28. Similar patterns were seen in feeding team and social work involvement. Consistent documentation of developmental care was dependent on the domain and site. Of the total days reviewed (n = 1,192), pain scores were documented in 95%. In those same days, documentation of whether or not a patient was out of the crib to be held varied by site from 11% to 93%. Type of oral feeding, breast versus bottle, was documented on the day prior to discharge 48% of the time. CONCLUSIONS There are significant, quantifiable variations in documented developmental care practices at both the individual and site level. More reliable documentation of developmental care practices is required to associate these variables with later outcomes and investigate disparities in individualized developmental care practices.
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Affiliation(s)
- Thomas A Miller
- University of Utah/Primary Children's Hospital and Maine Medical Center, Portland, ME
| | - Justin J Elhoff
- Baylor College of Medicine/Texas Children's Hospital, Houston, TX
| | | | - Samantha C Butler
- Boston Children's Hospital, Boston and Harvard Medical School, Boston, MA
| | - Karen C Uzark
- University of Michigan/CS Mott Children's Hospital, Ann Arbor, MI
| | | | | | - Amy J Lisanti
- University of Pennsylvania School of Nursing, Children's Hospital of Philadelphia, Philadelphia, PA
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34
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Brauchle M, Nydahl P, Pregartner G, Hoffmann M, Jeitziner MM. Practice of family-centred care in intensive care units before the COVID-19-pandemic: A cross-sectional analysis in German-speaking countries. Intensive Crit Care Nurs 2022; 68:103139. [PMID: 34750041 PMCID: PMC8421104 DOI: 10.1016/j.iccn.2021.103139] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Revised: 08/18/2021] [Accepted: 08/30/2021] [Indexed: 02/06/2023]
Abstract
OBJECTIVES To provide insights into visiting policies and family-centred care practices with a focus on children as visitors in Intensive Care Units in German-speaking countries. METHODS/DESIGN Online-survey with a mixed methods approach. Leading clinicians (n = 1943) from German-speaking countries were invited to participate. Outcomes included the percentage of intensive care units with open visiting policies, age restrictions, family-centred care activities and barriers. SETTING Paediatric, mixed and adult units RESULTS: In total, 19.8% (n = 385) of the clinicians responded. Open visiting times were reported by 36.3% (n = 117), with significant differences between paediatric (79.2%), adult (21.3%) and mixed-age (41.2%) units (p < 0.01). Two-thirds of clinicians stated that their units had no age restrictions for children as visitors (n = 221, 68.4%). The family-centred care activities most frequently implemented were open visiting times and dissemination of information. Significantly more German units have open visiting policies and more Swiss units allow children as visitors, compared to the other countries (both p < 0.001). Barriers to family-centred care were concerns about children being traumatized, infection and workload. CONCLUSION The majority reported that family-centred care policies had been implemented in their units, including open visiting policies, allowing children as visitors without age restriction and other family-centred care activities.
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Affiliation(s)
- Maria Brauchle
- Hospital Landeskrankenhaus Feldkirch, Department of Anaesthesiology and Intensive Care Medicine, Carinagasse 35, 6800 Feldkirch, Austria
| | - Peter Nydahl
- Department of Anaesthesiology and Intensive Care Medicine, University Hospital of Schleswig-Holstein, Kiel, Germany
| | - Gudrun Pregartner
- Institute for Medical Informatics, Statistics and Documentation, Medical University of Graz, Auenbruggerplatz 2/9/V, 8036 Graz, Austria
| | - Magdalena Hoffmann
- Department of Internal Medicine, Medical University of Graz, Graz, Austria,Executive Department for Quality and Risk Management, University Hospital Graz, Graz, Austria,Research Unit for Safety in Health, c/o Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, Auenbruggerplatz 1/3, 8036 Graz, Austria,Corresponding author at: Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Marie-Madlen Jeitziner
- Institute of Nursing Science (INS), Department of Public Health (DPH), Faculty of Medicine, University of Basel, Bernoullistrasse 28, 4056 Basel, Switzerland,Department of Intensive Care Medicine, University Hospital Bern (Inselspital), University of Bern, Freiburgstrasse 4, 3010 Bern, Switzerland
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35
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Birkett K, Liddle M, Jones E, Paulson A. Matching Level of Clinical Support to Patient Risk When Caring for Children With Behavioral Challenges. INTELLECTUAL AND DEVELOPMENTAL DISABILITIES 2022; 60:32-40. [PMID: 35104350 DOI: 10.1352/1934-9556-60.1.32] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Accepted: 07/02/2021] [Indexed: 06/14/2023]
Abstract
Adaptive care plans (ACPs) are an innovative method to providing care for children and adolescents with developmental disabilities who have challenging behaviors during healthcare encounters. ACPs take a family-centered approach to ensure that children with developmental disabilities are able to receive safe and appropriate healthcare by increasing communication and collaboration between caregivers and healthcare team members. Differing healthcare professionals are strategically involved in order to appropriately match the level of support to the patient's behavioral risk through a review of two case examples from the pediatric physical medicine and rehabilitation department. Specifically, case examples describe varying levels of accommodations and support provided to children with challenging behaviors, whose behaviors may have otherwise prevented them from receiving appropriate health interventions.
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Affiliation(s)
- Kerri Birkett
- Kerri Birkett, Cincinnati Children's Hospital Medical Center; Melissa Liddle, Psychological Wellness Center; Emily Jones, Cincinnati Children's Hospital Medical Center; and Andrea Paulson, Gillette Children's Specialty Healthcare
| | - Melissa Liddle
- Kerri Birkett, Cincinnati Children's Hospital Medical Center; Melissa Liddle, Psychological Wellness Center; Emily Jones, Cincinnati Children's Hospital Medical Center; and Andrea Paulson, Gillette Children's Specialty Healthcare
| | - Emily Jones
- Kerri Birkett, Cincinnati Children's Hospital Medical Center; Melissa Liddle, Psychological Wellness Center; Emily Jones, Cincinnati Children's Hospital Medical Center; and Andrea Paulson, Gillette Children's Specialty Healthcare
| | - Andrea Paulson
- Kerri Birkett, Cincinnati Children's Hospital Medical Center; Melissa Liddle, Psychological Wellness Center; Emily Jones, Cincinnati Children's Hospital Medical Center; and Andrea Paulson, Gillette Children's Specialty Healthcare
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36
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Baughn JM, Lechner HG, Herold DL, Brown VA, Eibner K, Sullivan M, Adamson DW, Rodemeyer J, Sorensen CM, Cleveland E, Morgenthaler TI, Lloyd RM. A Certified Child Life Specialist Influences the Emotional Response During Polysomnography Setup. Sleep Med 2022; 90:222-229. [DOI: 10.1016/j.sleep.2022.01.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Revised: 12/23/2021] [Accepted: 01/20/2022] [Indexed: 10/19/2022]
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Collaborative Legacy Building to Alleviate Emotional Pain and Suffering in Pediatric Cancer Patients: A Case Review. CHILDREN 2022; 9:children9010033. [PMID: 35053659 PMCID: PMC8774266 DOI: 10.3390/children9010033] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Revised: 12/16/2021] [Accepted: 12/18/2021] [Indexed: 11/28/2022]
Abstract
Childhood cancer patients experience emotional hardship associated with their life-threatening diagnoses. Interdisciplinary team members working in pediatric cancer care can help alleviate physical pain and psychological suffering of children by facilitating collaborative legacy-building activities with patients and families. The contents of this article aim to support legacy building as a medium for emotional healing prior to the end of life. The authors use a case review to contextualize legacy-building projects and provide a comprehensive overview of methods and considerations for these initiatives.
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38
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Chrisler AJ, Claridge AM, Staab J, Daniels SR, Vaden V, McTaggart D. Current evidence for the effectiveness of psychosocial interventions for children undergoing medical procedures. Child Care Health Dev 2021; 47:782-793. [PMID: 34322912 DOI: 10.1111/cch.12900] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2019] [Revised: 07/08/2021] [Accepted: 07/19/2021] [Indexed: 12/17/2022]
Abstract
BACKGROUND Because more than three million children are hospitalized every year in the United States, psychosocial and emotional impacts of hospitalization on children cannot be overlooked. As such, a variety of psychosocial support services are offered in pediatric facilities to reduce the negative effects often associated with hospitalization. This review examines current evidence for the effectiveness of common psychosocial interventions for children and youth undergoing medical procedures. METHODS A total of 34 studies that met selection guidelines, as outlined in Section 2, were included and coded based on study characteristics, intervention type, and study outcomes. RESULTS Findings from this literature review indicate that most studies examining the efficacy of psychosocial interventions reported at least positive outcomes for children. Although the review highlighted an overall pattern for improved outcomes following psychosocial intervention, there were some differences in outcomes based on type of intervention. In general, procedural support, preparation, and coping strategies were associated with reduced child anxiety/fear and distress. Procedural support was commonly associated with reduced pain, although many types of interventions demonstrated reduction in child pain. Procedural support was associated with improved procedural success. CONCLUSIONS This systematic review illustrates the benefits of offering psychosocial interventions, such as procedural support, preparation, teaching coping strategies, and medical play, that support children undergoing medical procedures. There is a need for additional studies that examine psychosocial interventions, including studies that examine long-term outcomes post-procedure or hospitalization. Furthermore, more studies need to collect cost-analysis information specific to the use of psychosocial interventions.
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Affiliation(s)
- Alison J Chrisler
- Department of Health Studies, American University, Washington, DC, USA
| | - Amy M Claridge
- Department of Child Development and Family Science, Central Washington University, Ellensburg, Washington, USA
| | | | - Sarah R Daniels
- St. Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Victoria Vaden
- St. Jude Children's Research Hospital, Memphis, Tennessee, USA.,Accelerated Enrollment Solutions, Orlando, FL
| | - Danielle McTaggart
- Stanford Children's Health, Lucile Packard Children's Hospital Stanford, Palo Alto, California, USA
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39
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Cordray H, Patel C, Prickett KK. Reducing Children's Preoperative Fear with an Educational Pop-up Book: A Randomized Controlled Trial. Otolaryngol Head Neck Surg 2021; 167:366-374. [PMID: 34699270 DOI: 10.1177/01945998211053197] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Preoperative education empowers children to approach surgery with positive expectations, and providers need efficient, child-focused resources. This study aimed to evaluate an interactive pop-up book as a tool for explaining surgery, managing preoperative anxiety, and strengthening coping strategies. STUDY DESIGN Prospective randomized controlled trial. SETTING Pediatric outpatient surgery center. METHODS Patients ages 5 to 12 undergoing outpatient surgery read a pop-up book about anesthesia (intervention) or received standard care (control). Patients self-reported their preoperative fear, pain expectations, views of the procedure and preoperative explanations, and coping strategies. Outcomes also included observer-rated behavioral anxiety and caregiver satisfaction. RESULTS In total, 148 patients completed the study. The pop-up book had a significant, large effect in reducing patients' fear of anesthesia induction (Cohen's d effect size = 0.94; P < .001). Intervention patients also expected less pain than control patients from the anesthesia mask and during surgery (d = 0.60-0.80; P < .001). The book encouraged more positive views of the procedure and preoperative explanations (P < .005). Furthermore, the book prepared patients to cope adaptively: intervention patients were significantly more likely to generate positive active coping strategies, distraction strategies, and support-seeking strategies (P < .001). Observer-rated behavioral anxiety at anesthesia induction did not differ between groups (P = .75). Caregivers in the intervention group were significantly more satisfied with each aspect of the surgical experience (P≤ .02). CONCLUSION The educational pop-up book offers a child-focused resource that helps alleviate children's preoperative fears, encourages positive coping, and improves caregivers' perceptions of the experience. This study was registered at ClinicalTrials.gov (NCT04796077).
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Affiliation(s)
- Holly Cordray
- Children's Healthcare of Atlanta at Egleston, Atlanta, Georgia, USA.,Department of Otolaryngology-Head and Neck Surgery, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Chhaya Patel
- Children's Healthcare of Atlanta at Egleston, Atlanta, Georgia, USA.,Department of Anesthesiology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Kara K Prickett
- Children's Healthcare of Atlanta at Egleston, Atlanta, Georgia, USA.,Department of Otolaryngology-Head and Neck Surgery, Emory University School of Medicine, Atlanta, Georgia, USA.,Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia, USA
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40
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Development of a Standardized Program for the Collaboration of Adult and Children's Surgeons. J Surg Res 2021; 269:36-43. [PMID: 34517187 DOI: 10.1016/j.jss.2021.07.038] [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: 03/01/2021] [Revised: 07/21/2021] [Accepted: 07/26/2021] [Indexed: 11/21/2022]
Abstract
BACKGROUND Children's hospitals within larger hospitals (CH/LH) have the specific clinical advantage of easily facilitated collaboration between adult and children's surgeons. These collaborations, which we have termed hybrid surgical offerings (HSOs) are often required for disease processes requiring interventions that fall outside the customary practice of children's surgeons. Formal models to describe or evaluate these practices are lacking. METHODS HSOs within a CH/LH were identified. Principles of systems-engineering were used to develop a standardized model (Children's Hybrid Enhanced Surgical Services [CHESS]) to describe and evaluate HSOs. Face validity was established via unstructured interviews of CH leaders and HSO surgeons. Areas for improved system-wide standardization and programmatic development were identified. RESULTS HSOs were identified in collaboration with adult bariatric, minimally invasive, advanced endoscopic, endocrine, thoracic, and orthopedic trauma surgical services. The CHESS framework encompassed: 1) quality improvement metrics, 2) credentialing and oversight, 3) transitions of care, 4) pediatric family-centered care, 5) maintenance of the cycle of expertise, 6) continuing medical education, 7) scholarship. While HSOs fulfilled the majority of aforementioned programmatic domains across all six HSO-providing services, areas for improvement included maintaining a cycle of expertise (33%), quality improvement metrics (50%), and pediatric family-centered care (66%). Additional noted advantages included faster translation of adult innovation to pediatric care and facilitation of emergency interdisciplinary care. CONCLUSION Formal evaluation of HSOs is necessary to standardize and improve the quality of children's surgical care. Development of a structured framework such as CHESS addresses gaps in quality oversight and provides a basis for performance improvement, patient safety, and programmatic development.
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Perasso G, Camurati G, Morrin E, Dill C, Dolidze K, Clegg T, Simonelli I, Lo HYC, Magione-Standish A, Pansier B, Gulyurtlu SC, Garone A, Rippen H. Five Reasons Why Pediatric Settings Should Integrate the Play Specialist and Five Issues in Practice. Front Psychol 2021; 12:687292. [PMID: 34267710 PMCID: PMC8275832 DOI: 10.3389/fpsyg.2021.687292] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Accepted: 06/02/2021] [Indexed: 11/13/2022] Open
Affiliation(s)
- Giulia Perasso
- Department of Psychology, University of Milano-Bicocca, Milan, Italy.,Porto dei Piccoli, Genoa, Italy
| | | | | | - Courtney Dill
- Children's Hospital of Philadelphia, Philadelphia, PA, United States
| | - Khatuna Dolidze
- Georgian Association for the Care of Children's Health, Tiblisi, Georgia
| | - Tina Clegg
- Health Play Specialist Education Trust, Leicester, United Kingdom
| | - Ilaria Simonelli
- Health Promoting Hospitals and Health Care Services - Children's and Adolescents' Task Force, Trento, Italy
| | | | | | | | | | - Adam Garone
- Starlight Children's Foundation, Culver City, CA, United States
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