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Murphy JD, Cooke KR, Symons HJ, VanGraafeiland B. Enteral nutrition optimization program for children undergoing blood & marrow transplantation: A quality improvement project. J Pediatr Nurs 2024; 74:61-68. [PMID: 38000117 DOI: 10.1016/j.pedn.2023.11.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Revised: 11/08/2023] [Accepted: 11/09/2023] [Indexed: 11/26/2023]
Abstract
BACKGROUND Malnutrition in children and young adults undergoing blood and marrow transplantation (BMT) increases morbidity and mortality. Addressing this via optimization of enteral nutrition can potentially improve outcomes. METHODS This Quality Improvement project utilized pre-post-intervention design and post-intervention survey to evaluate a novel program optimizing enteral nutrition support in children undergoing BMT. All patients aged 0-18 who were admitted during the 16-week implementation period followed the Enteral Nutrition Optimization Program from pre-BMT through discharge. Data on biometric indicators, complications, and post-transplant milestone time markers were evaluated via Mann-Whitney U, Fisher's exact, and Chi-square tests as indicated using SPSS™ Version 27. A separate sample of clinical providers completed a post-intervention survey to evaluate the feasibility and acceptance of the intervention. FINDINGS Six patients received the intervention, with 12 patients evaluated. There were no statistical differences between groups on measured evaluations of weight loss (0.15 kg vs +0.4 kg, p = 0.39), malnutrition (2 vs 3, p = 0.545), graft-versus-host-disease (2 vs 2, p = 1), time to engraftment (platelets day 22 vs 20.5, p = 0.589), infections (p = 0.368), and length of stay (32.5 days vs 31 days, p = 1). The provider sample of 45 participants showed overall feasibility and acceptance of the intervention (88.9% agreed or strongly agreed). DISCUSSION Feasibility and acceptance were high, resulting in increased use of nasogastric and gastrostomy tubes. Though no clinical significance, interpretation is limited due to the small sample size. PRACTICE IMPLICATIONS Implementing a novel nutritional support program resulted in a culture shift towards enteral nutrition optimization. Further studies are needed to determine clinical impacts.
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Affiliation(s)
- Jessica D Murphy
- Johns Hopkins University School of Nursing, 525 North Wolfe Street, Baltimore, MD, USA.
| | - Kenneth R Cooke
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
| | - Heather J Symons
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
| | - Brigit VanGraafeiland
- Johns Hopkins University School of Nursing, 525 North Wolfe Street, Baltimore, MD, USA.
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Abstract
OBJECTIVE Examine the advantages, disadvantages, and challenges of telehealth for the psychiatric mental health nurse practitioner (PMHNP) in practice and student education. Describe areas for future research and policy development regarding telehealth in PMHNP practice and training during and beyond the COVID-19 pandemic. METHODS Review current evidence, standards of practice, and education for the PMHNP. RESULTS Recent rapid pandemic-related shifts in utilization of telehealth for clinical practice and student education have highlighted the advantages, disadvantages, and areas in need of additional study. CONCLUSIONS Postpandemic telehealth care delivery will likely persist or expand. PMHNPs must advocate for high practice and education standards.
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Affiliation(s)
- Jessica L Zemlak
- Jessica L. Zemlak, PhD, MSN, FNP-BC, PMHNP-BC, Johns Hopkins School of Nursing, Baltimore, MD, USA
| | - Patty Wilson
- Patty Wilson, PhD, MSN, PMHNP-BC, Johns Hopkins School of Nursing, Baltimore, MD, USA
| | - Brigit VanGraafeiland
- Brigit VanGraafeiland, DNP, CRNP, CNE, Johns Hopkins School of Nursing, Baltimore, MD, USA
| | - Tamar Rodney
- Tamar Rodney, PhD, MSN, PMHNP-BC, Johns Hopkins School of Nursing, Baltimore, MD, USA
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VanGraafeiland B, Chiocca E, Perks D, Dietzman H, Horner G. Letter to the Editor. J Nurse Pract 2022. [DOI: 10.1016/j.nurpra.2022.08.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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Foli KJ, VanGraafeiland B, Snethen JA, Greenberg CS. Caring for nontraditional families: Kinship, foster, and adoptive. J SPEC PEDIATR NURS 2022; 27:e12388. [PMID: 35702024 DOI: 10.1111/jspn.12388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Revised: 05/18/2022] [Accepted: 05/27/2022] [Indexed: 11/30/2022]
Abstract
PURPOSE Information about nontraditional (kinship, foster, and adoptive) families is typically scattered or overlooked both in nursing education and nursing practice settings. Using a nursing-centric, population-focused lens, the current state of nontraditional families in the United States is briefly described. An overview of the challenges and psychological dynamics involved when a nonbiological parent assumes the role of caregiver is provided. CONCLUSION Based on the 2010 Census findings and other indicators, we now understand that nontraditional families and their children make up a considerable portion of the population. Nurses, regardless of level of practice, have the potential to positively impact health outcomes of nontraditional parents and their children. Knowledge of the formation and needs of nontraditional families can inform, and improve, culturally safe, trauma-informed nursing care. PRACTICE IMPLICATIONS This discussion is a first step in appreciating the formation of nontraditional families and the importance of trauma-informed, unbiased, nonstereotypic discourse in nursing care. By describing the heterogeneity of how families are built through kinship care, foster placements, and adoptive homes, nurses' assessments and interventions will be informed and through a lens of the high potential for past traumas. With this foundational knowledge, nurses interfacing with nontraditional families are better prepared to provide much needed support and relevant care for this unique population.
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Affiliation(s)
- Karen J Foli
- Purdue University School of Nursing, Johnson Hall of Nursing, West Lafayette, Indiana, USA
| | | | - Julia A Snethen
- College of Nursing, University of Wisconsin-Milwaukee, Milwaukee, Wisconsin, USA
| | - Cindy Smith Greenberg
- College of Health & Human Development, California State University, Fullerton, California, USA
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Wright R, Lee YJ, Yoo A, McIltrot K, VanGraafeiland B, Saylor MA, Taylor J, Han HR. Doctor of nursing practice project: Key challenges and possible solutions. J Prof Nurs 2022; 41:53-57. [DOI: 10.1016/j.profnurs.2022.04.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Revised: 04/15/2022] [Accepted: 04/17/2022] [Indexed: 01/26/2023]
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VanGraafeiland B, Chiocca E, Perks D, Dietzman H, Horner G. Overview of Recognition and Prevention of Child Sex Trafficking in the Primary Care Setting: A Primer for Nurse Practitioners. J Nurse Pract 2022. [DOI: 10.1016/j.nurpra.2021.12.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Choe MY, VanGraafeiland B, Parian A. Improving Follow-ups With Gastroenterologists Utilizing an Appointment Scheduling Protocol in Inflammatory Bowel Disease: A Quality Improvement Project. Gastroenterol Nurs 2021; 44:E91-E100. [PMID: 34411015 DOI: 10.1097/sga.0000000000000635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Accepted: 07/12/2021] [Indexed: 11/26/2022] Open
Abstract
Approximately one in four patients with inflammatory bowel disease are readmitted within 90 days. To reduce hospitalizations, regular follow-up appointments with gastroenterologists are essential. However, the mean wait time for gastroenterology clinic appointments significantly exceeded the target goal of 14 days in North America. Based on literature review, we developed and implemented a new appointment scheduling protocol. The inclusion criteria were adult patients with inflammatory bowel disease who were recently hospitalized or newly referred to a gastroenterology clinic. At weeks 0 and 12, wait times were extrapolated from chart review, and patient satisfaction rates were collected via surveys. Patient demographics and outcome data were examined using descriptive statistics. A total of 16 patients were included. Following the intervention, the mean wait time decreased from 40.4 (SD = 31.9) to 21.9 days (SD = 11.4), but the change was statistically insignificant (p = .408). Poor response rates (47%) limited the interpretation of the patient satisfaction data. Despite the small sample size, our project was the first quality improvement initiative that implemented an evidence-based appointment scheduling protocol among adult patients with inflammatory bowel disease. Further studies are warranted with a larger sample size to better evaluate its efficacy in achieving timely outpatient gastroenterology care.
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Affiliation(s)
- Monica Y Choe
- Monica Y. Choe, DNP, CRNP, AGNP-C, is Nurse Practitioner Resident, Geriatric Research, Education, and Clinical Center (GRECC), Baltimore Veterans Affairs Medical Center, Baltimore, Maryland
- Brigit VanGraafeiland, DNP, CRNP, FAAN, is Associate Professor, School of Nursing, Johns Hopkins University, Baltimore, Maryland
- Alyssa Parian, MD, is Associate Clinical Director, Division of Gastroenterology and Hepatology, Department of Medicine, Johns Hopkins University, Baltimore, Maryland
| | - Brigit VanGraafeiland
- Monica Y. Choe, DNP, CRNP, AGNP-C, is Nurse Practitioner Resident, Geriatric Research, Education, and Clinical Center (GRECC), Baltimore Veterans Affairs Medical Center, Baltimore, Maryland
- Brigit VanGraafeiland, DNP, CRNP, FAAN, is Associate Professor, School of Nursing, Johns Hopkins University, Baltimore, Maryland
- Alyssa Parian, MD, is Associate Clinical Director, Division of Gastroenterology and Hepatology, Department of Medicine, Johns Hopkins University, Baltimore, Maryland
| | - Alyssa Parian
- Monica Y. Choe, DNP, CRNP, AGNP-C, is Nurse Practitioner Resident, Geriatric Research, Education, and Clinical Center (GRECC), Baltimore Veterans Affairs Medical Center, Baltimore, Maryland
- Brigit VanGraafeiland, DNP, CRNP, FAAN, is Associate Professor, School of Nursing, Johns Hopkins University, Baltimore, Maryland
- Alyssa Parian, MD, is Associate Clinical Director, Division of Gastroenterology and Hepatology, Department of Medicine, Johns Hopkins University, Baltimore, Maryland
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Bryant C, VanGraafeiland B. Screening for Adverse Childhood Experiences in Primary Care: A Quality Improvement Project. J Pediatr Health Care 2020; 34:122-127. [PMID: 31704177 DOI: 10.1016/j.pedhc.2019.09.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2019] [Revised: 07/26/2019] [Accepted: 09/03/2019] [Indexed: 11/18/2022]
Abstract
INTRODUCTION The American Academy of Pediatrics (AAP) advocates for the screening of Adverse Childhood Experiences (ACEs) during well-child care visits by pediatric health care providers. The evidence shows a strong correlation between children with high ACE scores and the likelihood of physical and mental health problems as adults. The purpose of this Quality Improvement (QI) project was to increase pediatric providers' awareness on ACEs through education and increase the utilization of an ACE screening tool. METHOD This QI project used a pre-post test to evaluate the effectiveness of the educational model and the utilization of the screening tool within an urban pediatric primary care clinic. RESULTS This project demonstrated an increase in provider awareness as well as a marked increase in the utilization of the screening tool. DISCUSSION Four hundred eighty ACE screening tools were collected over a 12-week period. By introducing the ACE screening tool as the standard of care in the primary care office, providers can provide early interventions to mitigate the potential untoward outcomes. This QI project also demonstrated that there was a statistical and clinical significance (p value < 0.001) in the provider's knowledge pre-post the educational intervention.
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Hornor G, Quinones SG, Boudreaux D, Bretl D, Chapman E, Chiocca EM, Donnell C, Herendeen P, Kahn D, Loyke J, Morris KA, Mulvaney B, Perks DH, Terreros A, VanGraafeiland B. Building a Safe and Healthy America: Eliminating Corporal Punishment via Positive Parenting. J Pediatr Health Care 2020; 34:136-144. [PMID: 31836354 DOI: 10.1016/j.pedhc.2019.09.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Revised: 09/10/2019] [Accepted: 09/25/2019] [Indexed: 11/30/2022]
Abstract
corporal punishment (CP) is associated with negative short-term and long-term children outcomes. However, many caregivers continue to administer spankings and other forms of CP. Pediatric nurse practitioners are in a unique position to affect change in parental behavior related to CP use and other parenting practices. This article will summarize the research on the dangers of CP and the corresponding benefits of positive parenting. It defines positive parenting and offers resources pediatric health care providers, including pediatric nurse practitioners, can use to educate both themselves and caregivers about specific discipline techniques appropriate to each developmental stage. Finally, it suggests practice strategies pediatric nurse practitioners can use to help caregivers replace CP and other harsh parenting practices with positive parenting to build a safe and healthy America.
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Abate B, VanGraafeiland B. Improving Education and Communication in an Assisted Living Facility to Reduce Avoidable Emergency Department Transfers: A Quality Improvement Project. J Gerontol Nurs 2019; 45:23-29. [PMID: 31026329 DOI: 10.3928/00989134-20190404-01] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2018] [Accepted: 03/19/2019] [Indexed: 11/20/2022]
Abstract
The purpose of the current project was to determine the effectiveness of training and communication tools used as intervention strategies to reduce unnecessary emergency department transfers of assisted living facility (ALF) residents. Two communication protocols (SBAR and STOP and WATCH) were introduced to standardize clinical communication among licensed practical nurses (LPNs) and clinical providers. Twenty-nine LPNs working in an ALF with 172 units were recruited. LPNs participated in an intervention intended to improve knowledge on geriatric syndromes. Pre- and postintervention testing revealed improved LPN knowledge of geriatric syndromes. A satisfaction survey indicated positive LPN acceptance of the standardized communication tools. Through daily auditing of charts, adherence with use of the SBAR tool was 87%. This evidence-based, educational intervention project aimed to improve nursing staff geriatric knowledge, monitor nurse adherence to using the SBAR and STOP and WATCH tools, and assess overall satisfaction with use of SBAR. [Journal of Gerontological Nursing, 45(5), 23-29.].
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Gleason KT, VanGraafeiland B, Commodore-Mensah Y, Walrath J, Immelt S, Ray E, Dennison Himmelfarb CR. The impact of an innovative curriculum to introduce patient safety and quality improvement content. BMC Med Educ 2019; 19:156. [PMID: 31113414 PMCID: PMC6528273 DOI: 10.1186/s12909-019-1604-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Accepted: 05/13/2019] [Indexed: 05/09/2023]
Abstract
BACKGROUND The Fuld Fellows Program provides selected pre-licensure nursing students with a foundation in the science of patient safety, quality improvement and leadership through coursework and a mentored experience working on a quality improvement project. We evaluated this program's impact on Fellows' patient safety competence and systems thinking. METHODS Cohorts I-VI (n = 116) completed pre-post program evaluation that included measurement of patient safety competence through the Health Professional Education in Patient Safety Survey (H-PEPSS) and systems thinking using the Systems Thinking Scale. Pre- and post-program H-PEPSS and Systems Thinking Scale scores were compared using the Wilcoxon Signed-Rank Test. The Fellows were compared to non-Fellows on patient safety competence and systems thinking using t-tests. RESULTS Patient safety competence on all H-PEPSS scales improved from baseline to end of program: teamwork (2.6 to 3.1), communication (2.1 to 3.2), managing risk (2.2 to 3.3), human environment (2.8 to 3.7), recognize and respond to risk (2.7 to 3.6), and culture (2.9 to 3.8) (p < 0.05). The Fellows, in comparison to the non-Fellows, reported a significantly higher (p < 0.05) mean change score in five of the six H-PEPSS subscales. Fellows' mean systems thinking score increased from 66 ± 7 at baseline to 70 ± 6 at program completion (p < 0.05), this mean post completion score was significantly higher than the non-Fellows reported mean STS score of 62 ± 7. CONCLUSION The Fuld Fellows Program effectively facilitated patient safety and quality improvement and systems thinking learning among pre-licensure nursing students. This program can serve as a model for integrating quality and safety concepts into health professionals' curricula.
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Affiliation(s)
- Kelly T. Gleason
- School of Nursing, Johns Hopkins University, 525 N Wolfe Street, Baltimore, MD 21205 USA
| | - Brigit VanGraafeiland
- School of Nursing, Johns Hopkins University, 525 N Wolfe Street, Baltimore, MD 21205 USA
| | | | - Jo Walrath
- School of Nursing, Johns Hopkins University, 525 N Wolfe Street, Baltimore, MD 21205 USA
| | - Susan Immelt
- School of Nursing, Johns Hopkins University, 525 N Wolfe Street, Baltimore, MD 21205 USA
| | - Ellen Ray
- Carroll Health Group, Westminster, USA
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VanGraafeiland B, Sloand E, Silbert-Flagg J, Gleason K, Dennison Himmelfarb C. Academic-clinical service partnerships are innovative strategies to advance patient safety competence and leadership in prelicensure nursing students. Nurs Outlook 2019; 67:49-53. [DOI: 10.1016/j.outlook.2018.08.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2018] [Revised: 06/14/2018] [Accepted: 06/16/2018] [Indexed: 11/16/2022]
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VanGraafeiland B, Foronda C, Vanderwagen S, Allan L, Bernier M, Fishe J, Hunt EA, Jeffers JM. Improving the handover and transport of critically ill pediatric patients. J Clin Nurs 2018; 28:56-65. [PMID: 30016565 DOI: 10.1111/jocn.14627] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2018] [Revised: 06/25/2018] [Accepted: 07/03/2018] [Indexed: 11/30/2022]
Abstract
AIMS AND OBJECTIVES The aims of this project were to (a) determine barriers to current handover and transport process, (b) develop a new protocol and process for team-to-team handover, and (c) evaluate staff satisfaction with the new process. BACKGROUND The handover and transport of critically ill patients from the paediatric emergency department to the paediatric intensive care unit is a period of vulnerability associated with adverse events. DESIGN A mixed-methods study using a quasi-experimental design and qualitative approach. METHODS Focus groups were conducted to determine the barriers and facilitators of the current handover and transport process. Using these themes, a multidisciplinary team developed and implemented a new process including establishment of eight patient criteria for specialised transport and a standardised, interdisciplinary handover tool for team-to-team handover. Staff satisfaction was examined pre- and postintervention. RESULTS Content analysis of focus groups revealed five categories: need for improved communication, cultural dissonance among units, defects in system and processes, need for standardisation and ambiguity between providers regarding acuity. Staff members reported improvements in their perceptions of satisfaction, safety, communication and role understanding associated with the new process. CONCLUSIONS Standardisation through the establishment of severity of illness criteria and communication tools creates shared mental models and decreases risks to safety. A paradigm shift of team-to-team handover and transport is recommended. RELEVANCE TO CLINICAL PRACTICE This paper suggests the importance of improving communication during the handover and transport process through establishing standardised patient severity of illness criteria, use of standardised tools and team-to-team handover processes.
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Affiliation(s)
- Brigit VanGraafeiland
- Johns Hopkins University School of Nursing, Johns Hopkins University School of Medicine, Johns Hopkins Hospital, Baltimore, Maryland
| | - Cynthia Foronda
- Johns Hopkins University School of Nursing, Johns Hopkins University School of Medicine, Johns Hopkins Hospital, Baltimore, Maryland
| | - Sarah Vanderwagen
- Johns Hopkins University School of Nursing, Johns Hopkins University School of Medicine, Johns Hopkins Hospital, Baltimore, Maryland
| | - Laura Allan
- Johns Hopkins University School of Nursing, Johns Hopkins University School of Medicine, Johns Hopkins Hospital, Baltimore, Maryland
| | - Meghan Bernier
- Johns Hopkins University School of Nursing, Johns Hopkins University School of Medicine, Johns Hopkins Hospital, Baltimore, Maryland
| | - Jennifer Fishe
- Johns Hopkins University School of Nursing, Johns Hopkins University School of Medicine, Johns Hopkins Hospital, Baltimore, Maryland
| | - Elizabeth A Hunt
- Johns Hopkins University School of Nursing, Johns Hopkins University School of Medicine, Johns Hopkins Hospital, Baltimore, Maryland
| | - Justin M Jeffers
- Johns Hopkins University School of Nursing, Johns Hopkins University School of Medicine, Johns Hopkins Hospital, Baltimore, Maryland
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Hornor G, Bretl D, Chapman E, Herendeen P, Mitchel N, Mulvaney B, Quinones SG, VanGraafeiland B. Child Maltreatment Screening and Anticipatory Guidance: A Description of Pediatric Nurse Practitioner Practice Behaviors. J Pediatr Health Care 2017; 31:e35-e44. [PMID: 28844430 DOI: 10.1016/j.pedhc.2017.05.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2017] [Revised: 05/21/2017] [Accepted: 05/24/2017] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Given the number of children affected by child maltreatment and the dire consequences that can develop, prompt identification of child maltreatment is crucial. The purpose of this study was to describe pediatric nurse practitioner (PNP) practice behaviors related to screening and providing anticipatory guidance for child maltreatment and its psychosocial risk factors. METHOD The Risk Assessment Survey was developed for this study by 12 PNPs, all of whom were members of NAPNAP's Child Maltreatment Special Interest Group to ensure face validity; all 12 PNPs were content experts in child maltreatment. The content of the survey was derived from key characteristics from the evidence on child maltreatment. The survey was emailed to the more than 8500 NAPNAP members. RESULTS Two hundred forty-three PNPs responded to the survey, which represents a response rate of 3%. Approximately half of the participants (n = 121; 51%) stated that they never/rarely ask parents questions about domestic violence, more than one-fourth (n = 71; 30%) reported that they never/rarely ask parents questions about discipline, and half of the responding PNPs (n = 120; 50%) reported that they perform an ano-genital exam at well visits. DISCUSSION This study demonstrates that a significant number of PNPs do not routinely screen for child maltreatment and psychosocial risk factors. This is especially true in regards to sexual abuse screening and anticipatory guidance.
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Foronda C, VanGraafeiland B, Quon R, Davidson P. Handover and transport of critically ill children: An integrative review. Int J Nurs Stud 2016; 62:207-25. [PMID: 27552170 DOI: 10.1016/j.ijnurstu.2016.07.020] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2016] [Revised: 06/02/2016] [Accepted: 07/20/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND The handover and transport of critically ill pediatric patients requires communication amongst multiple disciplines. Poor communication is a leading cause of sentinel events and human factors affect handover and transport. OBJECTIVES To synthesize published data on pediatric handover and transport and identify gaps to provide direction for future investigation. METHODS Integrative literature review. RESULTS Forty research studies were reviewed and revealed the following themes: risk for patient complications, standardized communication, and specialized teams and teamwork were associated with improved outcomes. No articles were identified regarding transportation of critically ill pediatric patients from the emergency room to the intensive care unit. There was a knowledge gap in best practices in handover and transport within the unique subsets of the pediatric population including neonate, toddler, school-aged, and adolescents. CONCLUSIONS Research supported a combined approach of specialized teams using standardized communication in the handover and transport of the pediatric patient to improve outcomes. Further study is warranted on interprofessional (team to team) handover practices, select subsets of the pediatric population, and the handover and transport of critically ill patients from the emergency room to the intensive care unit.
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Affiliation(s)
- Cynthia Foronda
- Johns Hopkins University School of Nursing, 525N. Wolfe St., Suite 414, Baltimore, MD 21205, USA.
| | - Brigit VanGraafeiland
- Johns Hopkins University, School of Nursing, 525N. Wolfe St., Suite 415, Baltimore, MD 21205, USA.
| | - Robert Quon
- Johns Hopkins, Bloomberg School of Public Health, 615N. Wolfe Street, Baltimore, MD 1205, USA.
| | - Patricia Davidson
- Johns Hopkins University, School of Nursing, 525N. Wolfe St., Baltimore, MD 21205, USA.
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Speller-Brown B, Patterson Kelly K, VanGraafeiland B, Feetham S, Sill A, Darbari D, Meier ER. Measuring Transition Readiness: A Correlational Study of Perceptions of Parent and Adolescents and Young Adults with Sickle Cell Disease. J Pediatr Nurs 2015. [PMID: 26195300 DOI: 10.1016/j.pedn.2015.06.008] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Adolescents and young adults (AYAs) often transfer from pediatric to adult care without adequate preparation, resulting in increased morbidity and mortality. The purpose of this descriptive research study of parent/AYA dyads was to measure perceptions of transition readiness. Factors that were found to be associated with perceptions of increased readiness to transition included AYA age, the amount of responsibility AYAs assume for their healthcare and the degree of parent involvement. More attention should be focused on these aspects of care to improve transition from pediatric to adult care for AYAs with sickle cell disease.
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Affiliation(s)
| | - Katherine Patterson Kelly
- Children's National, Washington, DC; The George Washington University School of Nursing, Washington, DC
| | | | | | | | - Deepika Darbari
- Children's National, Washington, DC; The George Washington University School of Medicine and Health Sciences, Washington, DC
| | - Emily R Meier
- Children's National, Washington, DC; The George Washington University School of Medicine and Health Sciences, Washington, DC
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O'Grady EL, VanGraafeiland B. Bridging the gap in care for children through the clinical nurse leader. Pediatr Nurs 2012; 38:155-167. [PMID: 22908459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Care coordination has been identified as a gap in the nursing care of children and families who experience an encounter within the health care system. The educational preparation of the clinical nurse leader (CNL) enables the CNL to address many gaps found in health care. Current evidence suggests various gaps in care, as reported by patients, families, nurses, and other health care providers. Identified gaps in care include problems with communication, coordination, education, research, advocacy, psychological and social support, and the needs of siblings. The CNL may improve quality of care for children through efficient care coordination by acting as a liaison and advocate between the patient, family, and health care team to bridge gaps in the current practices of care.
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Affiliation(s)
- Erin L O'Grady
- University of Maryland, Baltimore School of Nursing, Baltimore, MD, USA
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Affiliation(s)
- Brigit VanGraafeiland
- Department of Child, Women's, and Family Health at the University of Maryland School of Nursing, Baltimore, Md, USA
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