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Genna C, Thekkan KR, Geremia C, Di Furia M, Cecchetti C, Rufini E, Salata M, Perrotta D, Dall'Oglio I, Tiozzo E, Raponi M, Gawronski O. Parents' Trigger Tool for Children with Medical Complexity - PAT-CMC: Development of a recognition tool for clinical deterioration at home. J Adv Nurs 2024. [PMID: 38661213 DOI: 10.1111/jan.16201] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Revised: 03/06/2024] [Accepted: 04/06/2024] [Indexed: 04/26/2024]
Abstract
AIM To develop a trigger tool for parents and lay caregivers of children with medical complexity (CMC) at home and to validate its content. DESIGN This was a multi-method study, using qualitative data, a Delphi method and a concept mapping approach. METHODS A three-round electronic Delphi was performed from December 2021 to April 2022 with a panel of 23 expert parents and 30 healthcare providers, supplemented by a preliminary qualitative exploration of children's signs of deterioration and three consensus meetings to develop the PArents' Trigger Tool for Children with Medical Complexity (PAT-CMC). Cognitive interviews with parents were performed to assess the comprehensiveness and comprehensibility of the tool. The COREQ checklist, the COSMIN guidelines and the CREDES guidelines guided the reporting respectively of the qualitative study, the development and content validity of the trigger tool and the Delphi study. RESULTS The PAT-CMC was developed and its content validated to recognize clinical deterioration at home. The tool consists of 7 main clusters of items: Breathing, Heart, Devices, Behaviour, Neuro-Muscular, Nutrition/Hydration and Other Concerns. A total of 23 triggers of deterioration were included and related to two recommendations for escalation of care, using a traffic light coding system. CONCLUSION Priority indicators of clinical deterioration of CMC were identified and integrated into a validated trigger tool designed for parents or other lay caregivers at home, to recognize signs of acute severe illness and initiate healthcare interventions. IMPACT The PAT-CMC was developed to guide families in recognizing signs of deterioration in CMC and has potential for initiating an early escalation of care. This tool may also be useful to support education provided by healthcare providers to families before hospital discharge. PATIENT OR PUBLIC CONTRIBUTION Parents of CMC were directly involved in the selection of relevant indicators of children's clinical deterioration and the development of the trigger tool. They were not involved in the design, conducting, reporting or dissemination plans of this research.
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Affiliation(s)
- Catia Genna
- Professional Development, Continuing Education and Research Unit, Medical Directorate, Bambino Gesù Children's Hospital IRCCS, Rome, Italy
| | - Kiara Ros Thekkan
- Professional Development, Continuing Education and Research Unit, Medical Directorate, Bambino Gesù Children's Hospital IRCCS, Rome, Italy
| | - Caterina Geremia
- Department of Emergency, Acceptance and General Pediatrics, Bambino Gesù Children's Hospital IRCCS, Rome, Italy
| | - Michela Di Furia
- Department of Anesthesia, Resuscitation and Surgical Compartment, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Corrado Cecchetti
- Department of Emergency, Acceptance and General Pediatrics, Bambino Gesù Children's Hospital IRCCS, Rome, Italy
| | - Emilia Rufini
- Pediatric Department, Bambino Gesù Children's Hospital IRCCS, Rome, Italy
| | - Michele Salata
- Center for Pediatric Palliative Care, Bambino Gesù Children Hospital IRCCS, Rome, Italy
| | - Daniela Perrotta
- Department of Anesthesia, Resuscitation and Surgical Compartment, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Immacolata Dall'Oglio
- Professional Development, Continuing Education and Research Unit, Medical Directorate, Bambino Gesù Children's Hospital IRCCS, Rome, Italy
| | - Emanuela Tiozzo
- Professional Development, Continuing Education and Research Unit, Medical Directorate, Bambino Gesù Children's Hospital IRCCS, Rome, Italy
| | | | - Orsola Gawronski
- Professional Development, Continuing Education and Research Unit, Medical Directorate, Bambino Gesù Children's Hospital IRCCS, Rome, Italy
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O'Halloran A, Lockwood J, Sosa T, Gawronski O, Nadkarni V, Kleinman M, Dewan M. How do we detect and respond to clinical deterioration in hospitalized children? Results of the Pediatric Care BefOre Deterioration Events (CODE) survey. J Hosp Med 2023; 18:1102-1108. [PMID: 37861210 DOI: 10.1002/jhm.13224] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Revised: 09/27/2023] [Accepted: 09/29/2023] [Indexed: 10/21/2023]
Abstract
Systems to detect and respond to deteriorating hospitalized children are common despite little evidence supporting best practices. Our objective was to describe systems to detect/respond to deteriorating hospitalized children at Pediatric Resuscitation Quality Collaborative (pediRES-Q) institutions. We performed a cross-sectional survey of pediRES-Q leaders. Questionnaire design utilized expert validation and cognitive interviews. Thirty centers (88%) responded. Most (93%) used ≥1 system to detect deterioration: most commonly, early warning scores (83%), watcher lists (55%), and proactive surveillance teams (31%). Most (90%) had a team to respond to deteriorating patients and the majority of teams could be activated by clinician or family concerns. Most institutions (90%) collect relevant data, including number of rapid responses (88%), arrests outside intensive care units (100%), and serious safety events (88%). In conclusion, most pediRES-Q institutions utilize systems to detect/respond to deteriorating hospitalized children. Heterogeneity exists among programs. Rigorous evaluation is needed to identify best practices.
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Affiliation(s)
- Amanda O'Halloran
- Division of Critical Care Medicine, Department of Anesthesiology and Critical Care, University of Pennsylvania and Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Justin Lockwood
- Section of Hospital Medicine, Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Tina Sosa
- Department of Pediatrics, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA
- Division of Pediatric Hospital Medicine, Golisano Children's Hospital, University of Rochester Medical Center, Rochester, New York, USA
- UR Medicine Quality Institute, Rochester, New York, USA
| | - Orsola Gawronski
- Professional Development, Continuing Education and Research Unit, Bambino Gesù Children's Hospital IRCCS, Rome, Italy
| | - Vinay Nadkarni
- Division of Critical Care Medicine, Department of Anesthesiology and Critical Care, University of Pennsylvania and Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Monica Kleinman
- Division of Critical Care Medicine, Department of Anesthesiology, Critical Care and Pain Medicine, Harvard Medical School and Boston Children's Hospital, Boston, Massachusetts, USA
| | - Maya Dewan
- Division of Critical Care, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati, Cincinnati, Ohio, USA
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Thekkan KR, Genna C, Ferro F, Cecchetti C, Dall'Oglio I, Tiozzo E, Raponi M, Gawronski O. Pediatric vital signs monitoring in hospital wards: Recognition systems and factors influencing nurses' attitudes and practices. J Pediatr Nurs 2023; 73:e602-e611. [PMID: 37977971 DOI: 10.1016/j.pedn.2023.10.041] [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: 07/26/2023] [Revised: 10/31/2023] [Accepted: 10/31/2023] [Indexed: 11/19/2023]
Abstract
AIMS To describe: 1) systems in place for recognition and response to deteriorating children in Italy, 2) attitudes and practices of registered nurses (RN) towards vital signs (VS) monitoring in pediatric wards, 3) the associations of nurses attitudes and pratices with nurses' and organizational characteristics. DESIGN AND METHODS A multicentre cross-sectional correlational study. Data were collected between January-May 2020 using: an adapted version of the 'Survey on Recognition and Response Systems in Australia', and the 'Ped-V Scale'. Descriptive and adjusted linear regression analysis was performed, accounting for clustering. RESULTS Ten Italian hospitals participated, 432 RNs responded to the Ped-V scale (response rate = 52%). Five (50%) hospitals had a VS policy in place, three hospitals (30%) had a Pediatric Early Warning System (PEWS), almost all hospitals had a system in place to respond to deteriorating children. Following multivariate regression analysis, having a PEWS was significantly associated with Ped-V scale 'Workload', 'Clinical competence', 'Standardization' dimensions; gender was associated with 'key indicators' and pediatric surgical ward with 'Clinical competence'. CONCLUSIONS The use of VS policies and PEWS was not consistent across hospitals caring for children in Italy. Nurses' attitudes and practices (i.e., perception of workload, and clinical competence) were significantly lower in hospitals with increased complexity of care/PEWS. Gender was significantly associated with knowledge scores. PRACTICE IMPLICATIONS System strategies to improve nurses' attitudes and practices towards VS monitoring and education are warranted to support effective behaviors towards VS monitoring, their interpretation, and appropriate communication to activate the efferent limb of the rapid response system.
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Affiliation(s)
- Kiara Ros Thekkan
- Professional Development, Continuing Education and Research Unit, Medical Directorate, Bambino Gesù Children's Hospital IRCCS, Rome, Italy
| | - Catia Genna
- Professional Development, Continuing Education and Research Unit, Medical Directorate, Bambino Gesù Children's Hospital IRCCS, Rome, Italy
| | - Federico Ferro
- Professional Development, Continuing Education and Research Unit, Medical Directorate, Bambino Gesù Children's Hospital IRCCS, Rome, Italy
| | - Corrado Cecchetti
- Department of Emergency, Acceptance and General Pediatrics, Bambino Gesù Children's Hospital IRCCS, Rome, Italy
| | - Immacolata Dall'Oglio
- Professional Development, Continuing Education and Research Unit, Medical Directorate, Bambino Gesù Children's Hospital IRCCS, Rome, Italy
| | - Emanuela Tiozzo
- Professional Development, Continuing Education and Research Unit, Medical Directorate, Bambino Gesù Children's Hospital IRCCS, Rome, Italy
| | | | - Orsola Gawronski
- Professional Development, Continuing Education and Research Unit, Medical Directorate, Bambino Gesù Children's Hospital IRCCS, Rome, Italy.
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Tofani M, Mustari M, Tiozzo E, Dall'Oglio I, Morelli D, Gawronski O, Salata M, Cantonetti L, Castelli E, Di Lallo D, Raponi M. The development of the International Classification of Functioning, Disability and Health for Child and Youth (ICF-CY) Core Sets: a systematic review. Disabil Rehabil 2023; 45:3951-3960. [PMID: 36271731 DOI: 10.1080/09638288.2022.2136269] [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] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Revised: 10/05/2022] [Accepted: 10/09/2022] [Indexed: 11/03/2022]
Abstract
PURPOSE The aim of this systematic review is to verify the development of the International Classification of Functioning, Disability and Health for Child and Youth (ICF-CY), investigating methodology and how many core sets have been created. METHODS Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines were used to carry out the systematic review. Six bibliographic databases were searched: MEDLINE, SCOPUS, Web of Sciences, CINHAL, PEDro, and OT Seeker. Papers included in the study have the following characteristics: (a) pediatric population with different health conditions, (b) assessment of ICF domains, (c) development of ICF-CY core set in different health conditions, and (d) recommendation for clinical uses. RESULTS Search strategies allowed to identify 270 research papers. After the elimination of duplicates, 154 articles were analyzed. Finally, 28 records were included for qualitative synthesis. Twelve different ICF-CY Core Sets were identified. Autism spectrum disorder, attention-deficit/hyperactivity disorder, and cerebral palsy were the main health conditions studied at international level. Most of the studies involved international experts using Cieza' methodology to inform ICF-CY Core Set. CONCLUSIONS After 15 years since the adoption of ICF-CY, it still finds some barriers to use. Concrete actions should be taken to develop further core sets following a rigorous methodology and to contribute implementing the ICF framework.Implication for rehabilitationIn 15 years since the implementation of International Classification of Functioning, Disability and Health for Child and Youth (ICF-CY), only 12 core sets have been developed.To develop ICF-CY Core Set, health professionals should follow methodology described by Cieza et al.Strong collaboration between low- and middle-income countries and high-income countries are recommended.
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Affiliation(s)
- Marco Tofani
- Professional Development, Continuous Education and Research Service, Bambino Gesù Children Hospital IRCCS, Rome, Italy
| | - Martina Mustari
- Professional Development, Continuous Education and Research Service, Bambino Gesù Children Hospital IRCCS, Rome, Italy
| | - Emanuela Tiozzo
- Professional Development, Continuous Education and Research Service, Bambino Gesù Children Hospital IRCCS, Rome, Italy
| | - Immacolata Dall'Oglio
- Professional Development, Continuous Education and Research Service, Bambino Gesù Children Hospital IRCCS, Rome, Italy
| | - Daniela Morelli
- Professional Development, Continuous Education and Research Service, Bambino Gesù Children Hospital IRCCS, Rome, Italy
| | - Orsola Gawronski
- Professional Development, Continuous Education and Research Service, Bambino Gesù Children Hospital IRCCS, Rome, Italy
| | - Michele Salata
- Center for Pediatric Palliative Care, Bambino Gesù Children Hospital IRCCS, Rome, Italy
| | - Laura Cantonetti
- Department of Intensive Neurorehabilitation and Robotics, Bambino Gesù Children Hospital, Rome, Italy
| | - Enrico Castelli
- Department of Intensive Neurorehabilitation and Robotics, Bambino Gesù Children Hospital, Rome, Italy
| | - Domenico Di Lallo
- Medical Directorate, Bambino Gesù Children Hospital IRCCS, Rome, Italy
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Pol A, Biagioli V, Adriani L, Fadda G, Gawronski O, Cirulli L, Stelitano R, Federici T, Tiozzo E, Dall'Oglio I. Non-urgent presentations to the paediatric emergency department: a literature review. Emerg Nurse 2023; 31:35-41. [PMID: 36727259 DOI: 10.7748/en.2023.e2154] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/23/2022] [Indexed: 02/03/2023]
Abstract
It is estimated that between 58% and 82% of children and young people who present to paediatric emergency department (PEDs) have a non-urgent condition. This systematic review of the literature explores why parents of children with non-urgent conditions present to the PED rather than to community healthcare services. Five databases were searched for studies on children and young people's presentations to the PED for the treatment of a non-urgent condition, as identified by a low priority triage code. This article describes and discusses the findings of the 18 included studies.
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Affiliation(s)
- Alessandra Pol
- paediatric emergency department, Bambino Gesù Children's Hospital in Rome, Italy
| | - Valentina Biagioli
- professional development, continuing education and research service, Bambino Gesù Children's Hospital in Rome, Italy
| | - Luca Adriani
- paediatric emergency department, Bambino Gesù Children's Hospital in Rome, Italy
| | - Giulia Fadda
- professional development, continuing education and research service, Bambino Gesù Children's Hospital in Rome, Italy
| | - Orsola Gawronski
- professional development, continuing education and research service, Bambino Gesù Children's Hospital in Rome, Italy
| | - Luisa Cirulli
- paediatric emergency department, Bambino Gesù Children's Hospital in Rome, Italy
| | - Rocco Stelitano
- paediatric emergency department, Bambino Gesù Children's Hospital in Rome, Italy
| | - Tatiana Federici
- paediatric emergency department, Bambino Gesù Children's Hospital in Rome, Italy
| | - Emanuela Tiozzo
- professional development, continuing education and research service, Bambino Gesù Children's Hospital in Rome, Italy
| | - Immacolata Dall'Oglio
- professional development, continuing education and research service, Bambino Gesù Children's Hospital in Rome, Italy
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Genna C, Thekkan KR, Raymakers-Janssen PAMA, Gawronski O. Reply to the letter by Dr Meyer et al. 2023. Eur J Pediatr 2023; 182:3797. [PMID: 37219628 DOI: 10.1007/s00431-023-05028-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Affiliation(s)
- Catia Genna
- Professional Development, Continuing Education and Research Unit, Medical Directorate, Bambino Gesù Children's Hospital IRCCS, Rome, Italy
| | - Kiara Ros Thekkan
- Professional Development, Continuing Education and Research Unit, Medical Directorate, Bambino Gesù Children's Hospital IRCCS, Rome, Italy
| | - Paulien A M A Raymakers-Janssen
- Department of Pediatric Intensive Care, Wilhelmina Children's Hospital/University Medical Center Utrecht, Utrecht, The Netherlands
| | - Orsola Gawronski
- Professional Development, Continuing Education and Research Unit, Medical Directorate, Bambino Gesù Children's Hospital IRCCS, Rome, Italy.
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Spitaletta G, Biagioli V, Greco F, Mascolo R, Liburdi A, Manzi G, Gawronski O, Ricci R, Tiozzo E, Vellone E, Grimaldi Capitello T, Salata M, Raponi M, Dall’Oglio I. Self-care in children and young people with complex chronic conditions: a qualitative study using Emotional Text Mining. Front Pediatr 2023; 11:1170268. [PMID: 37576150 PMCID: PMC10420086 DOI: 10.3389/fped.2023.1170268] [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] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Accepted: 07/10/2023] [Indexed: 08/15/2023] Open
Abstract
Objectives To explore: (1) self-care behaviors in children and young people (range: 6 months-24 years) with complex chronic conditions, characterized by the diagnosis of a severe chronic condition, substantial family-identified needs, functional limitations associated with technology dependence, and intensive use of healthcare services; (2) the contribution to self-care of family members and other persons involved in the child's health and daily life context (e.g., health professionals and teachers), and (3) the principal factors that might have influenced the self-care process associated with developmental age. Methods A qualitative descriptive study was conducted in an Italian academic tertiary pediatric hospital between September 2020 and May 2021. Overall, 25 focus groups and 7 online interviews were conducted via videoconferencing. Textual data were analyzed using Emotional Text Mining to identify three levels of communication: the factors, the main themes (clusters), and the sub-themes. Results A total of 104 participants were enrolled, including 27 patients with complex chronic conditions (12 males, mean age = 11.1 ± 4.40), 33 parents, 6 siblings, 33 health professionals, and 5 teachers. Participants described the process of self-care through four main factors: "self-care", "external settings", "family", and "management". Five clusters (themes) were identified: (1) Self-care management (device; consulting); (2) Shift of agency (influencing factors; parents; school); (3) Self-care support (normal life and personal development; multidisciplinary support); (4) Daily self-care maintenance/monitoring; (5) Treatment adherence. Self-care management was mostly relevant for parents of children aged between 6 months and 3 years. Conclusion The self-care process varies according to the needs related to the specific developmental age and the evolution of the clinical condition over time. The contribution of the family, health professionals, and social networks is fundamental for adequate self-care. To help families manage the unstable condition of their children at home, it is necessary to strengthen support networks implement home care, and ensure continuity of care.
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Affiliation(s)
- Giuseppina Spitaletta
- Professional Development, Continuing Education and Research Service, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| | - Valentina Biagioli
- Professional Development, Continuing Education and Research Service, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| | - Francesca Greco
- Department of Languages and Literatures, Communication, Education and Society, University of Udine, Udine, Italy
| | - Rachele Mascolo
- Pediatric Semi-Intensive Care Area/Unit, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| | - Annachiara Liburdi
- Professional Development, Continuing Education and Research Service, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| | - Giulia Manzi
- Professional Development, Continuing Education and Research Service, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| | - Orsola Gawronski
- Professional Development, Continuing Education and Research Service, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| | - Riccardo Ricci
- Professional Development, Continuing Education and Research Service, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| | - Emanuela Tiozzo
- Professional Development, Continuing Education and Research Service, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| | - Ercole Vellone
- Department of Biomedicine and Prevention, University of Rome “Tor Vergata”, Rome, Italy
| | | | - Michele Salata
- Paediatric Palliative Care Unit, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| | | | - Immacolata Dall’Oglio
- Professional Development, Continuing Education and Research Service, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
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Demir Kösem D, Bektaş M, Gawronski O. Psychometric properties of the Turkish version of the vital signs monitoring on pediatric wards scale (Ped-V scale). J Pediatr Nurs 2023:S0882-5963(23)00102-1. [PMID: 37142493 DOI: 10.1016/j.pedn.2023.04.013] [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: 03/15/2023] [Revised: 04/19/2023] [Accepted: 04/20/2023] [Indexed: 05/06/2023]
Abstract
PURPOSE The aim of this study should be to adopt the Turkish version of the vital signs monitoring on pediatric wards scale (Ped-V scale). DESIGN AND METHOD This methodological study was carried out with 331 pediatric nurses aged 18-65 between September 2022 and November 2022. The data were collected using an online questionnaire including a Descriptive Information Form and the Ped-V scale. Before starting the implementation of the study, the language adaptation of the scale was made, then expert opinion was taken and a pilot application was made. Then the main sampling was applied and evaluated. Explanatory and confirmatory factor analysis, Cronbach's alpha, and item-total score analysis were used for data analysis. RESULTS It was determined that the scale consisted of 30 items and four sub-dimensions and that four sub-dimensions explained 42.91% of the total variance. Both exploratory and confirmatory factor analyses indicated that all factor loads were >0.30. According to the confirmatory factor analysis, all of the fit indices were >0.80, and the RMSEA was <0.080. Cronbach's alpha was determined as 0.88 for the total scale and >0.60 for all sub-dimensions. CONCLUSION As a result of the analyses, it was determined that the Ped-V scale was a valid and reliable measurement tool for the Turkish sample. PRACTICE IMPLICATIONS Using the Ped-V scale, it can help to determine the attitudes of nurses working in pediatric clinics toward monitoring vital signs and to plan in-service training if there is a problem.
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Affiliation(s)
- Dilek Demir Kösem
- Hakkari University Faculty of Health Sciences, Department of Nursing, Hakkari, Turkey.
| | - Murat Bektaş
- Dokuz Eylul University Faculty of Nursing, Inciraltı, Izmir, Turkey.
| | - Orsola Gawronski
- Professional Development, Continuing Education and Research Unit, Bambino Gesù Children's Hospital IRCCS, Rome, Italy.
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Sansone V, Cancani F, Cecchetti C, Rossi A, Gagliardi C, Di Nardo M, Satta T, De Ranieri C, Dall'Oglio I, Tiozzo E, Gawronski O. Staff perception of the implementation, enablers and barriers to pediatric intensive care unit diary writing: A qualitative study. Intensive Crit Care Nurs 2023; 75:103351. [PMID: 36496317 DOI: 10.1016/j.iccn.2022.103351] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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: 04/06/2022] [Revised: 10/21/2022] [Accepted: 11/15/2022] [Indexed: 12/13/2022]
Abstract
OBJECTIVES To explore how the multi-professional pediatric intensive care unit staff experienced the implementation of the diary. RESEARCH METHODOLOGY/DESIGN Qualitative study using the implementation research approach. SETTING a six-bed pediatric intensive care unit at a large Italian tertiary care pediatric hospital, treating patients with acute conditions from the Emergency Department or hospital wards. MAIN OUTCOME MEASURES Healthcare providers' experiences of the implementation of the diaries. Data was collected by focus groups and interviews and thematic analysis was performed. FINDINGS Three focus groups and four interviews with staff were conducted after the implementation of thediaries from August 2020 to June 2021. Staff describe an initial disbelief towards the effectiveness of diaries followed by an increasing perception of their relevance for parents' emotional expression through shared narration. Diaries are reported as a beneficial communication tool between the family, the child, and health care providers, increasing staff understanding of parents' experiences of their child's admission and parents' sense of the care received by their child. For staff, barriers for diary writing were logistics, lack of time, limited sense of ownership, fear of legal retaliation and fear of emotional labor. CONCLUSION Health care providers perceived diaries as beneficial for parents and the healthcare team, potentially supporting their partnership as recommended by Family Centered Care models. The enablers and barriers that emerged for diary writing can support the development of implementation strategies to prevent the reported challenges to diary writing in the healthcare team, enhancing their uptake in the pediatric intensive care unit setting.
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Affiliation(s)
- Vincenza Sansone
- Professional Development, Continuing Education and Research Unit, Bambino Gesù Children's Hospital IRCCS, Rome, Italy; Department of Pediatric Hemato-Oncology, Santobono-Pausilipon Hospital, Naples, Italy.
| | - Federica Cancani
- Pediatric Intensive Care Unit, Department of Emergency, Acceptance and General Pediatrics, Bambino Gesù Children's Hospital IRCCS, Rome, Italy.
| | - Corrado Cecchetti
- Pediatric Intensive Care Unit, Department of Emergency, Acceptance and General Pediatrics, Bambino Gesù Children's Hospital IRCCS, Rome, Italy.
| | - Angela Rossi
- Clinical Psychology Unit, Bambino Gesù Children's Hospital IRCCS, Rome, Italy.
| | - Chiara Gagliardi
- Pediatric Intensive Care Unit, Department of Emergency, Acceptance and General Pediatrics, Bambino Gesù Children's Hospital IRCCS, Rome, Italy.
| | - Matteo Di Nardo
- Pediatric Intensive Care Unit, Department of Emergency, Acceptance and General Pediatrics, Bambino Gesù Children's Hospital IRCCS, Rome, Italy.
| | - Tiziana Satta
- Pediatric Intensive Care Unit, Department of Emergency, Acceptance and General Pediatrics, Bambino Gesù Children's Hospital IRCCS, Rome, Italy.
| | | | - Immacolata Dall'Oglio
- Professional Development, Continuing Education and Research Unit, Bambino Gesù Children's Hospital IRCCS, Rome, Italy.
| | - Emanuela Tiozzo
- Professional Development, Continuing Education and Research Unit, Bambino Gesù Children's Hospital IRCCS, Rome, Italy.
| | - Orsola Gawronski
- Professional Development, Continuing Education and Research Unit, Bambino Gesù Children's Hospital IRCCS, Rome, Italy.
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Genna C, Thekkan KR, Raymakers-Janssen PAMA, Gawronski O. Is nurse staffing associated with critical deterioration events on acute and critical care pediatric wards? A literature review. Eur J Pediatr 2023; 182:1755-1770. [PMID: 36763191 DOI: 10.1007/s00431-022-04803-2] [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: 12/05/2022] [Revised: 12/30/2022] [Accepted: 12/30/2022] [Indexed: 02/11/2023]
Abstract
UNLABELLED Pediatric and neonatal patients admitted to acute and critical care wards may experience critical deterioration events that may lead to unexpected deaths if unrecognized and untreated promptly. Adequate levels and skill-mix of nurse staffing are essential for the quality of patient monitoring and response to deteriorating patients. Insufficient staffing may have an impact on the occurrence of missed care and consequently on critical deterioration events, increasing the risk of mortality and failure-to-rescue. To review the literature to explore the association between nurse staffing levels or skill-mix and pediatric and neonatal critical deterioration events, such as mortality, pediatric intensive care unit (PICU)/neonatal intensive care unit (NICU) unplanned admissions, cardiac arrests, and failure-to-rescue. A structured narrative literature review was performed. Pubmed, Cinhal, and Web of Science were searched from January 2010 to September 2022. Four independent reviewers conducted the study screening and data extraction. The quality of the studies included was evaluated using the Joanna Briggs Institute critical appraisal tools. Out of a total of 2319 studies, 15 met the inclusion criteria. A total of seven studies were performed in PICU, six in NICU, and two in general pediatric wards. Nurse staffing measures and outcomes definitions used were heterogeneous. Most studies suggested nursing skill-mix, increased working experience, or higher nursing degrees were associated with increased survival in PICU. Decreased nursing staffing levels were associated with increased mortality in NICU and mechanically ventilated patients in PICU. CONCLUSION Evidence on the association of nurse staffing and critical deterioration events in PICU and NICU is limited, while there is no evidence reported for pediatric wards. Future research is needed to determine adequate levels of nurse/patient ratios and proportion of registered nurses in the skill-mix for pediatric acute and critical care nursing to improve outcomes on in-patient wards. WHAT IS KNOWN • Adult nursing skill-mix, staffing ratios, and level of education are associated with patient mortality and failure to rescue. • In children, nurse staffing levels are associated with clinical outcomes. WHAT IS NEW • Evidence on the association of nurse staffing levels or skill-mix with pediatric or neonatal mortality is limited. • There is some evidence regarding the association of nursing work experience, certification, higher level degree with in-hospital survival in PICU.
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Affiliation(s)
- Catia Genna
- Professional Development, Continuing Education and Research Unit, Medical Directorate, Bambino Gesù Children's Hospital IRCCS, Rome, Italy
| | - Kiara Ros Thekkan
- Professional Development, Continuing Education and Research Unit, Medical Directorate, Bambino Gesù Children's Hospital IRCCS, Rome, Italy
| | - Paulien A M A Raymakers-Janssen
- Department of Pediatric Intensive Care, Wilhelmina Children's Hospital/University Medical Center Utrecht, Utrecht, The Netherlands
| | - Orsola Gawronski
- Professional Development, Continuing Education and Research Unit, Medical Directorate, Bambino Gesù Children's Hospital IRCCS, Rome, Italy.
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11
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Gawronski O, Thekkan KR, Genna C, Egman S, Sansone V, Erba I, Vittori A, Varano C, Dall’Oglio I, Tiozzo E, Chiusolo F. Instruments to evaluate non-technical skills during high fidelity simulation: A systematic review. Front Med (Lausanne) 2022; 9:986296. [PMID: 36405618 PMCID: PMC9669714 DOI: 10.3389/fmed.2022.986296] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Accepted: 10/11/2022] [Indexed: 10/20/2023] Open
Abstract
INTRODUCTION High Fidelity Simulations (HFS) are increasingly used to develop Non-Technical Skills (NTS) in healthcare providers, medical and nursing students. Instruments to measure NTS are needed to evaluate the healthcare providers' (HCPs) performance during HFS. The aim of this systematic review is to describe the domains, items, characteristics and psychometric properties of instruments devised to evaluate the NTS of HCPs during HFS. METHODS A systematic review of the literature was performed according to the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA). Studies were retrieved from PubMed, Cinahl, Web of Science, Cochrane Library, ProQuest and PubPsych. Studies evaluating the measurement properties of instruments used to assess NTS during HFS training were included. Pairs of independent reviewers determined the eligibility, extracted and evaluated the data. Risk of bias and appraisal of the methodological quality of the studies was assessed using the Consensus-based Standards for the selection of health Measurement Instruments (COSMIN) checklist, and the quality of the evidence with the Grading of Recommendations, Assessment, Development and Evaluation (GRADE). RESULTS A total of 3,953 articles were screened. A total of 110 reports were assessed for eligibility and 26 studies were included. Studies were conducted in Europe/United Kingdom (n = 13; 50%), North America/Australia (n = 12; 46%) and Thailand (n = 1; 4%). The NTS instruments reported in this review included from 1 to 14 domains (median of 4, Q1 = 3.75, Q3 = 5) and from 3 to 63 items (median of 15, Q1 = 10, Q3 = 19.75). Out of 19 NTS assessment instruments for HFS, the Team Emergency Assessment Measure (TEAM) can be recommended for use to assess NTS. All the other instruments require further research to assess their quality in order to be recommended for use during HFS training. Eight NTS instruments had a positive overall rating of their content validity with at least a moderate quality of evidence. CONCLUSION Among a large variety of published instruments, TEAM can be recommended for use to assess NTS during HFS. Evidence is still limited on essential aspects of validity and reliability of all the other NTS instruments included in this review. Further research is warranted to establish their performance in order to be reliably used for HFS.
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Affiliation(s)
- Orsola Gawronski
- Professional Development, Continuing Education and Research Unit, Bambino Gesù Children’s Hospital (IRCCS), Rome, Italy
| | - Kiara R. Thekkan
- Professional Development, Continuing Education and Research Unit, Bambino Gesù Children’s Hospital (IRCCS), Rome, Italy
| | - Catia Genna
- Professional Development, Continuing Education and Research Unit, Bambino Gesù Children’s Hospital (IRCCS), Rome, Italy
| | - Sabrina Egman
- Clinical Risk, Innovation and Integration of Care Services, Bambino Gesù Children’s Hospital (IRCCS), Rome, Italy
| | - Vincenza Sansone
- Professional Development, Continuing Education and Research Unit, Bambino Gesù Children’s Hospital (IRCCS), Rome, Italy
| | - Ilaria Erba
- Department of Anesthesia and Critical Care, Bambino Gesù Children’s Hospital (IRCCS), Rome, Italy
| | - Alessandro Vittori
- Department of Anesthesia and Critical Care, Bambino Gesù Children’s Hospital (IRCCS), Rome, Italy
| | - Carmelita Varano
- Department of Pediatric Cardiology and Cardiac Surgery, Bambino Gesù Children’s Hospital (IRCCS), Rome, Italy
| | - Immacolata Dall’Oglio
- Professional Development, Continuing Education and Research Unit, Bambino Gesù Children’s Hospital (IRCCS), Rome, Italy
| | - Emanuela Tiozzo
- Professional Development, Continuing Education and Research Unit, Bambino Gesù Children’s Hospital (IRCCS), Rome, Italy
| | - Fabrizio Chiusolo
- Department of Anesthesia and Critical Care, Bambino Gesù Children’s Hospital (IRCCS), Rome, Italy
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Dall’Oglio I, Mascolo R, Portanova A, Ragni A, Amadio P, Fiori M, Tofani M, Gawronski O, Piga S, Rocco G, Tiozzo E, Latour JM. Staff Perceptions of Family-Centered Care in Italian Neonatal Intensive Care Units: A Multicenter Cross-Sectional Study. Children (Basel) 2022; 9:children9091401. [PMID: 36138710 PMCID: PMC9498145 DOI: 10.3390/children9091401] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Revised: 09/08/2022] [Accepted: 09/10/2022] [Indexed: 11/16/2022]
Abstract
Family Centered Care (FCC) in Neonatal Intensive Care Units (NICUs) included family involvement in the care process of newborns and infants. Staff perceptions of FCC may influence clinical practice and management strategies in NICUs, with an impact on quality and humanization of the care. The Family-Centred Care Questionnaire-Revised (FCCQ-R) was adapted for the NICU setting, therefore the FCCQ-R@it-NICU was developed and used for the present study in 32 Italian NICUs. We calculated internal consistency using Cronbach’s alpha correlation between Current and Necessary dimensions of the scale using the Pearson correlation coefficient. Furthermore, we investigated which characteristics could influence staff perceptions of FCC in NICUs. 921 NICU professionals participated in the study. The FCCQ-R@it-NICU revealed good internal consistency (0.96) and good correlation between dimensions (p < 0.05). Statistical and significant differences in Current and Necessary dimensions were found and some demographic characteristics were found predictable on FCC practice. The FCCQ-R@it-NICU is a valid tool to investigate staff perceptions about FCC in NICU settings. Profession, education level and work experience seem to positively influence the perception of what is required for FCC practice within NICUs.
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Affiliation(s)
- Immacolata Dall’Oglio
- Professional Development, Continuing Education and Research Service, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy
- Correspondence:
| | - Rachele Mascolo
- Semi-Intensive Care Area/Unit, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy
| | - Anna Portanova
- Neonatal Surgery Unit, Medical and Surgical Department of the Fetus-Newborn-Infant, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy
| | - Angela Ragni
- Neonatal Surgery Unit, Medical and Surgical Department of the Fetus-Newborn-Infant, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy
| | - Patrizia Amadio
- Neonatal Surgery Unit, Medical and Surgical Department of the Fetus-Newborn-Infant, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy
| | - Martina Fiori
- School of Nursing and Midwifery, Faculty of Health, University of Plymouth, Plymouth PL4 8AA, UK
| | - Marco Tofani
- Professional Development, Continuing Education and Research Service, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy
| | - Orsola Gawronski
- Professional Development, Continuing Education and Research Service, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy
| | - Simone Piga
- Unit of Epidemiology, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy
| | - Gennaro Rocco
- Centre of Excellence for Nursing Scholarship of Nursing Professional Order, Rome Nursing College, 00146 Rome, Italy
| | - Emanuela Tiozzo
- Professional Development, Continuing Education and Research Service, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy
| | - Jos M. Latour
- School of Nursing and Midwifery, Faculty of Health, University of Plymouth, Plymouth PL4 8AA, UK
- School of Nursing, Midwifery and Paramedicine, Faculty of Health Sciences, Curtin University, WA 6102 Perth, Australia
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Genna C, Thekkan KR, Geremia C, Di Furia M, Campana A, Dall'Oglio I, Tiozzo E, Gawronski O. Parents' process of recognition and response to clinical deterioration of their children with medical complexity at home: A grounded theory. J Clin Nurs 2022. [PMID: 36101491 DOI: 10.1111/jocn.16502] [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] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Revised: 07/30/2022] [Accepted: 08/08/2022] [Indexed: 11/27/2022]
Abstract
AIM To explore the process of recognition and response to clinical deterioration of children with medical complexity at home by their parents. BACKGROUND Children with medical complexity are characterised by known chronic conditions associated with frailty and functional limitations, dependence on healthcare services and high use of technology and resources. Their medical complexity often leads to the onset of complications. Targeted care ensures timely recognition and response to clinical deterioration at home, thus avoiding serious sequelae, inappropriate hospitalisations and improving quality of life. Evidence on parents' process of the recognition and response to clinical deterioration at home is limited. DESIGN Qualitative study using a Grounded Theory methodology. METHOD Seven online focus groups were conducted with parents and healthcare providers experienced in their care. The interviews were transcribed verbatim and analysed through open, axial and selective coding, using a constant comparative iterative method. The COREQ guidelines guided the reporting of this work. RESULTS Four categories and one core category were identified: (1) Awareness of the unique and shared characteristics of children with medical complexity; (2) Parents' care maintenance and management; (3) Parents' care monitoring; (4) Parents' response to clinical deterioration and (5) Seeking the Shift of Agency, the core category as the foundation of the Process of Recognition and rEsponse of PAREnts to Deterioration (PRE-PARE-D) theory. CONCLUSION The role of parents of children with medical complexity is evolving into active care leaders, by developing care management and care monitoring competences and negotiating care with healthcare providers. RELEVANCE TO CLINICAL PRACTICE The shift of agency from healthcare providers to parents requires education and counselling pathways to promote the development of parent's self-efficacy, competencies and empowerment in the care management of their children. Home care delivery for children with medical complexity should aim at sustaining this partnership between healthcare providers and parents.
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Affiliation(s)
- Catia Genna
- Professional Development, Continuing Education and Research Unit, Bambino Gesù Children's Hospital IRCCS, Rome, Italy
| | - Kiara Ros Thekkan
- Professional Development, Continuing Education and Research Unit, Bambino Gesù Children's Hospital IRCCS, Rome, Italy
| | - Caterina Geremia
- Department of Emergency, Acceptance and General Paediatrics, Bambino Gesù Children's Hospital IRCCS, Rome, Italy
| | - Michela Di Furia
- Department of Anesthesiology and Critical Care, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Andrea Campana
- Department of Emergency, Acceptance and General Paediatrics, Bambino Gesù Children's Hospital IRCCS, Rome, Italy
| | - Immacolata Dall'Oglio
- Professional Development, Continuing Education and Research Unit, Bambino Gesù Children's Hospital IRCCS, Rome, Italy
| | - Emanuela Tiozzo
- Professional Development, Continuing Education and Research Unit, Bambino Gesù Children's Hospital IRCCS, Rome, Italy
| | - Orsola Gawronski
- Professional Development, Continuing Education and Research Unit, Bambino Gesù Children's Hospital IRCCS, Rome, Italy
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14
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Gawronski O, Latour JM, Cecchetti C, Iula A, Ravà L, Ciofi Degli Atti ML, Dall'Oglio I, Tiozzo E, Raponi M, Parshuram CS. Escalation of care in children at high risk of clinical deterioration in a tertiary care children's hospital using the Bedside Pediatric Early Warning System. BMC Pediatr 2022; 22:530. [PMID: 36071513 PMCID: PMC9450425 DOI: 10.1186/s12887-022-03555-0] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2022] [Accepted: 08/16/2022] [Indexed: 11/30/2022] Open
Abstract
Background Escalation and de-escalation are a routine part of high-quality care that should be matched with clinical needs. The aim of this study was to describe escalation of care in relation to the occurrence and timing of Pediatric Intensive Care Unit (PICU) admission in a cohort of pediatric inpatients with acute worsening of their clinical condition. Methods A monocentric, observational cohort study was performed from January to December 2018. Eligible patients were children: 1) admitted to one of the inpatient wards other than ICU; 2) under the age of 18 years at the time of admission; 3) with two or more Bedside-Paediatric-Early-Warning-System (BedsidePEWS) scores ≥ 7 recorded at a distance of at least one hour and for a period of 4 h during admission. The main outcome -the 24-h disposition – was defined as admission to PICU within 24-h of enrolment or staying in the inpatient ward. Escalation of care was measured using an eight-point scale—the Escalation Index (EI), developed by the authors. The EI was calculated every 6 h, starting from the moment the patient was considered eligible. Analyses used multivariate quantile and logistic regression models. Results The 228 episodes included 574 EI calculated scores. The 24-h disposition was the ward in 129 (57%) and the PICU in 99 (43%) episodes. Patients who were admitted to PICU within 24-h had higher top EI scores [median (IQR) 6 (5–7) vs 4 (3–5), p < 0.001]; higher initial BedsidePEWS scores [median (IQR) 10(8–13) vs. 9 (8–11), p = 0.02], were less likely to have a chronic disease [n = 62 (63%) vs. n = 127 (98%), p < 0.0001], and were rated by physicians as being at a higher risk of having a cardiac arrest (p = 0.01) than patients remaining on the ward. The EI increased over 24 h before urgent admission to PICU or cardiac arrest by 0.53 every 6-h interval (CI 0.37–0.70, p < 0.001), while it decreased by 0.25 every 6-h interval (CI -0.36–0.15, p < 0.001) in patients who stayed on the wards. Conclusion Escalation of care was related to temporal changes in severity of illness, patient background and environmental factors. The EI index can improve responses to evolving critical illness. Supplementary Information The online version contains supplementary material available at 10.1186/s12887-022-03555-0.
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Affiliation(s)
- Orsola Gawronski
- Professional Development, Continuing Education and Research Unit, Medical Directorate, Bambino Gesù Children's Hospital IRCCS, P.zza S. Onofrio 4, Rome, Italy.
| | - Jos Maria Latour
- Faculty of Health, School of Nursing and Midwifery, University of Plymouth, Plymouth, UK.,School of Nursing, Midwifery and Paramedicine, Faculty of Health Sciences, Curtin University, Perth, Australia
| | - Corrado Cecchetti
- Pediatric Intensive Care Unit, Department of Emergency, Acceptance and General Pediatrics, Bambino Gesù Children's Hospital IRCCS, P.zza S. Onofrio 4, Rome, Italy
| | - Angela Iula
- Professional Development, Continuing Education and Research Unit, Medical Directorate, Bambino Gesù Children's Hospital IRCCS, P.zza S. Onofrio 4, Rome, Italy
| | - Lucilla Ravà
- Clinical Epidemiology Unit, Bambino Gesù Children's Hospital IRCCS, P.zza S. Onofrio 4, Rome, Italy
| | | | - Immacolata Dall'Oglio
- Professional Development, Continuing Education and Research Unit, Medical Directorate, Bambino Gesù Children's Hospital IRCCS, P.zza S. Onofrio 4, Rome, Italy
| | - Emanuela Tiozzo
- Professional Development, Continuing Education and Research Unit, Medical Directorate, Bambino Gesù Children's Hospital IRCCS, P.zza S. Onofrio 4, Rome, Italy
| | - Massimiliano Raponi
- Medical Directorate, Bambino Gesù Children's Hospital IRCCS, P.zza S. Onofrio 4, Rome, Italy
| | - Christopher S Parshuram
- Paediatric Intensive Care Unit, Critical Care Program, Hospital for Sick Children, 555 University Ave, Toronto, ON, M5G1X8, Canada
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15
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Tiozzo E, Rosati P, Brancaccio M, Biagioli V, Ricci R, d'Inzeo V, Scarselletta G, Piga S, MSc S, Vanzi V, Dall'Oglio I, Gawronski O, Offidani C, Pulimeno MA, Raponi M. A Cell-Phone Medication Error eHealth App for Managing Safety in Chronically Ill Young Patients at Home: A Prospective Study. Telemed J E Health 2022; 29:584-592. [PMID: 36070555 DOI: 10.1089/tmj.2022.0042] [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] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Introduction: Whereas ample information describes medication errors (MEs) in children or in mixed pediatric and adult populations discharged with acute or chronic diseases from hospital to community settings, little is known about MEs in children and adolescents with chronic diseases discharged home, a major concern. To promote home medication safety, we trained parents of children discharged with chronic diseases to record ME with a tailored cell-phone eHealth app. Methods: In a 1-year prospective study, we used the app to monitor ME in patients with chronic diseases discharged home from a tertiary hospital in Rome, Italy. Univariate and multivariate analyses detected the ME incidence rate ratio (IRR). Results: Of the 310 parents enrolled, 194 used the app. The 41 MEs involved all drug management phases. The ME IRR was 0.46 errors per child. Children <1 year had the highest ME risk (1.69 vs. 0.35, p = 0.002). Children discharged from the cardiology unit had a statistically higher ME IRR than others (3.66, 95% confidence interval: 1.01-13.23%). Conclusions: The highest ME risk at home involves children with chronic diseases <1 year old. A significant ME IRR at home concerns children with heart diseases of any age. Parents find a tailored eHealth app for monitoring and reporting ME at home easy to use. At discharge, clinical teams need to identify age-related and disease-residual risks to target additional actions for monitoring ME, thus increasing medication safety at home.
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Affiliation(s)
- Emanuela Tiozzo
- Professional Development, Continuing Education and Research, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Paola Rosati
- Clinical Pathways and Epidemiology Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Matilde Brancaccio
- Professional Development, Continuing Education and Research, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy.,Critical Care Department, Sant'Andrea Hospital, Rome, Italy
| | - Valentina Biagioli
- Professional Development, Continuing Education and Research, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Riccardo Ricci
- Professional Development, Continuing Education and Research, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Victoria d'Inzeo
- Professional Development, Continuing Education and Research, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Gianna Scarselletta
- Cardiology and Cardiac Surgery Department, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | | | - Stat MSc
- Clinical Pathways and Epidemiology Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Valentina Vanzi
- University Department of Pediatrics, and Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Immacolata Dall'Oglio
- Professional Development, Continuing Education and Research, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Orsola Gawronski
- Professional Development, Continuing Education and Research, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Caterina Offidani
- Unit of Legal Medicine, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Maria Ausilia Pulimeno
- Center of Excellence for Nursing Scholarship, Nursing Professions Order of Rome (OPI), Rome, Italy
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16
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Gawronski O, Biagioli V, Dall'oglio I, Cecchetti C, Ferro F, Tiozzo E, Raponi M. Attitudes and practices towards vital signs monitoring on paediatric wards: Cross-validation of the Ped-V scale. J Pediatr Nurs 2022; 65:98-107. [PMID: 35410733 DOI: 10.1016/j.pedn.2022.03.009] [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: 11/29/2021] [Revised: 02/15/2022] [Accepted: 03/21/2022] [Indexed: 11/16/2022]
Abstract
PURPOSE To develop and psychometrically test an instrument measuring the attitudes and practices towards vital signs (VS) monitoring in nurses caring for children on paediatric wards (Ped-V scale). DESIGN AND METHODS This is a multicentre cross-validation study with a cross-sectional design. The Ped-V scale was developed by adapting the V-scale to the paediatric context and administered to a convenience sample of clinical nurses working in paediatric wards from January to May 2020. The content validity of the Ped-V scale was evaluated by a group of 10 experts. The psychometric properties of the scale were tested through Exploratory Factor Analysis (EFA) and Confirmatory Factor Analysis (CFA). RESULTS Overall, 10 Italian hospitals participated in the study, and 640 questionnaires were completed (87% female). At EFA a 30-item version of the scale and four factors emerged. This solution was confirmed at CFA: F1) 'Inaccuracy of VS monitoring and workload'; F2) 'Clinical competence and communication'; F3) 'Standardization and protocol adherence'; F4) 'Misconceptions about key indicators'. Cronbach's alpha ranged between 0.63 and 0.85. CONCLUSIONS The Ped-V scale is valid and reliable for use in the paediatric context to identify barriers concerning nurses' self-efficacy, competences, and knowledge of clinical indicators of paediatric critical deterioration, attitudes towards accuracy, standardization, communication to senior team members and the appropriate use of technology in paediatric VS monitoring. PRACTICE IMPLICATIONS The Ped-V scale may assist in identifying gaps in nurses' attitudes and devising strategies to change nurses' beliefs, knowledge, skills and decreasing individual, local cultural or organizational barriers towards VS monitoring.
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Affiliation(s)
- Orsola Gawronski
- Professional Development, Continuing Education and Research Service, Bambino Gesù Children's Hospital, IRCCS, Piazza Sant'Onofrio 4, 00165 Rome, Italy.
| | - Valentina Biagioli
- Professional Development, Continuing Education and Research Service, Bambino Gesù Children's Hospital, IRCCS, Piazza Sant'Onofrio 4, 00165 Rome, Italy.
| | - Immacolata Dall'oglio
- Professional Development, Continuing Education and Research Service, Bambino Gesù Children's Hospital, IRCCS, Piazza Sant'Onofrio 4, 00165 Rome, Italy.
| | - Corrado Cecchetti
- Pediatric Intensive Care Unit, Department of Critical Care, Bambino Gesù Children's Hospital, IRCCS, Piazza Sant'Onofrio 4, 00165 Rome, Italy.
| | - Federico Ferro
- Professional Development, Continuing Education and Research Service, Bambino Gesù Children's Hospital, IRCCS, Piazza Sant'Onofrio 4, 00165 Rome, Italy
| | - Emanuela Tiozzo
- Professional Development, Continuing Education and Research Service, Bambino Gesù Children's Hospital, IRCCS, Piazza Sant'Onofrio 4, 00165 Rome, Italy.
| | - Massimiliano Raponi
- Medical Directorate, Bambino Gesù Children's Hospital, IRCCS, Piazza Sant'Onofrio 4, 00165 Rome, Italy.
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Amicucci M, Dall'Oglio I, Biagioli V, Gawronski O, Piga S, Ricci R, Angelaccio A, Elia D, Fiorito ME, Marotta L, Raponi M, Tiozzo E. Participation of nurses and allied health professionals in research activities: a survey in an academic tertiary pediatric hospital. BMC Nurs 2022; 21:159. [PMID: 35729532 PMCID: PMC9210609 DOI: 10.1186/s12912-022-00922-1] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Accepted: 05/16/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Involvement in research activities is complex in pediatric nursing and allied health professionals (AHPs). It is important to understand which individual factors are associated with it to inform policy makers in promoting research. METHODS A cross-sectional observational study was conducted to describe the level of participation in research activities over the last ten years of nurses and AHPs working in a tertiary pediatric hospital. A large sample of nurses and AHPs working in an Italian academic tertiary pediatric hospital completed an online self-report questionnaire between June and December 2018. Three multivariate logistic regression analyses were performed to predict participation in research projects, speaking at conferences, and writing scientific articles. RESULTS Overall, data from 921 health professionals were analyzed (response rate = 66%), of which about 21% (n = 196) reported participating in a research project, while 33% (n = 297) had attended a scientific conference as a speaker, and 11% (n = 94) had written at least one scientific paper. Having a Master or a Regional Advanced Course, working as an AHP or a ward manager, as well as regularly reading scientific journals and participation in an internal hospital research group or attendance in a specific course about research in the hospital, significantly predicted participation in research projects, speaking at conferences and writing scientific papers. It is important to foster research interest and competencies among health professionals to improve participation in research projects, speaking at conferences, and writing scientific papers. CONCLUSIONS Overall, we found a good level of attendance at conferences as speakers (33%), a moderate level of participation in research (21%), and low levels for writing scientific papers (11%). Our study highlighted the need to support participation in research activities among nurses and AHPs. Policymakers should identify strategies to promote research among nurses and AHPs, such as protected rewarded time for research, specific education, strengthened collaboration with academics, and financial support. Moreover, hospital managers should promote the development of research culture among health professionals, to improve their research competencies and evidence-based practice.
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Affiliation(s)
- Matteo Amicucci
- Department of Onco Haematology and Cell and Gene Therapy, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Immacolata Dall'Oglio
- Professional Development, Continuing Education and Research Service, Bambino Gesù Children's Hospital, IRCCS, Sant'Onofrio Square 4, 00165, Rome, Italy.
| | - Valentina Biagioli
- Professional Development, Continuing Education and Research Service, Bambino Gesù Children's Hospital, IRCCS, Sant'Onofrio Square 4, 00165, Rome, Italy
| | - Orsola Gawronski
- Professional Development, Continuing Education and Research Service, Bambino Gesù Children's Hospital, IRCCS, Sant'Onofrio Square 4, 00165, Rome, Italy
| | - Simone Piga
- Unit of Epidemiology, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Riccardo Ricci
- Professional Development, Continuing Education and Research Service, Bambino Gesù Children's Hospital, IRCCS, Sant'Onofrio Square 4, 00165, Rome, Italy
| | - Anna Angelaccio
- Department of Diagnostic Medicine and Laboratories, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Domenica Elia
- Department of Pediatric Subspecialties, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Mario E Fiorito
- Department of Images Diagnostic, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Luigi Marotta
- Department of Intensive Neurorehabilitation and Robotics, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | | | - Emanuela Tiozzo
- Professional Development, Continuing Education and Research Service, Bambino Gesù Children's Hospital, IRCCS, Sant'Onofrio Square 4, 00165, Rome, Italy
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Adriani L, Dall'Oglio I, Brusco C, Gawronski O, Piga S, Reale A, Buonomo E, Cerone G, Palombi L, Raponi M. Reduction of Waiting Times and Patients Leaving Without Being Seen in the Tertiary Pediatric Emergency Department: A Comparative Observational Study. Pediatr Emerg Care 2022; 38:219-223. [PMID: 35157406 DOI: 10.1097/pec.0000000000002605] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Analyze the effectiveness of an intervention to reduce waiting time and patients leaving without being seen in the pediatric emergency department. METHODS A comparative observational study was carried out from November 2018 to April 2019.Patients aged 3 months to 17 years were included. The new organizational model consisted of a dedicated outpatients' clinic for nonurgent codes and a fast track for traumatic and surgical emergency cases. RESULTS The comparative group included 14,822, and the intervention group included 15,585 patients. The new organizational model significantly reduced the numbers of patients who left the ED without being seen from 12.9% to 5.9%. CONCLUSIONS This new organizational model in the pediatric emergency department could be successfully used to reduce overcrowding, waiting time, and the numbers of patients leaving without being seen. However, more needs to be done by the pediatric services in the community to reduce nonurgent accesses to the emergency department.
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Affiliation(s)
| | - Immacolata Dall'Oglio
- Professional Development, Continuing Education and Research Service, Bambino Gesù Children's Hospital, IRCCS
| | - Carla Brusco
- Medical Direction, Bambino Gesù Children's Hospital
| | - Orsola Gawronski
- Professional Development, Continuing Education and Research Service, Bambino Gesù Children's Hospital, IRCCS
| | - Simone Piga
- Unit of Clinical Epidemiology, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Antonino Reale
- From the Emergency Department & General Pediatric, Bambino Gesù Children's Hospital, IRCCS
| | - Ersilia Buonomo
- Department of Biomedicine and Prevention, "Tor Vergata" University
| | - Gennaro Cerone
- Department of Biomedicine and Prevention, "Tor Vergata" University
| | - Leonardo Palombi
- Department of Biomedicine and Prevention, "Tor Vergata" University
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Gawronski O, Sansone V, Cancani F, Di Nardo M, Rossi A, Gagliardi C, De Ranieri C, Satta T, Dall'Oglio I, Tiozzo E, Alvaro R, Raponi M, Cecchetti C. Implementation of paediatric intensive care unit diaries: Feasibility and opinions of parents and healthcare providers. Aust Crit Care 2022; 36:370-377. [PMID: 35305896 DOI: 10.1016/j.aucc.2022.01.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [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: 08/29/2021] [Revised: 01/22/2022] [Accepted: 01/23/2022] [Indexed: 10/18/2022] Open
Abstract
BACKGROUND The implementation of paediatric intensive care unit (PICU) diaries has been reported as feasible in routine care. To date no feasibility study has compared PICU healthcare providers' (HCPs) and parents' opinions on this tool. OBJECTIVES The aim of this study is to describe the feasibility and perception of PICU diaries in an Italian PICU from the point of view of parents and HCPs. METHODS This is a single-centre, prospective, observational study conducted in a tertiary care paediatric hospital from August 2020 to May 2021. Children admitted to the emergency department PICU, intubated, and sedated for ≥48 h were enrolled. To explore their perceptions and attitudes with the PICU diary, parents were interviewed at 30 days from their child's discharge from the PICU, whereas PICU HCPs were surveyed at the end of the study. Data were analysed as proportions for categorical variables and means and medians for continuous variables according to the distribution, whereas qualitative data were summarised in categories by two independent researchers. RESULTS Twenty families were enrolled in this study. A total of 275 daily PICU diary entries were collected. Children's median age was 9 years (interquartile range = 2-13.25), and the length of stay ranged from 6 to 39 days. PICU diary applicability was rated high by parents and HCPs (>8 on a 1-10 Likert scale). Parents and HCPs perceived PICU diaries as beneficial for communication between staff and families, for parents by expressing their emotions and for staff by becoming aware of how parents experienced their child's admission. Reported barriers were the lack of a private environment, the risk of exposure to public reading, and PICU workload. CONCLUSIONS PICU diaries were feasible and perceived as beneficial both by parents and HCPs. Future research is warranted to understand the effect of PICU diaries on post-PICU outcomes.
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Affiliation(s)
- Orsola Gawronski
- Professional Development, Continuing Education and Research Unit, Medical Directorate, Bambino Gesù Children's Hospital, IRCCS, P.zza S. Onofrio 4, Rome, Italy.
| | - Vincenza Sansone
- Professional Development, Continuing Education and Research Unit, Medical Directorate, Bambino Gesù Children's Hospital, IRCCS, P.zza S. Onofrio 4, Rome, Italy; Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy.
| | - Federica Cancani
- Pediatric Intensive Care Unit, Department of Emergency, Acceptance and General Pediatrics, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy.
| | - Matteo Di Nardo
- Pediatric Intensive Care Unit, Department of Emergency, Acceptance and General Pediatrics, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy.
| | - Angela Rossi
- Clinical Psychology Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy.
| | - Chiara Gagliardi
- Pediatric Intensive Care Unit, Department of Emergency, Acceptance and General Pediatrics, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy.
| | | | - Tiziana Satta
- Pediatric Intensive Care Unit, Department of Emergency, Acceptance and General Pediatrics, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy.
| | - Immacolata Dall'Oglio
- Professional Development, Continuing Education and Research Unit, Medical Directorate, Bambino Gesù Children's Hospital, IRCCS, P.zza S. Onofrio 4, Rome, Italy.
| | - Emanuela Tiozzo
- Professional Development, Continuing Education and Research Unit, Medical Directorate, Bambino Gesù Children's Hospital, IRCCS, P.zza S. Onofrio 4, Rome, Italy.
| | - Rosaria Alvaro
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy.
| | | | - Corrado Cecchetti
- Pediatric Intensive Care Unit, Department of Emergency, Acceptance and General Pediatrics, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy.
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20
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Di Nardo M, Ahmad AH, Merli P, Zinter MS, Lehman LE, Rowan CM, Steiner ME, Hingorani S, Angelo JR, Abdel-Azim H, Khazal SJ, Shoberu B, McArthur J, Bajwa R, Ghafoor S, Shah SH, Sandhu H, Moody K, Brown BD, Mireles ME, Steppan D, Olson T, Raman L, Bridges B, Duncan CN, Choi SW, Swinford R, Paden M, Fortenberry JD, Peek G, Tissieres P, De Luca D, Locatelli F, Corbacioglu S, Kneyber M, Franceschini A, Nadel S, Kumpf M, Loreti A, Wösten-Van Asperen R, Gawronski O, Brierley J, MacLaren G, Mahadeo KM. Extracorporeal membrane oxygenation in children receiving haematopoietic cell transplantation and immune effector cell therapy: an international and multidisciplinary consensus statement. Lancet Child Adolesc Health 2022; 6:116-128. [PMID: 34895512 PMCID: PMC9372796 DOI: 10.1016/s2352-4642(21)00336-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Revised: 10/12/2021] [Accepted: 10/19/2021] [Indexed: 01/03/2023]
Abstract
Use of extracorporeal membrane oxygenation (ECMO) in children receiving haematopoietic cell transplantation (HCT) and immune effector cell therapy is controversial and evidence-based guidelines have not been established. Remarkable advancements in HCT and immune effector cell therapies have changed expectations around reversibility of organ dysfunction and survival for affected patients. Herein, members of the Extracorporeal Life Support Organization (ELSO), Pediatric Acute Lung Injury and Sepsis Investigators (PALISI) Network (HCT and cancer immunotherapy subgroup), the Pediatric Diseases Working Party of the European Society for Blood and Marrow Transplantation (EBMT), the supportive care committee of the Pediatric Transplantation and Cellular Therapy Consortium (PTCTC), and the Pediatric Intensive Care Oncology Kids in Europe Research (POKER) group of the European Society of Pediatric and Neonatal Intensive Care (ESPNIC) provide consensus recommendations on the use of ECMO in children receiving HCT and immune effector cell therapy. These are the first international, multidisciplinary consensus-based recommendations on the use of ECMO in this patient population. This Review provides a clinical decision support tool for paediatric haematologists, oncologists, and critical care physicians during the difficult decision-making process of ECMO candidacy and management. These recommendations can represent a base for future research studies focused on ECMO selection criteria and bedside management.
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Affiliation(s)
- Matteo Di Nardo
- Pediatric Intensive Care Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy.
| | - Ali H Ahmad
- Department of Pediatrics, Pediatric Critical Care, Houston, TX, USA
| | - Pietro Merli
- Department of Hematology/Oncology, Cell and Gene Therapy, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Matthew S Zinter
- Department of Pediatrics, Divisions of Critical Care and Bone Marrow Transplantation, University of California, San Francisco, CA, USA
| | - Leslie E Lehman
- Pediatric Hematology-Oncology, Dana-Farber Cancer Institute, Harvard University, Boston, MA, USA
| | - Courtney M Rowan
- Department of Pediatrics, Division of Critical Care, Indiana University School of Medicine, Riley Hospital for Children, Indianapolis, IN, USA
| | - Marie E Steiner
- Department of Pediatrics, University of Minnesota, Minneapolis, MN, USA
| | - Sangeeta Hingorani
- Department of Pediatrics, Division of Nephrology, University of Washington School of Medicine, and the Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Joseph R Angelo
- Renal Section, Baylor College of Medicine, Texas Children's Hospital, Houston, TX, USA
| | - Hisham Abdel-Azim
- Department of Pediatrics, Transplantation and Cell Therapy Program, Keck School of Medicine, University of Southern California, Children's Hospital Los Angeles, Los Angeles, CA, USA
| | - Sajad J Khazal
- Department of Pediatrics, Stem Cell Transplantation and Cellular Therapy, Houston, TX, USA; The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Basirat Shoberu
- Department of Pediatrics, Stem Cell Transplantation and Cellular Therapy, Houston, TX, USA; The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Jennifer McArthur
- Division of Critical Care Medicine, Department of Pediatric Medicine, St Jude Children's Research Hospital, Memphis, TN, USA
| | - Rajinder Bajwa
- Department of Pediatrics, Division of Blood and Marrow Transplantation, Nationwide Children's Hospital, The Ohio State University, Columbus, OH, USA
| | - Saad Ghafoor
- Division of Critical Care Medicine, Department of Pediatric Medicine, St Jude Children's Research Hospital, Memphis, TN, USA
| | - Samir H Shah
- Division of Pediatric Critical Care Medicine, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Hitesh Sandhu
- Division of Pediatric Critical Care Medicine, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Karen Moody
- CARTOX Program, and Department of Pediatrics, Supportive Care, Houston, TX, USA
| | - Brandon D Brown
- Department of Pediatrics, Stem Cell Transplantation and Cellular Therapy, Houston, TX, USA; The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | | | - Diana Steppan
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Taylor Olson
- Division of Critical Care Medicine, Children's National Hospital, Washington, DC, USA
| | - Lakshmi Raman
- Department of Pediatrics, UT Southwestern Medical Center, Dallas, TX, USA
| | - Brian Bridges
- Division of Pediatric Critical Care, Department of Pediatrics, Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Christine N Duncan
- Pediatric Hematology-Oncology, Dana-Farber Cancer Institute, Harvard University, Boston, MA, USA
| | - Sung Won Choi
- University of Michigan, Rogel Cancer Center, Ann Arbor, MI, USA; Department of Pediatrics, Ann Arbor, MI, USA
| | - Rita Swinford
- Department of Pediatrics, Division of Pediatric Nephrology, McGovern Medical School, The University of Texas Health Science Center, Houston, TX, USA
| | - Matt Paden
- Pediatric Critical Care, Children's Healthcare of Atlanta, and Emory University School of Medicine, Atlanta, GA, USA
| | - James D Fortenberry
- Pediatric Critical Care, Children's Healthcare of Atlanta, and Emory University School of Medicine, Atlanta, GA, USA
| | - Giles Peek
- Congenital Heart Center, University of Florida, Gainesville, FL, USA
| | - Pierre Tissieres
- Division of Pediatric Intensive Care and Neonatal Medicine, Paris South University Hospital, Le Kremlin-Bicetre, France; Institute of Integrative Biology of the Cell, CNRS, CEA, Univ. Paris Sud, Paris Saclay University, Paris, France
| | - Daniele De Luca
- Division of Pediatrics, Transportation and Neonatal Critical Care Medicine, APHP, Paris Saclay University Hospital, "A.Beclere" Medical Center and Physiopathology and Therapeutic Innovation Unit-INSERM-U999, Paris Saclay University, Paris, France
| | - Franco Locatelli
- Department of Hematology/Oncology, Cell and Gene Therapy, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Selim Corbacioglu
- Department of Pediatric Hematology, Oncology and Stem Cell Transplantation, University of Regensburg, Regensburg, Germany
| | - Martin Kneyber
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, Beatrix Children's Hospital Groningen, Groningen, Netherlands; Critical Care, Anesthesiology, Peri-Operative and Emergency Medicine (CAPE), University Medical Centre Groningen, University of Groningen, Groningen, Netherlands
| | - Alessio Franceschini
- Department of Cardiosurgery, Cardiology, Heart and Lung Transplant, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Simon Nadel
- Pediatric Intensive Care Unit, Imperial College Healthcare NHS Trust, London, UK
| | - Matthias Kumpf
- Interdisciplinary Pediatric Intensive Care Unit, Universitäetsklinikum Tuebingen, Tuebingen, Germany
| | - Alessandra Loreti
- Medical Library, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Roelie Wösten-Van Asperen
- Department of Pediatric Intensive Care, University Medical Center Utrecht/Wilhelmina Children's Hospital, Utrecht, Netherlands
| | - Orsola Gawronski
- Professional Development, Continuing Education and Research Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Joe Brierley
- Department of Pediatric Intensive Care, Great Ormond Street Hospital for Children, London, UK
| | - Graeme MacLaren
- Director of Cardiothoracic ICU, National University Health System, Singapore, Singapore; Pediatric Intensive Care Unit, The Royal Children's Hospital, Melbourne, Australia
| | - Kris M Mahadeo
- Department of Pediatrics, Stem Cell Transplantation and Cellular Therapy, Houston, TX, USA; The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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21
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Zanin A, Brierley J, Latour JM, Gawronski O. End-of-life decisions and practices as viewed by health professionals in pediatric critical care: A European survey study. Front Pediatr 2022; 10:1067860. [PMID: 36704131 PMCID: PMC9872024 DOI: 10.3389/fped.2022.1067860] [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] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Accepted: 12/12/2022] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND AND AIM End-of-Life (EOL) decision-making in paediatric critical care can be complex and heterogeneous, reflecting national culture and law as well as the relative resources provided for healthcare. This study aimed to identify similarities and differences in the experiences and attitudes of European paediatric intensive care doctors, nurses and allied health professionals about end-of-life decision-making and care. METHODS This was a cross-sectional observational study in which we distributed an electronic survey to the European Society of Paediatric and Neonatal Intensive Care (ESPNIC) members by email and social media. The survey had three sections: (i) 16 items about attitudes to EOL care, (ii) 14 items about EOL decisions, and (iii) 18 items about EOL care in practice. We used a 5-point Likert scale and performed descriptive statistical analysis. RESULTS Overall, 198 questionnaires were completed by physicians (62%), nurses (34%) and allied health professionals (4%). Nurses reported less active involvement in decision-making processes than doctors (64% vs. 95%; p < 0.001). As viewed by the child and family, the child's expected future quality of life was recognised as one of the most critical considerations in EOL decision-making. Sub-analysis of Northern, Central and Southern European regions revealed differences in the optimal timing of EOL decisions. Most respondents (n = 179; 90%) supported discussing organ donation with parents during EOL planning. In the sub-region analysis, differences were observed in the provision of deep sedation and nutritional support during EOL care. CONCLUSIONS This study has shown similar attitudes and experiences of EOL care among paediatric critical care professionals within European regions, but differences persist between European regions. Nurses are less involved in EOL decision-making than physicians. Further research should identify the key cultural, religious, legal and resource differences underlying these discrepancies. We recommend multi-professional ethics education to improve EOL care in European Paediatric Intensive Care.
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Affiliation(s)
- Anna Zanin
- Department of Women's and Children's Health, University of Padua, Padua, Italy
| | - Joe Brierley
- Critical Care Units, Great Ormond Street Hospital, London, United Kingdom
| | - Jos M Latour
- School of Nursing and Midwifery, University of Plymouth, Plymouth, United Kingdom
| | - Orsola Gawronski
- Professional Development, Continuing Education and Research Service, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
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22
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Biagioli V, Spitaletta G, Kania V, Mascolo R, Gawronski O, Liburdi A, Manzi G, Salata M, Vellone E, Tiozzo E, Dall'Oglio I. Instruments Measuring Self-Care in Children and Young Adults With Chronic Conditions: A Systematic Review. Front Pediatr 2022; 10:832453. [PMID: 35419323 PMCID: PMC8995847 DOI: 10.3389/fped.2022.832453] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Accepted: 02/28/2022] [Indexed: 11/25/2022] Open
Abstract
Children and young adults (CYAs) with chronic conditions need to engage in self-care to improve their quality of life. This study aimed to retrieve the literature on instruments to assess self-care in CYAs living with chronic conditions and evaluate the psychometric proprieties of the instruments retrieved. A systematic literature review was conducted on six databases to identify peer-reviewed papers that described or used an evaluation instrument of self-care in CYAs with chronic conditions. Twenty-three articles describing 11 instruments of self-care were identified. Five instruments (45.45%) were developed for specific diseases, while six (54.54%) for various chronic illnesses. Most of the instruments were focused on treatment adherence within self-care maintenance (i.e., behaviors to maintain illness stability), excluding the monitoring of clinical parameters or the management of exacerbations. This review provides an overview of available instruments that measure self-care in CYAs with chronic conditions, which health professionals could use for patient education.
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Affiliation(s)
- Valentina Biagioli
- Professional Development, Continuing Education and Research Service, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Giuseppina Spitaletta
- Professional Development, Continuing Education and Research Service, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Valeria Kania
- Department of Paediatric Emergency, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Rachele Mascolo
- Pediatric Semi-Intensive Care Area/Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Orsola Gawronski
- Professional Development, Continuing Education and Research Service, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Annachiara Liburdi
- Professional Development, Continuing Education and Research Service, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Giulia Manzi
- Professional Development, Continuing Education and Research Service, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Michele Salata
- Rheumatology Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Ercole Vellone
- Department of Biomedicine and Prevention, University of Rome "Tor Vergata," Rome, Italy
| | - Emanuela Tiozzo
- Professional Development, Continuing Education and Research Service, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Immacolata Dall'Oglio
- Professional Development, Continuing Education and Research Service, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
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23
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Lauridsen KG, Morgan RW, Dewan M, Gawronski O, Sen AI. In-hospital cardiac arrest characteristics, CPR quality, and outcomes in children with COVID-19. Resuscitation 2021; 169:39-40. [PMID: 34673154 PMCID: PMC8522673 DOI: 10.1016/j.resuscitation.2021.10.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Revised: 10/05/2021] [Accepted: 10/06/2021] [Indexed: 11/30/2022]
Affiliation(s)
- Kasper G Lauridsen
- Research Center for Emergency Medicine, Aarhus University Hospital, Denmark; Emergency Department, Randers Regional Hospital, Denmark; Center for Pediatric Resuscitation, Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, USA.
| | - Ryan W Morgan
- Center for Pediatric Resuscitation, Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, USA
| | - Maya Dewan
- Division of Critical Care Medicine, Cincinnati Children's Hospital Medical Center, USA
| | - Orsola Gawronski
- Professional Development, Continuing Education and Research Unit, Bambino Gesù Children's Hospital IRCCS, Italy
| | - Anita I Sen
- Department of Pediatrics, Columbia University, USA
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Biagioli V, Pol A, Gawronski O, Carlin C, Cirulli L, Piga S, Stelitano R, Offidani C, Raucci U, Reale A, Tiozzo E, Villani A, Dall'Oglio I. Pediatric patients accessing Accident and Emergency Department (A&E) for non-urgent treatment: Why do parents take their children to the A&E? Int Emerg Nurs 2021; 58:101053. [PMID: 34520965 DOI: 10.1016/j.ienj.2021.101053] [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] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Revised: 06/04/2021] [Accepted: 07/20/2021] [Indexed: 11/19/2022]
Abstract
INTRODUCTION About 20-30% of children access the Pediatric Accident and Emergency Department (A&E) for non-urgent health care that should normally follow other health care paths. This study aimed to investigate why parents take their children to the A&E for non-urgent visits rather than using primary care services. METHODS A one-year cross-sectional study was conducted in a large pediatric A&E in Italy. A paper-and-pencil 40-item questionnaire was administered to parents of children aged between 3 months to 6 years who accessed the A&E for non-urgent visits between July 2018 and June 2019. RESULTS Parents of 238 children completed the questionnaire (mean age = 2.6 years; male 58%). The most common symptoms were fever (n = 105; 44.1%) and skin rash (n = 63; 26.5%); symptoms usually started more than 24 h earlier (n = 163; 69.4%). Reasons for accessing the A&E for non-urgent visits included the availability of rapid medical tests (n = 71; 29.8%), deterioration of the clinical conditions after the pediatrician's visit (n = 67; 28.2%), and the perceived need for urgent care (n = 65; 27.3%). Besides, 26.6% (n = 63) of parents reported not being able to contact their pediatrician before accessing A&E. CONCLUSION Parents may need further education to distinguish between urgent and non-urgent pediatric health conditions.
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Affiliation(s)
- Valentina Biagioli
- Academic Department of Pediatrics, Bambino Gesù Children's Hospital, IRCCS, Piazza Sant'Onofrio 4, 00165 Rome, Italy.
| | - Alessandra Pol
- Professional Development, Continuing Education and Research Service, Bambino Gesù Children's Hospital, IRCCS, Piazza Sant'Onofrio 4, 00165 Rome, Italy.
| | - Orsola Gawronski
- Academic Department of Pediatrics, Bambino Gesù Children's Hospital, IRCCS, Piazza Sant'Onofrio 4, 00165 Rome, Italy.
| | - Claudia Carlin
- Academic Department of Pediatrics, Bambino Gesù Children's Hospital, IRCCS, Piazza Sant'Onofrio 4, 00165 Rome, Italy.
| | - Luisa Cirulli
- Professional Development, Continuing Education and Research Service, Bambino Gesù Children's Hospital, IRCCS, Piazza Sant'Onofrio 4, 00165 Rome, Italy.
| | - Simone Piga
- Bachelor for Pediatric Nursing, Sapienza University of Rome, Italy.
| | - Rocco Stelitano
- Professional Development, Continuing Education and Research Service, Bambino Gesù Children's Hospital, IRCCS, Piazza Sant'Onofrio 4, 00165 Rome, Italy.
| | - Caterina Offidani
- Paediatric Emergency Department, Bambino Gesù Children's Hospital, IRCCS, Piazza Sant'Onofrio 4, 00165 Rome, Italy.
| | - Umberto Raucci
- Professional Development, Continuing Education and Research Service, Bambino Gesù Children's Hospital, IRCCS, Piazza Sant'Onofrio 4, 00165 Rome, Italy.
| | - Antonino Reale
- Professional Development, Continuing Education and Research Service, Bambino Gesù Children's Hospital, IRCCS, Piazza Sant'Onofrio 4, 00165 Rome, Italy.
| | - Emanuela Tiozzo
- Academic Department of Pediatrics, Bambino Gesù Children's Hospital, IRCCS, Piazza Sant'Onofrio 4, 00165 Rome, Italy.
| | - Alberto Villani
- Professional Development, Continuing Education and Research Service, Bambino Gesù Children's Hospital, IRCCS, Piazza Sant'Onofrio 4, 00165 Rome, Italy.
| | - Immacolata Dall'Oglio
- Academic Department of Pediatrics, Bambino Gesù Children's Hospital, IRCCS, Piazza Sant'Onofrio 4, 00165 Rome, Italy.
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Gawronski O, Ferro F, Cecchetti C, Ciofi Degli Atti M, Dall'Oglio I, Tiozzo E, Raponi M. Adherence to the bedside paediatric early warning system (BedsidePEWS) in a pediatric tertiary care hospital. BMC Health Serv Res 2021; 21:852. [PMID: 34419038 PMCID: PMC8380378 DOI: 10.1186/s12913-021-06809-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Accepted: 07/22/2021] [Indexed: 12/03/2022] Open
Abstract
Background The aim of this study is to describe the adherence to the Bedside Pediatric Early Warning System (BedsidePEWS) escalation protocol in children admitted to hospital wards in a large tertiary care children’s hospital in Italy. Methods This is a retrospective observational chart review. Data on the frequency and accuracy of BedsidePEWS score calculations, escalation of patient observations, monitoring and medical reviews were recorded. Two research nurses performed weekly visits to the hospital wards to collect data on BedsidePEWS scores, medical reviews, type of monitoring and vital signs recorded. Data were described through means or medians according to the distribution. Inferences were calculated either with Chi-square, Student’s t test or Wilcoxon-Mann–Whitney test, as appropriate (P < 0.05 considered as significant). Results A total of 522 Vital Signs (VS) and score calculations [BedsidePEWS documentation events, (DE)] on 177 patient clinical records were observed from 13 hospital inpatient wards. Frequency of BedsidePEWS DE occurred < 3 times per day in 33 % of the observations. Adherence to the BedsidePEWS documentation frequency according to the hospital protocol was observed in 54 % of all patients; in children with chronic health conditions (CHC) it was significantly lower than children admitted for acute medical conditions (47 % vs. 69 %, P = 0.006). The BedsidePEWS score was correctly calculated and documented in 84 % of the BedsidePEWS DE. Patients in a 0–2 BedsidePEWS score range were all reviewed at least once a day by a physician. Only 50 % of the patients in the 5–6 score range were reviewed within 4 h and 42 % of the patients with a score ≥ 7 within 2 h. Conclusions Escalation of patient observations, monitoring and medical reviews matching the BedsidePEWS is still suboptimal. Children with CHC are at higher risk of lower compliance. Impact of adherence to predefined response algorithms on patient outcomes should be further explored.
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Affiliation(s)
- Orsola Gawronski
- Professional Development, Continuing Education and Research Unit, Bambino Gesù Children's Hospital IRCCS, P.zza S. Onofrio 4, 00165, Rome, Italy.
| | - Federico Ferro
- Professional Development, Continuing Education and Research Unit, Bambino Gesù Children's Hospital IRCCS, P.zza S. Onofrio 4, 00165, Rome, Italy
| | - Corrado Cecchetti
- Pediatric Intensive Care Unit, Department of Emergency, Acceptance and General Pediatrics, Bambino Gesù Children's Hospital IRCCS, P.zza S. Onofrio 4, 00165, Rome, Italy
| | - Marta Ciofi Degli Atti
- Clinical Epidemiology Unit, Bambino Gesù Children's Hospital IRCCS, P.zza S. Onofrio 4, 00165, Rome, Italy
| | - Immacolata Dall'Oglio
- Professional Development, Continuing Education and Research Unit, Bambino Gesù Children's Hospital IRCCS, P.zza S. Onofrio 4, 00165, Rome, Italy
| | - Emanuela Tiozzo
- Professional Development, Continuing Education and Research Unit, Bambino Gesù Children's Hospital IRCCS, P.zza S. Onofrio 4, 00165, Rome, Italy
| | - Massimiliano Raponi
- Medical Directorate, Bambino Gesù Children's Hospital IRCCS, P.zza S. Onofrio 4, 00165, Rome, Italy
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Sansone V, Cancani F, Gagliardi C, Satta T, Cecchetti C, de Ranieri C, Di Nardo M, Rossi A, Dall'Oglio I, Alvaro R, Tiozzo E, Gawronski O. Narrative diaries in the paediatric intensive care unit: A thematic analysis. Nurs Crit Care 2021; 27:45-54. [PMID: 34256419 DOI: 10.1111/nicc.12680] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 03/08/2021] [Revised: 06/04/2021] [Accepted: 06/21/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND The paediatric intensive care unit (PICU) diary is a shared tool, kept at the patient bedside, written by relatives and health care providers. There is little evidence about its feasibility and how it supports the families of children admitted to the PICU. Currently, there is no evidence about how the PICU diary is used and what we can learn from it. AIM To explore the contents of narrative PICU diaries in an Italian PICU. STUDY DESIGN Qualitative study of PICU diaries conducted with a narrative research approach. METHODS Children sedated and mechanically ventilated for >48 hours were enrolled in a six-bed Italian PICU of a tertiary care paediatric hospital. During the child's PICU admission, caregivers, relatives, friends, and health care providers were invited to report events, thoughts, and messages, and attach drawings/pictures for the child in the PICU diary. A thematic analysis of the PICU diary contents was performed. RESULTS Thirteen PICU diaries were completed between August and December 2020, mainly by parents (n = 95; 45%) and health care providers (n = 52; 25%). Three main themes emerged: "Social and spiritual support," "Caregiver's emotions, feelings and distress," and "PICU life." Diaries offer insight into caregivers' emotions, social support, clinical activities, and interactions with health care providers, and on progression towards recovery. CONCLUSION PICU diaries are valuable in facilitating family-centred care by providing a space for the written account of the child's admission by parents, other visitors, and health care providers. RELEVANCE TO CLINICAL PRACTICE PICU diaries support the relationship and the communication between the family and the team; they provide an informal account of the emotions and needs of parents that has the potential to improve mutual understanding and family-centred care. Social support and spiritual support are key elements reported by parents for coping with their child's PICU admission.
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Affiliation(s)
- Vincenza Sansone
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy.,Professional Development, Continuing Education and Research Unit, Medical Directorate, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Federica Cancani
- Pediatric Intensive Care Unit, Department of Emergency, Acceptance and General Pediatrics, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Chiara Gagliardi
- Pediatric Intensive Care Unit, Department of Emergency, Acceptance and General Pediatrics, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Tiziana Satta
- Pediatric Intensive Care Unit, Department of Emergency, Acceptance and General Pediatrics, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Corrado Cecchetti
- Pediatric Intensive Care Unit, Department of Emergency, Acceptance and General Pediatrics, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | | | - Matteo Di Nardo
- Pediatric Intensive Care Unit, Department of Emergency, Acceptance and General Pediatrics, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Angela Rossi
- Clinical Psychology Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Immacolata Dall'Oglio
- Professional Development, Continuing Education and Research Unit, Medical Directorate, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Rosaria Alvaro
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | - Emanuela Tiozzo
- Professional Development, Continuing Education and Research Unit, Medical Directorate, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Orsola Gawronski
- Professional Development, Continuing Education and Research Unit, Medical Directorate, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
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Sansone V, Dall'Oglio I, Gesualdo F, Cancani F, Cecchetti C, Di Nardo M, Rossi A, De Ranieri C, Alvaro R, Tiozzo E, Gawronski O. Narrative Diaries in Pediatrics: A Scoping Review. J Pediatr Nurs 2021; 59:e93-e105. [PMID: 33622642 DOI: 10.1016/j.pedn.2021.02.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 10/15/2020] [Revised: 02/03/2021] [Accepted: 02/04/2021] [Indexed: 11/24/2022]
Abstract
PROBLEM Health diaries with both clinical and narrative elements have been widely used in pediatrics to study children's and families' experiences of illness and coping strategies. The objective of this study is to obtain a synthesis of the literature about narrative health diaries using the PRISMA extension for scoping reviews. ELIGIBILITY CRITERIA Sources were limited to: English language; narrative diaries; children/adolescents and/or parents/caregivers. SAMPLE The following databases were searched: PubMed, Embase and CINAHL with no time limits. RESULTS Among 36 articles included the most common context where a diary was implemented was the home (61%), the hospital (17%) and the school (14%). The most common diarist is the child or adolescent (50%). Paper diary was the most common type (53%), followed by the video diary (19%), the e-diary (8%) or the audio diary (8%). None of the studies explored the impact of the use of diaries on patient outcomes. CONCLUSIONS The narrative health diary is used to report patient experiences of illness or common life from the point of view of the child, adolescent or other family members. The diversity of the diaries found shows how the narrative diary may be 'adapted' to different settings and pediatric populations. IMPLICATIONS The narrative diary is a relevant tool for the exploration of children's and adolescents' experiences of illness and common life. Studies are still needed to describe the impact of narrative diaries keeping on children's health outcomes.
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Affiliation(s)
- Vincenza Sansone
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy; Department of Pediatric Oncology, AORN Santobono-Pausilipon, Naples, Italy.
| | - Immacolata Dall'Oglio
- Professional Development, Continuing Education and Research Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Francesco Gesualdo
- Department of Predictive and Preventive Medicine, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Federica Cancani
- Pediatric Intensive Care Unit, Department of Critical Care, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Corrado Cecchetti
- Pediatric Intensive Care Unit, Department of Critical Care, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Matteo Di Nardo
- Pediatric Intensive Care Unit, Department of Critical Care, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Angela Rossi
- Clinical Psychology Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | | | - Rosaria Alvaro
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | - Emanuela Tiozzo
- Professional Development, Continuing Education and Research Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Orsola Gawronski
- Professional Development, Continuing Education and Research Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
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Dall'Oglio I, Rosati GV, Biagioli V, Tiozzo E, Gawronski O, Ricci R, Garofalo A, Piga S, Gramaccioni S, Di Maria C, Vanzi V, Querciati A, Alvaro R, Biancalani L, Buonomo E, Doria M, Villani A. Pediatric nurses in pediatricians' offices: a survey for primary care pediatricians. BMC Fam Pract 2021; 22:136. [PMID: 34187392 PMCID: PMC8243477 DOI: 10.1186/s12875-021-01457-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Accepted: 05/12/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND The role played by nurses in caring for children in pediatricians' officies in the community is crucial to ensure integrated care. In Italy, pediatricians are responsible for the health of children aged 0-14 years living in the community. This study aimed to describe Italian primary care pediatricians' opinions about the usefulness of several nursing activities that pediatric nurses could perform in pediatricians' offices. METHODS An online survey with pediatricians working in primary care in Italy was conducted between April-December 2018. A 40-item questionnaire was used to assess four types of nursing activities: clinical care, healthcare education, disease prevention, and organizational activities. The answers ranged from 1 (not useful at all) to 6 (very useful). Moreover, three open-ended questions completed the questionnaire. RESULTS Overall, 707 pediatricians completed the online survey. Participants were mainly female (63%), with a mean age of 57.74 (SD = 6.42). The presence of a pediatric nurse within the pediatrician's office was considered very useful, especially for healthcare education (Mean 4.90; SD 1.12) and disease prevention (Mean 4.82; SD 1.11). Multivariate analysis confirmed that pediatricians 'with less working experience', 'having their office in a small town', and 'collaborating with a secretary and other workers in the office' rated the nurse's activities significantly more useful. CONCLUSIONS A pediatric nurse in the pediatrician's office can significantly contribute to many activities for children and their families in the community. These activities include clinical care, healthcare education, disease prevention, and the organizational processes of the office. Synergic professional activity between pediatricians and pediatric nurses could ensure higher health care standards in the primary care setting.
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Affiliation(s)
- Immacolata Dall'Oglio
- Health Professionals Development, Continuing Education and Research Service; Bambino Gesù Children's Hospital, IRCCS, Piazza Sant'Onofrio 4, 00165, Rome, Italy.
| | - Giovanni Vitali Rosati
- Italian Pediatric Society, Rome, Italy
- Italian Federation of Pediatric Physicians, Rome, Italy
| | - Valentina Biagioli
- Health Professionals Development, Continuing Education and Research Service; Bambino Gesù Children's Hospital, IRCCS, Piazza Sant'Onofrio 4, 00165, Rome, Italy
| | - Emanuela Tiozzo
- Health Professionals Development, Continuing Education and Research Service; Bambino Gesù Children's Hospital, IRCCS, Piazza Sant'Onofrio 4, 00165, Rome, Italy
| | - Orsola Gawronski
- Health Professionals Development, Continuing Education and Research Service; Bambino Gesù Children's Hospital, IRCCS, Piazza Sant'Onofrio 4, 00165, Rome, Italy
| | - Riccardo Ricci
- Health Professionals Development, Continuing Education and Research Service; Bambino Gesù Children's Hospital, IRCCS, Piazza Sant'Onofrio 4, 00165, Rome, Italy
| | - Antonio Garofalo
- Health Professionals Development, Continuing Education and Research Service; Bambino Gesù Children's Hospital, IRCCS, Piazza Sant'Onofrio 4, 00165, Rome, Italy
| | - Simone Piga
- Unit of Clinical Epidemiology, Bambino Gesù Children's Hospital, IRCCS, Piazza Sant'Onofrio 4, 00165, Rome, Italy
| | - Simone Gramaccioni
- Academic Department of Pediatrics, Bambino Gesù Children's Hospital, IRCCS, Piazza Sant'Onofrio 4, 00165, Rome, Italy
| | - Claudio Di Maria
- Academic Department of Pediatrics, Bambino Gesù Children's Hospital, IRCCS, Piazza Sant'Onofrio 4, 00165, Rome, Italy
| | - Valentina Vanzi
- Academic Department of Pediatrics, Bambino Gesù Children's Hospital, IRCCS, Piazza Sant'Onofrio 4, 00165, Rome, Italy
| | - Alessandra Querciati
- Academic Department of Pediatrics, Bambino Gesù Children's Hospital, IRCCS, Piazza Sant'Onofrio 4, 00165, Rome, Italy
| | - Rosaria Alvaro
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | | | - Ersilia Buonomo
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | - Mattia Doria
- Italian Federation of Pediatric Physicians, Rome, Italy
| | - Alberto Villani
- Italian Pediatric Society, Rome, Italy
- Pediatric Emergency Department and General Pediatrics, Bambino Gesù Children's Hospital, IRCCS, Piazza Sant'Onofrio 4, 00165, Rome, Italy
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Tiozzo E, Biagioli V, Brancaccio M, Ricci R, Marchetti A, Dall'Oglio I, Gawronski O, Bonanni F, Piga S, Celesti L, Offidani C, Tozzi AE, Cirulli L, Raponi M. Using an App to monitor postoperative pain at home in pediatric patients. J Child Health Care 2021; 25:212-224. [PMID: 33571013 DOI: 10.1177/1367493520919313] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 11/15/2022]
Abstract
A prospective comparative study was conducted in 487 pediatric patients (69% male, mean age = 6.4 ± 4.0) to evaluate (a) the incidence, intensity, and characteristics of pain in pediatric patients at home during the first 24 hours and 5 days after surgery and (b) the factors associated with higher pain intensity, including the impact of an application (App) compared to the paper-and-pencil approach. Postoperative pain was assessed by patients or their parents at home using the 'Bambino Gesù' Children's Hospital (Ospedale Pediatrico Bambino Gesù, OPBG) tool for participants aged 4-17 years or the Faces, Legs, Arms, Cry, and Consolability scale for participants less than four years old. Participants were assigned to two groups: those who used the paper-and-pencil version of the pain scale and those who used the App. Overall, 209 of the 472 (44%) participants reported pain during the first 24 hours, and 92 of the 420 (22%) reported pain between one and five days after surgery. Higher pain intensity scores were associated with being in the App group, directly assessing own pain, and using the OPBG tool. The App was effective in facilitating pain assessment. Health professionals could empower pediatric patients and their parents in assessing pain at home through a dedicated App.
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Affiliation(s)
- Emanuela Tiozzo
- Health Professional Development, Continuing Education and Research Service, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Valentina Biagioli
- Health Professional Development, Continuing Education and Research Service, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Matilde Brancaccio
- Health Professional Development, Continuing Education and Research Service, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Riccardo Ricci
- Health Professional Development, Continuing Education and Research Service, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Anna Marchetti
- Health Professional Development, Continuing Education and Research Service, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Immacolata Dall'Oglio
- Health Professional Development, Continuing Education and Research Service, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Orsola Gawronski
- Health Professional Development, Continuing Education and Research Service, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Fabiana Bonanni
- Unit of Ambulatory Surgery, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Simone Piga
- Unit of Edidemiology, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Lucia Celesti
- Hospitality and Family Services, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Caterina Offidani
- Health Direction, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Alberto Eugenio Tozzi
- Innovation and Clinical Pathways Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Luisa Cirulli
- Unit of Ambulatory Surgery, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
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Dall’Oglio I, Gasperini G, Carlin C, Biagioli V, Gawronski O, Spitaletta G, Grimaldi Capitello T, Salata M, Vanzi V, Rocco G, Tiozzo E, Vellone E, Raponi M. Self-Care in Pediatric Patients with Chronic Conditions: A Systematic Review of Theoretical Models. Int J Environ Res Public Health 2021; 18:ijerph18073513. [PMID: 33800684 PMCID: PMC8037526 DOI: 10.3390/ijerph18073513] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 03/13/2021] [Accepted: 03/24/2021] [Indexed: 12/30/2022]
Abstract
Background: To improve outcomes in children and young adults (CYAs) with chronic conditions, it is important to promote self-care through education and support. Aims: (1) to retrieve the literature describing theories or conceptual models of self-care in CYAs with chronic conditions and (2) to develop a comprehensive framework. Methods: A systematic literature search was conducted on nine databases, according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. All peer-reviewed papers describing a theory or a conceptual model of self-care in CYAs (0–24 years) with chronic conditions were included. Results: Of 2674 records, 17 met the inclusion criteria. Six papers included a theory or a model of self-care, self-management, or a similar concept. Six papers developed or revised pre-existing models or theories, while five papers did not directly focus on a specific model or a theory. Patients were CYAs, mainly with type 1 diabetes mellitus and asthma. Some relevant findings about self-care in CYAs with neurocognitive impairment and in those living with cancer may have been missed. Conclusions: By aggregating the key elements of the 13 self-care conceptual models identified in the review, we developed a new overarching model emphasizing the shift of self-care agency from family to patients as main actors of their self-management process. The model describes influencing factors, self-care behaviors, and outcomes; the more patients engaged in self-care behaviors, the more the outcomes were favorable.
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Affiliation(s)
- Immacolata Dall’Oglio
- Bambino Gesù Children’s Hospital, IRCCS, Piazza Sant’Onofrio 4, 00165 Rome, Italy; (G.G.); (C.C.); (V.B.); (O.G.); (G.S.); (T.G.C.); (M.S.); (V.V.); (E.T.); (M.R.)
- Correspondence: ; Tel.: +39-0668592984; Fax: +39-0668592100
| | - Giulia Gasperini
- Bambino Gesù Children’s Hospital, IRCCS, Piazza Sant’Onofrio 4, 00165 Rome, Italy; (G.G.); (C.C.); (V.B.); (O.G.); (G.S.); (T.G.C.); (M.S.); (V.V.); (E.T.); (M.R.)
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, 00133 Rome, Italy;
| | - Claudia Carlin
- Bambino Gesù Children’s Hospital, IRCCS, Piazza Sant’Onofrio 4, 00165 Rome, Italy; (G.G.); (C.C.); (V.B.); (O.G.); (G.S.); (T.G.C.); (M.S.); (V.V.); (E.T.); (M.R.)
| | - Valentina Biagioli
- Bambino Gesù Children’s Hospital, IRCCS, Piazza Sant’Onofrio 4, 00165 Rome, Italy; (G.G.); (C.C.); (V.B.); (O.G.); (G.S.); (T.G.C.); (M.S.); (V.V.); (E.T.); (M.R.)
| | - Orsola Gawronski
- Bambino Gesù Children’s Hospital, IRCCS, Piazza Sant’Onofrio 4, 00165 Rome, Italy; (G.G.); (C.C.); (V.B.); (O.G.); (G.S.); (T.G.C.); (M.S.); (V.V.); (E.T.); (M.R.)
| | - Giuseppina Spitaletta
- Bambino Gesù Children’s Hospital, IRCCS, Piazza Sant’Onofrio 4, 00165 Rome, Italy; (G.G.); (C.C.); (V.B.); (O.G.); (G.S.); (T.G.C.); (M.S.); (V.V.); (E.T.); (M.R.)
| | - Teresa Grimaldi Capitello
- Bambino Gesù Children’s Hospital, IRCCS, Piazza Sant’Onofrio 4, 00165 Rome, Italy; (G.G.); (C.C.); (V.B.); (O.G.); (G.S.); (T.G.C.); (M.S.); (V.V.); (E.T.); (M.R.)
| | - Michele Salata
- Bambino Gesù Children’s Hospital, IRCCS, Piazza Sant’Onofrio 4, 00165 Rome, Italy; (G.G.); (C.C.); (V.B.); (O.G.); (G.S.); (T.G.C.); (M.S.); (V.V.); (E.T.); (M.R.)
| | - Valentina Vanzi
- Bambino Gesù Children’s Hospital, IRCCS, Piazza Sant’Onofrio 4, 00165 Rome, Italy; (G.G.); (C.C.); (V.B.); (O.G.); (G.S.); (T.G.C.); (M.S.); (V.V.); (E.T.); (M.R.)
| | - Gennaro Rocco
- Centre of Excellence for Nursing Scholarship-Nursing Professional Order of Rome, Viale Giulio Cesare, 78, 00192 Rome, Italy;
| | - Emanuela Tiozzo
- Bambino Gesù Children’s Hospital, IRCCS, Piazza Sant’Onofrio 4, 00165 Rome, Italy; (G.G.); (C.C.); (V.B.); (O.G.); (G.S.); (T.G.C.); (M.S.); (V.V.); (E.T.); (M.R.)
| | - Ercole Vellone
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, 00133 Rome, Italy;
| | - Massimiliano Raponi
- Bambino Gesù Children’s Hospital, IRCCS, Piazza Sant’Onofrio 4, 00165 Rome, Italy; (G.G.); (C.C.); (V.B.); (O.G.); (G.S.); (T.G.C.); (M.S.); (V.V.); (E.T.); (M.R.)
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Di Nardo M, Boldrini F, Broccati F, Cancani F, Satta T, Stoppa F, Genuini L, Zampini G, Perdichizzi S, Bottari G, Fischer M, Gawronski O, Bonetti A, Piermarini I, Recchiuti V, Leone P, Rossi A, Tabarini P, Biasucci D, Villani A, Raponi M, Cecchetti C, Choong K. The LiberAction Project: Implementation of a Pediatric Liberation Bundle to Screen Delirium, Reduce Benzodiazepine Sedation, and Provide Early Mobilization in a Human Resource-Limited Pediatric Intensive Care Unit. Front Pediatr 2021; 9:788997. [PMID: 34956989 PMCID: PMC8692861 DOI: 10.3389/fped.2021.788997] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Accepted: 11/08/2021] [Indexed: 11/18/2022] Open
Abstract
Background: Delirium, bed immobilization, and heavy sedation are among the major contributors of pediatric post-intensive care syndrome. Recently, the Society of Critical Care Medicine has proposed the implementation of daily interventions to minimize the incidence of these morbidities and optimize children functional outcomes and quality of life. Unfortunately, these interventions require important clinical and economical efforts which prevent their use in many pediatric intensive care units (PICU). Aim: First, to evaluate the feasibility and safety of a PICU bundle implementation prioritizing delirium screening and treatment, early mobilization (<72 h from PICU admission) and benzodiazepine-limited sedation in a human resource-limited PICU. Second, to evaluate the incidence of delirium and describe the early mobilization practices and sedative drugs used during the pre- and post-implementation periods. Third, to describe the barriers and adverse events encountered during early mobilization. Methods: This observational study was structured in a pre- (15th November 2019-30th June 2020) and post-implementation period (1st July 2020-31st December 2020). All patients admitted in PICU for more than 72 h during the pre and post-implementation period were included in the study. Patients were excluded if early mobilization was contraindicated. During the pre-implementation period, a rehabilitation program including delirium screening and treatment, early mobilization and benzodiazepine-sparing sedation guidelines was developed and all PICU staff trained. During the post-implementation period, delirium screening with the Connell Assessment of Pediatric Delirium scale was implemented at bedside. Early mobilization was performed using a structured tiered protocol and a new sedation protocol, limiting the use of benzodiazepine, was adopted. Results: Two hundred and twenty-five children were enrolled in the study, 137 in the pre-implementation period and 88 in the post-implementation period. Adherence to delirium screening, benzodiazepine-limited sedation and early mobilization was 90.9, 81.1, and 70.4%, respectively. Incidence of delirium was 23% in the post-implementation period. The median cumulative dose of benzodiazepines corrected for the total number of sedation days (mg/kg/sedation days) was significantly lower in the post-implementation period compared with the pre-implementation period: [0.83 (IQR: 0.53-1.31) vs. 0.74 (IQR: 0.55-1.16), p = 0.0001]. The median cumulative doses of fentanyl, remifentanil, and morphine corrected for the total number of sedation days were lower in the post-implementation period, but these differences were not significant. The median number of mobilizations per patient and the duration of each mobilization significantly increased in the post-implementation period [3.00 (IQR: 2.0-4.0) vs. 7.00 (IQR: 3.0-12.0); p = 0.004 and 4 min (IQR: 3.50-4.50) vs. 5.50 min (IQR: 5.25-6.5); p < 0.0001, respectively]. Barriers to early mobilization were: disease severity and bed rest orders (55%), lack of physicians' order (20%), lack of human resources (20%), and lack of adequate devices for patient mobilization (5%). No adverse events related to early mobilization were reported in both periods. Duration of mechanical ventilation and PICU length of stay was significantly lower in the post-implementation period as well as the occurrence of iatrogenic withdrawal syndrome. Conclusion: This study showed that the implementation of a PICU liberation bundle prioritizing delirium screening and treatment, benzodiazepine-limited sedation and early mobilization was feasible and safe even in a human resource-limited PICU. Further pediatric studies are needed to evaluate the clinical impact of delirium, benzodiazepine-limited sedation and early mobilization protocols on patients' long-term functional outcomes and on hospital finances.
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Affiliation(s)
- Matteo Di Nardo
- PICU, Children's Hospital Bambino Gesù, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Rome, Italy
| | - Francesca Boldrini
- Unit of Clinical Psychology, Department of Neurological Sciences, Children's Hospital Bambino Gesù, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Rome, Italy
| | - Francesca Broccati
- PICU, Children's Hospital Bambino Gesù, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Rome, Italy
| | - Federica Cancani
- PICU, Children's Hospital Bambino Gesù, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Rome, Italy
| | - Tiziana Satta
- PICU, Children's Hospital Bambino Gesù, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Rome, Italy
| | - Francesca Stoppa
- PICU, Children's Hospital Bambino Gesù, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Rome, Italy
| | - Leonardo Genuini
- PICU, Children's Hospital Bambino Gesù, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Rome, Italy
| | - Giorgio Zampini
- PICU, Children's Hospital Bambino Gesù, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Rome, Italy
| | - Salvatore Perdichizzi
- PICU, Children's Hospital Bambino Gesù, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Rome, Italy
| | - Gabriella Bottari
- PICU, Children's Hospital Bambino Gesù, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Rome, Italy
| | - Maximilian Fischer
- Pediatric Emergency Unit, Department of Medical and Surgical Sciences (DIMEC), St. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Orsola Gawronski
- Professional Development, Continuing Education and Research Unit, Medical Directorate, Bambino Gesù Children's Hospital, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Rome, Italy
| | - Annamaria Bonetti
- Functional Rehab Unit, Neurorehabilitation and Robotics Department, Bambino Gesù Children's Hospital, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Rome, Italy
| | - Irene Piermarini
- Respiratory Physiotherapy, Pediatric Pulmonology and Respiratory Intermediate Care Unit, Sleep and Long-Term Ventilation Unit, Academic Department of Pediatrics (DPUO), Bambino Gesù Children's Hospital, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Rome, Italy
| | - Veronica Recchiuti
- Functional Rehab Unit, Neurorehabilitation and Robotics Department, Bambino Gesù Children's Hospital, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Rome, Italy
| | - Paola Leone
- Respiratory Physiotherapy, Pediatric Pulmonology and Respiratory Intermediate Care Unit, Sleep and Long-Term Ventilation Unit, Academic Department of Pediatrics (DPUO), Bambino Gesù Children's Hospital, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Rome, Italy
| | - Angela Rossi
- Unit of Clinical Psychology, Department of Neurological Sciences, Children's Hospital Bambino Gesù, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Rome, Italy
| | - Paola Tabarini
- Unit of Clinical Psychology, Department of Neurological Sciences, Children's Hospital Bambino Gesù, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Rome, Italy
| | - Daniele Biasucci
- Department of Emergency, Intensive Care Medicine and Anesthesiology, Fondazione Policlinico Universitario "A. Gemelli" Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Rome, Italy
| | - Alberto Villani
- PICU, Children's Hospital Bambino Gesù, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Rome, Italy
| | - Massimiliano Raponi
- Medical Directorate, Bambino Gesu' Children's Hospital, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Rome, Italy
| | - Corrado Cecchetti
- PICU, Children's Hospital Bambino Gesù, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Rome, Italy
| | - Karen Choong
- Department of Pediatrics, McMaster University, Hamilton, ON, Canada.,Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
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Ferro F, Tozzi AE, Erba I, Dall’Oglio I, Campana A, Cecchetti C, Geremia C, Rega ML, Tontini G, Tiozzo E, Gawronski O. Impact of telemedicine on health outcomes in children with medical complexity: an integrative review. Eur J Pediatr 2021; 180:2389-2400. [PMID: 34196791 PMCID: PMC8246433 DOI: 10.1007/s00431-021-04164-2] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Revised: 06/10/2021] [Accepted: 06/12/2021] [Indexed: 01/11/2023]
Abstract
Children with medical complexity (CMC) are a high priority population with chronic illnesses dependent on the use of health services, on technological systems to support their vital functions and characterized by multiple health needs. One of the main challenges linked to chronic conditions is finding solutions to monitor CMC at home, avoiding re-hospitalization and the onset of complications. Telemedicine enables to remotely follow up patients and families. An integrative review was performed to assess whether telemedicine improves health outcomes for CMC. Medline/PubMed, CINAHL, Cochrane Library, Web of Science, and Scopus were searched to identify studies describing the effect of using telemedicine systems on health outcomes for CMC. The PRISMA guidelines were used to select the papers. The methodological quality of the studies was evaluated through the Johanna Briggs Institute critical appraisal tools and the Cochrane Collaboration ROB 2.0. A total of 17 papers met the quality criteria and were included. Specialized telemedicine systems (tele-visits), telehealth, and tele-monitoring have been reported to reduce unplanned hospitalizations and visits, decrease total costs for healthcare services and families, and increase satisfaction for family members. No effect was found on the quality of life in children and their families.Conclusion: Available evidence supporting the use of telemedicine in CMC is favorable but limited. High-quality methodological studies including other unexplored health outcomes such as mental health, hospital readmissions, mortality, caregiver competences, and self-efficacy are needed to confirm the effectiveness of telemedicine systems in improving health outcomes for CMC. What is Known: • CMC are an extremely fragile patient population with frequent access to healthcare services compared with other chronic conditions. • There is conflicting evidence of the effectiveness of telemedicine clinical outcomes, healthcare utilization, and costs in pediatrics. What is New: • There is some evidence that for CMC, telemedicine reduces unplanned hospitalizations, healthcare service costs, and financial burden for families, while increasing caregivers' satisfaction with care. • Further research is needed to confirm the effectiveness of telemedicine systems in improving health for CMC.
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Affiliation(s)
- Federico Ferro
- grid.414125.70000 0001 0727 6809Medical Directorate, Professional Development, Continuing Education and Research Unit, Bambino Gesù Children’s Hospital IRCCS, Rome, Italy
| | - Alberto Eugenio Tozzi
- grid.414125.70000 0001 0727 6809Scientific Directorate, Multifactorial Diseases and Complex Chronic Diseases, Bambino Gesù Children’s Hospital IRCCS, Rome, Italy
| | - Ilaria Erba
- grid.414125.70000 0001 0727 6809Department of Anesthesia and Critical Care, Pediatric Intensive Care Unit, Bambino Gesù Children’s Hospital IRCCS, Rome, Italy
| | - Immacolata Dall’Oglio
- grid.414125.70000 0001 0727 6809Medical Directorate, Professional Development, Continuing Education and Research Unit, Bambino Gesù Children’s Hospital IRCCS, Rome, Italy
| | - Andrea Campana
- grid.414125.70000 0001 0727 6809Department of Emergency, Acceptance and General Pediatrics, Bambino Gesù Children’s Hospital IRCCS, Rome, Italy
| | - Corrado Cecchetti
- grid.414125.70000 0001 0727 6809Department of Emergency, Acceptance and General Pediatrics, Pediatric Intensive Care Unit, Bambino Gesù Children’s Hospital IRCCS, Rome, Italy
| | - Caterina Geremia
- grid.414125.70000 0001 0727 6809Department of Emergency, Acceptance and General Pediatrics, Bambino Gesù Children’s Hospital IRCCS, Rome, Italy
| | - Maria Luisa Rega
- grid.8142.f0000 0001 0941 3192Department of Nursing, Sacred Heart Catholic University, Rome, Italy
| | - Gloria Tontini
- grid.414125.70000 0001 0727 6809Department of Emergency, Acceptance and General Pediatrics, Bambino Gesù Children’s Hospital IRCCS, Rome, Italy
| | - Emanuela Tiozzo
- grid.414125.70000 0001 0727 6809Medical Directorate, Professional Development, Continuing Education and Research Unit, Bambino Gesù Children’s Hospital IRCCS, Rome, Italy
| | - Orsola Gawronski
- Medical Directorate, Professional Development, Continuing Education and Research Unit, Bambino Gesù Children's Hospital IRCCS, Rome, Italy.
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Tiozzo E, Fondi S, Biagioli V, Piccinelli E, Alibrandi F, Gawronski O, Dall'Oglio I, Margarella E, Piga S, Ricci R, Ciaralli I. Electronic Assessment and Tracking of Pain at Home: A Prospective Study in Children With Hematologic or Solid Tumors. J Pediatr Oncol Nurs 2020; 38:82-93. [PMID: 33269620 DOI: 10.1177/1043454220975443] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
This study aimed to evaluate the intensity and characteristics of pain, which was assessed at home by children with cancer or their parents using an app for mobile devices, for a 1-month poststudy enrollment. The participants of this observational prospective study were outpatients at the hematology/oncology department of an academic hospital in Italy, aged between 0 and 21 years, and receiving hospital-at-home care. Patients or their parents were asked to assess pain levels for one month at home using the Faces, Legs, Arms, Cry, and Consolability (FLACC) scale for patients aged <4 years and the Ospedale Pediatrico Bambino Gesù (OPBG) tool for patients aged 4 to 21 years. At study conclusion, parents were asked to complete a survey about their satisfaction with the app and to rate their child's health in general, pain intensity, and frequency in the past 4 weeks. Of the 124 participants using the app, 94 (75.8%) reported pain (≥1) at least once during the 1 month. Of these, 53 (56.4%) at most reported mild pain, 33 (35.1%) moderate pain, and eight (8.5%) severe pain. The abdomen was identified as the most frequent (56.3%) pain site by patients aged 4 to 21 years. The child's maximum pain intensity during the study period was negatively correlated with the parent's report of the child's health during the past month (r = -.29, p < .01). Most of the participants were satisfied with the app and the information received about app usage. In conclusion, the app facilitated pain assessment and tracking in patients receiving hospital-at-home care.
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Affiliation(s)
| | - Serena Fondi
- Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | | | | | | | | | | | | | - Simone Piga
- Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
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Amicucci M, Mastronuzzi A, Ciaralli I, Piccioni F, Schiopu AC, Tiozzo E, Gawronski O, Biagioli V, Dall’Oglio I. The Management of Children with Cancer during the COVID-19 Pandemic: A Rapid Review. J Clin Med 2020; 9:E3756. [PMID: 33233447 PMCID: PMC7700610 DOI: 10.3390/jcm9113756] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Revised: 11/18/2020] [Accepted: 11/19/2020] [Indexed: 12/11/2022] Open
Abstract
Despite the fact that cancer patients seem to be at a higher risk of being infected with SARS-CoV-2, limited data are available in the pediatric oncology setting. A systematic rapid review was conducted to analyze scientific literature regarding the management, interventions, and strategies adopted to prevent the spread of COVID-19 in the pediatric cancer population. Our search on PubMed, Scopus, Cochrane, and EMBASE databases yielded 505 articles. After removing duplicates, 21 articles were included. Articles focused on infection prevention (n = 19; 90.5%), management (n = 18; 85.7%), overall management of specific treatments for cancer (n = 13; 61.9%), and education (n = 7; 33.3%). The interventions adopted to prevent the spread of COVID-19 were similar across organizations and in line with general recommendations. Most of them reported interventions that could be used as valid strategies for similar emergencies. The strategies included limiting the risk of contagion by restricting access to the wards and implementing hygiene measures, the identification of separate pathways for the management of patients suspected or confirmed to be infected with COVID-19, the postponement of people accessing the hospital for non-urgent or unnecessary tests or medical examinations, and the preventive screening of patients before chemotherapy treatment or transplantation of hematopoietic stem cells. It is necessary to identify key indicators in order to better evaluate the effectiveness of the interventions implemented over time. A summary of the recommendations is provided.
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Affiliation(s)
- Matteo Amicucci
- Department of Onco Haematology and Cell and Gene Therapy, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy; (A.M.); (I.C.); (F.P.)
| | - Angela Mastronuzzi
- Department of Onco Haematology and Cell and Gene Therapy, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy; (A.M.); (I.C.); (F.P.)
| | - Italo Ciaralli
- Department of Onco Haematology and Cell and Gene Therapy, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy; (A.M.); (I.C.); (F.P.)
| | - Federico Piccioni
- Department of Onco Haematology and Cell and Gene Therapy, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy; (A.M.); (I.C.); (F.P.)
| | | | - Emanuela Tiozzo
- Professional Development, Continuing Education and Nursing Research Service, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy; (E.T.); (O.G.); (V.B.); (I.D.)
| | - Orsola Gawronski
- Professional Development, Continuing Education and Nursing Research Service, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy; (E.T.); (O.G.); (V.B.); (I.D.)
| | - Valentina Biagioli
- Professional Development, Continuing Education and Nursing Research Service, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy; (E.T.); (O.G.); (V.B.); (I.D.)
| | - Immacolata Dall’Oglio
- Professional Development, Continuing Education and Nursing Research Service, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy; (E.T.); (O.G.); (V.B.); (I.D.)
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Dall'Oglio I, Marchetti F, Mascolo R, Amadio P, Gawronski O, Clemente M, Dotta A, Ferro F, Garofalo A, Salvatori G, Tarantino A, Tiozzo E, Giusti A. Breastfeeding Protection, Promotion, and Support in Humanitarian Emergencies: A Systematic Review of Literature. J Hum Lact 2020; 36:687-698. [PMID: 32032499 DOI: 10.1177/0890334419900151] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [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: 11/16/2022]
Abstract
BACKGROUND Infants, young children, and their mothers are vulnerable in humanitarian emergencies. The health benefits of optimal breastfeeding practices in emergency settings have been demonstrated by many researchers. Infant and Young Children Feeding in Emergency guidelines illustrate a series of interventions to protect, promote, and support breastfeeding, but unfortunately, these recommendations are still scarcely applied. RESEARCH AIMS (1) To review the literature describing the effectiveness of breastfeeding protection, promotion, and support interventions in humanitarian emergency contexts; (2) to describe the influence of interventions on breastfeeding initiation, exclusivity, and duration; and (3) to evaluate relevant mother and infant/child outcomes available in the literature. METHODS PubMed, CINAHL, Cochrane Library, Psychology Database, JSTOR, Web of Science, EMBASE, and Ovid were searched for articles that examined breastfeeding protection, promotion, or support interventions and the resulting outcomes without any time limits (N = 10). Articles that did not include the interventions and related outcomes were excluded (n = 1,391). RESULTS Improved breastfeeding outcomes were reported in four (40%) papers, and three (30%) highlighted a behavioral change in infant and young child feeding practices following the implementation of the interventions. Increased knowledge about appropriate infant and young child feeding practices among mothers and humanitarian/health staff was reported in eight (80%) papers. However, outcomes were sometimes only generically reported, and some of the included papers had a low strength of evidence. CONCLUSION In the literature, there is a great dearth of studies evaluating the influence of interventions aimed at improving breastfeeding in emergency settings. More evidence is urgently needed to encourage and implement optimal breastfeeding practices.
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Affiliation(s)
- Immacolata Dall'Oglio
- Health Professions Development, Continuing Education and Research Service, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Francesca Marchetti
- Department of Biomedicine and Prevention, Tor Vergata University, Rome, Italy
| | - Rachele Mascolo
- Health Professions Development, Continuing Education and Research Service, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Patrizia Amadio
- Department of Medical and Surgical Neonatology, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Orsola Gawronski
- Health Professions Development, Continuing Education and Research Service, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Maria Clemente
- Neonatology, Department of Life and Reproduction Science, University of Verona, Italy
| | - Andrea Dotta
- Department of Medical and Surgical Neonatology, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Federico Ferro
- Health Professions Development, Continuing Education and Research Service, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Antonio Garofalo
- Health Professions Development, Continuing Education and Research Service, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Guglielmo Salvatori
- Department of Medical and Surgical Neonatology, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Antonella Tarantino
- Department of Biomedicine and Prevention, Tor Vergata University, Rome, Italy
| | - Emanuela Tiozzo
- Health Professions Development, Continuing Education and Research Service, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
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Ista E, Scholefield BR, Manning JC, Harth I, Gawronski O, Bartkowska-Śniatkowska A, Ramelet AS, Kudchadkar SR. Mobilization practices in critically ill children: a European point prevalence study (EU PARK-PICU). Crit Care 2020; 24:368. [PMID: 32576273 PMCID: PMC7311184 DOI: 10.1186/s13054-020-02988-2] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Accepted: 05/12/2020] [Indexed: 11/11/2022] Open
Abstract
Background Early mobilization of adults receiving intensive care improves health outcomes, yet little is known about mobilization practices in paediatric intensive care units (PICUs). We aimed to determine the prevalence of and factors associated with physical rehabilitation in PICUs across Europe. Methods A 2-day, cross-sectional, multicentre point prevalence study was conducted in May and November 2018. The primary outcome was the prevalence of physical therapy (PT)- or occupational therapy (OT)-provided mobility. Clinical data and data on patient mobility, potential mobility safety events, and mobilization barriers were prospectively collected in patients admitted for ≥72 h. Results Data of 456 children admitted to one of 38 participating PICUs from 15 European countries were collected (456 patient days); 70% were under 3 years of age. The point prevalence of PT- and/or OT-provided mobility activities was 39% (179/456) (95% CI 34.7–43.9%) during the patient days, with significant differences between European regions. Nurses were involved in 72% (924/1283) of the mobility events; in the remaining 28%, PT/OT, physicians, family members, or other professionals were involved. Of the factors studied, family presence was most strongly positively associated with out-of-bed mobilization (aOR 7.83, 95% CI 3.09–19.79). Invasive mechanical ventilation with an endotracheal tube was negatively associated with out-of-bed mobility (aOR 0.28, 95% CI 0.12–0.68). Patients were completely immobile on 25% (115/456) of patient days. Barriers to mobilization were reported on 38% of patient days. The most common reported patient-related barriers were cardiovascular instability (n = 47, 10%), oversedation (n = 39, 9%), and medical contraindication (n = 37, 8%). Potential safety events occurred in 6% of all documented mobilization events. Conclusion Therapists are infrequently consulted for mobilization of critically ill children in European PICUs. This study highlights the need for a systematic and interdisciplinary mobilization approach for critically ill children. Graphical abstract ![]()
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Affiliation(s)
- Erwin Ista
- Pediatric Intensive Care Unit, Department of Paediatric Surgery, Erasmus Medical Center - Sophia Children's Hospital, P.O. Box 2060, 3000 CB, Rotterdam, The Netherlands. .,Nursing Science, Department of Internal Medicine, Erasmus Medical Center, Rotterdam, The Netherlands.
| | - Barnaby R Scholefield
- Birmingham Acute Care Research Group, Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK.,Paediatric Intensive Care Unit, Birmingham Women & Children's Hospital, Birmingham, UK
| | - Joseph C Manning
- Nottingham Children's Hospital & Neonatology, Nottingham University Hospitals NHS Trust, Nottingham, UK.,School of Health Sciences, The University of Nottingham, Nottingham, UK
| | - Irene Harth
- Pediatric Intensive Care Unit, Universitätsmedizin Mainz, Zentrum für Kinder- und Jugendmedizin, Mainz, Germany
| | - Orsola Gawronski
- Healthcare professional development Unit, Bambino Gesù Children's Hospital, Rome, Italy
| | | | - Anne-Sylvie Ramelet
- Institute of Higher Education and Research in Healthcare, University of Lausanne and Lausanne University Hospital, Lausanne, Switzerland
| | - Sapna R Kudchadkar
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA.,Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA.,Department of Physical Medicine & Rehabilitation, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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Biagioli V, Dall'Oglio I, Heller A, Carlin C, Biondi F, Gawronski O, Offidani C, Piga S, Pol A, Stelitano R, Tiozzo E, Raucci U, Cirulli BL, Reale A, Raponi M. [Paediatric patients who access the Emergency Department for non-urgent visits and use of community services]. Assist Inferm Ric 2019; 38:174-182. [PMID: 31834302 DOI: 10.1702/3273.32394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
UNLABELLED . Paediatric patients who access the Emergency Department for non-urgent visits and use of community services. INTRODUCTION Overcrowding in emergency departments, often due to the high number of patients who access for non-urgent visits, leads to serious problems concerning also the quality of care. AIM To investigate if and how parents who access a second level Emergency Department for non-urgent pediatric visits use community services. METHODS From 11 July to 16 September 2018 a 40-item paper and pencil questionnaire was administered to parents of children aged 0 to 6 years who received a non-urgent code for access to the Emergency Department. RESULTS Parents of 83 patients (males=62.7%, mean age=2 years±1.77) were enrolled. Most of them accessed the emergency departments because of their child's fever (n=31, 21.8%), for symptoms occurred more than 24 hours before (n=51, 61.4%). Most participants reported to consult sometimes/always the family pediatrician (n=72, 86.8%) but to hardly ever/never use the other health services available in the community. Parents need to receive more education regarding the management on the most typical symptoms in children, such as fever and skin rashes, or some minor frequent treatments. CONCLUSIONS Parents who access the Emergency Department for non-urgent visits rarely use or know the community health services, which could help them in managing their child's health conditions.
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Tiozzo E, Marchetti A, Nicolai I, Fosco C, Dall'Oglio I, Gawronski O, Guerrieri S, Spagnul C, Rubei D, Ciaralli I, Raponi M. Counseling for pediatric patients undergoing hematopoietic stem cell transplantation and their parents: A pilot descriptive study. Prof Inferm 2019; 72:213-220. [PMID: 31883572] [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: 06/10/2023]
Abstract
PURPOSE This study aimed to: (1) to assess the Quality of Life (QoL) of pediatric patients who had undergone Hematopoietic Stem Cell Transplantation (HSCT) and their parents; (2) to explore how patients and parents perceived a nurse counseling intervention; and (3) to explore how health professionals consider the nurse counselor's role. METHODS This was a pilot descriptive study using quantitative and qualitative data. RESULTS Parents' QoL was compromised in the domains of Social Functioning, Physical and Emotional roles. Patients' QoL was poor in all the domains except in Behavior and Family Cohesion. Patients and their parents considered the counseling as an effective help. Seven categories emerged from the analysis of qualitative data: support and taking charge, empathy, active communication and listening, evasion, sharing, awareness, and organizational availability. Regarding health professionals, five categories emerged from the analysis of the interviews and a focus group: support and taking charge, recovery in self-expression, support in relationship with patients and family, connecting role, and difficult integration within the team. CONCLUSIONS The nurse counselor could empower patients and parents to improve their attitudes towards care pathway. The nurse counselor can be an important resource in the context of HSCT, even if greater integration within the team is required.
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Affiliation(s)
- Emanuele Tiozzo
- PedRN, MSN, Nursing and Allied Health Professional Development, Continuing Education and Research Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Anna Marchetti
- RN, MSN, PhD, Nursing and Allied Health Professional Development, Continuing Education and Research Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Isabella Nicolai
- PedRN, MSN-Counselling, Oncology and Hematology Department Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Carla Fosco
- PedRN,MSN-Counselling Medical-Surgical Department of Pediatric Cardiology, Bambino Gesù Children's Hospital, IRCCS, Rome
| | - Immacolata Dall'Oglio
- PedRN, MSN, PhD, Nursing and Allied Health Professional Development, Continuing Education and Research, Bambino Gesù Children's Hospital, IRCCS, Rome
| | - Orsola Gawronski
- RN, MSN, PhD, Nursing and Allied Health Professional Development, Continuing Education and Research Bambino Gesù Children's Hospital, IRCCS, Rome
| | - Sara Guerrieri
- RN, Hepatology and Gastroenterology Unit, Bambino Gesù Children's Hospital, IRCCS, Rome
| | - Chiara Spagnul
- RN, Pediatrics Unit Gesù Children's IRCCS, Rome, Italy Bambino Hospital
| | - Desiree Rubei
- PedRNOncology and Hematology Unit Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Italo Ciaralli
- PedRN, Oncology and Hematology Department, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Massimiliano Raponi
- MD, Medical Directorate, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
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Fagioli D, Evangelista C, Gawronski O, Tiozzo E, Broccati F, Ravà L, Dall'Oglio I. Pain assessment in paediatric intensive care: the Italian COMFORT behaviour scale. Nurs Child Young People 2019; 30:27-33. [PMID: 30457241 DOI: 10.7748/ncyp.2018.e1081] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/11/2018] [Indexed: 11/09/2022]
Abstract
BACKGROUND Assessment of pain in paediatric intensive care units (PICUs) is crucial to minimise the risks of inadequate sedation. AIM To translate and validate the Italian version of the COMFORT behaviour scale (CBS) in a PICU in terms of its psychometric, construct, feasibility and reproducibility properties. METHOD Before and after tracheal suctioning, 71 observations were performed on 35 sedated and mechanically ventilated patients in three PICUs. Pain and distress were assessed using the CBS and the Nurse Interpretation of Sedation Score (NISS). RESULTS Interrater agreement and interrater reliability were high before the procedure and moderate after (pre: 100%, Cohen's kappa = 1; post: 79%, Cohen's kappa = 0.558). The scale's internal consistency was calculated before and after the procedure (Cronbach's alpha = 0.81 and 0.91). Agreement between the CBS and the NISS was low before and after the procedure (20% and 28%). The agreement between the tools was low because the NISS, a tool based on expert opinion, is not as precise as the CBS and could be affected by cultural biases. CONCLUSION The Italian version of the CBS proved to be valid and reproducible for the objective measurement of pain and distress in a wide age range of patients admitted to PICUs.
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Affiliation(s)
- Daniele Fagioli
- Clinical pharmacy unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Costanza Evangelista
- Respiratory unit, University Department of Paediatrics, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Orsola Gawronski
- Professional development, continuing education and nursing research service, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Emanuela Tiozzo
- Continuing education and nursing research service, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Francesca Broccati
- Emergency department, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Lucilla Ravà
- Clinical epidemiology unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Immacolata Dall'Oglio
- Professional development, continuing education and nursing research service, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
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- Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
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Dall'Oglio I, Mascolo R, Tiozzo E, Portanova A, Fiori M, Gawronski O, Dotta A, Piga S, Offidani C, Alvaro R, Rocco G, Latour JM. The current practice of family-centred care in Italian neonatal intensive care units: A multicentre descriptive study. Intensive Crit Care Nurs 2019; 50:36-43. [DOI: 10.1016/j.iccn.2018.07.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2018] [Revised: 07/08/2018] [Accepted: 07/09/2018] [Indexed: 10/28/2022]
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Fagioli D, Evangelista C, Gawronski O, Tiozzo E, Broccati F, Ravà L, Dall'Oglio I, Antonielli G, Borgiani A, Cancani F, Monoscalco M, Zambrini C, Stoppa F. Correction: Pain assessment in paediatric intensive care: the Italian COMFORT behaviour scale. Nurs Child Young People 2018; 30. [PMID: 31468800 DOI: 10.7748/ncyp.2018.e1081_crt] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
[This corrects the article DOI: 10.7748/ncyp.2018.e1081.].
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Dall'Oglio I, Di Furia M, Tiozzo E, Gawronski O, Biagioli V, Di Ciommo VM, Paoletti S, Bianchi N, Celesti L, Raponi M, Antonielli G, Baronio B, Bergami A, Cianchi D, Ciliento G, Vittoria Di Toppa M, Fabbiani A, Fagioli D, Frillici C, Guerrieri S, Lazo J, Madeddu R, Molinari F, Niccolò R, Padrini S, Paolucci F, Pomponi M, Ragni A, Tramutola P, Ventura M. Practices and Perceptions of Family Centered Care among Healthcare Providers: A Cross-sectional Study in a Pediatric Hospital. J Pediatr Nurs 2018; 43:e18-e25. [PMID: 30139704 DOI: 10.1016/j.pedn.2018.07.015] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [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: 04/13/2018] [Revised: 07/26/2018] [Accepted: 07/30/2018] [Indexed: 10/28/2022]
Abstract
PURPOSE This study aimed to: (1) investigate the extent to which Family Centered Care (FCC) principles are currently applied in clinical practice by healthcare providers working in inpatient units; (2) evaluate the extent to which FCC principles are perceived as necessary; and (3) examine the associations between FCC principles and socio-demographic and job characteristics of participants. Design and Methods A cross-sectional study was conducted at a large pediatric hospital using the Italian version of the FCC Questionnaire Revised (FCCQ-R). Univariate and multivariate analyses were performed. RESULTS Data from 469 healthcare providers were used for analysis. Scores for the FCC daily practices (Current activities) were significantly lower than those for their perceived necessity (Necessary activities) (p < .001). Participants who were male, younger, with work experience >20 years and working in rehabilitation reported a significantly higher perception of Current activities of FCC than others. The older and the more educated the participants, the greater was the perceived necessity of FCC activities. Female, older, and less experienced participants employed by the hospital but not working in the rehabilitation setting perceived a greater gap between Necessary and Current activities of FCC. CONCLUSIONS Scores for the Current and Necessary activities of FCC were lower than those reported in other studies. The lower scores in the Current activities and the significant gap can be due to organizational barriers or lack of skills, but the lower scores in the Necessary activities should be interpreted as a deficit of knowledge about FCC. PRACTICE IMPLICATIONS There is a need for further education about FCC in order to increase its perceived relevance in clinical practice.
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Affiliation(s)
- Immacolata Dall'Oglio
- Nursing and Allied Health Professional Development, Continuing Education and Research Service, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy.
| | - Michela Di Furia
- Department of Emergency, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy.
| | - Emanuela Tiozzo
- Nursing and Allied Health Professional Development, Continuing Education and Research Service, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy.
| | - Orsola Gawronski
- Nursing and Allied Health Professional Development, Continuing Education and Research Service, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy.
| | - Valentina Biagioli
- Nursing and Allied Health Professional Development, Continuing Education and Research Service, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy.
| | - Vincenzo M Di Ciommo
- Unit of Clinical Epidemiology, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Silvia Paoletti
- Department of Emergency, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy.
| | - Natalia Bianchi
- Nursing and health allied professionals Service, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy.
| | - Lucia Celesti
- Hospitality and Family Services, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy.
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Dall'Oglio I, Vanzi V, Tiozzo E, Gawronski O, Biagioli V, Tucci S, Raponi M. Five Years of Journal Clubs With Pediatric Nurses and Allied Health Professionals: A Retrospective Study and Satisfaction Survey. J Pediatr Nurs 2018; 41:e2-e7. [PMID: 29551233 DOI: 10.1016/j.pedn.2018.03.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [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: 10/13/2017] [Revised: 03/03/2018] [Accepted: 03/03/2018] [Indexed: 10/17/2022]
Abstract
PURPOSE Journal Clubs (JCs) for nurses and allied health professionals have been held in an Italian pediatric hospital since April 2008. This study aimed to: examine what type of articles have been used during JCs across 5years; investigate the potential implications for clinical and organizational practice; assess the participants' satisfaction about JCs and their contribution to professional development. DESIGN AND METHODS Using a retrospective design, all articles proposed in the JCs were examined. Specific criteria were used to evaluate the implications for practice within the hospital, which were classified as direct or indirect. Using a cross-sectional design, 63 JCs participants were asked to express their opinion and satisfaction about the JC sessions attended. RESULTS Overall, 132 articles were analyzed: most of them focused on pediatric care (64.4%) and nursing (96.2%). Almost half of the articles (n=60, 45.6%) were appraised as having brought implications for clinical practice, both direct (58.3%) and indirect (41.7%). Forty-one participants (12 attendees; 29 active participants) completed a questionnaire about their opinion about JCs. Most of participants (80.5%) reported that the topics selected for the JCs were interesting and relevant to their everyday practice. CONCLUSIONS Multidisciplinary JCs were considered useful for clinical practice, improvement of the quality of care, and professional development. However, lack of pragmatism and the difficulty to bridge the gap between research and practice were reported as weaknesses. PRACTICE IMPLICATIONS JCs can represent a quality improvement strategy for promoting research utilization among health professionals and thereby improving the quality of care.
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Affiliation(s)
- Immacolata Dall'Oglio
- Professional Development, Continuing Education and Nursing Research Service, Bambino Gesù Children's Hospital, IRCCS, Piazza Sant'Onofrio 4, 00165 Rome, Italy.
| | - Valentina Vanzi
- University Department of Pediatrics, Bambino Gesù Children's Hospital, IRCCS, Piazza Sant'Onofrio 4, 00165 Rome, Italy.
| | - Emanuela Tiozzo
- Professional Development, Continuing Education and Nursing Research Service, Bambino Gesù Children's Hospital, IRCCS, Piazza Sant'Onofrio 4, 00165 Rome, Italy.
| | - Orsola Gawronski
- Professional Development, Continuing Education and Nursing Research Service, Bambino Gesù Children's Hospital, IRCCS, Piazza Sant'Onofrio 4, 00165 Rome, Italy.
| | - Valentina Biagioli
- Professional Development, Continuing Education and Nursing Research Service, Bambino Gesù Children's Hospital, IRCCS, Piazza Sant'Onofrio 4, 00165 Rome, Italy.
| | - Serena Tucci
- Specialist Pediatric Department, Bambino Gesù Children's Hospital, IRCCS, Piazza Sant'Onofrio 4, 00165 Rome, Italy.
| | - Massimiliano Raponi
- Medical Direction, Bambino Gesù Children's Hospital, IRCCS, Piazza Sant'Onofrio 4, 00165 Rome, Italy.
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Dall'Oglio I, Biagioli V, Graziosi F, Vanelli E, Tiozzo E, Gawronski O, D'Elpidio G, Buonomo E, Villani A, Raponi M. [Nurses with pediatricians in pediatric outpatient clinics:<BR>a survey on family pediatricians' opinions]. Assist Inferm Ric 2018; 36:135-143. [PMID: 28956869 DOI: 10.1702/2786.28222] [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] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
. Nurses with pediatricians in pediatric outpatient clinics: a survey on family pediatricians' opinions. INTRODUCTION Pediatric nurses next to family pediatricians could contribute to several activities, included limiting inappropriate access to the emergency room. AIM To describe the perceived benefit of the activities that could be performed by pediatric nurses in the pediatrician's clinic according to the opinion of family pediatricians. METHODS Pilot on-line survey with family pediatricians, using list of activities grouped in four areas: "Care of pediatric patients with illnesses and disabilities", "Health education", "Prevention of diseases" and "Coordination and organizational activities". For each activity a judgement of benefit (1= not useful at all; 6= very useful) was reported. RESULTS Overall, 178 family pediatricians participated in the survey; 55% of them were female, mean age was 55 years. They rated as very useful both the presence of a pediatric nurse in their clinic (mean 5.37+1.06) and would recommend it to a colleague (5.36+1.05). Health education was perceived as the most important area of activity (4.88+0.97). The more they considered useful the pediatric nurse in their clinic, the higher they rated relevant the activities of the pediatric nurse (r=0.60-0.70). Older and more experienced pediatricians found less useful educational (r=-0.19 p<0.05; r=-0.23 p<0.01) and prevention (r=-0.18 p<0.05; r=-0.24 p<0.01) activities compared to younger and less experienced pediatricians. CONCLUSIONS Pediatricians consider very helpful a pediatric nurse in their clinic, for clinical, educational and organizational activities.
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Dall'Oglio I, Mascolo R, Gawronski O, Tiozzo E, Portanova A, Ragni A, Alvaro R, Rocco G, Latour JM. A systematic review of instruments for assessing parent satisfaction with family-centred care in neonatal intensive care units. Acta Paediatr 2018; 107:391-402. [PMID: 29239021 DOI: 10.1111/apa.14186] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [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: 01/31/2017] [Revised: 09/27/2017] [Accepted: 12/06/2017] [Indexed: 12/15/2022]
Abstract
This systematic review synthesised and described instruments measuring parent satisfaction with the increasing standard practice of family-centred care (FCC) in neonatal intensive care units. We evaluated 11 studies published from January 2006 to March 2016: two studies validated a parent satisfaction questionnaire, and nine developed or modified previous questionnaires to use as outcome measures in their local settings. Most instruments were not tested on reliability and validity. CONCLUSION Only two validated instruments included all six of the FCC principles and could assess parent satisfaction with FCC in neonatal intensive care units and be considered as outcome indicators for further research.
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Affiliation(s)
- Immacolata Dall'Oglio
- Professional Development; Continuing Education and Nursing Research Service; Bambino Gesù Children's Hospital; IRCCS; Rome Italy
- Department of Biomedicine and Prevention; University of Rome Tor Vergata; Rome Italy
| | - Rachele Mascolo
- Professional Development; Continuing Education and Nursing Research Service; Bambino Gesù Children's Hospital; IRCCS; Rome Italy
| | - Orsola Gawronski
- Professional Development; Continuing Education and Nursing Research Service; Bambino Gesù Children's Hospital; IRCCS; Rome Italy
- Department of Biomedicine and Prevention; University of Rome Tor Vergata; Rome Italy
| | - Emanuela Tiozzo
- Professional Development; Continuing Education and Nursing Research Service; Bambino Gesù Children's Hospital; IRCCS; Rome Italy
| | - Anna Portanova
- Department of Medical and Surgical Neonatology; Bambino Gesù Children's Hospital; IRCCS; Rome Italy
| | - Angela Ragni
- Department of Medical and Surgical Neonatology; Bambino Gesù Children's Hospital; IRCCS; Rome Italy
| | - Rosaria Alvaro
- Department of Biomedicine and Prevention; University of Rome Tor Vergata; Rome Italy
| | - Gennaro Rocco
- Centre of Excellence for Nursing Scholarship of IPASVI Rome Nursing College; Rome Italy
| | - Jos M. Latour
- School of Nursing and Midwifery; Faculty of Health and Human Sciences; Plymouth University; Plymouth UK
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Dall'Oglio I, Fiori M, Tiozzo E, Mascolo R, Portanova A, Gawronski O, Ragni A, Amadio P, Cocchieri A, Fida R, Alvaro R, Rocco G, Latour JM. Neonatal intensive care parent satisfaction: a multicenter study translating and validating the Italian EMPATHIC-N questionnaire. Ital J Pediatr 2018; 44:5. [PMID: 29304879 PMCID: PMC5756347 DOI: 10.1186/s13052-017-0439-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2017] [Accepted: 12/11/2017] [Indexed: 11/18/2022] Open
Abstract
Background In Neonatal Intensive Care Units (NICUs), parent satisfaction and their experiences are fundamental to assess clinical practice and improve the quality of care delivered to infants and parents. Recently, a specific instrument, the EMpowerment of PArents in THe Intensive Care-Neonatology (EMPATHIC-N), has been developed in the Netherlands. This instrument investigated different domains of care in NICUs from a family-centered care perspective. In Italy, no rigorous instruments are available to evaluate parent satisfaction and experiences in NICU with family-centered care. The aim of this study was to translate and validate the EMPATHIC-N instrument into Italian language measuring parent satisfaction. Methods A psychometric study was conducted in nine Italian NICUs. The hospitals were allocated across Italy: four in the North, four in Central region, one in the South. Parents whose infants were discharged from the Units were enrolled. Parents whose infants died were excluded. Results Back-forward translation was conducted. Twelve parents reviewed the instrument to assess the cultural adaptation; none of the items fell below the cut-off of 80% agreement. A total of 186 parents of infants who were discharged from nine NICUs were invited to participate and 162 parents responded and returned the questionnaire (87%). The mean scores of the individual items varied between 4.3 and 5.9. Confirmatory factor analysis was performed and all factor loadings were statistically significant with the exception of item ‘Our cultural background was taken into account’. The items related to overall satisfaction showed a higher trend with mean values of 5.8 and 5.9. The Cronbach’s alpha’s (at domain level 0.73-0.92) and corrected item-total scale correlations revealed high reliability estimates. Conclusions The Italian EMPATHIC-N showed to be a valid and reliable instrument measuring parent satisfaction in NICUs from a family-centered care perspective. Indeed, it had good psychometric properties, validity, and reliability. Furthermore, this instrument is fundamental for further research and internationally benchmarking. Electronic supplementary material The online version of this article (10.1186/s13052-017-0439-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Immacolata Dall'Oglio
- Professional Development, Continuing Education and Nursing Research Service, Bambino Gesù Children's Hospital, IRCCS, IRCCS P.za Sant'Onofrio 4, 00165, Rome, Italy. .,Department of Biomedicine and Prevention, Tor Vergata, University of Rome, Rome, Italy.
| | - Martina Fiori
- Professional Development, Continuing Education and Nursing Research Service, Bambino Gesù Children's Hospital, IRCCS, IRCCS P.za Sant'Onofrio 4, 00165, Rome, Italy.,Plymouth University, Faculty of Health and Human Sciences, School of Nursing and Midwifery, Plymouth, UK
| | - Emanuela Tiozzo
- Professional Development, Continuing Education and Nursing Research Service, Bambino Gesù Children's Hospital, IRCCS, IRCCS P.za Sant'Onofrio 4, 00165, Rome, Italy
| | - Rachele Mascolo
- Professional Development, Continuing Education and Nursing Research Service, Bambino Gesù Children's Hospital, IRCCS, IRCCS P.za Sant'Onofrio 4, 00165, Rome, Italy
| | - Anna Portanova
- Department of Medical and Surgical Neonatology, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Orsola Gawronski
- Professional Development, Continuing Education and Nursing Research Service, Bambino Gesù Children's Hospital, IRCCS, IRCCS P.za Sant'Onofrio 4, 00165, Rome, Italy.,Department of Biomedicine and Prevention, Tor Vergata, University of Rome, Rome, Italy
| | - Angela Ragni
- Department of Medical and Surgical Neonatology, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Patrizia Amadio
- Department of Medical and Surgical Neonatology, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | | | - Roberta Fida
- Norwich Business School, University of East Anglia, Norwich, UK
| | - Rosaria Alvaro
- Department of Biomedicine and Prevention, Tor Vergata, University of Rome, Rome, Italy
| | - Gennaro Rocco
- Centre of Excellence for Nursing Scholarship, IPASVI Rome Nursing College, Rome, Italy
| | - Jos M Latour
- Plymouth University, Faculty of Health and Human Sciences, School of Nursing and Midwifery, Plymouth, UK
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Gawronski O, Parshuram C, Cecchetti C, Tiozzo E, Ciofi Degli Atti ML, Dall'Oglio I, Scarselletta G, Offidani C, Raponi M, Latour JM. Qualitative study exploring factors influencing escalation of care of deteriorating children in a children's hospital. BMJ Paediatr Open 2018; 2:e000241. [PMID: 29862330 PMCID: PMC5976135 DOI: 10.1136/bmjpo-2017-000241] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2017] [Revised: 04/20/2018] [Accepted: 04/29/2018] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND System-level interventions including rapid response teams and paediatric early warning scores have been designed to support escalation of care and prevent severe adverse events in hospital wards. Barriers and facilitators to escalation of care have been rarely explored in paediatric settings. AIM This study explores the experiences of parents and healthcare professionals of in-hospital paediatric clinical deterioration events to identify factors associated with escalation of care. METHODS Across 2 hospital sites, 6 focus groups with 32 participants were conducted with parents (n=9) and healthcare professionals (n=23) who had cared for or witnessed a clinical deterioration event of a child. Transcripts of audio recording were analysed for emergent themes using a constant comparative approach. FINDINGS Four themes and 19 subthemes were identified: (1) impact of staff competencies and skills, including personal judgement of clinical efficacy (self-efficacy), differences in staff training and their impact on perceived nursing credibility; (2) impact of relationships in care focusing on communication and teamwork; (3) processes identifying and responding to clinical deterioration, such as patient assessment practices, tools to support the identification of patients at risk and the role of the rapid response team; and (4) influences of organisational factors on escalation of care, such as staffing, patient pathways and continuity of care. CONCLUSIONS Findings emphasise the considerable influence of social processes such as teamwork, communication, models of staff organisation and staff education. Further studies are needed to better understand how modification of these factors can be used to improve patient safety.
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Affiliation(s)
- Orsola Gawronski
- Continuing Education and Nursing Research Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy.,Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | - Christopher Parshuram
- Department of Critical Care Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Corrado Cecchetti
- Department of Critical Care Medicine, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Emanuela Tiozzo
- Continuing Education and Nursing Research Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | | | - Immacolata Dall'Oglio
- Continuing Education and Nursing Research Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy.,Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | - Gianna Scarselletta
- Department of Cardiology and Cardiac Surgery, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Caterina Offidani
- Medical Directorate, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | | | - Jos M Latour
- School of Nursing and Midwifery, Faculty of Health and Human Sciences, University of Plymouth, Plymouth, UK
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Dall'Oglio I, Fiori M, Di Ciommo V, Tiozzo E, Mascolo R, Bianchi N, Ciofi Degli Atti ML, Ferracci A, Gawronski O, Pomponi M, Raponi M. Effectiveness of an improvement programme to prevent interruptions during medication administration in a paediatric hospital: a preintervention-postintervention study. BMJ Open 2017; 7:e013285. [PMID: 28062470 PMCID: PMC5223703 DOI: 10.1136/bmjopen-2016-013285] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
OBJECTIVE To assess the effectiveness of an improvement programme to reduce the number of interruptions during the medication administration process in a paediatric hospital. DESIGN AND METHODS A prestudy-post study design was used to monitor nursing interruptions during medication cycles in a paediatric hospital. Interruptions were reported on an observation sheet (MADOS-P) adapted to the paediatric context. SETTING A 600-bed tertiary paediatric research hospital in Italy. INTERVENTION The interventions included a yellow sash worn by nurses during medication cycles, a yellow-taped floor area indicating the 'No interruption area', visual notices in the medication areas, education sessions for healthcare providers and families, patient and parent information material. RESULTS 225 medication cycles were observed before the intervention (T0) and 261 after the intervention (T1). The median of interruptions occurring in each cycle decreased significantly from baseline to postintervention (8.0 vs 2.0, p=0.002), as the rate ratios (interruptions/patient post-pre ratio: 0.34; interruptions/medication post-pre ratio: 0.37; interruptions/hour of medication cycle post-pre ratio: 0.53, p<0.001). During preintervention, the main causes of interruptions were 'other patients' (19.9%), 'other nurses' (17.2%) and 'conversation' (15.7%); during postintervention, they were 'other nurses' (26.1%), 'conversation' (18.2%) and 'other patients' (17.4%). CONCLUSIONS This bundle of interventions proved to be an effective improvement programme to prevent interruptions during medication administration in a paediatric context.
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Affiliation(s)
- Immacolata Dall'Oglio
- Professional Development, Continuing Education and Nursing Research Service, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Martina Fiori
- Professional Development, Continuing Education and Nursing Research Service, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | | | - Emanuela Tiozzo
- Professional Development, Continuing Education and Nursing Research Service, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Rachele Mascolo
- Professional Development, Continuing Education and Nursing Research Service, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Natalia Bianchi
- Nursing Service, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | | | | | - Orsola Gawronski
- Professional Development, Continuing Education and Nursing Research Service, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Manuel Pomponi
- Organization and Quality Nursing Service, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
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Gawronski O. Evidence-based paediatric nursing: paediatric early warning systems. Nurs Child Young People 2016; 28:53-54. [PMID: 27214413 DOI: 10.7748/ncyp.28.4.53.s29] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
In hospital cardiac arrest are rare events in paediatrics. Most children receive appropriate care without experiencing undetected severe clinical deterioration during hospital admission. Outcomes of paediatric cardiac arrests are however generally poor, with high mortality rates and neurological damage at survival. A review of child mortality in the UK showed that a high proportion of unexpected deaths were preventable ( Pearsons 2008 ). Several studies of patient records of children who suffered cardiac arrests showed the presence of clear signs of clinical deterioration up to 24 hours before (Tume 2006). Appropriate recognition of clinical deterioration could have led to timely intervention to stabilise the patient. Missed deterioration may be due to lack of staff situational awareness, communication failure among professionals or between staff and families and other human factors ( Brady 2014 ).
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Affiliation(s)
- Orsola Gawronski
- Certified in paediatrics, Bambino Gesù Children's Hospital (BGCH) IRCCS
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Gawronski O, Ciofi Degli Atti ML, Di Ciommo V, Cecchetti C, Bertaina A, Tiozzo E, Raponi M. Accuracy of Bedside Paediatric Early Warning System (BedsidePEWS) in a Pediatric Stem Cell Transplant Unit. J Pediatr Oncol Nurs 2015; 33:249-56. [PMID: 26497915 DOI: 10.1177/1043454215600154] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
Hospital mortality in children who undergo stem cell transplant (SCT) is high. Early warning scores aim at identifying deteriorating patients and at preventing adverse outcomes. The bedside pediatric early warning system (BedsidePEWS) is a pediatric early warning score based on 7 clinical indicators, ranging from 0 (all indicators within normal ranges for age) to 26. The aim of this case-control study was to assess the performance of BedsidePEWS in identifying clinical deterioration events among children admitted to an SCT unit. Cases were defined as clinical deterioration events; controls were all the other patients hospitalized on the same ward at the time of case occurrence. BedsidePEWS was retrospectively measured at 4-hour intervals in cases and controls 24 hours before an event (T4-T24). We studied 19 cases and 80 controls. The score significantly increased in cases from a median of 4 at T24 to a median of 14 at T4. The proportion of correctly classified cases and controls was >90% since T8. The area under the curve receiver operating characteristic was 0.9. BedsidePEWS is an accurate screening tool to predict clinical deterioration in SCT patients.
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Affiliation(s)
- Orsola Gawronski
- University of Tor Vergata, Rome, Italy Bambino Gesù Children's Hospital IRCCS, Rome, Italy
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