Thesis (M.S.)--Boston University

Experiences of women regarding unexpected neonatal resuscitation were studied in this research. The objective of the study was to explore and describe the experiences of labouring women whose babies required unexpected resuscitation at birth. Recommendations were made based on the findings of the study. Labour and birth do not always go as well as expected as deviations could happen at any of the four stages of labour. Midwives tend to focus on the neonate when resuscitation is needed and leave the mother unattended and wondering what is happening as they rush away with the neonate. The situation motivated the researcher to conduct the study. The focus was on the experience of during the time of resuscitation. The study is qualitative, and exploratory, descriptive, contextual and narrative research approaches were used to reach the objective. The research population included women who delivered in the identified site from six hours to six weeks post delivery period. Inclusion criteria were the following: Women must have attended antenatal care at least four times. Their pregnancies were categorized as low risk. The ages of the women were 18-35 years. Gestational age was 38-41 weeks. The neonate should have been resuscitated successfully and admitted for observation in the nursery. Non-probability, purposive sampling was used. Data was collected by conducting semi-structured one-on-one interviews using a tape recorder. The site for the study was a public hospital, and the managers and operational midwives were used as gatekeepers. Fifteen participants gave permission to participate in the study willingly and were interviewed individually and anonymously. The interviews were transcribed, and Creswell’s data analysis spiral image was used. The period for data collection was seven months in one academic year. An independent coder’s services were utilized to increase the trustworthiness of the findings. The trustworthiness of the study was also ensured by conforming to Lincoln and Guba’s model of trustworthiness. Strategies used to ensure trustworthiness were credibility, transferability, dependability and conformability. The researcher maintained the ethical standards for conducting research by adhering to ethical principles, such as human rights, beneficence and justice. Confidentiality was maintained by using numbers instead of names, and only the researcher knows the participants’ names. Only the researcher, supervisor and the independent coder have access to the information. The data is kept in a locked cabinet and will be kept for the next five years following the publication of results. Two main themes emerged from the data analysis with each having two sub-themes Mothers verbalized varying emotions regarding their neonates’ inability to breathe properly. Mothers verbalized the importance of receiving support and information from midwives. To optimise the discussion of research findings, direct quotes were used from the raw data of interviews to support the description of experiences. Recommendations for midwives were to prepare the pregnant women during antenatal care for unexpected emergencies during labour and to reinforce this information on admission when labour commences. Managers are to update the guidelines on maternity care and the health education checklist. Nursing schools should train student midwives in debriefing and counselling skills. Both study objectives were successfully met.

The delivery process of the intravenous (IV) medication, one of the activities of greater responsibility of the nursing team, has a high incidence in child care in urgent and emergency situation. This process is considered highly complex and when not planned, controlled and monitored through indicators is exposed to unpredictable results affecting the quality of care. The objective was to evaluate the nursing practice in drug administration in child trough IV. Exploratory, descriptive, observational, quantitative study. It was developed in the urgency and emergency department in a pediatric referral hospital of the municipal sphere of Fortaleza. The study population consisted of 69 nurses whom participated in the drug administration via IV process that was in work schedules during the study period in the investigated unit. The sample of professionals was composed by 36 licensed practice nurses and 2 nurses. For the number of observations, it was considered the calculation for finite population with a total of 327 observations of intravenous medication delivery process. Interviews were carried out for data collection with the nursing staff and systematic observation of drug delivery process in children via IV. For data collection interviews were performed with the nursing staff and systematic observation by IV drug delivery process in children, considering seven stages, namely: medical prescription reading, hand hygiene, preparation of material and medication , guidance on the procedure, puncture technique and administration of the drug. Such steps have the total 47 shares. The data was stored in a database produced on the Windows Excel 2010 and analyzed according to the literature. The study was approved by the Ethics Committee under CAAE protocol 34651314.7.0000.5054. It was found that in 15% of the observations nursing professionals did not understand the prescription due to illegible handwriting professional. In 78.0% of the time there was no hand hygiene. It was found that all professionals used personal protective equipment (cap and mask), but none used gloves. Among the 327 observations included: peripheral intravenous device most commonly used was the scalp 21 (63.3%); selection of dorsal hand veins arc (83.9%); success on the first attempt of venipuncture (82.6%); explains the procedure for child and /or guardian (5.5%); calms the child (82.6%); performs antisepsis of the skin at the site to be punctured with a swab with 70% alcohol (100%); awaits antiseptic evaporation to then continue the procedure (45.6%); proper disposal of the materials used during the procedure (89.3%); checks the prescription immediately after drug administration (86.8%). It was found unsatisfactory performance in 23 actions by IV drug administration process. Therefore, we suggest the development of training for nursing professionals about medication delivery process. / O processo de administraÃÃo de medicamento por via intravenosa (IV), uma das atividades mais importante da equipe de Enfermagem, possui alta incidÃncia na assistÃncia à crianÃa em situaÃÃo de urgÃncia e emergÃncia. Tal processo à considerado de alta complexidade e, quando nÃo planejado, controlado e monitorado por meio de indicadores, fica exposto à imprevisibilidade de seus resultados, interferindo na qualidade da assistÃncia. Objetivou-se avaliar a prÃtica de enfermagem no processo de administraÃÃo de medicamento por via IV na crianÃa. Trata-se de um estudo exploratÃrio, descritivo, observacional, de natureza quantitativa, desenvolvido no setor de urgÃncia e emergÃncia de um hospital pediÃtrico de referÃncia da esfera municipal de Fortaleza-CE. A populaÃÃo do estudo foi constituÃda por 69 profissionais de enfermagem que participaram do processo de administraÃÃo de medicamento pela via IV e que estavam nas escalas de trabalho durante o perÃodo do estudo na unidade investigada. A amostra dos profissionais foi composta por 36 tÃcnicos de enfermagem e 2 enfermeiros. Para o nÃmero de observaÃÃes, considerou-se o cÃlculo para populaÃÃo finita, com um total de 327 observaÃÃes do processo de administraÃÃo de medicamento por via IV. Para a coleta de dados realizou-se entrevista com a equipe de enfermagem e observaÃÃo sistemÃtica do processo de administraÃÃo de medicamento por via IV na crianÃa, considerando sete etapas, quais sejam: leitura da prescriÃÃo mÃdica, higienizaÃÃo das mÃos, preparo do material e medicaÃÃo, orientaÃÃo acerca do procedimento, tÃcnica de punÃÃo e administraÃÃo do medicamento. Tais etapas possuem ao total 47 aÃÃes. Os dados foram armazenados em um banco de dados produzidos no Excel do Windows 2010, analisados estatisticamente e de acordo com a literatura pertinente. O estudo foi aprovado pelo Comità de Ãtica sob parecer N0 805.953. Constatou-se que em 15% das observaÃÃes o profissional de enfermagem nÃo compreendeu a prescriÃÃo mÃdica devido à letra ilegÃvel do profissional. Em 78,0% das observaÃÃes nÃo houve a higienizaÃÃo das mÃos. Identificou-se que todos os profissionais utilizaram equipamento de proteÃÃo individual (gorro e mÃscara), entretanto nenhum utilizou luvas. Dentre as 327 observaÃÃes destacaram-se como dispositivo intravenoso perifÃrico mais utilizado o scalp n 21 (63,3%); escolha das veias do arco dorsal da mÃo (83,9%); Ãxito na primeira tentativa da punÃÃo venosa (82,6%); orientaÃÃo sobre o procedimento para crianÃa e/ou responsÃvel (5,5%); acalma a crianÃa (82,6%); realizaÃÃo de antissepsia da pele no local a ser puncionado com algodÃo embebido com Ãlcool a 70% (100%); aguarda a evaporaÃÃo do antissÃptico para em seguida dar prosseguimento ao procedimento (45,6%); descarte adequado dos materiais utilizados durante o procedimento (89,3%); checou a prescriÃÃo imediatamente apÃs a administraÃÃo do medicamento (86,8%). Concluiu-se desempenho insatisfatÃrio em 23 aÃÃes do processo de administraÃÃo de medicamento por via IV. Portanto, sugere-se o desenvolvimento de capacitaÃÃo para os profissionais de enfermagem acerca do processo de administraÃÃo de medicamento.

Background: More than 200,000 children are admitted annually to Pediatric Intensive Care Units (PICUs) in the US. Research has shown young children can provide insight into their hospitalization experiences; child reports rather than parental reports are critical to understanding the child’s experience. Information relating to children’s perceptions while still in the PICU is scarce. Aims: The purpose of this qualitative study was to investigate school age children’s and adolescents’ perceptions of PICU while in the PICU; changes in perceptions after transfer to the General Care Unit (GCU); differences in perceptions of school age children/adolescents and those with more invasive procedures. Methods: Interviews were conducted in PICU within 24-48 hours of admission and 24-48 hours after transfer to GCU. Data on demographics, clinical care and number/types of procedures were obtained. Results: Participants were 7 school age children, 13 adolescents; 10 Hispanic; 13 males. Five overarching themes: Coping Strategies, Environmental Factors, Stressors, Procedures/Medications, and Information. Children emphasized the importance of peer support and visitation; adolescents relied strongly on social media and texting. Parent visits sometimes were more stressful than peer visits. Video games, TV, visitors, and eating were diversional activities. In the PICU, they wanted windows to see outside and interesting things to see on the ceiling above them. Children expressed anticipatory fear of shots and procedures, frustration with lab work, and overwhelming PICU equipment. Number of child responses was higher in PICU (927) than GCU (593); the largest difference was in Environmental Factors. Variations between school age children and adolescents were primarily in Coping Strategies, especially in social support. Number of GCU procedures were the same (8 children) or greater (2 children) than PICU procedures. Discussion: Admission to PICU is a very stressful event. Perceptions from children while still in PICU found information not previously found in the literature. Longitudinal studies to identify children’s perceptions regarding PICU hospitalization and post-discharge outcomes are needed.

Introduction The problem at hand is understanding if pediatric acute lymphoblastic leukemia (ALL) treatment affects neurocognitive function or development. As the children battle ALL and are given treatments such as cranial radiation therapy and chemotherapy, they are having issues later on in life because the treatment regimens are very strong and are given during a crucial period of development. Purpose Statement and Question Does one pediatric treatment option affect neurocognitive development more than another later in life? Literature Review Research was conducted online via Google Scholar and East Tennessee State University Library database. Key terms used were pediatric ALL and neurocognitive effects of chemotherapy and radiation. Five studies were collected all pertaining to the question at hand. Findings The findings from the research collected was that certain demographics have a stronger effect on the development of a child post-ALL treatment. The treatment regimen and the strength of the treatment affect cognitive development. Cognitive impairment related to attention occurs with all children treated for ALL. Conclusion Nurses see first-hand the effects treatment have on children as the grow. We have to provide resources to help with attention deficits among other cognitive issues that result from treatment. The literature gave a great insight to what effects are to be expected post-treatment.

Purpose: To explore the decision-making experiences of and the supports provided to the parents of children with life-limiting conditions. Qualitative Study: A qualitative interpretive description study guided by the Ottawa Decision Support Framework was conducted. Interviews with parents and healthcare professionals revealed that parents made difficult healthcare decisions for their child and were prone to experiencing decisional conflict. Participants described a need for interprofessional support, guided decision support, and a preference for formal and informal support networks. Scoping Review: A scoping review was conducted. The three eligible studies revealed that parents require early and timely decision support provided by an interprofessional team of healthcare professionals and aided by a structured decision support intervention. Conclusions: Decisions made by parents of children with life-limiting conditions are complex. Healthcare professionals are required to facilitate appropriate decision support interventions for parents including a parent based support network.

Ensuring the safety and welfare of children has a lasting effect on society. As we progress to a more inclusive concept of what constitutes a family, the effect of same sex parenting (SSP) must be considered. Health related outcomes describing the advantages, disadvantages and unique challenges experienced by this population is surprisingly robust.

Pediatric oncology is known to be a stressful work environment due to the difficult aspects regarding patient care. This known stress related to work and caring for pediatric oncology patients can negatively impact nurses, patients, and families. The purpose of this study is to examine: relationships between patient symptom management and nurse distress; strategies used by nurses to manage symptoms in pediatric patients with cancer; nurse perceptions of the effectiveness of non-pharmacologic or nursing interventions; and nurse distress related to managing symptoms in pediatric patients with cancer. Registered nurses (N=13) at a local children’s hospital participated in an online survey. The survey included the Nurses’ Distress and Interventions for Symptoms Survey (NDISS) and the Stressor Scale for Pediatric Oncology Nurses (SSPON). Descriptive and correlation statistics were used to analyze data. Results showed that the most commonly managed symptoms were pain (100%), nausea/vomiting (100%), hair loss (100%), fatigue (92.3%), worry (92.3%), mouth sores (84.6%), and trouble sleeping (69.2%). On average, participants reported using at least 10 strategies to manage these symptoms. The most common strategies included: active listening, encouraging family involvement, family support, and reducing sleep interruptions. Most participants felt like they managed the symptoms effectively. Overall, the most common stressors for pediatric oncology nurses were related to co-workers (71.8%) and system demands (68.9%). There was no statistically significant relationship between symptom management and nurse distress. Further research should be conducted on the relationship between nurses and significant stressors other than symptom management. Identifying these significant stressors, especially related to co-workers and system demands, would be the first step in the development of appropriate interventions, such as supportive programs, for decreasing nurses’ stress response.

As of 2007, approximately 2 to 3 million children and adolescents in the United States had been identified as deaf or hard of hearing. These children are affected by all of the same health issues as hearing children, but are presented with an added challenge of communication with hearing nurses who are not always prepared with ways to understand and communicate with them. As a result, deaf and hard of hearing children are at a greater risk for misguided treatment of health disorders, especially the undertreatment of pain. It is imperative that nurses understand ways to best interpret nonverbal communication from these children and to effectively respond to these children nonverbally. Current research has neglected discovering and discussing ways to improve communication with deaf, hard of hearing and nonverbal children, focusing instead on improving verbal communication between nurses and parents, thereby leaving children as passive participants in their own health care. The results of this integrated literature review present simple and effective strategies nurses can implement into daily practice to facilitate communication nonverbally with deaf and hard of hearing children. The use of appropriate technology and assessment tools, better understanding and enhanced use of facial expressions, eye gaze, touch, presence, and personal space were examined. The writing of this review is an effort to encourage nurses and nursing educators to integrate culturally competent care of deaf and hard of hearing children into everyday nursing practice and into a nursing educational curriculum.

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