...Running Head: Research Critique Part 1 1 Research Critique Part 1 CLABSI in the Pediatric Oncology Population Cathy Frederick Grand Canyon University NRS-433V Introduction to Nursing Research October 11, 2015 Research Critique Part 1 2 Purpose of the Research This paper will perform a research critique on a qualitative research study published in the Infection Control and Hospital Epidemiology, March 2013, Vol. 34, No.3. The study was presented with contributions from multiple individuals, Dr. A. Gaur, Dr. D, Bundy, C. Gao, PhD, Dr. E. Werner, Dr. A. Billett, Dr. J. Hord, Dr. J. Siegel, Dr. D. Dickens, C. Winkle, RN., and Dr. M. Miller. The research was to identify the host and organism characteristics of the hospital-acquired condition, central line-associated bloodstream infections (CLABSIs) in pediatric hematology/oncology patients. Problem Statement CLABSIs increase the risk for increased mortality and morbidity, extended hospital stays, and raises the overall cost of healthcare. Children’s Hospital Association Hematology-Oncology Quality Transformation Collaborative Project (CHAHQTCP), was a qualitative research project that began on November 1, 2009 and ended July 31, 2011. This project was initiated to identify the contributing factors to blood stream infections (BSI) in pediatric hematology patients. The goal of this research was to reduce CLABSIs by 50%. To be included, the CLABSI needed occur 48 hours after being hospitalized or...
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...January 23, 2012 Table of Contents Authors.......................................................................................................................................... 3 Acknowledgments ......................................................................................................................... 4 Executive Summary ...................................................................................................................... 5 Provider Survey ......................................................................................................................... 6 Standards of Care Economic Model .......................................................................................... 7 Recommendations .................................................................................................................... 8 Care Management ................................................................................................................................ 8 Payment Reform ................................................................................................................................... 9 Workforce Supply ............................................................................................................................... 10 Background and Role of the Diabetes Working Group ............................................................... 12 Background ......................................................
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...A Case Review of EHR Implementation in a Pediatric Emergency Department Jennifer Juif Southern New Hampshire University A Case Review of EHR Implementation in a Pediatric Emergency Department Organizations face many challenges when implementing an electronic medical record (EHR) system. Quality, safety, and efficiency need to be maintained during implementation. The case study reviewed: Impact of electronic health record implementation on patient flow metrics in a pediatric emergency department (Kennebeck, Timm, Farrell, Sooner, 2012) attempted to quantify the effects of offloading low acuity patients and its impact on length of stay. Length of stay and volume of patients in an emergency department are correlated. The study was conducted in a pediatric emergency department (ER) in Cincinnati, Ohio. Prior to implementation, a plan was utilized to off load patients to a different area in the ER due to a surge from the H1N1 flu virus. This was successful in decreasing patient numbers and length of stay. The organization decided to use the same template for the EHR implementation. Despite its prior success, offloading patients did not improve efficiency or length of stay (LOS) during EHR implementation. The primary issue identified was the failure of offloading patients. The study stated, “During implementation only 5% of patients were diverted. During the H1N1 surge, 10-20% of patients were diverted.” (Kennebeck, Timm, Farrell, Spooner, 2012). The...
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... 2 Review and Classification of Evidence Source Type Appropriate Type of (American Academy of Pediatrics; American Academy of Family Physicians, 2004) or inappropriate Filtered Appropriate: This article establishes diagnosis and management guidelines for the treatment of AOM. Additionally, the authors make recommendations regarding treatment options for the symptoms of AOM and address the concept of watchful waiting as opposed to immediate antibiotic therapy. Recommendations are provided for clinical practice and were created using a systematic review of clinical research, making it an appropriate source for nursing practice. Research Evidence based guideline (Block, 1997) Unfiltered Appropriate: Primary research This article contains evidence up to date research...
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...Is becoming a Pediatric Hematologist/Oncologist worth the long years of training and hard work? Many of those whom choose to enter this field develop their initial interest as Pediatric residents experience the challenges and joys of caring for children and teenagers with complex disorders such as blood diseases and cancer. Students interested in becoming a Pediatric Hematologist/Oncologist, should understand the basic information about the pediatric's job description, working conditions, and the required training. Although radiation and surgeon oncologists may treat cancer in pediatric patients, the term '' pediatric oncologist '' refers to the physicians who have received further training in medical oncology and hematology after specializing in pediatric. Since pediatric oncologists treat children and teens, their focus is somewhat different than of medical oncologists who treat adults. Patients of the pediatrics are not usually afflicted by the wide variety of cancers that are commonly seen in adult patients, therefore pediatric oncologists may deal with fewer cancer cases and more genetic hematologic disorders. Most hematologic disorders (sickle-cell disease, hemophilia, von Willebrand disease, leukemia, lymphoma, and embryonic tumors) occurring during infancy, childhood, and adolescence are uncommon and require a highly sophisticated approach to diagnosis and treatment based on molecular and cellular biology, and other academic disciplines. The rapid and impressive progress...
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...According to Mahlmeister (1996), each nurse should own a copy of the ANA code, as this document can provide guidance on situations that nurses face on an almost daily basis. For example, consider a situation that may result from one hospital trying to institute policies concerning cost containment. In order to keep the cost down, the nurse in charge of a 7 bed unit (without a nurse's assistance) is expected under a restructuring plan to also work a second adult ward if there are fewer than three children on the pediatric unit during the night shift (Mahlmeister, 1996). This split shift leaves these pediatric patients unattended while the nurse is in the adult ward. The ANA Code of Ethics states that it is the nurse's responsibility "to safeguard the client and the public when health care and safety are affected by incompetent, unethical or illegal practice of any person" (Mahlmeister, 1996, p. 130). Even though this nurse was ordered by a manager to leave the pediatric setting, the nurse is personally accountable for his or her actions for any situation that may arise during this absence. Not only is this practice unacceptable professionally, but it is also problematic legalistically, as the nurse could be personally sued for any negative consequences to these patients (Mahlmeister, 1996). Therefore, it is the nurse's duty to recognize these unacceptable risks and exhaust all avenues available within the hospital to correct this requirement (Mahlmeister, 1996). Another problematic...
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...According to Mahlmeister (1996), each nurse should own a copy of the ANA code, as this document can provide guidance on situations that nurses face on an almost daily basis. For example, consider a situation that may result from one hospital trying to institute policies concerning cost containment. In order to keep the cost down, the nurse in charge of a 7 bed unit (without a nurse's assistance) is expected under a restructuring plan to also work a second adult ward if there are fewer than three children on the pediatric unit during the night shift (Mahlmeister, 1996). This split shift leaves these pediatric patients unattended while the nurse is in the adult ward. The ANA Code of Ethics states that it is the nurse's responsibility "to safeguard the client and the public when health care and safety are affected by incompetent, unethical or illegal practice of any person" (Mahlmeister, 1996, p. 130). Even though this nurse was ordered by a manager to leave the pediatric setting, the nurse is personally accountable for his or her actions for any situation that may arise during this absence. Not only is this practice unacceptable professionally, but it is also problematic legalistically, as the nurse could be personally sued for any negative consequences to these patients (Mahlmeister, 1996). Therefore, it is the nurse's duty to recognize these unacceptable risks and exhaust all avenues available within the hospital to correct this requirement (Mahlmeister, 1996). Another problematic...
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...According to Mahlmeister (1996), each nurse should own a copy of the ANA code, as this document can provide guidance on situations that nurses face on an almost daily basis. For example, consider a situation that may result from one hospital trying to institute policies concerning cost containment. In order to keep the cost down, the nurse in charge of a 7 bed unit (without a nurse's assistance) is expected under a restructuring plan to also work a second adult ward if there are fewer than three children on the pediatric unit during the night shift (Mahlmeister, 1996). This split shift leaves these pediatric patients unattended while the nurse is in the adult ward. The ANA Code of Ethics states that it is the nurse's responsibility "to safeguard the client and the public when health care and safety are affected by incompetent, unethical or illegal practice of any person" (Mahlmeister, 1996, p. 130). Even though this nurse was ordered by a manager to leave the pediatric setting, the nurse is personally accountable for his or her actions for any situation that may arise during this absence. Not only is this practice unacceptable professionally, but it is also problematic legalistically, as the nurse could be personally sued for any negative consequences to these patients (Mahlmeister, 1996). Therefore, it is the nurse's duty to recognize these unacceptable risks and exhaust all avenues available within the hospital to correct this requirement (Mahlmeister, 1996). Another problematic...
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...Chairman of Neurology and Director of Acute Stroke and TeleStroke Services meant he had little time to chat, Farrell used the near-collision as an opportunity to quickly mention a recent conversation with a nurse from Falmouth Hospital on Cape Cod. An active participant in the TeleStroke service, Falmouth Hospital was regularly honored for its adherence to best practices in stroke care. “Recently some Falmouth nurses asked how we can convince other MGH departments—such as in critical-care pediatrics—to provide similar telemedicine consultation services,” Farrell stated, adding “Their nurse stroke coordinator, Jean Estes, is a huge cheerleader for TeleStroke.” Dr. Schwamm continued moving toward his office as he replied, No tC Shawn, don’t we already have too much to do? I need to see patients, complete the analysis for a study I am working on, submit a grant application. Next week I will speak at an international neurology conference. Telemedicine can certainly be invaluable in many clinical domains, but there just are not enough hours in the day for us to get involved beyond stroke care. Before entering his office and shutting his door, Dr. Schwamm added one last remark: “We can’t do everything, Shawn—but we can do TeleStroke very well.” Shawn Farrell was not a medical doctor. A graduate of the Boston University School of Management, he had worked as an operational manager in several Boston area hospitals...
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...emergency department are often subjected to painful and anxiety-producing procedures, both for diagnostic purposes and for treatment of symptoms. Historically, pediatric patients have not been afforded the same level of care as adults with regard to the management of procedural pain. Pain in the young child age group (1-7 years) has often been under-treated, resulting in increased fear of the healthcare setting and postponement of necessary immunizations and procedures by the patients and parents. Close examination of the concept of pain – specifically, procedural pain in the young child age group in the emergency department (ED) setting, is necessary for understanding how nursing practice may be improved in order to produce a more positive patient experience. A thoughtful review of current literature will provide insight into the concept of pediatric pain, permitting a detailed analysis. This analysis will assist in the formulation of theoretical and operational definitions of the concept for use in further study. Review of Literature A review of literature was conducted to compare and contrast views of the concept of pain across multiple disciplines. The disciplines chosen are nursing, psychology, and pharmacology due to their close multidisciplinary relationship regarding the concept, assessment, and treatment of pediatric procedural pain in the young child age group. Nursing Discipline Original research conducted by Nilsson, Hallqvist, Sidenvall, and Enskar (2011) explores...
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...Appendices: i. SECAMB Clinical Management Plan/Patient Group Directive ii. FIGURE 3 - Thompson et al (2009) A review of evidence supporting the use of Antibiotics in the treatment of Acute Otitis Media in children to prevent Mastoiditis. Student no 18830 Rationale The Paramedic Practitioner (PP) role has recently adopted a number of Clinical Management plans and Patient Group Directives (PGD) increasing the scope of practice. One such PGD (Appendix i) allows for the utilisation of antibiotics, namely Amoxicillin and Clarithromycin, for the treatment of Otitis Media (OM). This essay will look at the evidence supporting the use of these antibiotics, their efficacy and if early use prevents OM from developing in to Mastoiditis. Its primary aim is to enhance a PP’s knowledge and support education working towards clinical autonomy. Description Otitis Media literally means inflammation of the middle ear (Merriam-Webster 2011) and is predominantly caused by an effusion with in the middle ear caused by Eustachian tube dysfunction (Dhillon and East, 1994, pp 7). This dysfunction is caused by a relative obstruction of the Eustachian tube that creates a negative air pressure within the middle ear. Over time interstitial fluid is drawn in from the surrounding tissue resulting in the effusion (Natal 2011). Eustachian tube dysfunction often follows an upper respiratory tract infection and whilst the effusion is not always infectious it is can be...
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...Pediatric Chiropractic Care: Scientifically Indefensible? Published by Sam Homola under Chiropractic,Science and Medicine Comments: 37 In a paper published in 2008, two academic chiropractors offered this observation: “The health claims made by chiropractors with respect to the application of manipulation as a health care intervention for pediatric health conditions continue to be supported by only low levels of scientific evidence. Chiropractors continue to treat a wide variety of pediatric health conditions.”1 Despite lack of support by the medical and scientific community, chiropractic treatment of children is growing in popularity, and more chiropractors are specializing in “chiropractic pediatrics.” The International Chiropractic Association offers a post-graduate “Diplomate in Clinical Chiropractic Pediatrics” (DICCP) and publishes a “peer reviewed” Journal of Clinical Chiropractic Pediatrics. The diplomate syllabus is a 30-module, 360+ hours classroom course during weekends over a three-year period. There is no hospital training and no contact with diseased or injured children — only a “mandatory observational/training weekend at a chiropractic center for special needs children under multi-disciplinary care.”2 A post-graduate certification in chiropractic pediatrics (CICCP) can be earned after 180 hours of classroom instruction. In a June 2008 joint press release, the American Chiropractic Association’s (ACA) Council on Chiropractic Pediatrics and the Council...
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...Basically primary care consists of i) medical care (family physicians/primary care doctors); ii) district care (district nurses and midwives); and iii) social care (social workers). Medical care and district care together are primary health care (PHC). Social care is organized, managed and financed by local communities and since the beginning of the 90-ties is separated from health care. Social care tasks are focusing on support of inhabitants of local communities in case of poverty and are to prevent exclusion. Social care includes activities such as analyses of the local environment, the economical status of community members and making decisions on financing or co-financing of help measures requested by individuals. The social care budget is also playing a role in financing health services for the unemployed (from the central budget) and the homeless/uninsured (from the local community budget). From the central social care budget money flows to the National Health Fund (NFZ), which is the central insurance institution in Poland, and is further disseminated among the 16 regions of Poland in which branches of NFZ are located. From the local community budget, moneys are paid directly to selected health care units. Due to the yet unfinished implementation of family medicine, primary health care in Poland consists of two dimensions or care models: the old Semashko model with its group out-patient units and the family medicine model. Nowadays both dimensions have equal representation...
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...The Norwegian Version of the Pediatric Nurses’ Knowledge and Attitudes Survey Regarding Pain: Reliability and Validity Kari Raaum Hovde, Tone Høilo Granheim, Knut-Andreas Christophersen, Alfhild Dihle P ain in children is still both under-estimated and under-treated (Bell et al., 2009; Liossi, 2006; Stinson, Yamada, Dickson, Lamba, & Stevens, 2008; Zempsky, Cravero, & the Committee on Pediatric Emergency Medicine and Section of Anesthesiology and Pain Medicine, 2004). Inadequate treatment of pain in children may cause many negative psychological and physiological consequences, such as fear and anxiety, post-traumatic stress disorder, increased risk of infections, and delayed wound healing. In addition, poor pain control may result in increased length of stay in the hospital, contribute to the development of chronic pain, and even lead to death (American Academy of Pediatrics [AAP] & American Pain Society [APS], 2001; Liossi, 2006; Schechter, Berde, & Yaster, 2003; Vincent, 2005; Zempsky et al., 2004). The purpose of this study was to evaluate the reliability and validity of the Norwegian version of the Pediatric Nurses’ Knowledge and Attitudes Survey Regarding Pain (PNKAS-N) in nurses who work with children in pain. The PNKAS was translated into Norwegian in accordance with international guidelines and pilot tested with 10 nurses. The reliability was estimated using Cronbach’s alpha coefficient and the test-retest method using Pearson’s r coefficient. Construct validity...
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...Pediatric Incision Care Abstract This paper explores several articles that show results about wound care education research and its effects throughout the world. It also provides information about a case study based on this type of research. The case study included an interview process and a presentation to the client. An important component of this research includes providing education specifically to parents or guardians of the pediatric population which include patients aged from zero to eighteen years of age. Since clients are often unaware of the appropriate interventions following incision care treatments, it is important to discuss and instruct them about the correct methods of providing care after a procedure. Keywords: wound care education, knowledge and skill of wound care, patient education, wound infection Wound Care Education Patients or caretakers of pediatrics patients are often unaware of how to care for incisions after medical procedures. Nurses are responsible for educating patients on the effects and complications of these treatments. Since wound infection has been attributed to many incision procedures, it is crucial that clients improve their knowledge and skills to reduce this type of infection when sent home. According to the Journal of Clinical Nursing, after providing a wound care program to 89 participants, there was greater understanding, skills, and satisfaction from the group who was provided the program than from those without the education...
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