The purpose of this study was to elucidate the experiences of parents during their child's resuscitation in the hospital setting.
This qualitative descriptive study took place in a 280 bed children's ...hospital with parents whose children experienced resuscitation while they were present in the room or nearby. Semi-structured interviews were conducted between one and twelve months following a child's resuscitation. A rigorous thematic analysis was performed.
This study elucidates parent experience during a child's resuscitation using four overarching themes; “Overwhelming chaos”, “Getting through it”, “Cognitive presence” and “Joy mixed with heartache”. Parents described their experience to be stressful, yet identified things that helped them get through it and make sense of the experience.
During a child's resuscitation parents perceived a sense of overwhelming chaos, yet still had an innate need to be present and know what was going on. While emotional support was appreciated, most important was to receive real time clinical information from healthcare staff and to see and feel that the team was personally invested in their child.
During a child's resuscitation, parents should be allowed to choose their level of presence to meet their individual needs. A clinical staff member should answer questions and share clinical information with parents. In addition, clinicians should allow themselves to connect with parents on a personal level. This research provides a foundation for further study, including parents' experience after experiencing a child's resuscitation.
•Clinical information during resuscitation helps make sense of what is happening.•Some parents preferred clinical information over spiritual or emotional support.•Compassionate, connected care from clinical staff is valued.•Mothers in the delivery room feel unable to be “present” at the experience.
Understanding perceptions of parents is necessary to meet parents’ needs during a child’s resuscitation. Parent presence at pediatric resuscitations has been slow to become consistent practice in all ...hospital settings and remains controversial. The purpose of this integrative review was to synthesize research on parents’ experience while present during a child’s resuscitation to improve understanding for health care providers and to facilitate application in practice. Nine studies met inclusion criteria, identifying four major themes. Parents experienced conflicting emotions, articulated a need for communication and support, reported that being physically present was comforting, and described their reactions to the experience. The available research on parents’ experience during presence at their child’s resuscitation offers a foundation for further detailed study. Further study is needed about parents’ perspective of support needed while present during a child’s resuscitation, as well as about any long-term effects of presence on parent stress and coping.
•Participants described a thin and overtly muscular body as the female body ideal.•Athleisure connotates adherence to “health” and “fitness,” akin to fitspiration.•A person’s body type determines ...their access to athleisure; larger = less access.•Wearing athleisure encourages adherence to the athleisure lifestyle and body ideal.•Participants experienced cognitive dissonance about athleisure and body standards.
Clothes play a ubiquitous, yet under-appreciated social role. In the context of body image, clothes may both reflect and facilitate wearers’ ideals and anxieties about their physical appearance. Athleisure, referring to athletic-inspired workout apparel that explicitly accentuates wearers’ physiques, is a hitherto unexamined clothing trend worth tens of billions of dollars annually (and growing) in the United States consumer market alone. We conducted the first qualitative examination of athleisure by interviewing 20 women who regularly wore athleisure. Four master themes emerged from the data: (1) the athleisure lifestyle, (2) the conditional nature of athleisure, (3) athleisure embodiment, and (4) athleisure-linked cognitive dissonance. Our results suggest that wearing athleisure communicates to others an adherence to the lifestyles depicted in fitspiration – a class of social media imagery that glorifies thin-fit bodies. Participants articulated that athleisure encouraged them to feel more confident and athletic; athleisure also emphasized the women’s physiques, and whether they aligned with the thin-fit ideal. Thus, the act of wearing athleisure motivated participants to engage in fitspiration-based activities. Given the (a) massive public demand for athleisure, and (b) industry projections for continued growth in athleisure spending, our findings compel additional research on the connections between clothing and body image.
Abstract
Policy mandates consumer involvement in decisions at all levels of the mental health system. One barrier to this involvement is the expectation that consumers involved in systemic work ...represent broader consumer experiences. To examine how the rhetoric of ‘representation’ was used in relation to consumer involvement in mental health, a qualitative exploratory design was employed using interviews for data collection. Participants were consumers (n = 6) working with public or private mental health organizations in Australia, and colleagues (n = 3) or managers (n = 5) of these consumers. Discursive psychological principles informed the analytic process, to explore contexts in which ‘representativeness’ was used to empower and disempower consumers. The findings suggest there is a lack of clarity about what is meant by representation in the mental health sector. Expecting individual consumer leaders to be representative of consumer views more broadly disempowered them in their roles. Some participants instead discussed ways that organizations should be responsible for seeking representation from more consumer leaders, thus empowering consumers working in the sector. Using the term ‘representative’ to refer to consumers working in mental health does not reflect the value of the consumer perspective and is not well understood within the sector. Comprehensive training should be provided so that mental health service providers are clear regarding the expectations of people in these roles.
Abstract
The thalamus is a critical relay center for neural pathways involving sensory, motor, and cognitive functions, including cortico-striato-thalamo-cortical and ...cortico-ponto-cerebello-thalamo-cortical loops. Despite the importance of these circuits, their development has been understudied. One way to investigate these pathways in human development in vivo is with functional connectivity MRI, yet few studies have examined thalamo-cortical and cerebello-cortical functional connectivity in development. Here, we used resting-state functional connectivity to measure functional connectivity in the thalamus and cerebellum with previously defined cortical functional networks in 2 separate data sets of children (7–12 years old) and adults (19–40 years old). In both data sets, we found stronger functional connectivity between the ventral thalamus and the somatomotor face cortical functional network in children compared with adults, extending previous cortico-striatal functional connectivity findings. In addition, there was more cortical network integration (i.e. strongest functional connectivity with multiple networks) in the thalamus in children than in adults. We found no developmental differences in cerebello-cortical functional connectivity. Together, these results suggest different maturation patterns in cortico-striato-thalamo-cortical and cortico-ponto-cerebellar-thalamo-cortical pathways.
Children, caregivers, and clinicians often prefer midstream clean catch technique to urethral catheterization for obtaining urine cultures. However, contamination is common, potentially resulting in ...unnecessary medical intervention and cost. With this resident-led initiative, we aimed to reduce pediatric midstream clean catch urine culture contamination over 6 months.
A bundled intervention was implemented in the emergency department, inpatient units, and outpatient clinics at our institution. Baseline contamination rates were collected April 2016 to September 2017; the intervention was introduced October 2017 to March 2018 and evaluated April 2018 to September 2018. Sustainability was measured October 2018 to September 2020. Balancing measures included rates of repeat urine cultures, positive cultures, and contaminated cultures by urethral catheterization.
Rates of midstream clean catch urine culture contamination were 45.3% preintervention and 30.9% postintervention, a 14.7% (95% confidence interval: 8.0% to 21.5%) absolute decrease. Before and after intervention, girls and patients 16 to 17 years old had the highest rates of midstream clean catch contamination. Six months postintervention, the rate of repeat urine culture decreased from 4.9% to 0.9% with no change in positive culture results or contaminated cultures by urethral catheterization. Over the subsequent 2 years, the impact of the intervention decreased (rate of contamination over 30 months postintervention: 38.4%, a 7.3% 95% confidence interval: 2.9% to 11.6% absolute decrease; rate of repeat urine culture: 3.2%).
An intervention to improve midstream clean catch urine culture collection was associated with a clinically meaningful decrease in contamination. Impact of the resident-led intervention decreased over time.
Objective To determine the impact of tic severity in children with Tourette syndrome on parenting stress and the impact of comorbid attention-deficit hyperactivity disorder (ADHD) and ...obsessive-compulsive disorder (OCD) symptomatology on parenting stress in both children with Tourette syndrome and typically developing children. Study design Children with diagnosed Tourette syndrome (n = 74) and tic-free typically developing control subjects (n = 48) were enrolled in a cross-sectional study. Results Parenting stress was greater in the group with Tourette syndrome than the typically developing group. Increased levels of parenting stress were related to increased ADHD symptomatology in both children with Tourette syndrome and typically developing children. Symptomatology of OCD was correlated with parenting stress in Tourette syndrome. Parenting stress was independent of tic severity in patients with Tourette syndrome. Conclusions For parents of children with Tourette syndrome, parenting stress appears to be related to the child's ADHD and OCD comorbidity and not to the severity of the child's tic. Subthreshold ADHD symptomatology also appears to be related to parenting stress in parents of typically developing children. These findings demonstrate that ADHD symptomatology impacts parental stress both in children with and without a chronic tic disorder.
Paediatric fever is a common cause of emergency department (ED) attendance. A lack of prompt and definitive diagnostics makes it difficult to distinguish viral from potentially life-threatening ...bacterial causes, necessitating a cautious approach. This may result in extended periods of observation, additional radiography, and the precautionary use of antibiotics (ABs) prior to evidence of bacterial foci. This study examines resource use, service costs, and health outcomes.
We studied an all-year prospective, comprehensive, and representative cohort of 6518 febrile children (aged < 16 years), attending Alder Hey Children's Hospital, an NHS-affiliated paediatric care provider in the North West of England, over a 1-year period. Performing a time-driven and activity-based micro-costing, we estimated the economic impact of managing paediatric febrile illness, with focus on nurse/clinician time, investigations, radiography, and inpatient stay. Using bootstrapped generalised linear modelling (GLM, gamma, log), we identified the patient and healthcare provider characteristics associated with increased resource use, applying retrospective case-note identification to determine rates of potentially avoidable AB prescribing.
Infants aged less than 3 months incurred significantly higher resource use than any other age group, at £1000.28 95% CI £82.39-£2993.37 per child, (p < 0.001), while lesser experienced doctors exhibited 3.2-fold 95% CI 2.0-5.1-fold higher resource use than consultants (p < 0.001). Approximately 32.4% of febrile children received antibiotics, and 7.1% were diagnosed with bacterial infections. Children with viral illnesses for whom antibiotic prescription was potentially avoidable incurred 9.9-fold 95% CI 6.5-13.2-fold cost increases compared to those not receiving antibiotics, equal to an additional £1352.10 per child, predominantly resulting from a 53.9-h increase in observation and inpatient stay (57.1 vs. 3.2 h). Bootstrapped GLM suggested that infants aged below 3 months and those prompting a respiratory rate 'red flag', treatment by lesser experienced doctors, and Manchester Triage System (MTS) yellow or higher were statistically significant predictors of higher resource use in 100% of bootstrap simulations.
The economic impact of diagnostic uncertainty when managing paediatric febrile illness is significant, and the precautionary use of antibiotics is strongly associated with increased costs. The use of ED resources is highest among infants (aged less than 3 months) and those infants managed by lesser experienced doctors, independent of clinical severity. Diagnostic advances which could increase confidence to withhold antibiotics may yield considerable efficiency gains in these groups, where the perceived risks of failing to identify potentially life-threatening bacterial infections are greatest.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Kamishibai (K) cards are a quality improvement process focused on improved bundle compliance and promotion of peer-to-peer feedback that the health system has used for a few years.
Changing personnel ...structure and an emphasis on patient outcomes prompted a need to revamp the K Card process.
A team approach was used to redesign the process resulting in a program that moved from utilization of champions to engaging all bedside nurses and having a standard completion requirement for all units. In 2 phases spanning 16 weeks, the nurse managers, point-of-care educators, and all bedside nurses were trained in the process using a computer-based training module and validated in the application of the process.
By the end of the 16-week period, the completion compliance target was reached, and the system began to see a decrease in central line and Foley catheter device usage days.
The result of the project design was a peer-to-peer feedback mechanism, which promotes evidence-based practices and system standards.
Kamishibai Cards Stewart, Stephanie
Journal of nursing care quality,
10/2021, Letnik:
36, Številka:
4
Journal Article
Recenzirano
Background:Kamishibai (K) cards are a quality improvement process focused on improved bundle compliance and promotion of peer-to-peer feedback that the health system has used for a few ...years.Problem:Changing personnel structure and an emphasis on patient outcomes prompted a need to revamp the K Card process.Approach:A team approach was used to redesign the process resulting in a program that moved from utilization of champions to engaging all bedside nurses and having a standard completion requirement for all units. In 2 phases spanning 16 weeks, the nurse managers, point-of-care educators, and all bedside nurses were trained in the process using a computer-based training module and validated in the application of the process.Outcomes:By the end of the 16-week period, the completion compliance target was reached, and the system began to see a decrease in central line and Foley catheter device usage days.Conclusion:The result of the project design was a peer-to-peer feedback mechanism, which promotes evidence-based practices and system standards.
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