Background: The impact of malnutrition on pediatric patients in the acute care setting is significant. Hospitalized patients with malnutrition have been shown to have poor clinical outcomes. Nutrition screening is the first critical step in identifying and treating malnutrition. Although several pediatric nutrition screening tools exist, none incorporate both electronic health record (EHR) compatibility and the recommended indicators of pediatric malnutrition, a gap recently identified in a systematic review by the Academy of Nutrition and Dietetics. The aim of this study was to prove the validity of a new version of Screening Tool for the Assessment of Malnutrition in Pediatrics (STAMP), EHR-STAMP, modified for incorporation into the EHR and inclusion of updated pediatric malnutrition indicators. Methods: An interprofessional team modified the existing STAMP for integration into the EHR. Audits were performed by the research dietitian to assess accuracy and provide feedback for continuous improvement of the tool design. Results: A total of 3553 pediatric inpatients were studied from August 2017 to May 2019. Accuracy, sensitivity, and specificity improved with each modification to the EHR-STAMP. The final version of the EHR-STAMP found 85% accuracy, 89% sensitivity, and 97% specificity, with a positive predictive value of 60% and a negative predictive value of 94%. Conclusion: The EHR-STAMP is a highly reliable tool in the screening of nutrition risk for pediatric hospitalized patients. The tool is easy to use, EHR compatible, and incorporates the current indicators recommended for assessing pediatric malnutrition.
The number of children living with chronic, complex medical needs is steadily increasing secondary to advances in clinical technology and disease management. As a result, patient care requirements become multifaceted with the need for specific therapies and treatments that require extensive knowledge and skills. As these children are managed throughout the health care continuum, nurses are challenged to offer specialized care for complex conditions, while meeting the personnel and financial demands of the changing health care environment. It is well established that medically complex children can put a burden on family life, resulting in compassion fatigue for nonclinical caregivers. It is possible that, secondary to frequent and lengthy hospitalizations, nurses may also be affected. Therefore, a review of compassion fatigue or professional burnout in nurses caring for medically complex children was conducted. Appropriate identification of nurses at risk for compassion fatigue is imperative to provide the necessary interventions and support. Reducing compassion fatigue is likely to improve outcomes, including nursing turnover, nursing professional engagement, and job satisfaction, thus improving the care delivery experience for children with complex conditions.
The role of pediatric hospitals in the COVID-19 pandemic changed quickly. The team of clinical nurse specialists and clinical nurse educators in a large pediatric hospital were instrumental in the institutional response through simulations, serving as change agents, collaboration, and implementing systems thinking. Leveraging the expertise of this team during this historical and unprecedented time optimized patient and associate safety as part of a pediatric hospital's COVID-19 response. COVID-19 has introduced a "new normal" way of life, especially for nurses and all healthcare providers, with the challenge of maintaining safety and continuing promotion of excellent patient care practices. Despite ongoing U.S. preparedness planning for a pandemic, incorporating recommendations from the World Health Organization (WHO) and the Centers for Disease Control and Prevention (CDC), the novel coronavirus has presented challenges far beyond any expected or imagined. Since 2014, the CDC and WHO have updated and published essential steps for a national pandemic plan, and the Department of Health and Human Services updated the pandemic influenza plan in 2017 (Jester et al., 2018). The basis of this planning included personal protective measures, social distancing, and other methods to slow the transfer of the virus, along with adequate hospital beds and equipment, which are all part of the present plan to manage COVID-19 (Jester et al., 2018). However, previous planning did not address the current situation in the United States and the world, which includes a deadly virus with significant infectious characteristics in a population lacking any known immunity or previous exposure. COVID-19 has affected and changed everyday life as it was known only several months ago and came into being with limited information and understanding and continues to evolve.The lack of knowledge and experience in dealing with this novel virus was obvious, requiring health care, in general, and specifically nurses who are at the forefront of
Background: Second-victim impact describes emotional suffering that occurs secondary to an adverse patient event and occurs in approximately half of all healthcare providers. Immediate intervention is needed to reduce consequences including nursing turnover, job absenteeism, repeat adverse events, professional burnout, and posttraumatic stress. Purpose: To provide clinical nurse specialists a summary of second-victim impact secondary to adverse patient events, a review of associated negative outcomes, and clinical nurse specialist practice recommendations. Recommendations: Clinical nurse specialist nursing interventions include implementation of validated screening tools, identification of healthcare providers at high risk of second-victim impact, recognition of signs of second-victim impact, facilitating supportive clinical debriefings, providing supporting dialogue, and mentorship through stages of recovery and the institutional response. Clinical nurse specialist organization/system interventions to reduce the consequences of second-victim impact include supporting a culture of safety, leading organizational improvement, as well as advocating for education and support for second victims on the national level. Conclusions: Clinical nurse specialists have the potential to mitigate the effects of second-victim impact associated with adverse patient events and secondary complications through use of evidence-based practice interventions.
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