Angela Green

Physiologic effects of retinopathy of prematurity screening examinations.

Purpose:Preterm infants weighing less than 1500 g routinely undergo a series of eye examinations to screen for retinopathy of prematurity (ROP). While these examinations are important for the prevention of blindness, infants may suffer adverse physiologic events during and after the examination. The procedure includes administration of mydriatic eye drops that may be absorbed systemically and physical manipulation of the eye that is accompanied by stress and pain. The purpose of the study was to monitor changes in infant health status and adverse physiologic events in the 2 days after ROP eye screening. Subjects:The study used 50 preterm infants with a mean gestational age of 32 weeks, undergoing their first ROP examination in a NICU located in a university medical center. Design:This pilot study used a prospective, descriptive design. Methods:Physiologic changes and illness events were recorded before and for 2 days after the eye examination, using tools that tracked parameters of respiratory, cardiovascular, gastrointestinal, and neurological status. Data were collected directly from daily audits of medical records. McNemars test for comparing paired proportions and the signed rank test were used for comparing significance of physiologic changes before and after the ROP eye examination. Principal Results:Apnea events increased significantly (P = .04) in the 24- to 48-hour period after the eye examination compared with apnea events before the eye examination. These results were based on 39 infants who were not receiving ventilator support. There was a significant difference in the frequency of oxygen desaturation events between infants with and without apnea (0–24 hours after examination, P < .002; 25–48 hours after examination, P < .001). There were no significant differences in heart rate, cyanosis, gastric residuals, or seizures after the eye examinations. Conclusions:The ROP examinations may be associated with increased apnea, a clinically significant problem. Nursing implications include careful monitoring of infants during and after ROP eye examinations, discharge teaching for caregivers, and continued research on nursing interventions to prevent adverse physiologic events.

Geographic variability in human papillomavirus vaccination among U.S. young women

BACKGROUND Little information is available on geographic disparity of human papillomavirus (HPV) vaccination among women aged 18-26 years in the U.S. Genital HPV is the most common sexually transmitted infection in the U.S. Persistent HPV infection with oncogenic types can cause cervical cancer. PURPOSE This study utilized data collected from the 2010 National Health Interview Survey (NHIS). It identified geographic variability and other factors contributing to the disparities in HPV vaccine series initiation in a nationally representative sample of women aged 18-26 years. METHODS The study utilized data collected from 1867 women who participated in the Cancer Control Module Supplement of the 2012 NHIS. A multivariable logistic regression model was used to assess characteristics associated with initiation of the HPV series. Analyses were performed in 2012. RESULTS After adjusting for other characteristics, women living in the West and North Central/Midwest had 54% and 20% greater odds of initiating the HPV series, respectively, compared with those living in the Northeast. Other factors associated with HPV series initiation were younger age, Hispanic background, being single/never married, childlessness, a history of HPV, and current alcohol use. Factors correlated with failure to initiate the HPV series were: not having insurance, living below the 200% poverty level, not being a high school graduate, not currently using hormone-based birth control, most recent Pap >1 year ago, no regular provider, last clinic visit ≥12 months ago, and never having received the hepatitis B vaccine. CONCLUSIONS Results demonstrate disparity in HPV vaccine uptake by region of residence in the U.S. among young women. Further research is needed to understand the factors contributing to this geographic disparity. Evaluation of vaccination policies and practices associated with higher coverage regions might help characterize effective methods to improve HPV vaccination among women aged 18-26 years.

Improving Family-Centered Care Through Research

The need for change toward more family centered care involved focusing on issues identified by families and staff on a medical-surgical infant and toddler unit of a pediatric hospital. The research process was used to identify issues of concern and to develop and evaluate interventions to improve family centered care. This article presents the research process, the interventions employed, and family and staff perceptions of family and centered care pre and post intervention.

Resident-to-Resident Violence Triggers in Nursing Homes

Certified nurses’ assistants (CNAs) employed by a rural nursing home in Northeast Arkansas described their perceptions of resident-to-resident violence in order to provide insight on factors, including unmet needs, that may trigger the phenomenon. Semistructured interviews were conducted with 11 CNAs. Data were analyzed using content analysis and constant comparison. Two categories of triggers emerged from the data—active and passive. Active triggers involved the actions of other residents that were intrusive in nature, such as wandering into a residents’ personal space, taking a resident’s belongings, and so forth. Passive triggers did not involve the actions of residents but related to the internal and external environment of the residents. Examples were factors such as boredom, competition for attention and communication difficulties. Results indicate that there are factors, including unmet needs within the nursing home environment that may be identified and altered to prevent violence between residents.

Increasing Capacity for Evidence-Based Practice Through the Evidence-Based Practice Academy

: Although mentoring is an important aspect of implementing evidence-based practice (EBP), few models exist for EBP education. The EBP Academy is an innovative, 6-month educational program designed to develop clinical staff as EBP nurse mentors. Sessions provide protected time for participants to work on their EBP projects with assigned mentors who have EBP expertise and similar clinical or research interests. Participants develop EBP projects focused on improving care in their clinical areas. Evaluation of the EBP Academy is based on a four-level model, including participant feedback about the program, perception of meeting program objectives, ability to apply knowledge to practice through EBP projects, and outcome data measured as a result of implementing the EBP changes. By developing EBP mentors, capacity to move nursing practice to a stronger evidence-based foundation can be enhanced. Positive, professional nursing and patient outcomes have been demonstrated when structured EBP education is provided.

Challenges of implementation of a web-camera system in the neonatal intensive care unit.

Over the past ten years, web-cameras often have been used in the NICU to support parents and connect families with their hospitalized neonate. This article describes the history of images and video use in the NICU to aid in linking parents and then focuses on the challenges and lessons learned through redesign, installation, and management of a new web-camera system. Technology can support NICU families, and when implemented with input from nurses and families, the process can be a positive experience.

Physical activity and obesity in children with congenital cardiac disease

BACKGROUND Children with congenital cardiac disease experience challenges in developing healthy patterns of physical activity due to decreased exercise capacity and parental fear and confusion about what is permissible. The purpose of this study was to describe physical activity habits in children 10-14 years of age with congenital cardiac disease and the relationship of those habits to obesity as defined by body mass index. METHODS This cross-sectional study used self-report measures and clinical data to describe the association between physical activity participation and body mass index in 10- to 14-year-old children with congenital cardiac disease. Further, physical activity levels were compared between children who were overweight or obese and those who were not. RESULTS Children (n = 84; 51 males; 33 females) reported low rates of physical activity compared to reports on healthy children. Only 9.5% were overweight (body mass index between the 85th and 94th percentile), and alarmingly 26% were obese (body mass index at or above the 95th percentile). Physical activity and body mass index were not significantly correlated (r = -0.11, p = 0.45) and there was no significant difference in mean physical activity (t = 0.67) between children who were overweight or obese and those who were not. CONCLUSIONS Children in this study reported low rates of physical activity and a higher obesity rate than was reported in previous studies. However, the two were not significantly correlated. Further research is indicated to determine the specific factors contributing to obesity and to test interventions to combat obesity in children with congenital cardiac disease.

Charting the Course of Pediatric Nursing Research: The SPN Delphi Study

In order to inform the care of children at this pivotal time in the history of healthcare, the Society of Pediatric Nurses (SPN) sought to identify priorities for nursing research and key challenges facing pediatric nursing. A three round Delphi study was conducted electronically with SPN members. The top 10 priorities and challenges were identified and will serve as a valuable guide for pediatric nursing practice, education, policy and administration over the coming decade.

Soft on sticks: an evidence-based practice approach to reduce children's needlestick pain.

Soft on Sticks is a comprehensive, interdisciplinary, evidence-based practice initiative that was implemented to ensure consistent use of pharmacologic and nonpharmacologic interventions to reduce pain associated with needlestick procedures performed on children. Pre- and postimplementation data from children, parents, and nurses showed positive results from the practice change and identified areas for further improvement.

Web Camera Use of Mothers and Fathers When Viewing Their Hospitalized Neonate.

Background:Mothers and fathers of neonates hospitalized in a neonatal intensive care unit (NICU) differ in their experiences related to NICU visitation. Purpose:To describe the frequency and length of maternal and paternal viewing of their hospitalized neonates via a Web camera. Methods/Search Strategy:A total of 219 mothers and 101 fathers used the Web camera that allows 24/7 NICU viewing from September 1, 2010, to December 31, 2012, which included 40 mother and father dyads. We conducted a review of the Web cameras Web site log-on records in this nonexperimental, descriptive study. Findings/Results:Mothers and fathers had a significant difference in the mean number of log-ons to the Web camera system (P = .0293). Fathers virtually visited the NICU less often than mothers, but there was not a statistical difference between mothers and fathers in terms of the mean total number of minutes viewing the neonate (P = .0834) or in the maximum number of minutes of viewing in 1 session (P = .6924). Patterns of visitations over time were not measured. Implications for Practice:Web camera technology could be a potential intervention to aid fathers in visiting their neonates. Both parents should be offered virtual visits using the Web camera and oriented regarding how to use the Web camera. Implications for Research:These findings are important to consider when installing Web cameras in a NICU. Future research should continue to explore Web camera use in NICUs.