Becky J. Christian

Hallmark of Excellence: Research and Evidence-Based Practice as the Foundation for Quality Pediatric Nursing

The hallmark of excellence in pediatric nursing is the use of research and evidence-based practice as the foundation for quality care for children and their families. Creating a culture and an organizational environment focused on quality and safety outcomes leads to improved accountability and excellence in nursing practice.

Translational Research – The Imperative for Integrating Evidence Into Pediatric Nursing Practice to Improve Health Outcomes

With the translation of research and integration of evidence into practice, the quality of health outcomes for children and their families is improved and pediatric nursing practice is transformed. EVIDENCE GENERATED FROM research and translated into pediatric nursing practice leads to improved health outcomes for children and their families (Christian, 2012a, 2012b, 2012c, 2013a, 2013b, 2013c). New knowledge and evidence generated from clinical nursing research builds upon and extends nursing knowledge, thereby improving clinical outcomes and the quality of nursing practice (Polit & Beck, 2012). New approaches and interventions developed and tested through research create new methods and more effective strategies for addressing the challenging health problems that affect children and their families. This new evidence generated from research is then translated and integrated into practice to improve the quality of care. Translating research evidence into pediatric nursing practice provides the foundation for improving the quality of pediatric nursing care, ultimately resulting in improved child and family health outcomes (Christian, 2011, 2012a, 2012b). Quality health outcomes are linked to evidence-based practice and produce the best possible outcomes for patients (Melnyk & Fineout-Overholt, 2011). Thus, evidence-based practice improves the quality of pediatric nursing care and children’s health outcomes (Hockenberry & Wilson, 2011). Moreover, translation of new evidence and integration into pediatric nursing practice transforms the practice landscape through the development of new intervention strategies. To that end, it is imperative that new research evidence is translated and integrated into pediatric nursing practice in order to improve health outcomes for children and their families. In this issue of the Journal of Pediatric Nursing, seven research articles have employed a variety of research

Sleep Quality, Stress, Caregiver Burden, and Quality Of Life in Maternal Caregivers of Young Children With Bronchopulmonary Dysplasia

Little is known about the influence of sleep quality, stress, and caregiver burden on quality of life in maternal caregivers of young children with bronchopulmonary dysplasia (BPD). In 61 maternal caregivers (mean age 29.59 years) of young children with BPD (mean age 13.93 months), caregivers reported sleeping a mean of 5.8 hours, and significant correlations were found between sleep quality and depressive symptoms and stress, as well as an inverse correlation with quality of life. Sleep quality was found to be the most significant predictor of quality of life in maternal caregivers.

Rebirth and Renewal Through Research—New Evidence and Strategies for Improving the Quality of Pediatric Nursing Care

NEW EVIDENCE AND strategies specific to children are designed to improve the quality of pediatric nursing care through research. Without new evidence, pediatric nursing care stagnates, resulting in poor quality of care for children and their families. In effect, new developmentally-appropriate research evidence provides the promise of change and improvement in pediatric nursing practice—that is, the promise of rebirth and renewal through research. New evidence and strategies are created through the development of new knowledge generated from research; the innovative interventions specifically designed for children, their parents, and pediatric healthcare providers; translation of new research methods to practice; and the creative application of new strategies to improve pediatric clinical practice. Clinical nursing research is conducted to generate and

The Function of Parents and Their Children With Cerebral Palsy

To determine associations between the function of parents and that of their children with cerebral palsy (CP) and the influence of the levels of the childs impairment, parenting stress, parent self‐efficacy, and family functioning.

Characteristics of the nighttime hospital bedside care environment (sound, light, and temperature) for children with cancer.

Background: Children with cancer must cope not only with their disease and its treatment but also with the environment in which treatment is given. The intensities of sound and light levels required to perform necessary patient care may result in a disruptive nighttime care environment. Objective: The purpose of this study was to describe nighttime patterns of environmental factors, sound, light, and temperature levels, at the bedside of children with cancer receiving inpatient chemotherapy. Methods: Participants were 15 school-aged children receiving chemotherapy on an inpatient pediatric oncology unit. Sound, light, and temperature in the childs room were measured continuously using a digital-sound pressure-level meter and an external channel data logger. Results: Mean nighttime sound levels were 49.5 (SD, 3.1) dB (range, 34.6-84.8 dB). Sound and light intensities were greatest early in the shift and decreased through the night. A basic mixed linear model identified significant main effects of time of night for both sound (F = 50.42, P < .01) and light (F = 12.43, P < .01). Conclusions: Study findings identified a bedside care environment with persistently elevated sound levels and abrupt increases in sound intensity throughout the night. Such a disruptive nighttime environment is not conducive to restful nighttime sleep and may serve as an additional source of physiological and psychological stress for hospitalized children with cancer. Implications for Practice: Efforts are needed to identify modifiable sources of nighttime sound and develop interventions to reduce nighttime sound. Collaborative efforts to organize clinical care to minimize nighttime disruptions may lead to reduced bedside sound levels.

Nighttime Sleep Disruptions, the Hospital Care Environment, and Symptoms in Elementary School-Age Children With Cancer

PURPOSE/OBJECTIVES To describe nighttime sleep-wake patterns during a 12-hour night shift among school-age children with cancer receiving inpatient chemotherapy and relationships among nighttime sleep, environmental stimuli, medication doses, and symptoms during that shift. DESIGN Exploratory, descriptive, multiple-case study. SETTING Inpatient pediatric oncology unit at a tertiary pediatric hospital in the western United States. SAMPLE 15 elementary school-age children with cancer receiving inpatient chemotherapy. METHODS Wrist actigraphs measured sleep-wake patterns. Data loggers and sound pressure level meters measured bedside light, temperature, and sound levels. Medication doses and occurrences of pain, nausea, and vomiting were identified through chart review. MAIN RESEARCH VARIABLES Minutes of sleep. FINDINGS Sleep varied based on time of night (F = 56.27, p < 0.01), with sleep onset delayed past 10 pm. A basic mixed linear model identified significant fixed effects for sound (F = 50.87, p < 0.01) and light (F = 7.04, p < 0.01) on minutes of sleep. A backward regression model including sound, light, medication doses, pain, and nausea accounted for about 57% of the variance in sleep minutes (F = 62.85, p < 0.01). CONCLUSIONS Sleep was marked by frequent awakenings, limiting childrens ability to experience full sleep cycles. Multiple factors-in particular, excessive sound levels-compromise sleep quantity and quality throughout the night. IMPLICATIONS FOR NURSING Efforts to develop and test individualized and system-based interventions to modify the hospital care environment to promote nighttime sleep are needed. Oncology nurses have the opportunity to influence the care environment at an individual level and to influence unit-based practices to promote a healthy nighttime sleep environment.

Translational Research—Improving Everyday Pediatric Nursing Practice Through Research and Evidence-Based Practice

Clinical problems identified frompediatric nursing practice are used as sparks to ignite research, evidence-based practice (EBP) projects, and quality improvement (QI) programs. IT IS CRITICAL that lessons learned from research are translated and applied to everyday pediatric nursing practice to improve the quality of care for children and their families. For pediatric nursing practice, clinical nursing research is conducted to develop, refine, and expand nursing knowledge to guide practice (Polit & Beck, 2012) and ultimately improve the health and quality of life of children and their families. Clinical problems identified from pediatric nursing practice are used as sparks to ignite research, evidence-based practice (EBP) projects, and quality improvement (QI) programs. Translating research evidence into best clinical practices enhances the quality of pediatric nursing practice by improving child and family health outcomes (Christian, 2012b). Thus, improving pediatric nursing practice requires that evidence from research, EBP projects, and QI programs are conducted, translated, and integrated into everyday pediatric nursing practice (Christian, 2011, 2012a, 2012b). Pediatric nurses are in an excellent position to translate evidence from nursing research, EBP projects, and QI programs to improve everyday pediatric nursing practice. Interdisciplinary partnerships between researchers and pediatric nurse clinicians enhance the quality of pediatric nursing research, EBP projects, and QI programs, providing critical evidence grounded in the lives of children and adolescents to improve clinical practice and the quality of childrens lives (Christian, Pearce, Roberson, & Rothwell, 2010). By translating and integrating new evidence into pediatric practice, pediatric nurses promote the health and welfare of children and their families through improved quality of care (Hockenberry & Wilson, 2011).

Translating Research Into Everyday Practice—The Essential Role of Pediatric Nurses

Pediatric nurses play an essential role in translating research into best practices, thereby improving the quality of child and family health outcomes, as well as the quality of everyday practice. TRANSLATINGRESEARCHEVIDENCE into best clinical practices enhances the quality of pediatric nursing practice by improving child and family health outcomes. Given that the role of pediatric nurses is to promote the health and welfare of children and their families through excellent patient care (Hockenberry & Wilson, 2011), pediatric nurses are in a unique position to improve clinical practice. Excellence in pediatric nursing is achieved through the translation of research to guide clinical practice for children and their families (Christian, 2011). Evidence-based practice is the integration of best evidence with clinical expertise and patient preferences in clinical decision making (Polit & Beck, 2012) and then translation of clinical research into everyday practice (Hockenberry & Wilson, 2011). Thus, best practices for pediatric nursing improve the quality of care for children and their families (Christian, 2012). Moreover, pediatric nurses play an essential role in translating research evidence into clinical practice to improve the quality of care for children and their families. In this issue of the Journal of Pediatric Nursing, six articles demonstrate the essential role of pediatric nurses in translating research into best practices for improving child and family health outcomes:

Translational research - transforming the quality of pediatric nursing practice.

Testing interventions and translating evidence into practice is an iterative cycle that advances and transforms pediatric nursing practice to improve the quality of health outcomes for children and families. TRANSFORMING THE QUALITY of pediatric nursing practice is achieved through translational research. Generating knowledge through clinical nursing research improves nursing practice through the development of new evidence (Polit & Beck, 2012). New evidence leads to new strategies that have been implemented and tested through research and then translated into practice (Christian, 2013b). This iterative cycle of testing interventions and translating evidence into practice serves to advance and transform nursing practice. Thus, evidence from research and quality improvement projects is translated into everyday practice to improve the care of children and their families. Indeed, evidence-based practice improves the quality of health outcomes (MelnykF