Jennifer A. Jewell

Pediatric Palliative Care and Hospice Care Commitments, Guidelines, and Recommendations

Pediatric palliative care and pediatric hospice care (PPC-PHC) are often essential aspects of medical care for patients who have life-threatening conditions or need end-of-life care. PPC-PHC aims to relieve suffering, improve quality of life, facilitate informed decision-making, and assist in care coordination between clinicians and across sites of care. Core commitments of PPC-PHC include being patient centered and family engaged; respecting and partnering with patients and families; pursuing care that is high quality, readily accessible, and equitable; providing care across the age spectrum and life span, integrated into the continuum of care; ensuring that all clinicians can provide basic palliative care and consult PPC-PHC specialists in a timely manner; and improving care through research and quality improvement efforts. PPC-PHC guidelines and recommendations include ensuring that all large health care organizations serving children with life-threatening conditions have dedicated interdisciplinary PPC-PHC teams, which should develop collaborative relationships between hospital- and community-based teams; that PPC-PHC be provided as integrated multimodal care and practiced as a cornerstone of patient safety and quality for patients with life-threatening conditions; that PPC-PHC teams should facilitate clear, compassionate, and forthright discussions about medical issues and the goals of care and support families, siblings, and health care staff; that PPC-PHC be part of all pediatric education and training curricula, be an active area of research and quality improvement, and exemplify the highest ethical standards; and that PPC-PHC services be supported by financial and regulatory arrangements to ensure access to high-quality PPC-PHC by all patients with life-threatening and life-shortening diseases.

Child life services

Child life programs have become standard in most large pediatric centers and even on some smaller pediatric inpatient units to address the psychosocial concerns that accompany hospitalization and other health care experiences. The child life specialist focuses on the strengths and sense of well-being of children while promoting their optimal development and minimizing the adverse effects of children’s experiences in health care or other potentially stressful settings. Using play and psychological preparation as primary tools, child life interventions facilitate coping and adjustment at times and under circumstances that might prove overwhelming otherwise. Play and age-appropriate communication may be used to (1) promote optimal development, (2) present information, (3) plan and rehearse useful coping strategies for medical events or procedures, (4) work through feelings about past or impending experiences, and (5) establish therapeutic relationships with children and parents to support family involvement in each child’s care, with continuity across the care continuum. The benefits of this collaborative work with the family and health care team are not limited to the health care setting; it may also optimize reintegration into schools and the community.

Policy statement - Principles of pediatric patient safety: Reducing harm due to medical care

Pediatricians are rendering care in an environment that is increasingly complex, which results in multiple opportunities to cause unintended harm. National awareness of patient safety risks has grown in the 10 years since the Institute of Medicine published its report To Err Is Human, and patients and society as a whole continue to challenge health care providers to examine their practices and implement safety solutions. The depth and breadth of harm incurred by the practice of medicine is still being defined as reports continue to uncover a variety of avoidable errors, from those that involve specific high-risk medications to those that are more generalizable, such as patient misidentification. Pediatricians in all venues must have a working knowledge of patient-safety language, advocate for best practices that attend to risks that are unique to children, identify and support a culture of safety, and lead efforts to eliminate avoidable harm in any setting in which medical care is rendered to children.

Examining the Associations of Racism, Sexism, and Stressful Life Events on Psychological Distress among African American Women

African-American women may be susceptible to stressful events and adverse health outcomes as a result of their distinct social location at the intersection of gender and race. Here, racism and sexism are examined concurrently using survey data from 204 African-American women residing in a southeastern U.S. urban city. Associations among racism, sexism, and stressful events across social roles and contexts (i.e., social network loss, motherhood and childbirth, employment and finances, personal illness and injury, and victimization) are investigated. Then, the relationships among these stressors on psychological distress are compared, and a moderation model is explored. Findings suggest that racism and sexism are a significant source of stress in the lives of African-American women and are correlated with one another and with other stressful events. Implications for future research and clinical considerations are discussed.

The Sexualized Girl: A Within-Gender Stereotype among Elementary School Children.

Two studies (conducted in 2013) examined whether elementary-aged children endorse a within-gender stereotype about sexualized girls. In Study 1, children (N = 208) ages 6-11 rated sexualized girls as more popular but less intelligent, athletic, and nice compared to nonsexualized girls. These distinctions were stronger for girls and older children, and in accordance with our developmental intergroup theoretical framework, were related to childrens cognitive development and media exposure. Study 2 (N = 155) replicated the previous findings using more ecologically valid and realistic images of girls and further explored individual differences in the endorsement of the sexualized girl stereotype. Additional results indicated that the belief that girls should be appearance focused predicted their endorsement of the sexualized girl stereotype.

Pediatric observation units.

Pediatric observation units (OUs) are hospital areas used to provide medical evaluation and/or management for health-related conditions in children, typically for a well-defined, brief period. Pediatric OUs represent an emerging alternative site of care for selected groups of children who historically may have received their treatment in an ambulatory setting, emergency department, or hospital-based inpatient unit. This clinical report provides an overview of pediatric OUs, including the definitions and operating characteristics of different types of OUs, quality considerations and coding for observation services, and the effect of OUs on inpatient hospital utilization.

A Powerful Nudge? Presenting Calculable Consequences of Underpowered Research Shifts Incentives Toward Adequately Powered Designs

If psychologists have recognized the pitfalls of underpowered research for decades, why does it persist? Incentives, perhaps: underpowered research benefits researchers individually (increased productivity), but harms science collectively (inflated Type I error rates and effect size estimates but low replication rates). Yet, researchers can selectively reward power at various scientific bottlenecks (e.g., peer review, hiring, funding, and promotion). We designed a stylized thought experiment to evaluate the degree to which researchers consider power and productivity in hiring decisions. Accomplished psychologists chose between a low sample size candidate and a high sample size candidate who were otherwise identical. We manipulated the degree to which participants received information about (1) productivity, (2) sample size, and (3) directly calculable Type I error and replication rates. Participants were intolerant of the negative consequences of low-power research, yet merely indifferent regarding the practices that logically produce those consequences, unless those consequences were made quite explicit.

Participant gender, stalking myth acceptance, and gender role stereotyping in perceptions of intimate partner stalking: a structural equation modeling approach

The present research used a mock juror experiment (N = 360) to assess two primary goals: (1) to examine the direct and indirect effects of participant gender, stalking myth acceptance, and gender role stereotyping on guilt ratings in a stalking trial; and (2) to examine the role of perceived victim fear and distress, and defendant intended danger on perceptions of a stalking trial. Using structural equation modeling, we found an indirect effect of participant gender, and both direct and indirect effects of stalking myth acceptance and gender role stereotyping on guilt ratings. Men and participants who endorsed more traditional gender role stereotypes were associated with adherence to stalking myth acceptance beliefs. Endorsement of particular stalking myth acceptance beliefs offers a partial explanation for why women and men differed on perceptions of the defendants intent to cause danger and the victims perceived fear and distress. Results provide insight into the efficacy of current anti-stalking legislation that relies on a jurors capacity to evaluate an ‘objective’ interpretation (i.e., ‘reasonable person’) standard of fear for intimate partner stalking.

Sue daMones, the "911" Operator, and Boxer Shorts.

Interacting with residents, medical students, and other “learners” (the new politically correct, nonperjorative term) affords loads of opportunities. Sure, this responsibility forces providers to maintain a certain level of competency; it reminds us of the fragility of the young ego; it allows us to believe that we are somehow molding the future of medicine. Working with learners also ensures loads of fodder for our story-telling and future comedy routines. Of course, non–health care personnel find none of these tales funny. In fact, most of our nonpediatric hospitalist colleagues find these stories juvenile and immature. But I think it is time we just admit it: pediatric hospitalists appreciate humor, especially humor involving our learners. Sometimes it gets us into trouble. Sometimes the hospital has to change its policies. Sometimes we just shake our heads and think, “Who is going to believe this?” The anonymous features inherent in overhead paging systems and beepers have the ability to draw pediatric residents from the darkness of midwinter depression into the light of midwinter dysthymia. Imagine wandering the halls, not sure which button to push on the elevator to get to the sixth floor, because the numbers all look like Asian characters after hours of sleep deprivation. (You will have difficulty with this imagery if your trained after-duty hours were mandated.) Suddenly, you hear a very earnest hospital operator instruct, “Billy Rubin, please report immediately to the Newborn Nursery. Billy Rubin to the nursery.” And you giggle in an elevator full of internists and psychiatrists until coffee is coming out of your nose. By the time you get to the sixth floor, Dr Laracy, the second-year pediatric resident, is at it again. This time, he requests the operator to recite the following, “Sue daMonas to microbiology. Sue daMonas to micro.” Or “Sal Monella to the …