Joseph Manning

Interruptions and medication administration in critical care.

BACKGROUND Medication administration has inherent risks, with errors having enormous impact on the quality and efficiency of patient care, particularly in relation to experience, outcomes and safety. Nurses are pivotal to the medication administration process and therefore must demonstrate safe and reliable practice. However, interruptions can lead to mistakes and omissions. AIM To critique and synthesize the existing literature relating to the impact that interruptions have during medication administration within the paediatric critical care (PCC) setting. SEARCH STRATEGY Key terms identified from background literature were used to search three electronic databases (Medline, CINHAL and BNI). Selected sources were critically appraised using the Critical Appraisal Skills Programme (CASP) tool. FINDINGS There is confusion within the literature concerning the definition of interruption. Moreover, an assumption that all interruptions have a negative impact on patient safety exists. The literature identifies the multi-dimensional nature of interruptions and their impact on medication administration and patient safety. The cumulative effect of interruptions depends on what type of task is being completed, when it occurs, what the interruption is and which method of handling is utilized. A conceptual schema has been developed in order to explicate the themes and concepts that emerged. CONCLUSIONS This review summarizes debates within the international arena concerning the impact of interruptions on medication administration. However, conclusions drawn appear applicable in relation to practice, education and future research to other critical care settings. RELEVANCE TO CLINICAL PRACTICE Findings show that no single strategy is likely to improve the negative effect of interruptions without focus on patient safety. Practice education to improve team building interactions is required that equips nurses with the skills in managing interruptions and delegating high priority secondary tasks.

Protocol for a longitudinal qualitative study: survivors of childhood critical illness exploring long-term psychosocial well-being and needs—The SCETCH Project

Introduction Life-threatening critical illness affects over a quarter of a million children and adolescents (0–18 years old) annually in the USA and the UK. Death from critical illness is rare; however, survivors and their families can be exposed to a complex array of negative physical, psychological and social problems. Currently, within the literature, there is a distinct paucity of child and adolescent survivor self-reports, thus limiting our understanding of how survivors perceive this adversity and subsequently cope and grow in the long-term following their critical illness. This study aims to explore and understand psychosocial well-being and needs of critical illness survivors, 6–20 months post paediatric intensive care admission. Methods and analysis A longitudinal, qualitative approach will provide a platform for a holistic and contextualised exploration of outcomes and mechanisms at an individual level. Up to 80 participants, including 20 childhood critical illness survivors and 60 associated family members or health professionals/teachers, will be recruited. Three interviews, 7–9 weeks apart, will be conducted with critical illness survivors, allowing for the exploration of psychosocial well-being over time. A single interview will be conducted with the other participants enabling the exploration of contextual information and how psychosocial well-being may inter-relate between critical illness survivors and themselves. A ‘tool box’ of qualitative methods (semi-structured interviews, draw and tell, photo-elicitation, graphic-elicitation) will be used to collect data. Narrative analysis and pattern matching will be used to identify emergent themes across participants. Ethics and dissemination This study will provide an insight and understanding of participants’ experiences and perspectives of surviving critical illness in the long term with specific relation to their psychosocial well-being. Multiple methods will be used to ensure that the findings are effectively disseminated to service users, clinicians, policy and academic audiences. The study has full ethical approval from the East Midlands Research Ethics Committee and has received National Health Service (NHS) governance clearance.

Co-producing a digital educational programme for registered children’s nurses to improve care of children and young people admitted with self-harm

Despite the increasing prevalence of hospital admissions for self-harm in children and young people (CYP), there is paucity of registered children’s nurse (rCN) training or involvement of children to improve care for this often stigmatized patient group. This article describes a participatory approach towards using co-production with CYP and rCN to develop a digital educational programme to improve nurses’ knowledge, attitudes and confidence in caring for CYP with self-harm injuries. A priority-setting workshop with rCNs was used to establish consensus of information needs. This was followed by an e-learning content development workshop undertaken with CYP whom had previously experienced hospital admissions for self-harm injuries. Findings from the nurse priority-setting workshop identified three educational priorities: (1) knowledge of self-harm, (2) effective communication and (3) risk management. The CYP subsequently developed these topic areas to ensure the contents and design of the e-learning resource had fidelity by reflecting the experiences of CYP and needs when cared for in hospital. This article illustrates that involving service users to co-develop educational materials is a feasible and important step in designing educational resources and ensures the content is relevant, appropriate and sensitive to both the recipient of care and those responsible for its delivery.

‘Our Care through Our Eyes’: a mixed-methods, evaluative study of a service-user, co-produced education programme to improve inpatient care of children and young people admitted following self-harm

Introduction Within Europe, the UK has one of the highest rates of self-harm, with a particularly high prevalence in children and young people (CYP). CYP who are admitted to paediatric hospital wards with self-harm are cared for by registered childrens nurses who have been identified to lack specific training in caring for this patient group. This may impede the delivery of high quality care. Therefore, this study aims to co-produce, implement and evaluate an education programme for registered childrens nurses to improve their knowledge, attitudes and confidence when caring for CYP admitted with self-harm. Methods and analysis This mixed-methods evaluative study will involve a three-stage design. Stage 1: A priority-setting workshop will be conducted with 19 registered childrens nurses. A Delphi technique will be used to establish consensus of information needs. Stage 2: An online educational intervention will be co-produced with 25 CYP and 19 registered childrens nurses based on the priorities identified in Stage 1. Stage 3: The intervention will be implemented and evaluated with 250 registered childrens nurses at a single hospital. Online Likert scale questionnaires will be administered at baseline and postintervention to assess levels of knowledge, attitudes and confidence in caring for CYP who self-harm. Descriptive and inferential statistics will be used to analyse the data. Statistical significance will be assessed at the 5% (two-sided) level. One-to-one qualitative interviews will also be undertaken with approximately 25 participants to explore any perceived impact on clinical practice. An interpretive descriptive approach will guide qualitative data collection and analysis. Ethics and dissemination This study aims to develop, trial and evaluative a service-user, co-produced education programme for acute hospital registered childrens nurses to improve the care of CYP admitted due to self-harm. The study has ethical approval from the National Health Services Research Ethics Committee and full governance clearance.

Blended foods for tube-fed children: a safe and realistic option? A rapid review of the evidence

With the growing number of children and young people with complex care needs or life-limiting conditions, alternative routes for nutrition have been established (such as gastrostomy feeding). The conditions of children and young people who require such feeding are diverse but could relate to problems with swallowing (dysphagia), digestive disorders or neurological/muscular disorders. However, the use of a blended diet as an alternative to prescribed formula feeds for children fed via a gastrostomy is a contentious issue for clinicians and researchers. From a rapid review of the literature, we identify that current evidence falls into three categories: (1) those who feel that the use of a blended diet is unsafe and substandard; (2) those who see benefits of such a diet as an alternative in particular circumstances (eg, to reduce constipation) and (3) those who see merit in the blended diet but are cautious to proclaim potential benefits due to the lack of clinical research. There may be some benefits to using blended diets, although concerns around safety, nutrition and practical issues remain.

Stories of survival: Children’s narratives of psychosocial well-being following paediatric critical illness or injury

Survival from critical illness can expose children to an array of negative physical and psychological problems. While the perspective of parents and professionals have been well documented, there is limited understanding of how childhood critical care survivors make sense of their experiences in relation to psychosocial well-being. We aimed to explore long-term psychosocial well-being of childhood survivors of critical illness through their stories. A qualitative, exploratory study using serial in-depth interviews was employed. Nine children (aged 6–15 years) were recruited to the study, 6–14 months post-discharge from a paediatric intensive care unit. Qualitative art-based methods were used with a responsive interviewing technique and data were analysed using narrative psychological analysis. Four themes emerged: disrupted lives and stories; survivors revealed uncertainties in their stories as they recalled their critical care event, exposure to death and dying; talking about extreme physical vulnerability provoked anxieties, mediating between different social worlds and identities; revealed the dynamic nature of survival and getting on with life; the prospective outlook survivors had on their existence despite newly manifesting adversities. Childhood survivors’ stories identify challenges and adversities that are faced when attempting to readjust to life following critical illness that both enhance and impair psychosocial well-being.

Survived so what? Identifying priorities for research with children and families post-paediatric intensive care unit: Survived so what? Identifying priorities for research with children and families post-PICU

The involvement of patients and the public in the development, implementation and evaluation of health care services and research is recognized to have tangible benefits in relation to effectiveness and credibility. However, despite >96% of children and young people surviving critical illness or injury, there is a paucity of published reports demonstrating their contribution to informing the priorities for aftercare services and outcomes research. We aimed to identify the service and research priorities for Paediatric Intensive Care Unit survivors with children and young people, their families and other stakeholders. We conducted a face-to-face, multiple-stakeholder consultation event, held in the Midlands (UK), to provide opportunities for experiences, views and priorities to be elicited. Data were gathered using write/draw and tell and focus group approaches. An inductive content analytical approach was used to categorize and conceptualize feedback. A total of 26 individuals attended the consultation exercise, including children and young people who were critical care survivors; their siblings; parents and carers; health professionals; academics; commissioners; and service managers. Consultation findings indicated that future services, interventions and research must be holistic and family-centred. Children and young people advisors reported priorities that focused on longer-term outcomes, whereas adult advisors identified priorities that mapped against the pathways of care. Specific priorities included developing and testing interventions that address unmet communication and information needs. Furthermore, initiatives to optimize the lives and longer-term functional and psycho-social outcomes of Paediatric Intensive Care Unit survivors were identified. This consultation exercise provides further evidence of the value of meaningful patient and public involvement in identifying the priorities for research and services for Paediatric Intensive Care Unit survivors and illuminates differences in proposed priorities between children, young people and adult advisors.

Survived so what?: Identifying priorities for research with children and families post-paediatric intensive care unit

The involvement of patients and the public in the development, implementation and evaluation of health care services and research is recognized to have tangible benefits in relation to effectiveness and credibility. However, despite >96% of children and young people surviving critical illness or injury, there is a paucity of published reports demonstrating their contribution to informing the priorities for aftercare services and outcomes research. We aimed to identify the service and research priorities for Paediatric Intensive Care Unit survivors with children and young people, their families and other stakeholders. We conducted a face-to-face, multiple-stakeholder consultation event, held in the Midlands (UK), to provide opportunities for experiences, views and priorities to be elicited. Data were gathered using write/draw and tell and focus group approaches. An inductive content analytical approach was used to categorize and conceptualize feedback. A total of 26 individuals attended the consultation exercise, including children and young people who were critical care survivors; their siblings; parents and carers; health professionals; academics; commissioners; and service managers. Consultation findings indicated that future services, interventions and research must be holistic and family-centred. Children and young people advisors reported priorities that focused on longer-term outcomes, whereas adult advisors identified priorities that mapped against the pathways of care. Specific priorities included developing and testing interventions that address unmet communication and information needs. Furthermore, initiatives to optimize the lives and longer-term functional and psycho-social outcomes of Paediatric Intensive Care Unit survivors were identified. This consultation exercise provides further evidence of the value of meaningful patient and public involvement in identifying the priorities for research and services for Paediatric Intensive Care Unit survivors and illuminates differences in proposed priorities between children, young people and adult advisors.

Transition of care from children’s to adult services

Transition service development is high on the agenda in contemporary healthcare improvement and there is a wealth of literature focusing on the shortcomings of many existing transition services. This literature review aims at identify and summarise research on the issues and needs surrounding transitional care from childrens to adult services, and to explore, critique and evaluate the effectiveness of interventions, processes and systems relating to supporting transitions for young people between childrens and adult services. Many studies focus on the transition of young people from childrens to adult services. Some areas of transitional care have been researched thoroughly, including the self-reported experiences of young people. A large number of studies have explored specific interventions aimed at young people and healthcare systems. A single approach or intervention to support transition appears to be neither beneficial for all young people, nor appropriate for all services. The effect of specific interventions is largely inconclusive.

‘Our Care through Our Eyes’. Impact of a co-produced digital educational programme on nurses’ knowledge, confidence and attitudes in providing care for children and young people who have self-harmed: a mixed-methods study in the UK

Objectives (1) To determine the impact of a digital educational intervention on the knowledge, attitudes, confidence and behavioural intention of registered children’s nurses working with children and young people (CYP) admitted with self-harm. (2) To explore the perceived impact, suitability and usefulness of the intervention. Intervention A digital educational intervention that had been co-produced with CYP service users, registered children’s nurses and academics. Setting A prospective, uncontrolled, intervention study with preintervention and postintervention measurement, conducted at a large acute NHS Trust in the UK. Participants From a pool of 251 registered children’s nurses and 98 participants were recruited to complete the intervention (response rate=39%). At follow-up, 52% of participants completed the postintervention questionnaire, with 65% (n=33) of those reporting to have completed the digital educational intervention. Primary outcome measures Attitude towards self-harm in CYP was measured using a 13-item questionnaire; knowledge of self-harm in CYP was measured through an adapted 12-item questionnaire; confidence in different areas of practice was measured through Likert Scale responses; self-efficacy for working with CYP who have self-harmed was measured through an adapted version of the Self-efficacy Towards Helping Scale; clinical behavioural intention was measured by the Continuing Professional Development Reaction Questionnaire. Semistructured interviews were undertaken with a purposive sample of participants. Results For those who completed the intervention (n=33), improvements were observed in knowledge (effect size, ES: 0.69), confidence, and in some domains relating to attitudes (effectiveness domain-ES: 0.49), and clinical behavioural intention (belief about consequences-ES:0.49; moral norm-ES: 0.43; beliefs about capability-ES: 0.42). Qualitative findings suggest participants experienced skill development, feelings of empowerment and reflection on own practice. Conclusions The effect of the intervention is promising and demonstrates the potential it has in improving registered children’s nurse’s knowledge, confidence and attitudes. However, further testing is required to confirm this.