ISSUES AND PURPOSE:To examine the roles of public policy and poverty on the rising number of children in family foster care, and to examine the impact of different types of family foster care on children's well-being.CONCLUSIONS:Recent changes in welfare legislation increase the likelihood of family poverty, with a subsequent increase in the number of children in out-of-home care. Greater emphasis needs to be placed on preventing entry into out-of-home care, improving the quality of foster care, and giving children a voice in care decisions.PRACTICE IMPLICATIONS:Nurses have important roles to play in the prevention of family dissolution, the design of healthcare delivery systems for children in foster care, in evaluating and educating all types of foster families, and as advocates in legal and legislative proceedings.
Role Play is an issues-related forum to engender dialogue about the roles assumed by nurses who care for children and their families.
ISSUES AND PURPOSE.To present an ecological model of child care health consultation that defines the role of the health consultant as a resource and advocate within child care programs, as well as a supportive link among families, child care providers, and the healthcare system.CONCLUSIONS.Nurses have provided health consultation to child care programs for more than 30 years and represent the majority of health consultants nationally. Pediatric nurses and advanced practice nurses are well prepared to shape and lead the development of this emerging role.PRACTICE IMPLICATIONS.With expertise in caring for children, understanding families, and care across systems, pediatric nurses and advanced practice nurses should engage in current state and national efforts to develop child care health consultatits.
ISSUES AND PURPOSE:To describe how African-American mothers' spirituality helped them cope during the time of their infants' hospitalization for a serious illness.DESIGN AND METHODS:Fourteen mothers whose infants were seriously ill in the early months of life were interviewed for this retrospective, descriptive study.RESULTS:The core theme related to prayer. Four mothers reported a strengthened faith, while two mothers continued to have difficulty relating to God or attending church.PRACTICE IMPLICATIONS:These findings support the importance of understanding and respecting the spiritual needs and expressions of spirituality in African-American mothers who are coping with a serious illness in one of their children.
Role Play is an issues‐related forum to engender dialogue about the roles assumed by nurses who care for children and their families.
News from the Society showcases SPN activities of interest to JSPN readers. This is the second in our series of reports highlighting the accomplishments of SPN committees.
ISSUES AND PURPOSE:This article examines the issues of youth violence and the role of the pediatric nurse in addressing youth at risk for violence. An example of a school-based violence prevention program is included.CONCLUSIONS:Black adolescent males from lower socioeconomic backgrounds and violent communities tend to be at highest risk. However, the profile of risk for violence is expanding to include youth in rural and middle-class suburban settings.PRACTICE IMPLICATIONS:Pediatric nurses play a vital role in the identification of at-risk youth and in the planning and evaluation of interventions for youth violence prevention.
ISSUES AND PURPOSE:This study compared clinical and economic outcomes for infants who were exclusively fed breast milk and infants who were fed commercial formula.DESIGN AND METHODS:A retrospective medical record review from a regional neonatal intensive care unit (N = 80) using consultation logs from the lactation coordinator and a matched sample of formula-fed infants.RESULTS:Neither clinical (weight gain, length of stay, days of parenteral nutrition) nor economic outcomes (direct variable costs, net revenue) differed significantly between the groups.PRACTICE IMPLICATIONS:While it may not be possible to demonstrate sufficient cost savings while the infant resides within the NICU to justify a lactation coordinator, long-term clinical and economic outcomes may be sensitive to this specialized nursing service.
ISSUES AND PURPOSE:Dexamethasone has been used to prevent postextubation stridor in children, but its use is controversial. Five randomized, controlled clinical trials were reviewed to analyze the effectiveness of prophylactic dexamethasone on postextubation stridor in pediatric patients.CONCLUSIONS:Previous studies had inconsistent results. Several factors may contribute to postextubation stridor in pediatric patients. Postextubation stridor and extubation failure do not always result from airway edema.PRACTICE IMPLICATIONS:In addition to prophylactic dexamethasone, other approaches should be used to prevent postextubation stridor, such as preparing the patient, following established guidelines, and providing appropriate postextubation care.
The Advocate is a forum for exploring our roles as advocates for the children and families we serve.
Scientific Inquiry provides a forum to facilitate the ongoing process of questioning and evaluating practice, presents informed practice based on available data, and innovates new practices through research and experimental learning.
ISSUES AND PURPOSE:Contraceptive methods that decrease bone density in a population already deficient in calcium are a rising concern in women's health.CONCLUSIONS:Use of Depo-Provera (DMPA) significantly decreases bone mass density (BMD) in normal adolescents up to the age of 21. DMPA is often used in adolescents with disabilities who may already be at high risk for osteoporosis. The effects are likely to be similar to that in able-bodied adolescents, but research is limited.PRACTICE IMPLICATIONS:Through early identification of risk factors in able-bodied and disabled adolescents, primary care providers considering the use of DMPA in adolescents can optimize BMD by providing adequate nutritional assessment, counseling on nutritional sources of calcium, calcium supplementation, guidance on exercise, and alcohol and smoking prevention or cessation.
In the rapidly progressing field of critical care, the diverse delivery of such care seems to be reaching new "heights." In particular, aeromedical transport of critically ill patients involves detailed preparation for the worst possibilities but with expectations for the best outcomes. The following case is presented as testimony to the challenges of critical care transport.
The Advocate is a forum for exploring our roles as advocates for the children and families we serve.
Pain assessment in critically ill children emphasizes the need to place expert nursing judgment prominently on the list of assessment strategies. The expert nurse is uniquely qualified to identify subtle responses to physiologic and environmental stimuli and to titrate analgesics and other pain relief strategies accordingly. While it is challenging to assess pain with limited verbal and behavioral cues, pain assessment is not only possible, but even more critical, when the available cues are subtle and can be easily overlooked or attributed to other causes. The question that sparked these comments reflects the passion I so often witness in intensive care nurses committed to eliminating pain as an emotional and physiological stressor for these vulnerable children. When that passion is empowered by evidence-based nursing judgment, children receive the best possible care.
ISSUES AND PURPOSE:To evaluate the characteristics of vaso-occlusive episodes, home management of pain and its impact on the daily activities, and a diary as a method of data collection.DESIGN AND METHODS:Forty-six adolescents and 75 children were asked to complete daily diaries during the intervention period of a larger study.RESULTS:Mild pain was recorded 95% of the time; moderate pain, 3%; and severe pain, 1%. The pattern and location of pain varied greatly. Adolescents used more interventions than did children. When pain intensity was mild, 80% of the children/adolescents maintained school, social, and home activities, but decreased play/sport activities. When pain intensity was high, they decreased their participation in all activities.PRACTICE IMPLICATIONS:Sickle cell pain episodes are unpredictable and highly variable. Diaries can enhance children's and adolescents' documentation and communication about their pain experiences.
It is our professional responsibility to encourage membership in nursing organizations. Membership helps nurses make intelligent, well-informed decisions about health care and our profession. It also enhances our credibility and helps validate nursing as a profession. Plato said, "Those having torches will pass them on to others." As nurses, educators, preceptors, advocates and mentors, we carry the fire.
Journal for Specialists in Pediatric NursingVolume 6, Issue 4 p. 196-200 Abby's Gift Tracy Pasek, Corresponding Author Tracy Pasek Advanced Practice RN Pediatric Intensive Care Unit Children's Hospital of PittsburghAuthor contact: pasekt@chplink.chp.edu with a copy to the Editor: Roxie.foster@uchsc.eduSearch for more papers by this author Tracy Pasek, Corresponding Author Tracy Pasek Advanced Practice RN Pediatric Intensive Care Unit Children's Hospital of PittsburghAuthor contact: pasekt@chplink.chp.edu with a copy to the Editor: Roxie.foster@uchsc.eduSearch for more papers by this author First published: 12 June 2007 https://doi.org/10.1111/j.1744-6155.2001.tb00244.xAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat Volume6, Issue4October 2001Pages 196-200 RelatedInformation
ISSUES AND PURPOSE:As no consistent predictor of insertion tube distance has been determined for intestinal feeding tubes and fluoroscopic placement is very expensive, this study sought a reliable method of blind placement.DESIGN AND METHODS:This cross-sectional study measured the internal distance from the lip to the pylorus in 387 children undergoing upper gastrointestinal endoscopy and compared those measurements to the external distances measured from the nose around the ear to the 10th rib and lip around the ear to the 10th rib.RESULTS:Regression equations using height fitted in four age groups were the best predictors of the internal pyloric distances.PRACTICE IMPLICATIONS:Predicting this distance with height may help healthcare providers be more successful in blind placement of intestinal feeding tubes. A table of predicted nasointestinal tube insertion distances is included.
Ask the Expert provides research‐based answers to practice questions submitted by JSPN readers.
