Discharge Of Children Research Articles

Parental satisfaction with paediatric intensive care

Literature reviews, parental consultation and multi-disciplinary input informed the development of a questionnaire to evaluate parental satisfaction with a regional paediatric intensive care service. The questionnaire was tested in a postal survey of 220 parents (response rate 50 percent) following their child's discharge from the unit in order to measure satisfaction levels, determine positive service attributes and identify strategies for future service development. There was a high level of parental satisfaction with many aspects of the service, particularly the standard of care, the perceived competency of staff and the level of support and involvement experienced. Satisfaction with facilities was more variable, although this was largely in relation to the hospital as a whole, rather than paediatric intensive care (PIC) facilities. Respondents provided suggestions for service development, particularly regarding information, communication and preparation for the transition from PIC to ward environments. Many of the strategies identified to optimise the service were not dependent upon extensive organisational change or excessive additional resources.

Aboriginal perspective on middle ear disease in the arid zone of Western Australia.

To explore perceptions, knowledge and experience of otitis media (OM) and barriers to compliance with treatment among Aboriginal people of the Kalgoorlie-Boulder area, Western Australia. This qualitative applied research study is based on a holistic design. We conducted structured interviews with three community focus groups, 56 key informants, and 22 mothers of babies known to have suffered from OM. Written records of interviews were checked with participants. The three sources of data enabled comparison and verification of results. People were concerned about serious consequences of OM, especially deafness and learning difficulties. Since early disease may have no localizing symptoms, not surprisingly, people had limited understanding of the aetiology of OM and were often only aware of disease once ear discharge was visible. Nevertheless, they usually sought treatment for non-specific symptoms. Competing demands in people's daily lives and the unpleasant, intensive nature of treatment result in families becoming resigned to a child's chronic ear discharge. Someone other than the biological mother within the extended family may be responsible for administering treatments. Half the carers thought passive smoking may predispose children to OM and 70% suggested clearing the nasal passages to prevent OM. Results of surgery were viewed positively but specialist services were not always readily accessible. Since responsibility for treatment may not lie with the biological mother, awareness campaigns must target the entire community. As early OM may be asymptomatic, health personnel should be encouraged to do otoscopy on all children with non-specific symptoms.

Évaluation des pratiques autour de la sortie de néonatalogie : 3 ans d’expérience

This study purpose was to identify the advantages and limitations of our practice in planning newborns' discharge from the neonatal unit. We searched for appropriate actions to promote good family conditions and environment for infants being discharged from the neonatal unit. During a six-month period in 1999, we interviewed 110 families whose infants were discharged from our units. All interviews were conducted by the same person using a semi-directive protocol to collect the parents' perceptions of their child's hospitalisation and discharge and their recall of the first days at home. Data were collected after a sufficient period of adaptation at home. Analysis of the interviews showed that different difficulties could be prevented. Based on these findings, we instituted different pluridisciplinary discharge group to review practices in September 2000. In 2002, the same type of survey was conducted to evaluate improvement. Discharge from the neonatal unit was affected by the parents' perceptions of hospitalization, their ability to anticipate, before announcement of the "medical" discharge, home life with their child and to imagine their own professional and familial network. The parents' abilities to elaborate a discharge plan all along their child's hospitalisation helps improve the newborn's arrival in the family.

Parent's management of their child's pain in the home following day surgery.

When a child returns home following day case surgery, the parent becomes responsible for the assessment and treatment of their child's pain. Pain is documented as being the most common complication following day case surgery. The study investigated parental management of their child's pain at home following day surgery. A purposive sample of 100 parents of children undergoing day case surgery at a regional paediatric hospital was obtained. Parents were contacted by telephone in their own home 24 hours after day surgery and, through a structured interview schedule, were asked a series of questions relating to their child's pain management and discharge information. The results indicated that parents managed their child's pain in the home if provided with information and suitable analgesia on discharge. Instigation of telephone follow-up for parents was upheld as a measure to provide support to parents, as 79 percent of parents found the telephone call useful.

The effect of standard care, ibuprofen, and distraction on pain relief and patient satisfaction in children with musculoskeletal trauma

Introduction: The purpose of this study was to determine the effectiveness of nursing interventions in decreasing pain for children with minor musculoskeletal trauma and moderate pain and to examine patient satisfaction. Methods: Children were assigned to 1 of 3 intervention groups: (1) standard care (ice, elevation, and immobilization) only; (2) standard care and ibuprofen; or (3) standard care and distraction. Children were monitored for pain ratings for 60 minutes. Children who sustained minor musculoskeletal trauma within the past 24 hours and presented with pain ratings of 2 or greater using the 0-5 Wong/Baker faces scale were included. Two patient satisfaction questions were asked of parents upon their child's discharge from the emergency department. Results: A statistically significant decrease in pain for all patients (76) occurred at 30 minutes (F = 4.39, P <.05) and was maintained at 60 minutes. The distraction group demonstrated a statistically significant reduction in pain compared with the other groups at 30 minutes; this reduction was maintained at 60 minutes (F = 47.07, P <.05). Parents of only 6 children expressed dissatisfaction with overall pain management. Twelve percent of children who were not in the group receiving medication received analgesics while in the emergency department. At discharge, only 37% of children with fractures and/or sprains had received medications for pain. Discussion: Children with musculoskeletal trauma may be undermedicated. Distraction techniques can be an effective adjunct to analgesia for children with musculoskeletal pain in the emergency department and should be made available. Ibuprofen may not be an effective analgesic for children with these injuries; stronger analgesics may be required.

Parent Support of Feeding in the Neonatal Intensive Care Unit

To examine the perceptions of parent education and support of feeding in the neonatal intensive care unit (NICU), a survey was conducted with occupational therapists (OTs) and parents of infants in the NICU. Data were collected from 32 OTs and 11 parents. The results showed that OTs used a variety of teaching methods to convey information about feeding to parents, that parents felt “very confident” and OTs felt “confident” in the parents' understanding of the material, and that different types of equipment and follow-up services were offered to parents following their child's discharge from the NICU.

Clinical Guidelines and Hospital Discharges of Children with Acute Urinary Tract Infections

Clinical Guidelines and Hospital Discharges of Children with Acute Urinary Tract Infections

Treatment of the seriously burned infant.

Infants (younger than 12 months) with large (more than 30%) burns are reported to have poorer chances for survival than older children with similar injuries. However, recent experience with such infants has been positive, prompting a 5-year review of management techniques. The injuries were approached in an organized fashion that included precise fluid support, excision, and biologic closure of full-thickness wounds within 5 days, limited exposure to high inflating pressures (more than 40 cm H2O), weekly replacement of central venous catheters, and intensive nutritional support via the enteral route whenever possible. Twelve such infants were treated during the 5-year interval. Their average age was 7.8 months (range, 1 to 12 month[s]), average weight was 8.8 kg (range, 4.3 to 13 kg), and average burn size was 42% (range, 30% to 90%). Inhalation injury was present in two of the children, and one child aspirated hot liquid. Six (50%) of the infants required the support of a mechanical ventilator for an average of 11.6 days (range, 4 to 18 days). Eight children required an average of 5.7 operations (range, 1 to 18 operation[s]), seven required central venous catheters, and five required arterial cannulae. Major infectious complications were seen in four children. Complications included pneumonia (two), catheter sepsis (two), peritonitis from a perforated ulcer (one), and wound sepsis (two). Six children required parenteral nutritional support for an average of 15 days (range, 5 to 36 days), and six children required enteral tube feedings for an average of 23 days (range, 9 to 55 days). Anabolic agents were not used. Discharge weights averaged 8.6 kg (range, 4.9 to 10.5 kg). The average ratio of the children's discharge to admission weight was 101% (range, 73% to 120%). All children survived and were discharged home. We conclude that these difficult injuries can be approached successfully with a strategy that emphasizes precise fluid repletion; early excision and biologic closure of wounds; avoidance of ventilator-induced lung injury; and intensive nutritional support.

Does physical exercise influence the occurrence of epileptiform EEG discharges in children?

To determine if, and how, epileptiform EEG discharges in children were influenced by physical exercise. Twenty-six children with intractable partial and generalized epilepsy exercised during video-telemetry recording, aiming at exhaustion after approximately 10 min. During the exercise, epileptiform discharges decreased in 20 of 26 children (17 children had at least 25% reduction) and showed a rebound increase after the exercise (17 of 26 children) compared to baseline conditions. This exercise-induced reduction in epileptiform discharges reached statistical significance only in the 16 patients with localization-related epilepsy. Five patients showed an atypical EEG response to exercise with either unchanged or increased epileptiform activity while exercising. As compared to the other patients, these 5 children had experienced frequent clinical seizures during or immediately after exercise in their leisure time. In the majority of the tested children, epileptiform EEG discharges decreased during exercise. "Exercise-EEG" may be a helpful diagnostic tool to identify patients who are disposed to have exercise-induced seizures.

Parental perceptions, expectations and preferences for the postanaesthetic recovery of children.

Improvements in anaesthesia have led to the introduction of rapid-acting agents which quicken recovery and decrease sleepiness. Whether parents believe a rapid postanaesthetic recovery is an advantage is unknown. Therefore, we evaluated the parental perceptions, expectations and preferences for the postanaesthetic recovery of children. One hundred and three parents of children having ambulatory surgery completed a structured questionnaire and the results of 101 are presented. Results indicate that 93% of parents expect their child to be sleepy after surgery. Seventy-four per cent of parents indicated they would prefer their child to be sleepy or tired in the first 24 h postoperatively. Eight-five percent of parents would not be upset if their child's discharge was delayed up to three hours because their child was too sleepy. Finally 45.5% of parents are extremely concerned about their child experiencing postoperative pain and 68% believe that their child would be in more pain if they recovered rapidly from the anaesthetic. These results indicate that rapid recovery from anaesthesia and quick discharge from hospital are not key expectations of parents of children admitted for day surgery. Parents associate a rapid recovery with more pain. Parents need to be more fully informed of the advantages of a rapid recovery and reassured that children can recover quickly and completely but at the same time be comfortable postanaesthetic.

Nurses’ and parents’ perceptions of participation and partnership in caring for a hospitalized child

A descriptive study was undertaken to determine whether parents were able to participate in the care of their hospitalized child and work in partnership with the nurses. The study utilized method triangulation and was conducted in two phases. In phase one a postal survey of 65 nurses was undertaken in three children's wards within an NHS trust hospital, while in the second phase, 12 in-depth interviews were completed with parents in their own homes following their child's discharge from hospital. The quantitative data were analysed using descriptive statistics and the qualitative data were subjected to content analysis. The data suggested that parents were willing to be involved in caring for their hospitalized child yet experienced difficulties as a result of inadequate information and the nurses' reluctance to relinquish control of the nursing care. These findings demonstrated that nurses and parents had different perceptions of their individual roles. Consequently, the nurse/parent relationship was not always conducive to a partnership approach, which has implications for both nurse education and clinical practice.

The behavior of preschoolers during and after brief surgical hospitalizations.

This qualitative study describes the behavior of preschool children during and after very brief hospitalizations for tonsillectomies and/or adenoidectomies. Structured, open-ended home interviews were conducted with 23 parents 5 to 7 days after their children's hospital discharge. Parents were asked to describe their children's behaviors during hospitalization and the first week at home. Approximately half of the parents and children had attended an optional surgical preadmission teaching program. The remaining parents had prepared their children for hospitalization using toy doctor kits and library books. Preoperatively, children who had attended the program behaved similarly to those who had not: They either cooperated fully, resisted initially, or completely refused to cooperate with admission procedures. Most children separated easily from their parents to enter the operating room, whereas some (n = 5) demonstrated great anxiety. However, immediately after surgery, most children who had not attended the program appeared more distressed than those who had attended. Finally, despite their relatively minor surgeries and brief hospitalizations, after discharge the majority of children (83%), regardless of whether they had attended the program, exhibited signs of distress. In comparison with their prehospitalization behavior, parents reported that their children were more irritable, had more nightmares, had appetite changes, and experienced more separation anxiety. Implications for nursing practice and research are discussed.

Parental concerns following a child's discharge from a bone marrow transplant unit.

The purpose of this descriptive study was to explore the concerns of parents following a child's discharge from a bone marrow transplant unit. A qualitative approach which included components of grounded theory was used to explore the posttransplant experience from the parents' perspective. Seven parents of five children who were transplanted for a variety of malignancies at a number of out-of-state centers were interviewed about their experiences. Chart analysis and participant observation provided additional sources of data. Initial coding of audio-taped interviews revealed 32 topics of concern voiced by the parents. Use of the constant comparative analysis technique resulted in the emergence of six major themes of the posttransplant experience. The Return Home, Changing Relationships, Working with This, Learning the Rules, The New Norm, and The Uncertain Future were components of this transitional period for each family. Similarities were found between the experiences of study parents and the parents of chronically ill children and parents or spouses of organ transplant recipients. Awareness of posttransplant concerns may facilitate the efforts of both transplant and referral center staff to educate, support, and care for these children and their families.

Young, scarred children and their mothers—a short-term investigation into the practical, psychological and social implications of thermal injury to the preschool child. Part I: implications for the mother

A short-term, prospective study, using both quantitative and qualitative methods, was designed to determine the practical, psychological and social implications of thermal injury resulting in scarring, for the mothers of thermally injured children, during the 6 months following the child's discharge from hospital. Mothers of 57 thermally injured children under 5 years of age were interviewed whilst the child was in hospital and at home, at 1 week, 2 months and 6 months following hospital discharge. Thermal injuries ranged from 1 to 41 per cent of body surface area and all required skin grafting. Qualitative analysis of interview transcripts resulted in the development of a model of the mother's response-The Maternal Thermal Injury Response Pattern (MTIRP) - which describes a phasic pattern of general response categories. The mothers' psychiatric morbidity was measured using Goldberg's (1978) 60-item General Health Questionnaire (GHQ). The mean of the mothers' total GHQ scores was 2.42 for the retrospective, pre-injury score, 24.5 at the hospital interview and 5.96 at 6 months following the child's discharge from hospital. In conclusion, the mother is a neglected victim of a young child's thermal injury. Use of the MTIRP as an educational tool for carers would promote increased understanding and, thus, more appropriate support.

Young, scarred children and their mothers — a shortterm investigation into the practical, psychological and social implications of thermal injury to the preschool child. Part II: implications for the child

A short-term, prospective study, using both quantitative and qualitative methods, was designed to determine the practical, psychological and social implications of thermal injury resulting in scarring for children under 5 years of age, during the 6 months following the child's discharge from hospital. Mothers of 57 children (whose thermal injuries ranged from 1 to 41 per cent of body surface area and who all required skin grafting) were interviewed whilst the child was in hospital and at home, at 1 week, 2 months and 6 months following hospital discharge. From the mothers' descriptions, four categories of child behavioural response to thermal injury and hospitalization were identified. In the first week after discharge from the burns unit, 56 per cent (32/57) of children displayed minor or major disturbed behaviour, which had reduced to 19.3 per cent (11/57) by the 6-month interview. There were many reported physical and practical problems associated with the thermal injury and after-care. The MacGregor Deformity Scale was employed to assess the child's appearance. The child behaviour test scores (S. Jenkins et al. J. Child Psychol. Psychiatr. 1980; 21:5; N. Richman et al. Pre-school to School -A Behavioural Study. 1982; Academic) demonstrated a similar progression of behavioural responses as the qualitative data, and, furthermore, indicated that the children under 2 years of age seemed to be affected for a more prolonged period.

Primary closure of contaminated wounds in perforated appendicitis

We studied the clinical course of 506 children consecutively admitted with appendicitis at The Hospital for Sick Children from 1985 to 1989. One hundred eighty-one children (35%), ranging in age from 1 to 17 years, presented with perforation verified by histological examination. Ninety-six of them (53%) had generalized peritonitis, 47 (26%) had localized peritonitis, and 38 (21%) had abscess formation. Usually, triple antibiotics were begun preoperatively if perforation was suspected; otherwise, cefoxitin was started. Triple antibiotics were used postoperatively for 5 to 7 days in almost all children in the perforated group. Neither abdominal nor subcutaneous drainage was routinely used even in cases of intraabdominal abscess. The skin was closed primarily with steri-strips (63%), staples (20%), subcutaneous Dexon (11%), or silk (4%). Postoperative wound infection arose in 20 children (11%). Wound infections were noted from 1 to 14 days postoperatively (mean, 5.9 days). Whereas 9 of these were treated with local therapy only, 11 delayed the child's discharge or necessitated readmission. No patient suffered major complications from wound infection in that there were no cases of necrotizing fasciitis, reoperation for debridement, sepsis, or death. The intraabdominal abscess rate in this group of 181 children was 6% (n = 11). The low rate of infective complications fully justifies the policy of primary closure in contaminated wounds. This policy eliminates the necessity for painful and time-consuming dressing changes, shortens hospitalization, and obviates the trauma of delayed suturing of wounds in children.

Percepción materna de la calidad en la atencion a niños hospitalizados.

In order to evaluate the perception of mothers on the care given to their hospitalized children, a survey was specially designed and carried out with 100 mothers on the day of their child's discharge. Hospital care was rated excellent or good by a 96%, regular or bad by 4% of surveyed mothers. Most (74%) mothers saw at least one member of the caring team acting affectionately with their children; only 2% complained that her child was reprimanded or punished. Lack of equipment or human resources and comfort facilities were frequently perceived by mothers but quality of care was generally considered to be satisfactory. This kind of studies is probably useful to improve community's health services.

Transition From Hospital to Home for Children With Complex Medical Care

Home care has become a well-accepted option for children with chronic illnesses, such as cancer, who require continued technological care for survival. Components of successful home care include assessment of the child and family for this option, assessment of the community's ability to provide the services the family needs, development of a comprehensive care plan, education of care givers, and ongoing evaluation of the plan. Nurses play a major role in the discharge planning for home care by educating care givers to perform the necessary care, by providing opportunities for care givers to demonstrate competence before assuming total responsibility, and by ensuring that the care givers and the home environment are ready for the child's discharge. Throughout this process, the principles of normalization are applied to provide the child with an optimun home environment. Establishing parent-professional partnerships is crucial to providing family support that empowers family members, especially parents, to assume the responsibilities of caring for their child.

The Function of Self-Touchings, Posture Shifts, and Motor Discharges in Children from 3 to 6 Years of Age

The function of self-touchings, posture shifts, and discharges was studied by comparing videotapes of 48 normal children aged 3 to 6 yr. performing on two tasks, watching cartoons and telling about these cartoons. We scored the occurrence of self-touchings, posture shifts and discharges by 5-sec. intervals on both tasks. We could not find developmental changes between 3 and 6 yr. of age, but significant differences in the numbers of movements between watching and telling appeared. Children moved much more during telling than during watching cartoons. This was interpreted as a reflection of task-specific attention in watching and telling. The attention-regulating function of the behavior was further shown by an outburst of movements during the first 10 sec. after the start of watching each cartoon. Self-touchings, posture shifts, and discharges seem to be part of the 'orienting reflex'.

On‐Line Detection of Transient Neuropsychological Disturbances During Eeg Discharges in Children with Epilepsy

Short-term memory tasks (visual-spatial and verbal) were devised to identify the influence of transient EEG discharges, without clinically manifest disturbances, on neuropsychological performance. 53 children with subclinical focal and generalized EEG discharges were tested 72 times and 16-channel telemetered EEG and video-recordings were made. 36 per cent of test sessions showed a significant preponderance of errors when discharges were recorded. Children with right-sided discharges had impaired performance in 50 per cent of their test sessions, with performance on the visual-spatial task most affected: left-sided discharges appeared to exert greater influence on the verbal task. These tests can easily be used to monitor six- to 15-year-old children.