Pediatric Clients Research Articles

Digital Parenting

Abstract Parenting helps socialization in children. The inevitable presence of digital media has a major impact on parent–child relationships and parenting skills. The increased use of digital devices, such as smartphones and tablets, by children forces the parents to change their parenting styles. Digital parenting refers to a process adopted by parents to monitor and regulate the activities of their young ones in handling digital devices. The main aim of this style is to protect their children from various online dangers. Parents need to use several approaches for regulating digital media behaviors of children, such as setting limits, practicing constructive discipline, spending time with their kids, and so forth. However, there are challenges associated with digital parenting. Some of the issues include unlimited access to Internet, parents’ job, reverse socialization, and so on. Pediatric nurses can help parents in successfully managing digital parenting styles through education and advocacy as part of health promotion activities of pediatric clients both in hospital and community settings.

An LGBTQIA+ Symposium to Improve Care for Sexual and Gender Minority Youth.

Multilevel factors drive health disparities experienced by sexual and gender minority (SGM) populations. We developed a 3-hour symposium focusing on care for SGM youth to address this. The symposium was a free, extracurricular event open to the public, with an emphasis on health professional students and providers from all disciplines and involved interprofessional didactic and interactive components. Participants completed optional retrospective pre/postsurveys immediately and 10-months postsymposium. Surveys contained Likert-scale questions addressing five indicators of symposium effectiveness related to knowledge, confidence, and comfort in providing care for SGM populations. We used 1-tailed paired t tests to evaluate the effectiveness of the symposium, and analysis of variance tests to compare differences by professional role. Of 208 individuals who attended the symposium, 67 completed the initial survey, and 23 completed the 10-months postsymposium survey. Participants reported significantly higher ( P<.001) scores across all five measures of effectiveness from pre- to immediately postsymposium, and remained at significantly higher ( P<.05) scores across all measures from presymposium to 10 months postsymposium, except for comfort recommending care for SGM pediatric patients or clients. Results suggest that the symposium improved participants' perceived effectiveness in serving SGM pediatric patients, although selection bias is a concern. Dissemination of educational approaches that incorporate interprofessional didactic and active learning components may help improve workforce capacity to improve SGM health.

A Comprehensive Quality Assurance Platform in Canada for National Point-of-Care Chronic Kidney Disease Screening: The Kidney Check Program

A Comprehensive Quality Assurance Platform in Canada for National Point-of-Care Chronic Kidney Disease Screening: The Kidney Check Program

Relationship Between Parental Attachment and Stress Elevation and Synchrony in Pediatric Occupational Therapy Patient–Parent Dyads

Populations already experiencing chronic stress, such as families with children who are neurologically atypical, are at particular risk for developing stress-related disease. To establish feasibility of collecting salivary samples from pediatric occupational therapy patients and their parents in a clinical setting and at home and to examine associations among parental attachment style, parent self-reported stress, and physiological stress (i.e., cortisol) in pediatric occupational therapy patients who were neurologically atypical and their parents (N = 10 dyads). Cross-sectional pilot study to test feasibility. Sliding-scale university clinic. Participants were 10 children undergoing occupational therapy treatment and their parent. Families were approached and told the study was voluntary and would not affect their treatment. Families provided informed consent. Parents completed measures to assess their own attachment style, general and parenting stress, and stress in their child. Children and parents provided saliva samples during an occupational therapy clinic visit and collected samples at home to measure cortisol level. Parent attachment avoidance was related to increased parent cortisol levels in the clinic and increased child cortisol levels at home. Parent and child cortisol levels had a strong, positive relationship in the clinic but not at home. We did not observe a difference between cortisol levels in children or parents in the clinic or at home. We concluded that this protocol is feasible and provide suggestions for future research. Stress physiology in pediatric occupational therapy clients should be considered within the context of the family system. Family-based interventions may be particularly helpful for reducing client stress in this population.

The Transferability of Goal Attainment Scaling (GAS) for Child Life Specialists Working in Pediatric Rehabilitation: A Critical Review of the Literature

There is much variation in the way child life specialists implement and document their interventions and services, especially among practice arenas. This variation includes the methods child life specialists use to set individual goals with pediatric clients and families, as well as to evaluate the effectiveness of their interventions and services. The purpose of this paper is to highlight how goal attainment scaling (GAS) could and should be inte-grated into the daily practices of child life specialists working in a pediatric rehabilitation setting. GAS is a widely used individualized outcome measure, designed to assess whether individuals have achieved the goals of intervention by quantifying their progress (Kiresuk &amp; Sherman, 1968). As there is currently no literature on the integration or utility of GAS as an outcome measure for child life specialists, this paper will critically examine the available peer-reviewed literature to demonstrate how and why GAS is currently being implemented in pediatric rehabilitative settings by other health care practitioners. Recommendations for the transferability of GAS in child life practice will subsequently be discussed to not only address this gap in knowledge, but to further emphasize the benefits of using an individual-ized outcome measure in clinical practice.

Outcomes Among Student-Clinicians After Participation in LEGO® Club: A Service-Learning Pilot Program

Abstract Date Presented 03/26/20 This project explores the impact of a service-learning pilot program, LEGO club, on OT and speech-language pathology graduate students’ self-efficacy in clinical and interpersonal collaboration skills. Students facilitated weekly LEGO club sessions with pediatric clients with and without social-skills deficits and reflected on their professional growth throughout the program. Primary Author and Speaker: Aubrey Matthews Additional Authors and Speakers: Amanda Worek, Andrea Fairman Contributing Authors: Sarah Friel, Anthony Sindelar

Hippotherapy Practice and Safety Patterns in the United States: A Descriptive Survey Study.

Objective: The use of equine movement as a therapy tool in a plan of care, or hippotherapy, has grown considerably over the past three decades. However, there is little evidence of safety rates and related practice patterns to guide key stakeholders such as clients, therapists, the health care team, and third-party payers. The purpose of this article is to describe the safety and practice patterns of contemporary use of hippotherapy. Design: A survey was distributed to occupational therapy (OT), physical therapy (PT), and speech-language pathology clinicians who incorporate hippotherapy into their practice. The survey included questions about clinicians' practice patterns, safety procedures, and rates of safety incidents. Results: Results indicate that hippotherapy is most often used by PT and OT clinicians for pediatric clients. Use of hippotherapy varies by geographic location, and frequency and duration vary widely. Clinicians most often contract their services to a program that provides a facility and horses. Recommended safety practices are widely adopted, and rates of safety incidents requiring basic first aid (0.05% of sessions) or off-site care (0.01% of sessions) are low. Emergency dismounts are frequently practiced and often effective in preventing an incident. Conclusions: Although there are inherent risks to incorporating horses into a therapeutic plan of care, these risks appear to be well managed by recommended safety practices. Results of this study can (1) help clinicians to make informed decisions regarding practice and safety procedures, (2) provide evidence of safety practices and incident rates to clients, members of the health care team, and third-party payers, and (3) maximize safety for clients who participate in hippotherapy.

EFEKTIFITAS MODEL AAPTASI ROY DALAM MANAGEMEN KASUS DEMAM NEUTROPENIA PADA ANAK DI RUMAH SAKIT CIPTO MANGUNKUSUMO

Demam neutropenia merupakan komplikasi yang terjadi paska kemoterapi. Tujuan Karya Ilmiah Akhir adalah menggambarkan aplikasi model adaptasi Roy dalam merawat anak dengan kanker yang mengalami masalah demam neutropenia dan pencapaian kompetensi praktik spesialis keperawatan anak. Peran perawat yang dilakukan selama praktik adalah pemberi asuhan, advokator, konselor, pendidik, kolaborator, peneliti dan inovator berlandaskan etik dan legal dalam keperawatan. Pendekatan model adaptasi Roy diaplikasikan pada 5 kasus dan proses keperawatan yang dilalui adalah pengkajian perilaku, pengkajian stimulus, diagnosa keperawatan, tujuan keperawatan, intervensi dan evaluasi. Evaluasi yang didapat adalah nilai ANC lebih dari 1000 mm3 saat anak keluar dari ruang rawat demam neutropenia, dan gejala klinis mengalami perbaikan. Model adaptasi Roy dapat diterapkan pada anak kanker di ruang rawat anak dalam upaya mencapai proses adaptasi dan meningkatkan kualitas hidup anak.

Youth Suicide: Examining Pediatric OT Practitioner Knowledge, Comfort, and Training Needs

Abstract Date Presented 04/04/19 Suicide is the second-leading cause of death among youth ages 10 to 24 in the US, and youth who receive OT services may be at risk. Yet, little is known about OT provider capabilities to identify and reduce suicide risk in pediatric clients. In this study, we surveyed pediatric OT providers about their knowledge, comfort, and training needs related to youth suicide. This information is necessary to inform steps to enhance the impact OT can make on the reduction of youth suicide. Primary Author and Speaker: Anne Kirby Contributing Authors: Alexandra Terrill, Jarrett Henderson

Researching experiences of childhood brain injury: co-constructing knowledge with children through arts-based research methods

Objective: In the knowledge base examining experiences of childhood brain injury, the perspectives of children with brain injury are notably lacking. This failure to represent the voices of pediatric clients has resulted in an incomplete knowledge base from which to inform evidence-based rehabilitation practice. In this paper, we examine why the perspectives of children with brain injury are rarely sought and propose a new way forward.Methods: We draw upon current evidence and practices in related fields and present an exemplar from an in-progress qualitative arts-based research project with children with brain injury.Results: Assumptions ingrained in research practices, particularly those surrounding the capacity of ‘doubly vulnerable’ children with brain injury to produce knowledge, have resulted in the relative exclusion of this group from research that concerns them. For the field to evolve, research practices must value children’s first-hand accounts, engage them in co-constructing knowledge about their lives, and invite methods that meet their interests and abilities.Conclusion: By reframing how we think about the capacities of children with disabilities and shifting our research practices to include children with brain injury as knowledgeable participants, it becomes possible to expand the knowledge base upon which clinical rehabilitation practices are built.Implications for RehabilitationCurrent research practices preclude ‘doubly vulnerable’ pediatric populations, including children with brain injury, from actively contributing to research that concerns them.As a result, the perspectives of children with brain injury are virtually absent from research, rendering the evidence base upon which rehabilitative practices are built incomplete.Reframing how we think about the capacities of children with brain injury can shift how we engage with them, both in research and clinic, and may subsequently impact the knowledge available to us.Implications for client-centred rehabilitation are discussed, including the need to understand children as capable of insight into their own experience, as able to contribute to a more complete understanding of the health phenomena that affect them, and as invaluable and active participants in research and clinical care.

Physician Mediation Theory and Pediatric Media Guidance in the Digital Age: A Survey of Autism Medical and Clinical Professionals

ABSTRACT Research on physician mediation suggests that physicians actively discuss media use (e.g., seeking online health information) with their patients. This theory has been limited though with respect to incorporating key behavioral determinants, varied forms of mediation, and samples beyond primary care physicians (MDs). A survey of 335 U.S.-based medical and clinical professionals (MCPs) treating pediatric clients on the autism spectrum (e.g., pediatricians, speech-language pathologists) examined how they advise caregivers about managing their child’s recreational media and technology use, also known as media guidance. Results indicate the frequency of these discussions varies by MCP type. Hierarchical regression analyses show, as hypothesized, that additional behavioral and contextual determinants not previously considered (i.e., perceived norms, self-efficacy, information sources and child factors) are significantly associated with positive, negative and redirective mediation practices. Results expand existing theory and justify extending physician mediation research beyond MDs. Implications for clinical practice and health communication research are discussed.

The use of telehealth in pediatric occupational therapy

Introduction: The need for an on-time assertive and specialized approach to pediatric clients of occupational therapy is growing. Not all children have access to on-time intervention, and some are not even identified as needing so. Engaging in web-based social communication groups/sites/pages, etc., either from parents [1], but also from colleagues provides, amongst other advantages/benefits: a) a way to bring the occupational therapy prevention /assessment/intervention to the children and their families; b) it is an effective and up-to-date manner of spreading the word about occupational therapy. There were identified some gaps/needs in pediatric occupational therapy intervention [2], mainly in babies population (0–24m), which were not identified/diagnosed with any specific issue/problem/concern. Although, when in daily routine, specific questions/doubts/concerns arise related mainly with routines, self-regulation and mother anxiety. Objectives/Goals: Evidence the use of telehealth in pediatric occupational therapy and its potential; Evidence the role of the occupational therapist; Identify the main concerns/issues of the mothers who use the social media to obtain answers. Materials and methods: There were 3 phases for this pilot study: Informal Contact Phase, Formal Contact Phase and Evaluation Phase. This pilot study abides by the Declaration of Helsinki. The formal contact phase sample size was of 57 participants. From the formal contact phase, only 31,5% passed to the Evaluation phase. The data collected, voluntarily and anonymously, in the Evaluation phase included: Age distribution, Formal contact issue, Feelings towards formal contact, Client Satisfaction, Recommendation to others, Hour of the day of the formal contact. Results: The results revealed that 51% of respondents were mothers of babies between 0–12 months of age; mainly concerned about Daily Routines (56%), specially Feeding and Sleep. Over 55% felt Clarified and Supported, with 89% Satisfaction Rate and 94% Recommendation to others rate. Discussion and conclusions: Clear evidence of the effectiveness of the use of Telehealth in Pediatric Occupational Therapy. Further needs rely on gathering a larger sample size, include geographical data collection and the need to share study results with the paediatric health professional community.

HSR19-080: Situational Analysis and Needs Assessment Regarding the Availability and Extent of Pediatric Palliative Care Services in the Philippines

Background: Around 200,000 pediatric clients are diagnosed with cancer each year globally. Majority (84%) of cancer cases are found in developing countries with 20% average survival rate (Ferlay et al, 2012). Two-thirds of pediatric oncology clients in the Philippines are diagnosed at advanced stages (Lecciones, 2015). Abandonment of treatment is high at 80%. Only about 10%–20% of clients attain long-term survival despite availability of multidisciplinary management. These outcomes reflect the gap in service delivery for pediatric oncology clients (Ferlay et al, 2012). Therefore, to improve accessibility to healthcare, it is necessary to determine the perceived palliative care needs of clients, their caregivers, and healthcare providers. Objective: To identify the availability of palliative care services in the country, identify barriers in service delivery, and determine the palliative care needs of pediatric oncology clients, their caregivers, and healthcare providers. Methods: The descriptive, cross-sectional study design involved a situational analysis by mapping 2 Philippine palliative centers. Focus group discussions (FGD) and interviews with healthcare professionals were conducted to determine the extent of services, geographical coverage, and perceived palliative care needs. The needs assessment tool by WHO (2004) was adopted to identify the palliative care needs of pediatric oncology clients as perceived by caregivers. Results: From a total of 181 primary caregivers, the identified main problems in caring was the economical (95.6%) aspect. Financial support (92%) was the most pressing need. Caregivers would like to learn more about general cancer care (39%) and nutrition counseling (24%). The most common palliative care needs as perceived by caregivers included accessibility to cancer facility (27%), free cancer medications (12.7%), and financial assistance (14.9%). The common barriers in rendering care were financial constraints (66%), behavioral changes (12.7%), and travel limitations (6%). The common themes found during the FGDs and interviews were: (1) inadequate human and structural health resources; (2) need to focus on psychosocial care; (3) addressing economic constraints; and (4) need to increase cancer awareness among caregivers. Conclusion: The findings of the study documented the need for the development of structured programs for pediatric palliative care in the Philippines.

Interprofessional Collaboration between Occupational Therapists and Speech Language Pathologists with Children who have Sensory Processing Deficits

Introduction Background: Occupational therapists (OT) and speech-language pathologists (SLP) are unique within their skills. Both professions work closely together in a collaborative manner to improve child and family outcomes. Purpose:The aim of this study is to develop evidence based interprofessional educational modules to improve outcomes between occupational therapists and speech-language pathologists when working with a child who demonstrates sensory processing disorder. Aim of the study: 1.Understand the impact of interprofessional collaboration OTs and SLPs when working with a child with sensory processing deficits 2.Understand the influence of educating SLPs on sensory processing 3.Demonstrate the Methodology Research Design: Mixed Methods Study using Pre-test Post-test and Qualitative Method Initial stage of study: 5 Speech Language Pathologists to determine Face Validity and 5 Occupational Therapists to determine Content Validity. Results Phase 1: Complete Phase 2: Recruitment is to begin September 2018 Phase 3: Recruitment to begin Spring 2019 Conclusions Conclusion to be determined upon Phase 2 CompletionImplications for practice: In this study, we have sought to demonstrate the value of interprofessional collaboration between occupational therapy and speech therapy graduate students treating sensory processing issues in pediatric clients. There is a growing body of research emphasizing sensory processing as an important component of human behavior, affecting health care practices and increasing among children in the United States (Dunn, 2007). Individuals with sensory processing challenges, mostly children, can experience disruptions to their daily routines, decreased participation at home and school, and attention issues that cause challenges during speech therapy sessions and that may hinder treatment outcomes. Our study has aimed to increase the body of knowledge pertaining to sensory processing challenges in relation to speech therapy specifically, such as ways that speech therapists can identify sensory processing challenges among their pediatric clients and make necessary referrals for occupational therapy services to increase therapy outcomes, as well as to demonstrate effective collaboration and interprofessional education practices between occupational therapists and speech therapists to be furthered by future research.

Progress Measurement in Children With Developmental Disabilities Using Goal Attainment Scaling

Abstract Date Presented 4/21/2018 The aim of this research was to determine whether diverse pediatric clients receiving therapy services were making sufficient progress toward individualized client-centered goals when measured quarterly using goal attainment scaling. Factors that may contribute to reported progress are discussed. Primary Author and Speaker: Maureen Russell Additional Authors and Speakers: Amber Nivens, Lauren Hall

Nurse’s Health Education in Families of Pediatric Surgical Clients

Health education is one important component in caring for children with surgical cases. Health education is done to clients and families as an intervention of various nursing problems that appear both pre and post surgery. This study aims to find out how the implementation of health education provided by nurses to families of child surgical clients. This research method is descriptive qualitative phenomenology by using in-depth interview. The number of participants was 5 nurses. The amount is determined after the researchers assume that the research data saturated. The research produced five themes: preoperative health education, postoperative health education, postoperative nutrition, surgical wound care and post operative post pain. The health education provided by the majority nurses is physical. Psychosocial should also be a topic in health education provided by nurses to clients of children and their families.

A Network Analysis of Youth with Physical Disabilities Attending a Therapeutic Camp

Pediatric clients with physical disabilities are at-risk for psychosocial stress compared to peers without health conditions. Therapeutic camps are one program known to provide positive psychosocial outcomes yet effects tend to extinguish over time. The value of therapeutic camps in improving true reciprocal friendship opportunities while enhancing important matters discussant groups is unknown. The aim of this study was to explore the impact camp participation had on enhancing reciprocal relationships and important matters discussant group alters, test for significant differences reported by children and adolescents, and examine the distribution of reported alters within networks. An important matters discussant group name generator centered on four hierarchical role-relation prompts along with one exchange relation approach question. The name generator was administered to 76 youth with physical disabilities 8-18 years of age attending a two week residential camp. Statistically significant differences were found for adolescents seeking out non-relative peer supports in comparison to children. No difference was found in years attending camp and network composition despite 21% of the overall networks comprised of camp contacts indicating a possible social inoculation effect regardless of years attending. Distribution of important matters alters appears to be skewed toward relatives. Future implications focus on testing and improving the therapeutic camp model to address the extinguishing psychosocial effects post camp by capitalizing on the potential rapid social inoculation that may be currently confined to short term residential experiences. Subscribe to TRJ

A study to find out the barriers and facilitators related to iv line insertion and maintenance in pediatric emergency

Background : IV line insertion and maintenance is very crucial to prevent nosocomial infection in pediatric patients visiting pediatric emergency.PGIMER is a tertiary care hospital that cater to the needs of pediatric clients by providing 24 hours services in Advance Pediatric Center (APC).Pediatric emergency department is located on the ground floor in APC and has capacity of 22 beds and 24 incubators. Daily admission of patient in pediatric emergency is approximately 30-40 children in a day, whereas as early transfer of patients to other units is not feasible. This leads to overcrowding and HCPs have to manage two to three children on single bed. Though in each shift 10-12 nursing officers and 12-14 residents are posted on duty and they strive hard to provide quality care, still there are many barriersrelated to IV line insertion and maintenance.If such barriers are identified and managed time to time the infection rates can be reduced. Keeping this fact in view we conducted this study to find out the barriers and facilitators related to IV line insertion and maintenance.A total of 8 focused group discussion were conducted with the health care personnel of pediatric emergency, out of which 5 were conducted with nursing officers and 3 were conducted with physicians (junior and senior residents). In each FGD 4 to 5 members were included. Discussions were recorded and field notes were taken. Focused group discussion guide was used to know the barriers and facilitators, it included questions aboutHCPs view about current status of infection associated with IV line, possible cause of infection that is phlebitis and infiltration, measures taken by HCPs to prevent IV line related infections, causes of not being able to adhere to infection control measures, suggestive measures to reduce incidence of infection. After conducting discussion interviews were transcribed, read and reread and themes were generated. Physician mentioned about high rates of infection in the unit. According to them themes relatedto the barriers of IV line insertionwere lack of supply of articles, difficult to manage the time, over- crowding of patient, less co-ordination between health care workers, low socioeconomic status of patients. The facilitators identified were availability of tourniquets, available and arranged articles and parental help to restrain the child. The suggested remedial measures were to improve the practices related infection prevention such as to increase hand washing/ hand rubbing and ensure liberal supply of: hand rubs, gloves, additional packs and trays. They also emphasized on the need of assistance form nursing personal to hold the child and fix the cannula. They also highlighted the routine checking of the cannula sites, its fixation and removal of blood from 100cm extensions by nurses. Related to maintenance of iv line they mentioned that HCPs should perform hand hygienebefore touching cannula hub and administering drugs as lack of handhygiene is a source of infection.

Animal-Assisted Interventions in Audiology

Animal-Assisted Interventions in Audiology

Profile of HIV positive clients: an ICTC record based retrospective study

Background: Deaths in productive age group due to HIV/AIDS have damaging impact on families and communities, skills are lost, workforce shrinks &amp; children's are orphaned. Our study reports the socio-demographic characteristics of HIV/ AIDS clients from one of the Integrated Counselling &amp; Testing Centre (ICTC) situated at Amtala, West Bengal. This will give us an insight on the distribution of various epidemiological characteristics of the HIV positive clients in this region thus help in formulating strategies for effective implementation of its prevention. The objective was to study socio-demographic profile and risk behavior pattern of HIV positive clients attending ICTC.Methods: It was an observational study cross sectional in design. Records of last eight years of HIV positive clients were accessed from ICTC centre at Amtala hospital, rural training centre, Department of community medicine, ESI PGIMSR medical college, Joka, Kolkata. Data was entered in SPSS for Windows version 20 software. Data was presented in percentages, mean with standard deviation etc.Results: Retrospective record of 62 HIV positive clients was studied, of them 37 were males (5 pediatric cases) and 25 females (7 ANC).Excluding pediatric clients, mean age of clients was 32 years. It was observed that majority of clients were illiterate and were on daily wages. Except one male client who was homosexual rest were heterosexual. Majority of clients 71.9% males and 92% females were married, of them 45.3% males and 34.7% females were sero concordant with their spouse. Seventeen subjects were co infected with TB.Conclusions: HIV sero prevalence rate has inverse relation with literacy level. Majority of male clients were daily wagers who act as link between high risk populations to general population i.e. their spouse, which in turn can pass on the infection to her baby. Lack of knowledge on mode of spread and preventive measures against HIV infection devastate the families making many children orphaned. There is need to carry out intense IEC activities for behavior change at grass root level.