Pediatric Emergency Department Nurses Research Articles

Quality of life of emergency department nurses in pediatric and general hospitals in Greece: A cross sectional study

Introduction: The Emergency Department (ED) is a quite stressful workplace for nurses, affecting their quality of life. The existence of factors that affect the quality of life of ED nurses in daily clinical practice, leads to exhausted nurses. Consequently, there is a need to find the factors and the implementation of interventions that will improve the quality of life of nurses. Purpose: To investigate the factors that affect the quality of life of nurses in children's and adult hospitals. Method: The sample of this cross-sectional study consisted of ED nurses in children's and adult hospitals in Greece. To assess the nurses' quality of life, the WHOQOL-BREF questionnaire was used for the ED nurses. Analysis was done with IBM SPSS 26.0. A value of p<0.05 was considered as the level of significance and all statistical tests were two-tailed. Results: Study population included 210 nurses. No statistical significance was found for the relationship between pediatric ED nurses and adult ED nurses regarding their quality of life, sleep, and fatigue. However, a statistically significant relationship was found regarding social relationships tending to a better score in pediatric nurses compared to adults (p=0.011). In all five dimensions of life evaluated by the tool, the quality of life of the nurses in our sample was at moderate levels (Mean-General=69.32, Mean-Physical health=64.70, Mean-Psychological health=67.85, Mean-social relations=69.01 and Mean-Environment =57.60). Conclusion: One or more factors are sufficient to affect or have an impact on the quality of life, sleep completeness and fatigue levels of ED nurses.

Subjective Study on Pediatric Emergency Department Nurses′ Perceptions of Urgency Using Q Methodology

PurposeIn the emergency department (ED), triage significantly impacts patient safety. Therefore, triage nurses must make decisions accurately and timeously. This study aims to investigate how South Korean pediatric emergency nurses perceive urgency and classify severity using the Q methodology, which examines individuals’ subjectivity. MethodsWe collected 84 statements from a Q population based on a literature review and interviews, and selected 33 Q samples. The P samples included 30 pediatric emergency nurses at a Seoul tertiary-care hospital. The principal component factor analysis method was employed to analyze data using the PC-QUANL program. ResultsFour urgency perception types were identified among pediatric ED nurses. Type 1: “Experiential coping”; Type 2: “Careful reasoning”; Type 3: “Patient-centered thinking”; and Type 4: “Intuitive prediction.” These types appear to be an integrated process of knowledge and clinical experience that considers children’s characteristics and developmental stages. ConclusionsThis study may serve as a basis for future education to improve pediatric ED nurses’ urgency judgment and severity classification skills.

The Effects of Moral Distress on Resilience in Pediatric Emergency Department Nurses

IntroductionMoral distress is widespread in health care, and nurses working in high-pressure environments, such as emergency departments, experience stress at high rates. Understanding how moral distress affects pediatric emergency nursing care is essential to moderate its negative impacts. Increased resilience has been promoted as a tool to mitigate moral distress. The purpose of this study, conducted prior to the pandemic, was to examine patterns of moral distress and the impact of moral distress on resilience among pediatric emergency nurses. MethodsA cross-sectional exploratory study of pediatric emergency nurses was performed. Moral Distress Scale-Revised (Pediatric) and Connor-Davidson Resilience Scale 25© scores were collected and calculated. Exploratory factor analysis with principal components was used to identify patterns of moral distress that impact resilience. ResultsFour distinct patterns of moral distress that impact resilience were identified: (1) incompetent practice, (2) incongruent truth-telling, (3) potentially inappropriate care, and (4) discordant health care teams. DiscussionOur study was the first to identify 4 patterns of moral distress in pediatric emergency nurses. As a result, actions to promote resilience include: (1) supporting competent practice, (2) upholding appropriate truth-telling, (3) recognizing and addressing potentially inappropriate care, and (4) building concordant health care teams and systems. This pre-pandemic data provides a foundational understanding of the relationship between moral distress and resilience in pediatric emergency nurses. Identifying factors of moral distress that impact resilience has significant implications for pediatric emergency nursing, including the development of future initiatives, education, and research.

Moral Distress and Its Relating Factors Among Pediatric Emergency Department Nurses: A Cross-Sectional Study.

Emergency services are patient circulation units that require chaos, trauma, and high tension. It was aimed to determine the moral distress levels of pediatric nurses in pediatric emergency and emergency departments and relevant factors. This study is a descriptive and cross-sectional study. It consists of 255 nurses with their data. The Participant Information Form and the Moral Distress Scale-Revised for Pediatric Nurses (MDS-R) were used to collect data. In the study, the mean score of MDS-R frequency was found to be 27.36 ± 13.16, the mean score of MDS-R intensity to be 37.65 ± 17.53, and the mean total score of MDS-R to be 58.96 ± 39.40. It was determined that 93.7% of the nurses received training on moral distress, and education level was effective on moral distress levels of the nurses. The nurses working in the pediatric emergency service had higher moral distress levels than the nurses serving pediatric patients in the emergency department ( P(total MDS-R) = 0.02, P(frequency of MDS-R) = 0.008). Job satisfaction ( P(total MDS-R) = 0.003, P(frequency of MDS-R) < 0.001, P(intensity of MDS-R) < 0.001) and frequency of thinking about changing working unit ( P(frequency of MDS-R) = 0.02, P(intensity of MDS-R) = 0.01) were found to be effective on the level of moral distress. It was determined that the type of emergency service, the working time in the emergency service, and the level of job satisfaction significantly affected the total moral distress scores of the nurses ( P < 0.001, R2 = 0.09). It was found in the study that nurses had low levels of moral distress; however, many factors relevant to working conditions were associated with moral distress. The pediatric emergency service nurses were determined to experience a higher moral distress compared with the emergency department nurses serving pediatric patients.

Evaluating workload and manpower planning among pediatric emergency department nurses in Turkey during COVID-19: A cross-sectional, multicenter study

PurposeQuality nursing care in pediatric emergency departments (PEDs) can be achieved only through sustained workload-based manpower planning. The purpose of this paper to evaluate perceptions of workload and manpower planning in the PED setting in Turkey from the nurses' point of view. Design and methodsThis cross-sectional, multicenter study that was conducted among 187 nurses working in a PED setting in Turkey between June and September 2021. Data were collected using a questionnaire that measured nurses' perceptions of workload and manpower planning. The reporting of this study adhered to STROBE guidelines. ResultsThe majority of the respondents perceived the number of patients-per-nurse during a shift to be too high, the number of nurses to be insufficient in proportion to the workload, and the nursing manpower-planning to be insufficient and biased. Those with ≤1 year of nursing experience in the PED perceived an increased workload and more burnout during the COVID-19 pandemic period. ConclusionsNurses working in PED setting perceived the workload and manpower planning to be inadequate. In addition, nurses who were less experienced or felt burnout perceived their workload to be increased during the COVID-19 pandemic. Practice implicationsFurther exploration of workload and manpower planning in PEDs is required. Quantifying nurses' perspectives of workload and manpower when managing emergency pediatric patients is essential for designing appropriate interventions to improve the working environment. Future studies should focus on comparing nurses' perceptions with actual workloads and manpower planning in PEDs using appropriate measurement tools.

Bladder Stimulation for Clean Catch Urine Collection: Improved Parent and Provider Satisfaction.

Previous studies have demonstrated the efficacy of fluid intake with suprapubic and lumbar paravertebral massage for clean catch urine (CCU) collection in infants. We investigated the acceptability and feasibility of integrating this bladder stimulation technique (BST) into routine care in the pediatric emergency department (PED). This was a prospective cohort study. Infants less than 6 months of age requiring a urinalysis and urine culture as part of their PED visit were recruited. All PED nurses and technicians received a standardized training outlining the BST using a video module and print materials. Success rates, bacterial contamination, parental perception of patient distress, and parent and provider satisfaction with the BST for CCU collection were compared with urethral catheterization. A total of 124 patients were recruited. The BST was successful in 38% (47/124) with a median time to void of 73 seconds (interquartile range: 19, 151). The BST was more likely to be successful in infants less than 90 days (53%; 95% confidence interval, 0.075-0.046; P = 0.005). A urinary tract infection was diagnosed in 4% of patients, with no significant differences between BST (1/47; 2%) and catheterization (4/59; 7%; P = 0.65). Patients experienced less discomfort during the BST compared with catheterization (mean numeric rating scale score, 2/10 vs 6/10; P < 0.001), and the BST was viewed positively by both parents and providers. Compared with catheterization, parents were significantly more satisfied with the BST (BST, 98%; catheterization, 58%; P < 0.001) and were more likely to consent to the BST in the future (BST, 98%; catheterization, 69%; P < 0.001). Most providers reported that the BST was well tolerated by participants (46/47; 98%), and providers felt that the BST improved parental satisfaction with the clinical encounter (46/47; 98%). The BST for CCU collection is a well-tolerated and well-received approach that can easily be implemented into clinical practice with minimal training.

Child passenger safety education in the emergency department: teen driving, car seats, booster seats, and more

BackgroundThe leading cause of death in children less than 19 years old is motor vehicle crashes (MVC). Non-use or improper use of motor vehicle car seats significantly adds to the morbidity and mortality. Emergency department (ED) encounters provide an opportunity for caregiver education. Our objective was to determine the effect of an educational intervention on knowledge and counseling behaviors of pediatric ED nurses regarding child passenger safety (CPS).MethodsA pre/post educational intervention study was conducted with nursing staff in an urban ED. Responses to CPS related knowledge and counseling behaviors were collected using surveys administered before and after the intervention. The ED nurse education intervention was a one-hour lecture based on the American Academy of Pediatrics (AAP) CPS guidelines and Alabama state law regarding ages for each car seat type and teen driving risky behaviors. Individual data from pre and post surveys were matched, and nominal variables in pre-post matched pairs were analyzed using McNemar’s test. To compare categorical variables within pre or post test data, we used the Chi-square test.ResultsPretests were administered to 83/110 ED nurses; 64 nurses received the educational intervention and posttest. On the pretests, nurses reported “never” or “occasionally” counseling about CPS for the following: 56% car seats, 62% booster seat, 56% teen driving, 32% seat belts. When comparing the pretest CPS knowledge between nurses working 0-1 year vs. ≥ 2 years there was no statistically significant difference. Two CPS knowledge questions did not show significance due to a high correct baseline knowledge rate (> 98%), including baseline knowledge of MVC being the leading cause of death. Of the remaining 7 knowledge questions, 5 questions showed statistically significant improvement in knowledge: age when children can sit in front seat, state GDL law details, seat belt state law for back seat riders, age for booster seat, and rear facing car seat age. All four counseling behavior questions showed increases in intent to counsel families; however, only intent to counsel regarding teen driving reached statistical significance.ConclusionsEducational efforts improved pediatric ED nursing knowledge regarding CPS. Intent to counsel was also improved following the education.

Just-in-time training for nurse administration of anesthetic cream application

Introduction: Just-In-Time Training (JITT) is an emerging concept in medical education. Providing a brief educational intervention in the form of a video immediately prior to the patient intervention may be an effective method to teach health care providers. In this pilot study, we sought to determine if pediatric emergency department nurses could effectively apply a topical anesthetic to the lower back for lumbar puncture after watching a JITT video. Methods: Between October 19, 2011 and November 1, 2011, thirty nurses were asked to complete a questionnaire assessing their comfort level on applying a topical anesthetic prior to lumbar puncture. Accuracy of sham cream placement onto the back of an infant mannequin was assessed pre- and post-JITT video. Self-reported comfort levels in cream placement, cream coverage, and overall accuracy of cream placement were compared both pre- and post-JITT intervention. Results: There was a statistically significant change in the self-reported comfort level of the subjects in applying the cream post-JITT ( p &lt; .01). In addition, there was a statistically significant difference in cream coverage after the JITT ( p &lt; .01). Furthermore, subjects who were inaccurate with cream placement pre-JITT were more likely to be accurate post-JITT ( p &lt; .01). Conclusions: JITT is an effective tool in medical education for teaching topical anesthetic cream application onto the back by pediatric emergency department nurses. JITT may offer other possibilities for enhancing medical education.

Attitudes and Knowledge Regarding Emergency Contraception Among Emergency Department Adolescents and Providers

Teen pregnancy is a public health issue in the United States. Emergency contraception (EC) has the potential to reduce teen pregnancy rates. The use of EC remains controversial, and barriers have been identified for adolescents seeking care. The objective of this study was to evaluate similarities and differences of knowledge and attitudes regarding EC among pediatric emergency department (PED) female adolescents, nurses, and physicians/nurse practitioners (NPs). A quantitative survey including demographics, knowledge, and attitudes regarding EC was administered to 3 groups: (1) PED nurses, (2) PED physicians and NPs, and (3) adolescent female patients seeking care in the PED. Demographic data were analyzed using descriptive statistics. Differences between groups were analyzed using Student t test for continuous variables and χ or Fisher exact test for categorical variables. Attitude and knowledge differences among the groups were analyzed using the nonparametric Wilcoxon test. There was no difference in overall knowledge regarding EC between nurses and physicians/NPs, adolescents and nurses or adolescents and physicians/NPs, and overall knowledge was poor among all groups. There was no difference in overall attitudes between nurses and adolescents; however, physicians were more liberal in their attitudes regarding EC compared with adolescents (P < 0.0001) and nurses (P < 0.0001). Older age trended toward more conservative responses (P = 0.05). Adolescents and nurses had more conservative attitudes toward EC than physicians. Further studies are needed to confirm the generalizability of these findings.

Can Pediatric Emergency Department Nurses Use a Modified Alvarado Score to Accurately Predict Appendicitis?

Can Pediatric Emergency Department Nurses Use a Modified Alvarado Score to Accurately Predict Appendicitis?

A Randomized, Controlled Trial of Sucrose Analgesia in Infants Younger Than 90 Days of Age Who Require Bladder Catheterization in the Pediatric Emergency Department

To determine whether an oral sucrose solution improves pain response for infants undergoing bladder catheterization in an emergency department (ED) population. A randomized, double-blinded study comparing the analgesic effects of a sucrose solution to placebo for infants < or = 90 days of age and requiring bladder catheterization. Infants with prior bladder catheterization, previous painful procedures that day, or neurological or genital abnormalities were excluded. Infants were assigned baseline pain scores and then given 2 mL of sucrose or water 2 minutes before catheterization. Trained pediatric ED nurses rated the infants for pain, presence of cry, and time to return to baseline. Eighty-three patients were enrolled; 40 were randomized to sucrose, and 40, to placebo. Baseline pain scores were similar within each age group. Overall, sucrose did not produce a significant analgesic effect. In subgroup analysis, infants 1-30 days of age receiving sucrose showed a smaller change in pain scores (2.9 vs. 5.3, p = 0.035), were less likely to cry with catheterization (29% vs. 72%, p = 0.008), and returned to baseline more rapidly after catheter removal (10 seconds vs. 37 seconds, p = 0.04) compared with infants who received placebo. Infants older than 30 days of age who received sucrose did not show statistically significant differences in pain scores, crying, or time to return to baseline behavior. There was no overall treatment effect when using an oral sucrose solution before bladder catheterization in infants younger than 90 days of age. However, infants younger than or equal to 30 days of age who received sucrose had smaller increases in pain scores, less crying, and returned to baseline more rapidly than infants receiving placebo. Older infants did not show an improved pain response with oral sucrose.

Comparison of 1- Versus 2-Person Bag-Valve-Mask Techniques for Manikin Ventilation of Infants and Children

We compare the mean tidal volumes per weight and peak pressures generated by the 1- and 2-person techniques of bag-valve-mask ventilation in a pediatric model. This was a prospective, descriptive study in which postgraduate year 1, postgraduate year 2, and postgraduate year 3 pediatric residents, postgraduate year 2 emergency medicine residents, pediatric emergency department nurses, transport personnel, and paramedics were asked to perform 1- and 2-person bag-valve-mask ventilation on infant and child manikins. Participants were randomly assigned a partner and performed both techniques. Tidal volume and peak pressure were recorded every 15 seconds for 3 minutes by a blinded assistant. Seventy participants, 10 in each group, completed the study. Overall, for the infant- and child-manikin groups, the 2-person technique generated higher mean tidal volume per weight than the 1-person technique (infant: 7.2 versus 5.9; child: 8.8 versus 6.1). Overall, the 2-person technique generated higher mean peak pressures than the 1-person technique (infant: 27.4 versus 22.0; child: 27.2 versus 21.8). Similar results were found among all provider groups. Paramedics were the only providers able to generate a recommended median tidal volume per weight of 10 mL/kg in the child manikin group when using either technique and were the only providers, when using the 2-person technique, to generate a mean tidal volume per weight of 10 mL/kg in the infant group. Two-person bag-valve-mask ventilation provided greater mean tidal volumes per weight and peak pressures in the infant- and child-manikin model compared with the 1-person technique.

Parental and health care provider understanding of childhood fever: a Canadian perspective

Fever is common in children and causes misconceptions among parents. Many investigators have called for improved parental education to dispel "fever phobia." Our objectives were to assess parental and health care provider understanding of fever, its treatment, and beliefs about its consequences, as well as to identify parental sources of information about fever. Self-administered surveys were distributed to 3 parent groups and 4 health care provider groups. Parent groups included parents of children with fever presenting to the emergency department (ED) (fever group, n = 209), parents of children with an injury presenting to ED (injury group, n = 160), and parents of healthy school children (school group, n = 141). Provider groups included pediatric ED physicians (n = 16), pediatric ED nurses (n = 39), general pediatricians (n = 26) and family physicians (n = 79). Parent groups considered a temperature of 37.9 degrees C to be a fever, 39.1 degrees C to be a high fever, and 39.9 degrees C to be a dangerous fever. Parents were most concerned about discomfort, seizures and dehydration, and parents in the "fever group" worried more about dehydration (p = 0.01) and brain damage (p = 0.03) than other parents. Most physicians were concerned about dehydration and seizures, but family physicians were most likely to express concerns about brain damage (40.5%) and death (34.1%). Fever phobia exists among parents and health care providers and is most likely in parents of febrile children and family physicians. Health care providers varied in their knowledge of fever and its treatment. Greater education of health care workers is required in order to provide families with appropriate information.

Pediatric Emergency Department Nurses' Perspectives on Fever in Children

Pediatric Emergency Department Nurses' Perspectives on Fever in Children