Pediatric nursing
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Nurses' knowledge and attitudes about pain affect their ability to manage patients' pain. A mechanism was sought to evaluate nursing competency in pain management at eight pediatric hospitals. Several pain survey tools were reviewed, considering the patient population around which they were designed, the basis for survey content, and format. ⋯ The tool was modified for applicability to the nurses caring for pediatric populations that do not include oncology. Revisions were made with the concurrence of Manworren to assure that neither the content being tested, nor the integrity of the tool, was affected. Stability of the modified tool (PNKAS-Shriners Version 2002) was verified by retesting 6-8 weeks after initial survey.
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Adolescents in foster care experience complex health care needs and face multiple barriers in receiving the necessary and appropriate health care services. When the adolescent ages-out of foster care at 18 or 21 years-old they are expected to make a transition to independence with no financial resources, poor access to health care, few personal and family connections and little if any support from the foster care system. This places them at risk for poor physical and mental health status, poverty, unemployment, homelessness, and incarceration. No formalized system of transition planning has yet been established to meet the needs of adolescents before discharge from the foster care system.
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Nurses' knowledge and attitudes about pain management affect their capability to attend to children in pain. A modified version of the Pediatric Nurses' Knowledge and Attitude Survey (PNKAS--Manworren and Shriners Hospitals for Children Version, 2002) was used to evaluate nursing competency to manage pain at eight pediatric hospitals. A convenience sample of 295 nurses attained a mean individual test score of 74% correct. ⋯ The novice group with 0-2 years nursing experience had significantly (p<0.05) lower scores (fewer correct answers) than the other five groups with more than 2 years of nursing experience. The nurses who participated in professional nursing organizations or nursing committees had significantly higher scores than those who did not participate. Nursing education, professional activity, and years of clinical experience contribute to the knowledge necessary for competency in pain management, as evidenced by higher scores using this survey tool.
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To improve care of children who die in acute care settings there is a need to develop a clearer understanding of the barriers to provision of palliative care. The purpose of this study was to describe the experiences and views of health care providers in giving care to children who have undergone intensive therapies for life-threatening illnesses. A qualitative, descriptive design was conducted in the intensive care nursery, pediatric intensive care unit, and pediatric blood and marrow transplant unit at a southeastern US medical center. ⋯ Three challenges in employing palliative care to acutely ill infants and children were identified: (a) finding the true dying point, (b) making the transition to palliative care, and (c) turning care over to an outside palliative care team at a critical juncture of caring. Professional issues in providing palliative care included inadequate preparation and, especially for nurses, the crossing of professional boundaries. An integrated model of palliative care is needed that is initiated at diagnosis and allows for the bidirectional transitioning across the illness and treatment trajectories.