Pediatric nursing
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Many children present to the emergency department (ED) in pain and/or experience pain as a result of interventions necessary to manage their illness. Pediatric pain assessment and management is complex and challenging. Despite the presence of published standards of care specific to pain assessment and management, nurses in the ED may not know about and/or consistently use these evidence-based practices. In particular, pediatric patients are inconsistently and/or inappropriately assessed for pain in the ED. ⋯ Significant improvements in nurses' pain knowledge are demonstrated via an education program. Implementation of a pain assessment protocol is one mechanism to standardize nursing practice with pediatric patients in the ED setting.
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Disorders of sexual differentiation (DSD) describe a number of genetically influenced congenital anomalies of the genitalia for which the previous standard of care has included emergent sex assignment and early genitoplasty and gonadectomy. This article provides a brief summary of the most common DSD and their genotypic and phenotypic variations. ⋯ The discussion applies the moral principles of autonomy, beneficence, and nonmaleficence for the care of individuals with DSD. In the process, the advantages of early as well as delayed cosmetic genital surgery will be discussed when contemplating the ethical question: Do parents have the moral right to provide informed consent to surgically alter the ambiguous genitalia of their infants born with DSD?
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Increasingly, early warning system scores are being introduced into pediatric clinical practice to support the early recognition of and intervention for clinical deterioration in hospitalized children at risk. This integrative review explored what is known about early warning system scores with pediatric patients. ⋯ Five major concepts emerged from analysis of retrieved documents: overview of pediatric early warning system scores, supplementary benefits, facilitators to successful implementation, barriers to successful implementation, and needed research. Greater psychometric testing of tools is needed before any recommendations can be made regarding extensive implementation with the pediatric population.