Pediatric nursing
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Admitting pediatric patients promptly to the appropriate unit where they can receive specialty care is of critical importance to safe, quality care. A daily morning huddle was implemented at one children’s hospital as a quality improvement project. The aim of this project was to improve patient flow throughout the children’s hospital by improving interprofessional and interdepartmental communication and collaboration. ⋯ Findings from this study are of vital importance to pediatric patients, nurses, and physicians. Promptly admitting patients from the ED to the appropriate unit where they can receive needed specialty care that potentially improves the quality and safety of patient care is paramount. Further research is needed to determine what format and contexts the huddle can be utilized to facilitate efficient patient flow and improve patient outcomes.
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Numerous studies have shown that in comparison to adults, children do not receive analgesia (oligoanalgesia) and are not adequately treated for pain. Several organizations, including The Joint Commission and Institute of Medicine (IOM) have emphasized patients' rights to pain management and the need for initial assessment and ongoing evaluation. Nurses are responsible for assessing patients' pain and implementing appropriate pain management in the emergency department (ED). ⋯ The purpose of this quality improvement project was to improve nurses' assessment and management of children's pain in an emergency department. A total of 1,200 EMRs of pediatric patients ages 3 months to 6 years of age were reviewed before and after an educational intervention (600 before and 600 after the intervention). Pain education for ED nurses improved pain assessment and management among children.
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The American Academy of Pediatrics recommends the human papillomavirus (HPV) vaccine for all 11 to 12-year olds as part of the adolescent immunization platform. However, this vaccine has not been universally accepted by health care providers, parents, or the public, and has lower vaccination coverage rates than other recommended vaccines for the same age group. ⋯ Nurses were knowledgeable about specific HPV information but were less knowledgeable about the extent of HPV infection seen in males or the availability or indications of HPV vaccine for males. This study demonstrates that nurses need more education about HPV and HPV vaccine.
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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?