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The challenges of nursing leadership in the COVID-19 era
Leading the implementation of systems to prevent the child’s clinical deterioration: new challenges and trends
PAIN MANAGEMENT IN MENTALLY RETARDED CHILDREN
Abstract
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Background and aims
An accurate measurement of pain is essential to establish its presence, and to monitor the effectiveness of interventions for relief and prevention. Pain measurement in mentally retarded children is challenging, because they are not able to express pain clearly or they express it differently. This literature study aims to identify the most reliable method of pain measurement for mentally retarded children with acute pain.
Methods
We searched PubMed for studies published between 2005 and 2019. The articles were selected on title, abstract and full text according predefined inclusion and exclusion criteria.
Results
We included four studies, which describe the reliability of existing pain measurement tools in mentally retarded children: the Comfort Scale, the (revised) Face, Legs, Activity, Cry and Consolability checklist (FLACC), Non-Communicating Children’s Pain Checklist (NCCPC), Pediatric Pain Profile (PPP) and the Checklist Pain Behavior Scale (CPBS). The studies show that no matter which pain measurement tool is used, the opinion of parents weighs heavily when measuring pain of a child with mental retardation. The revised FLACC shows the best reliability with excellent intraclass correlation coefficients (0.76-0.90) and adequate κ statistics (0.44-0.57). This tool incorporates several additional behavioral descriptors, such as verbal outbursts and tremors. In addition, it is possible to personalize the tool via open‐ended descriptors in each category.
Conclusion
The revised FLACC is the most reliable tool to measure pain of mentally retarded children. Consultation with parents about specific pain behaviors of their child is an essential item in this tool.
EFFICACY OF CHLORHEXIDINE-IMPREGNATED DISCS ON CATHETER RELATED BACTERIAL COLONISATION IN PAEDIATRIC ONCOLOGY PATIENTS IN LATVIA
Abstract
Abstract Body
Background
Port catheters are applied for patients to supply long-term venous access. 75 % of paediatric patients treated from oncology malignancies in Latvia use port catheters. Port catheters provide safe venous access, however microbial contamination might lead to sepsis. Therefore, proper antiseptic techniques are crucial when accessing the implanted ports.
Objective
To identify most common agents of bacterial colonisation on port catheters and determine the antimicrobial activity of chlorhexidine discs against them.
Methods
A laboratory study was conducted. Culture of port catheter’s needle was plated over blood, mannitol salt, MacConkey and Sabouraud agar for subsequent bacterial isolation. Clinical isolates were identified using a VITEK®2 system. Modified disk diffusion test for 10 days was performed to determine the antimicrobial effect of commercially available chlorhexidine-impregnated discs.
Results
Overall, a total of 81 samples isolated from paediatric oncology patients were tested from 1 February 2019 through 29 February 2020. Of the 81 patients, cultures with bacteria present were found in 18 (22%) patients. Chlorhexidine-impregnated discs demonstrated steady antimicrobial activity in all clinical isolates throughout the 10-day test period.
Conclusion
The findings of the study indicate that chlorhexidine discs are advantageous for prevention of bacterial colonisation for 10 days in vitro, which is longer time than recommended seven days for dressing change of central venous access device. In the clinical context, chlorhexidine-impregnated dressings for catheter insertion site might be considered as a part of catheter care protocol for paediatric oncology patients in Latvia.
ENGAGING PAEDIATRIC CRITICAL CARE NURSES TO USE A WORKSPACE APP FOR ENHANCED OFF-SITE COMMUNICATIONS: THE EDINBURGH EXPERIENCE
Abstract
Abstract Body
Title
Engaging Paediatric Critical Care Nurses to Use a Workspace App for Enhanced Off-site Communications: The Edinburgh Experience
Background and Aims
Nurse communication in our unit relied heavily upon being physically on-site at the hospital via safety briefs, hospital emails, and a communication book. Our staff found these methods ineffective when off-site. This study aims to develop and implement a workspace app that may be accessed via nurses’ smartphones to enhance communications.
Methods
A prospective study was conducted over a 15 month period between July 2018 and September 2019. A pre-selected group of nurses were invited to pilot the workspace app for 1 month to determine its usefulness for disseminating work information and to become the app trainer for implementation from August 2018. An email invitation to download the app was sent to all staff. Posters regarding the implementation were displayed around the unit and this was communicated to staff on-site at safety brief. The app’s usage was monitored until September 2019 to assess up-take. For new staff joining the unit after implementation, the Education team provided the app invitation email on induction.
Results
All nurses in the pilot found the app useful for off-site information dissemination. 70 staff (70%) were actively using the app by October 2018. Active users increased to 79% and 82% respectively by 6 and 12 months post-implementation.
Conclusions
We have successfully engaged our nursing staff to use a workspace app within 1 month of implementation. Its impact on communications and staff morale warrant further investigations.