Archive for the ‘children's health’ Category

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Codeine Overused in Children: Alternatives Exist for Hard-to-Manage Pain

April 23, 2014

By Jacob Molyneux, senior editor

According to a story at MedlinePlus, a study in Pediatrics has found that codeine is still prescribed too often to children during ER visits, though it’s known that a small but significant subset of children metabolize the painkiller far more rapidly than do other children, leading to potentially dangerous results. As AJN‘s February CE article on treating the often severe and stubborn posttonsillectomy pain in children noted, there are other effective and safer options for children in pain, such as hydrocodone in combination with acetaminophen, as well as some non-opioid analgesics. Here’s a brief overview of the article:

Tonsillectomy, used to treat a variety of pediatric disorders, including obstructive sleep apnea, peritonsillar cellulitis or abscesses, and very frequent throat infection, is known to produce nausea, vomiting, and prolonged, moderate-to-severe pain. The authors review the causes of posttonsillectomy pain, current findings on the efficacy of various pharmacologic and nonpharmacologic interventions in pain management, recommendations for patient and family teaching regarding pain management, and best practices for improving medication adherence.

There’s often no perfect answer in pain management, but it helps to know the full range of available strategies, their safety, and how well they work. As with all CE articles, this one is free.

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Recent Nurse Blog Posts of Interest, Inhaled Insulin, a Note on Top Blogs Lists

April 4, 2014

By Jacob Molyneux, AJN senior editor/blog editor

Here you will find some links to nursing blog posts, a look at this week’s Affordable Care Act health exchange enrollment numbers, and a couple of items of interest about new treatments or studies, plus a note on blogs that award other blogs badges. A grab bag, so bear with me…

crocus shoots, early spring, I think/ via Wikimedia Commons

crocus shoots, early spring, I think/ via Wikimedia Commons

At the nursing blogs:

RehabRN has a post about a friend who was bullied by a nurse of much higher authority in the same hospital. Such stories, if true, are always upsetting. What can you do but take it when the power differential is so great?

At the INQRI blog (I’m not going to tell you what the initials stand for except that it has something to with quality, research, and nursing), there’s a post about why stroke survivors need a team approach to palliative care.

Megen Duffy (aka Not Nurse Ratched) has a really very good post at a site she sometimes blogs for. I already shared it via a tweet yesterday, but it deserves more. It’s called “Nursing Will Change You.”

At Infusion Nurse Blog, there’s a post addressing IV solution shortages (now happening on top of shortages of some common and necessary drugs due to a variety of reasons). It gives some practical steps clinicians and organizations can take to conserve and is definitely worth a quick look.

A sweet little post called “Nursing Sisters” is at Adrienne, {Student} Nurse. It’s about how nurses help each other out, starting right from the beginning in nursing school.

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The Power of Imagination: Helping Kids with Sickle Cell Disease to Cope with Pain

April 2, 2014

By Sylvia Foley, AJN senior editor

Many people with sickle cell disease suffer from both acute and chronic pain, which can be severe. Although the exact mechanism isn’t known, the pain is believed to result when sickled erythrocytes occlude the vascular beds, causing tissue ischemia. Such pain, which often begins in early childhood, arises unpredictably. Although some pain crises may require ED visits, hos­pitalization, opioid treatment, or a combination of these, most are managed at home. Yet little is known about at-home pain management in people with sickle cell disease, especially children.

Table 2. Changes in Self-Efficacy, Imaging Ability, and Pain Perception in School-Age Children After Guided Imagery Training

Table 2. Changes in Self-Efficacy, Imaging Ability, and Pain Perception in School-Age Children After Guided Imagery Training

Cognitive behavioral therapy (CBT) has shown promise in helping patients with other chronic illnesses to cope with pain. Cassandra Elaine Dobson and Mary Woods Byrne decided to test guided imagery, a form of CBT, among children enrolled at one sickle cell treatment clinic in New York City. They report on their findings in this month’s original research CE, “Using Guided Imagery to Manage Pain in Young Children with Sickle Cell Disease.” The abstract below offers a quick overview; if you click the image above, you’ll see an enlarged view of one table showing key results.

Objectives: The purposes of this study were to test the effects of guided imagery training on school-age children who had been diagnosed with sickle cell disease, and to describe changes in pain perception, analgesic use, self-efficacy, and imaging ability from the month before to the month after training.
Methods: A quasi-experimental interrupted time-series design was used with a purposive sample of 20 children ages six to 11 years enrolled from one sickle cell disease clinic, where they had been treated for at least one year. Children completed pain diaries daily for two months, and investigators measured baseline and end-of-treatment imaging ability and self-efficacy.
Results: After training in the use of guided imagery, participants reported significant increases in self-efficacy and reductions in pain intensity, and use of analgesics decreased as well.
Conclusions: Guided imagery is an effective technique for managing and limiting sickle cell disease–related pain in a pediatric population.

The technique was easily taught in training sessions lasting 15 to 45 minutes, with no child needing more than one session. The authors concluded that “the use of guided imagery in this population assumes that a child’s imagination has the potential to affect health, and our findings support that assumption.” Because this was a small study, they urged further large-scale clinical trials.

To learn more, read the article, which is free online. As always—and especially if you have experience caring for children with sickle cell disease—we welcome your comments.

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AJN’s April Issue: Sickle Cell Anemia, Telehealth, Systematic Reviews, FOAMed, More

March 28, 2014

AJN0414.Cover.OnlineAJN‘s April issue is now available on our Web site. Here’s a selection of what not to miss, including two continuing education (CE) articles that you can access for free.

Coping with pain in sickle cell anemia. Our April cover features a painting of red flowers in a vase. But on closer inspection, you might notice that the flowers are actually red blood cells, painted by a young girl who suffers from sickle cell anemia. Afflicting about 90,000 to 100,000 people in the United States, sickle cell disease often causes acute and chronic pain syndromes described as being on par with cancer-related pain. Cognitive behavioral therapies, such as the use of guided imagery, have shown promise in changing pain perception and coping patterns in people with chronic illnesses. April’s original research CE article, “Using Guided Imagery to Manage Pain in Young Children with Sickle Cell Disease,” suggests that this technique can be effective for managing pain in school-age children with the disease.

Implementing advances in telehealth. New technologies such as remote monitoring and videoconferencing often emerge before a facility is ready to efficiently integrate them. Sometimes referred to as disruptive innovations, these technologies, while convenient and easy to use, may not be readily accepted. “Telehealth: A Case Study in Disruptive Innovation” discusses the many applications of telehealth, a means of delivering care that is likely to be a part of every nurse’s skill set. If you’re reading AJN on your iPad, you can listen to a podcast interview with the author by tapping on the podcast icon on the first page. The podcast is also available on our Web site.

New installment on systematic reviews. Last month, we debuted our new series from the Joanna Briggs Institute on the systematic review. This second installment, “Developing the Review Question and Inclusion Criteria,” provides an overview of the first steps taken when conducting such a review, starting with forming the perfect review question.

#FOAMed. The April iNurse column, “Have You FOAMed?” delves into the new and still evolving social media concept called FOAM, or Free Open Access Meducation. FOAM is an umbrella concept that refers to online media that students and professionals can use to educate themselves and to share and discuss new knowledge and ideas. It spans many social media platforms and is a fast, free way to keep up with the latest in medical knowledge. Read the rest of this entry ?

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Posttonsillectomy Pain in Children: Safer, More Effective Treatment Strategies

February 26, 2014

By Shawn Kennedy, editor-in-chief

Capture

One of the CE articles in the February issue is “Posttonsillectomy Pain in Children.” It might seem like a no-brainer—ice-collar, cold fluids, and acetaminophen with codeine, right? WRONG. As the article indicates, there’s a lot more to managing this stubborn, sometimes severe pain.

For one thing, there’s been a big reversal in choice of pain medication. Acetaminophen with codeine, long a mainstay in managing children’s pain, is no longer recommended—in fact, the FDA issued a black box warning last year saying that codeine should not be used because its metabolism rate in one subset of children can cause excessive sedation. Reports of three deaths and a case of nonfatal respiratory depression in children who received appropriate doses prompted the warning. Read the rest of this entry ?

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AJN’s February Issue: New Nurses, Children’s Posttonsillectomy Pain, Medication Errors, More

January 31, 2014

AJN0214.Cover.Online

AJN’s February issue is now available on our Web site. Here’s a selection of what not to miss, including two continuing education (CE) articles, which you can access for free.

With high hospital turnover rates, keeping newly licensed RNs (NLRNs) continues to be a priority for hospitals. This month’s original research article, “Changing Trends in Newly Licensed RNs,” found that new nurses considered themselves to have fewer job opportunities and to be less likely to work in hospitals and more likely to have a second job than new nurses who were surveyed six years earlier. Earn 2.5 CE credits by reading this article and taking the test that follows.

Tonsillectomy is effective at treating a variety of pediatric disorders, such as sleep apnea and frequent throat infection. But it often results in prolonged, moderate-to-severe pain. “Posttonsillectomy Pain in Children” reviews the causes of posttonsillectomy pain, the efficacy of various treatment interventions, and the recommendations for patient and family teaching regarding pain management. Earn 2.3 CE credits by reading this article and taking the test that follows. If you’re reading AJN on your iPad, you can listen to a podcast interview with the author by tapping on the podcast icon on the first page. The podcast is also available on our Web site.

According to an Institute of Medicine report, at least 1.5 million preventable medication-related adverse events occur in the U.S every year. This month’s Cultivating Quality article, “The Sterile Cockpit: An Effective Approach to Reducing Medication Errors” (abstract only without a subscription or article purchase), describes how nurses on one hospital unit used a commercial aviation industry innovation in an attempt to reduce medication errors. Read the rest of this entry ?

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Smoking, Nurses, Knowledge: We’ve Come a Long Way, But Not Far Enough

January 22, 2014

By Shawn Kennedy, MA, RN, AJN editor-in-chief

"Smoke break"/by sylvar, via Flickr

“Smoke break”/by sylvar, via Flickr

Back in the day, I remember riding in the car with my parents, both of whom smoked. My siblings and I used to jockey for the window seats so we could be near the fresh air streaming in.  And I recall holidays with visiting relatives when all the adults would sit in the living room smoking cigarettes. (Kent filter-tips for the women; Camels for the men.) And as kids, we used to “smoke” candy cigarettes. The ones that “puffed” when you blew into them were our favorites.

But I also recall getting older and not wanting to visit my Uncle Joe, a once tough New York City police detective, because he would just sit on the edge of his chair, leaning over a table and struggling to breathe. This made my dad quit cold turkey after he had a heart attack at age 48 and our family physician told him he could either keep smoking or quit and see his children get married. My mom quit when she was pregnant with my youngest sister, after the surgeon general’s report said smoking could harm the fetus.

Our parents were constantly telling us that they wished they’d never started (my dad began in the army, when cigarettes were standard issue for GIs), that it was a “dirty habit” and an expensive one—and “don’t forget Uncle Joe.” Their efforts paid off—neither I nor any of my six siblings smoke today. Ironically, while I repeated those same messages (bolstered with more clinical information) to my three sons, two of them took up smoking during adolescence. Fortunately, they did stop, but not from my efforts—their girlfriends (who later became wives) pushed them into quitting . Read the rest of this entry ?

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Confronting Commercial Sexual Exploitation and Sex Trafficking of Minors in the U.S.: An IOM Report

December 2, 2013


By Natalie McClain, PhD, RN, CPNP, clinical associate professor, William F. Connell School of Nursing, Boston College, and Barbara Guthrie, PhD, RN, FAAN, Independence Foundation Professor of Nursing, Yale University School of Nursing. The above educational video was created by the Institute of Medicine and is available on YouTube.

Each day in the United States, minors experience abuse and violence that is overlooked and unidentified. In some cases, recognition of the abuse makes these minors subject to arrest rather than assistance and care. These children and adolescents are the victims and survivors of commercial sexual exploitation and sex trafficking. A recent report from the Institute of Medicine (IOM) and the National Research Council sheds light on this serious domestic problem and underscores the critical role that nurses must play in preventing, identifying, and responding to these crimes.

Confronting Commercial Sexual Exploitation and Sex Trafficking of Minors in the United States is the culmination of a two-year study conducted by an independent panel of experts appointed by the National Academies of Science and funded by the Department of Justice’s Office of Juvenile Justice and Delinquency Prevention. The report states that commercial sexual exploitation and sex trafficking of minors are acts of abuse and violence against children and adolescents. However, the response to these victims is often starkly different from that experienced by other victims of child abuse and neglect. In most states, for example, underage victims of commercial sexual exploitation and sex trafficking can be arrested and prosecuted.

Long-term consequences; inadequate services. The report also notes that the consequences of commercial sexual exploitation and sex trafficking are far-reaching and long lasting and include a range of mental and physical health problems. The committee found that there are too few services available to meet current needs of victims of commercial sexual exploitation and sex trafficking of minors. In addition, “services that do exist are unevenly distributed geographically, lack adequate resources, and vary in their ability to provide specialized care to victims/survivors of these crimes” (IOM and NRC, 2013, p. 260).

This form of abuse and violence against children and adolescents is largely underreported. This is because identification of victims can be challenging. Once victims are identified, there are few service providers who are adequately prepared to assist and care for them. The report describes this and numerous other challenges faced by professionals in law enforcement, education, victim and support services, and health care who seek to prevent and identify these crimes and to assist their victims. It also provides clear guidance on and examples of strategies to increase awareness, strengthen laws, and advance knowledge and understanding.

Nurses are essential partners in preventing, identifying, and responding to commercial sexual exploitation and sex trafficking of minors. Two of the report chapters—Health and Health Care and The Education Sector—underscore the critical role of nurses as first responders in prevention, detection, and care of victims. Victims may seek out health care, thereby providing an opportunity for nurses in a range of settings to identify victims and survivors of this abuse. Read the rest of this entry ?

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Giving Thanks for Meaning in a Nonclinical Setting

November 25, 2013

Julianna Paradisi, RN, OCN, writes a monthly post for this blog and works as an infusion nurse in outpatient oncology. The illustration of this post is by the author.

NiceNurseSome Thanksgiving seasons, it feels like the only specific nursing thing to be thankful for is the overstocked larder of the staff lounge, marking the advent of The Season of Eating.

I’m being facetious. Actually, there’s lots to be thankful for in nursing, including a regular paycheck, which is not taken for granted. However, most nursing units remain understaffed, despite hoards of nursing school graduates desperately seeking jobs—creating a no-net gain on the gratitude side of the ledger.

Ethical issues and long hours also make finding gratitude a challenge. It’s not the gifts from patients of flavored popcorn and boxes of chocolates in the staff lounge that warm a nurse’s heart so much as the handwritten cards accompanying them, thanking us for their care. For nurses, finding meaning in what we do goes hand in hand with gratitude.

This season, however, I was surprised by an opportunity to find meaning as a nurse outside of a clinical setting, and I want to share the experience.

One afternoon, a neighbor came to my door asking for help. She is the mother of two small children, and her toddler had accidentally burnt his hand in the kitchen. She’d taken him to the emergency department and a burn specialist was consulted.

My neighbor stood in the doorway, holding her toddler, whose hand was bound in gauze. Her preschool-aged daughter was at her side. The burn specialist had prescribed daily wound care and dressing changes. This was distressing to her, for all the reasons you can think of. My neighbor knew I’d been a pediatric intensive care nurse. Would I come over and help with the first dressing change?

Of course I said yes.

Early that evening I knocked on their door, happy to help, but apprehensive. Would the child tolerate the dressing change? Would he fear me from now on because of it? Read the rest of this entry ?

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NP Develops Innovative Runaway Intervention Program in Minnesota

November 22, 2013

Ten years ago, NP Laurel Edinburgh began to see a number of sexually exploited girls in her practice at the Midwest Children’s Resource Center, a child abuse clinic within Children’s Hospitals and Clinics of Minnesota in St. Paul. The girls, who were runaways, were quickly slipping through the cracks. Half were no longer in school, many hadn’t been reported missing by their parents, and many were staying with gang members. Some had been gang-raped; others had had sex with men in exchange for money or drugs.

Via U.S. Dept. of Health and Human Services Web site

Via U.S. Dept. of Health and Human Services Web site

That’s the start of a profile (“Nurse Develops Runaway Intervention Program”) by editor Amy Collins in the November issue of AJN. It’s about a nurse practitioner in Minnesota who, in the course of her daily practice, noticed a population in need and did something about it, finding ways to establish contact with runaway girls and help them rebuild their lives. The article will be free until December 6. The nurse who started the program, Laurel Edinburgh, RN, CNP, hopes her approach will catch on in other states—so please give it a read.—Jacob Molyneux, senior editor

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