In Pediatrics, What’s the Best Way to Assess for Pressure Injury Risk?

The evolution of a scale.

In children, most hospital-acquired pressure injuries are related to medical devices rather than immobility. A device that can’t be repositioned, such as this cast, presents additional risk. Photo by Rafael Ben-Ari/Alamy Stock Photo.

Pressure injury prevention has always been a top nursing priority. Do you know about the latest tool for early identification of pediatric patients at risk for pressure injury?

The well-known Braden Scale, developed in 1987, was followed in 1996 by the Braden Q Scale for use in kids. Both were developed by nurses and are widely used around the world. However, the Braden Q Scale focused on immobility as a risk factor and wasn’t designed to address device-related pressure injuries, risks to children younger than three weeks of age or older than eight years, or children with congenital heart disease.

An update to include device-related risk in children.

So Sandy Quigley and Martha Curley, the nurses who modified Braden and Bergstrom’s original Braden Scale, set out to validate an updated version of their pediatric tool in order to address medical device use, a broader age range, and children born with heart disease. In “How to Predict Pediatric Pressure Injury Risk with the Braden QD Scale” in this month’s AJN, they explore the use of their Braden QD Scale (the D is for device related).

Quigley, Curley, and colleagues emphasize that while immobility-related pressure injuries in children have decreased significantly, “[in pediatrics] most hospital-acquired pressure injuries are associated […]

2018-11-07T10:32:44-05:00November 7th, 2018|Nursing|0 Comments
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Babies at the Border: Reflections on Nursing on Ellis Island

Immigrants at Ellis Island. Library of Congress.

For the past few years, the nation’s attention has been repeatedly drawn to “the immigration problem” on the southern borders of the United States. This past summer, images of babies screaming for their mothers as families were separated, and photos of teens and young children peering through chain-link fences—with foil blankets crumpled in the background—tugged at heartstrings. With recent fear-mongering about a caravan of refugees making their way through Mexico toward the United States, the issue is once again taking center stage.

A nation of immigrants.

With each image, my thoughts turn to our nation’s long history of regulating immigration. After all, we are a nation of immigrants. Many of our ancestors sought religious freedom, freedom from persecution, or economic opportunity in America. That history is replete with conflicting policies: from the exclusion of Chinese, prejudice against those of Irish and Italian descent, and the deportation of those who were seen as “unfit” physically or mentally to enter the country, to decrees from the president that all immigrants be treated with respect.

A history of working with immigrants ‘in a middle place.’

For over a century, nurses have worked with immigrants in “a middle place”—balancing the needs of newly arrived families with their own […]

2018-11-02T10:17:29-04:00November 2nd, 2018|Nursing, nursing history, Public health|0 Comments
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Nurses Concerned About Removal of Key Children’s Health Advocate at EPA

At the end of September, the Environmental Protection Agency (EPA), with no explanation, placed the director of the Office of Children’s Health Protection (OCHP), Dr. Ruth Etzel, on administrative leave. This sidelining of a vocal children’s health advocate as the office was heading into October, Children’s Environmental Health Month, was concerning for all who work in children’s environmental health.

The OCHP’s essential role.

The OCHP was created under an executive order in 1997 as public consciousness was increasing about the special vulnerabilities of children to environmental hazards. It is housed in the Office of the Administrator so as to be able to provide guidance to EPA leadership and ensure that children’s health protection is prioritized throughout the agency’s activities. This is essential because, as many have observed, children are not simply miniature adults—what they eat, drink, and breathe can profoundly affect their physical and mental development, while their hand-to-mouth and on-the-floor activities put them at greater risk for exposures from environmental hazards.

The office provides essential resources for health professionals and the public on environmental health issues such as environmental triggers of asthma and how parents can reduce exposures, reducing exposures to lead, and air quality in schools. The OCHP-produced report, America’s Children and […]

2018-10-31T11:54:23-04:00October 31st, 2018|environmental health, health care policy, nursing perspective, Public health|0 Comments
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Managing Acute Pain in People with Opioid Use Disorder

Photo © IStock.

Have you ever used the Clinical Opiate Withdrawal Scale (COWS) to ascertain whether your patient might be experiencing opioid withdrawal?

Considering the current prevalence of opioid misuse, it’s not unlikely that a patient admitted for a non-drug-related cause could be a person who uses opioids—someone who may or may not have shared that information with you.

The Clinical Opiate Withdrawal Scale is one of many helpful points of assessment and management discussed in this month’s CE article, “Acute Pain Management for People with Opioid Use Disorder.”

Compassionate, informed, nonjudgmental care.

This article, not specifically about unrevealed opioid intake, focuses on the management of acute pain in a person who is known to use opioids because they are currently on medication-assisted treatment (MAT)—that is, someone receiving methadone, buprenorphine, or naltrexone for opioid use disorder who is also experiencing acute pain from (for example) cancer, or after surgery or trauma.

[…]

2018-10-29T08:03:46-04:00October 29th, 2018|Nursing|0 Comments
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November Issue: Patient Handling in Nursing Curricula, Pediatric Pressure Injury Risk, More

“The technical skills and knowledge needed for nursing can be learned. For some nurses, this is enough. They do nursing, but nursing isn’t part of their identity. So how do we change that?” —EIC Maureen (Shawn) Kennedy in her November editorial

The November issue of AJN is now live. Here are some of the articles we’re pleased to have a chance to publish this month.

CE: Original Research: Patient Handling and Mobility Course Content: A National Survey of Nursing Programs

What do nursing programs teach students about lifting, turning, transferring, repositioning, and mobilizing patients? Despite evidence supporting the use of safe patient handling and mobility practices, the authors’ findings suggest that most curricula need updating in this area.

CE: How to Predict Pediatric Pressure Injury Risk with the Braden QD Scale

This article offers guidance on use of the Braden QD Scale—a pediatric risk assessment instrument that reliably predicts both immobility-related and medical device–related pressure injuries. Readers can test their skills by assigning scores to patients in a variety of scenarios.

Looking Back: Nurses Fight for the Right to Vote

The author shares the stories of four nurse suffragists—Lavinia Lloyd Dock, Mary Bartlett Dixon, Sarah Tarleton Colvin, and […]

2018-10-26T08:30:41-04:00October 26th, 2018|Nursing|0 Comments
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Views expressed on the blog are solely those of the authors or persons quoted. They do not necessarily reflect AJN’s views or those of Wolters Kluwer Health/Lippincott Williams and Wilkins.
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