Journal of Pediatric Surgical Nursing

Surgical correction for pectus excavatum (PE) is often performed during adolescence for patients exhibiting cardiac and respiratory problems. The surgery to correct PE is a thoracoscopic-assisted minimally invasive repair of PE or Nuss procedure. The postoperative clinical management is largely related to addressing pain from the constant pressure from the bar(s) on the sternum. A quality improvement project was developed to improve nurses' knowledge of appropriate postoperative care for the pediatric patient undergoing a Nuss procedure.

A literature search was conducted using CINAHL and MEDLINE (ProQuest) to identify research studies that have evaluated nurses' knowledge of postoperative care for patients undergoing surgical correction for PE. Six studies were identified that investigated nurses' knowledge and attitudes of postoperative pain management in the pediatric patient and the effectiveness of enhanced recovery pathways to improve patient outcomes. A pretest and posttest were developed from the findings of the literature review along with an educational intervention. The educational presentation focused on the postoperative care of the pediatric patient who undergoes a Nuss procedure. A complete supplemental care plan is provided, which includes an enhanced recovery after surgery pathway, recommended pain treatment plan, exercises, medication recording sheet, home management tips for pain control, and patient discharge information.

Implementation of a targeted educational program for the care of the pediatric patient who undergoes a Nuss procedure improved the clinician's knowledge and attitudes, resulting in a positive impact on pain management practice and patient outcomes.

Targeted educational interventions to improve pain management knowledge in nurses can result in increased understanding of appropriate postoperative pain management. This increased knowledge has the possibility to improve pain management and significantly improve the nurse and patient experience.

Approximately 350 million diagnostic radiation imaging procedures are performed on pediatric patients annually. This population is at a greater risk of developing cancer after exposure to ionizing radiation because of a higher intake, accumulation, and increased sensitivity to radiation as well as a long-life expectancy postexposure.

This quality improvement project used convenience sampling with a pre–post design to evaluate two independent samples: (a) pediatric intraoperative staff members including registered nurses and scrub technicians and (b) pediatric patients receiving intraoperative ionizing radiation imaging. Outcome measures included pediatric intraoperative staff knowledge and confidence of education for intraoperative shielding (preimplementation: n = 9; postimplementation: n = 6). Shielding audits were performed to assess for frequency of shield placement to radiosensitive organs and accuracy of shield placement (preimplementation: n = 26; postimplementation: n = 27).

Data analysis showed improvement in staff confidence related to gonad shield placement (p = .013) and self-reported frequency of gonad shield use (p = .032). Knowledge scores showed nonsignificant improvement (p = .076). Shielding audits showed statistically significant improvement in shield placements for thyroid, gonads, and breast tissue (p < .05).

The pediatric population has unique characteristics to consider when making decisions about shielding practice. This project discusses these characteristics, considerations for “exception-based shielding,” and how to improve the rates of shielding in situations where the practice is appropriate.

Male victims of sexual abuse are often overlooked and marginalized. We seek to understand current literature surrounding male sexual assault victims with the ultimate goal of exploring the role of nursing in providing physical, spiritual, mental, and emotional care to the patient. We reviewed current literature, using keywords, including sexual assault/abuse, male sexual assault/abuse, male victims, female-perpetrated sexual assault, mental health, male survivors of sexual assault/abuse, and mental health of sexual assault/abuse survivors. Studies show that approximately one in six men is sexually abused in their lifetime, and the abuse often occurs before the age of 18 years (1in6, 2020). Male victims are less likely to report sexual abuse. Behavioral-specific questions may help identify this patient population to provide trauma-informed care. Nurses must be trained to identify, treat, and care for male sexual abuse victims. Any adverse events experienced in childhood must be appropriately addressed to prevent late effects in adulthood.

An appendectomy is the most common urgent surgical intra-abdominal procedure performed on children. Approximately one third of the population ends up having complicated appendicitis requiring the use of intravenous antibiotics and a prolonged hospital stay. Antibiotic-associated diarrhea (AAD) is a common obstacle seen in both outpatient and inpatient settings. Use of probiotics in a pediatric population exposed to antibiotics and gastrointestinal surgery such as an appendectomy may provide a protective effect and prevent AAD.

This study was a prospective randomized controlled trial conducted at a large freestanding pediatric hospital. Patients in the treatment group received a standard dose of Lactobacillus rhamnosus GG capsule twice a day until discharge, and those in the control group received a placebo twice a day until discharge. In this study, we hypothesize that patients given probiotics will decrease the overall length of stay (LOS) by 25% versus the LOS in those patients who do not receive probiotics.

Ninety-eight patients were randomized, with 93 included in the data analysis, into the probiotic group (n = 57) and the placebo group (n = 41). The LOS for the probiotic group (n = 53; M = 121.55, SD = 59.51) was lower than that for the placebo group (n = 40; M = 131.69, SD = 74.27) but was not found to be statistically different (t(91) = 0.731, p = .467). The average total number of diarrhea counts was higher in the probiotic group (M = 13, SD = 16) than in the placebo group (M = 10, SD = 11) but was not found to be statistically different (t(91) = −1.017, p = .312).

Use of probiotics to reduce AAD has been found to be effective in other patient populations. Because of the small sample size, we were unable to determine if the use of L. rhamnosus in patients with complicated appendicitis was effective in reducing the LOS or average diarrhea counts.