Journal of Pediatric Surgical Nursing

The pediatric cardiac intensive care unit, a department dedicated to caring for cardiac patients, conducted a program evaluation to identify registered nurse (RN) and family perceptions of barriers and facilitators to parent engagement during postoperative care after surgery.

A quasi-experimental presurgical/postsurgical design examined RN data using the Questionnaire of Factors That Influence Family Engagement and parent perception of engagement data via a survey.

Nearly half (44.6%) of RNs responded; most were younger (30–49 years old, 44.8%), female (91.4%), and White (94.8%) and held a bachelor's degree (72.4%). Those with more experience (>15 vs. <5 years) had a higher parent engagement score (p = .021). RNs indicated that workflow (τb = .579, p = .000), unit environment (τb = .572, p = .000), nurse attitude (τb = .520, p = .000), and patient acuity (τb = .519, p = .000) correlated with overall family engagement score. The nine parents (100%) invited responded; most were mothers (n = 7, 77.8%) and married (n = 6, 66.7%), and 56% (n = 50) indicated this was not the child's first hospitalization. Parent overall safety score improved (presurgery/postsurgery, Z = −2.000, p = .046). RN barriers for family engagement included lack of written policy. For parents, a facilitator for engagement was safety. Both groups identified collaboration, communication, and shared decision making as a facilitator.

Results contribute to planning and implementing quality improvement initiatives. Understanding and developing a partnership between parents and RNs, nurturing mutual respect, and enhancing shared decision making improves parent engagement in care and, ultimately, a child's physical and psychological health.

Gastrostomy tube (G-tube)-related problems, including dislodgements, are a frequent cause for emergency department (ED) visits in pediatric patients. We aimed to reduce G-tube-related ED visits at our children's hospital.

An interprofessional team was formed including a family advisor, nurse practitioners, discharge coordinators, a pediatric surgeon, surgical residents, nurses, and quality improvement coaches. A number of interventions were put into place intended to improve caregiver preparation for G-tube placement, improved communication during the hospitalization, and postoperative interventions, including a new family education pathway and mechanical barriers to prevent tube dislodgment.

Overall, tube dislodgment accounted for 64% of G-tube-related ED visits: 14% in tubes less than 3 months from insertion and 86% in tubes older than 3 months. Our rate of ED visits for G-tube dislodgement had an initial baseline of nine visits per month. In the 3 years after the intervention, ED visits decreased from a median of 9.5 per month to 8 per month.

An interprofessional team implemented a quality improvement project that reduced G-tube-related ED visits in pediatric patients. Further efforts are needed to better understand the contributing drivers of G-tube-related ED visits and ways to minimize these events. Grant monies have been obtained from URMC Quality Institute and Vermont Oxford Network NICU Follow Thru Health Equity to continue our family-led quality improvement efforts.

Congenital heart disease is one of the most common congenital disorders, affecting between 0.8% and 1.2% of live births worldwide. The treatment of children with congenital heart defects is highly specialized and includes, among others, surgical treatment as the first-choice approach and postoperative care in intensive care units. The aim of this review is to explore nursing care plans for post-cardiac surgery children during their stay in intensive care units.

An integrative review was performed to obtain articles from the online databases SCOPUS, ScienceDirect, Scielo, PubMed, EMBASE, and Redalyc. The synthesis of information was performed based on diagnoses and interventions. In addition, complications and associated factors were identified.

Nursing diagnoses and interventions focus on problem-centered care to respond to cardiovascular and ventilatory needs, sedation and analgesia, infection control, and nutrition. The main complications identified were increased time on mechanical ventilation, postoperative infection, renal failure, and mortality. Complications were associated with intrinsic conditions such as age, gender, or type of malformation and clinical and procedural conditions such as extracorporeal circulation, mechanical ventilation, or higher postoperative risk index.

This review identified problem-focused nursing diagnoses and interventions with a strong focus on the physiological conditions of the child. Although the results of this study show the conceptual level of nurses for specialized care, it denotes the need to complement the nursing process through diagnoses and interventions that promote the transversality of care beyond the problem-centered approach based on the possibilities of the response of the child and the family.