Current Issue : January - March Volume : 2018 Issue Number : 1 Articles : 6 Articles
Objectives\nIn the context of serious or life-limiting illness, pediatric patients and their families are faced\nwith difficult decisions surrounding appropriate resuscitation efforts in the event of a cardiopulmonary\narrest. Code status orders are one way to inform end-of-life medical decision\nmaking. The objectives of this study are to evaluate the extent to which pediatric providers\nhave knowledge of code status options and explore the association of provider role with\n(1) knowledge of code status options, (2) perception of timing of code status discussions,\n(3) perception of family receptivity to code status discussions, and (4) comfort carrying out\ncode status discussions.\nDesign\nNurses, trainees (residents and fellows), and attending physicians from pediatric units\nwhere code status discussions typically occur completed a short survey questionnaire\nregarding their knowledge of code status options and perceptions surrounding code status\ndiscussions.\nSetting\nSingle center, quaternary care childrenââ?¬â?¢s hospital.\nMeasurements and main results\n203 nurses, 31 trainees, and 29 attending physicians in 4 high-acuity pediatric units\nresponded to the survey (N = 263, 90% response rate). Based on an objective knowledge\nmeasure, providers demonstrate poor understanding of available code status options, with\nonly 22% of providers able to enumerate more than two of four available code status\noptions. In contrast, provider groups self-report high levels of familiarity with available code\nstatus options, with attending physicians reporting significantly higher levels than nurses\nand trainees (p = 0.0125). Nurses and attending physicians show significantly different perception of code status discussion timing, with majority of nurses (63.4%) perceiving discussions\nas occurring ââ?¬Å?too lateââ?¬Â or ââ?¬Å?much too lateââ?¬Â and majority of attending physicians\n(55.6%) perceiving the timing as ââ?¬Å?about rightââ?¬Â (p 0.0001). Attending physicians report significantly\nhigher comfort having code status discussions with families than do nurses or trainees\n(p0.0001). Attending physicians and trainees perceive families as more receptive to\ncode status discussions than nurses (p 0.0001 and p = 0.0018, respectively).\nConclusions\nProviders have poor understanding of code status options and differ significantly in their\ncomfort having code status discussions and their perceptions of these discussions. These\nfindings may reflect inherent differences among providers, but may also reflect discordant\nvisions of appropriate care and function as a potential source of moral distress. Lack of\nknowledge of code status options and differences in provider perceptions are likely barriers\nto quality communication surrounding end-of-life options....
Introduction. In Ethiopia, it is the second cause for clinical presentation among under five-year child population. Objective. The\nmain aim of this study was to assess knowledge, practice, and associated factors of home-based management of diarrhea among\ncaregivers of children attending the under-five clinic. Methods. Institution based quantitative cross-sectional study was carried out\nfromMarch 1, 2016, to April 22, 2016. Results. Two hundred eight (56.2%) of them had good knowledge and one hundred thirtynine\n(37.6%) of them had the good practice of home management of diarrhea, specifically, primary education (AOR: 5.384, 95%\nCI: 2.008, 14.438), secondary and above education (AOR: 11.769, 95% CI: 3.527, 39.275), daily laborer (AOR: 0.208, 95% CI: 0.054,\n0.810), and no information about diarrhea (AOR: 0.139, 95% CI: 0.054, 0.354). Moreover, age range of 25ââ?¬â??35 (AOR: 4.091, 95% CI:\n1.741, 9.616) and 36ââ?¬â??45 (AOR: 3.639, 95% CI: 1.155, 11.460), being single (AOR: 0.111, 95% CI: 0.013, 0.938), being divorced (AOR:\n0.120, 95% CI: 0.024, 0.598), illiteracy (AOR: 0.052, 95% CI: 0.017, 0.518), primary education (AOR: 0.143, CI: 0.046, 0.440), and no\ninformation about diarrhea (AOR: 0.197, 95% CI: 0.057, 0.685) were significantly associated variables with the outcome variables in\nmultivariate regression. Conclusion. Caregivers had slightly adequate knowledge but poor practice....
Background: Malnutrition contributes significantly to child morbidity and mortality. Nurses\nrequire appropriate knowledge, skills and attitudes to prevent and treat malnutrition in\nchildren using appropriate guidelines or protocols.\nObjectives: The aim of this article was to assess nurses� knowledge, attitudes towards\nmalnutrition and its management using the World Health Organization (WHO) or United\nNations International Children�s Fund guidelines for the treatment of severely malnourished\nchildren and to evaluate factors associated with their knowledge and attitudes.\nMethods: Participants included 104 nurses working in the outpatient and paediatric units or\ndepartments of four hospitals in Tamale metropolis. An 88-item questionnaire was used to\nmeasure nurses� socio-demographic characteristics as well as their knowledge and attitudes\ntowards malnutrition in children and its management using the WHO guidelines for the\ninpatient treatment of severely malnourished children.\nResults: Nurses� knowledge in malnutrition and its management was slightly above average\n(54.0%), but their attitudes were highly positive. Factors that were associated with nurses�\nknowledge were number of nutrition courses undertaken in nursing school, number of years\nworking as a nurse, receipt of a refresher course on nutrition after school and receipt of training\non the guidelines. Nurses� attitudes were associated with report of having awareness on the\nguidelines, number of years a nurse has been involved in the treatment of a severely\nmalnourished child.\nConclusion: Nurses� knowledge levels in the inpatient treatment of severely malnourished\nchildren were not desirable. However, their attitudes were generally positive. Receipt\nof previous training, awareness of the WHO guidelines, practice experience and\nnumber of years as a nurse significantly affected knowledge and attitude scores in the\npositive direction....
Background: Viral hepatitis B and C share the same transmissions route with HIV. This fact could explain the relative high prevalence of HIV and Hepatitis B and C virus co-infection. Objective: The purpose of this study is to determine HIV and Hepatitis B and C virus co-infection frequency among HIV infected children's cohort at Cotonou National Teaching Hospital and identify predicting factors of this coinfection. Materials and methods: Authors performed a descriptive, cross-sectionnal and analytic study covering the periood of 1st of May to 31st of August at the Cotonou National Teaching Hospital which is a tertiary hospital dedicated to HIV infected children follow up and management. Recruitment was exhaustive and sociodemographic, clinical and biological data (Ag HBs, ac HBc) were registered. Results: 31 cases of co-infection were registered among 234 HIV infected children (13.2%). HIV/VHB coinfection was encountered in 12.8% of cases and HIV/VHC co-infection in 0.4%. Through univariate analysis history of blood transfusion was an associated factor and through multivariate analysis, predicting factors of that co-infection were length of HAART (p=0.0375), children's hepatitis B immunization status (p=0.0461) and history of blood transfusion (p=0.0162). Conclusion: This work will contributes to reinforce regular screening of hepatitis B and C co-infection among HIV infected children before HAART initiation and also serve as tool for advocacy for hepatitis B immunization at birth in our country....
Acute Respiratory Tract Infection (ARTI) remains a health problem for toddlers\nin Indonesia and the leading cause of death for toddlers. In addition to\ncausing health problems, ARTI can also cause death. Indonesia, as one of the\ncountries signing of the Millennium Development Goals (MDGs), is required\nto be able to reduce toddler mortality rate. The research intends to find the\neffectiveness of treatment training for children with ARTI in increasing the\nknowledge, attitude, and skill of mothers of toddlers in the working area of\nCommunity Health Centre Sukajadi, Bandung. It employed a quasiexperimental\nmethod with the pre-posttest two group designs. The sample, taken\nwith the random sampling technique, consisted of 26 mothers of toddlers for\nthe control and intervention groups, respectively. For the intervention group,\nthe treatment training for children with ARTI was given for 4 - 5 hours in one\nday, and the control group was only given a conventional extension program\nfor 15 minutes. The knowledge, attitudes, and skills before and after intervention\nwere measured three days after the training using the same instrument\nused during the pretest. The results of this research show that in terms of the\neffectiveness of the training using modules, there were differences in the average\nscores for knowledge with p value (0.030 â�¤ �± (0.05), for the aspect of attitudes\nwith p value (0.046) â�¤ �± (0.05), and for the sub-variable of skills as\nproven by the p value of (0.046) â�¤ �± (0.05). Based on these results, the intervention\nof ARTI treatment training at home had significant effect on the\nknowledge, attitudes, and skills of the toddlersâ�� mothers. With this inference,\nit is recommended that the research results can be made a topic of study for\nthe development of a training model or standardized training guidelines that\nwill be used by health officers at Community Health Centre Sukajadi, Bandung\nCity Indonesian....
Aim\nAlarm fatigue is a well-recognized patient safety concern in intensive care settings.\nDecreased nurse responsiveness and slow response times to alarms are the potentially\ndangerous consequences of alarm fatigue. The aim of this study was to determine the factors\nthat modulate nurse responsiveness to critical patient monitor and ventilator alarms in\nthe context of a private room neonatal intensive care setting.\nMethods\nThe study design comprised of both a questionnaire and video monitoring of nurse-responsiveness\nto critical alarms. The Likert scale questionnaire, comprising of 50 questions\nacross thematic clusters (critical alarms, yellow alarms, perception, design, nursing action,\nand context) was administered to 56 nurses (90% response rate). Nearly 6000 critical\nalarms were recorded from 10 infants in approximately 2400 hours of video monitoring.\nLogistic regression was used to identify patient and alarm-level factors that modulate nurseresponsiveness\nto critical alarms, with a response being defined as a nurse entering the\npatientââ?¬â?¢s room within the 90s of the alarm being generated.\nResults\nBased on the questionnaire, the majority of nurses found critical alarms to be clinically relevant\neven though the alarms did not always mandate clinical action. Based on video observations,\nfor a median of 34% (IQR, 20ââ?¬â??52) of critical alarms, the nurse was already present\nin the room. For the remaining alarms, the response rate within 90s was 26%. The median\nresponse time was 55s (IQR, 37-70s). Desaturation alarms were the most prevalent and\naccounted for more than 50% of all alarms. The odds of responding to bradycardia alarms,\ncompared to desaturation alarms, were 1.47 (95% CI = 1.21ââ?¬â??1.78; 0.001) while that of responding to a ventilator alarm was lower at 0.35 (95% CI = 0.27ââ?¬â??0.46; p 0.001). For\nevery 20s increase in the duration of an alarm, the odds of responding to the alarm (within\n90s) increased to 1.15 (95% CI = 1.1ââ?¬â??1.2; p 0.001). The random effect per infant improved\nthe fit of the model to the data with the response times being slower for infants suffering\nfrom chronic illnesses while being faster for infants who were clinically unstable.\nDiscussion\nEven though nurses respond to only a fraction of all critical alarms, they consider the vast\nmajority of critical and yellow alarms as useful and relevant. When notified of a critical alarm,\nthey seek waveform information and employ heuristics in determining whether or not to\nrespond to the alarm.\nConclusion\nAmongst other factors, the category and duration of critical alarms along with the clinical status\nof the patient determine nurse-responsiveness to alarms....
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