Paediatric fever management: continuing education for clinical nurses
Child; Cross-Sectional Studies; Female; Humans; Male; Analgesics; Attitude of Health Personnel; Education; Questionnaires; Health Services Needs and Demand; Nurse's Role; Time Factors; Hospitals; Nursing Staff; Practice; Pediatric; Attitudes; PedPal Lit; Health Knowledge; Non-Narcotic/therapeutic use; Nursing; Educational Status; Certification; Urban; Nursing Process; Clinical Competence/standards; Continuing/organization & administration; Evidence-Based Medicine/education; Fever/nursing/prevention & control; Hospital/education/psychology; Negativism; Pediatric Nursing/education
PURPOSE: This study examined the influence of level of practice, additional paediatric education and length of paediatric and current experience on nurses' knowledge of and beliefs about fever and fever management. METHOD: Fifty-one nurses from medical wards in an Australian metropolitan paediatric hospital completed a self-report descriptive survey. RESULTS: Knowledge of fever management was mediocre (Mean 12.4, SD 2.18 on 20 items). Nurses practicing at a higher level and those with between one and four years paediatric or current experience were more knowledgeable than novices or more experienced nurses. Negative beliefs that would impact nursing practice were identified. Interestingly, beliefs about fever, antipyretic use in fever management and febrile seizures were similar; they were not influenced by nurses' knowledge, experience, education or level of practice. CONCLUSIONS: Paediatric nurses are not expert fever managers. Knowledge deficits and negative attitudes influence their practice irrespective of additional paediatric education, paediatric or current experience or level of practice. Continuing education is therefore needed for all paediatric nurses to ensure the latest clear evidence available in the literature for best practice in fever management is applied.
2006
Walsh AM; Edwards HE; Courtney MD; Wilson JE; Monaghan SJ
Nurse Education Today
2006
Article information provided for research and reference use only. PedPalASCNET does not hold any rights over the resource listed here. All rights are retained by the journal listed under publisher and/or the creator(s).
Journal Article
Nurse-led paediatric pre operative assessment: an equivalence study
Child; Female; Humans; Male; Great Britain; Medical Staff; Nurse's Role; Sensitivity and Specificity; Hospitals; Nursing Evaluation Research; Single-Blind Method; Teaching; Nursing Staff; adolescent; Preschool; PedPal Lit; infant; Comparative Study; Clinical Competence/standards; Hospital/standards; Pediatric Nursing/education/organization & administration; Ambulatory Surgical Procedures/education/nursing; Hospital/education/standards; Medical History Taking/standards; Nursing Assessment/standards; Perioperative Nursing/education/organization & administration; Physical Examination/nursing/standards; Preoperative Care/nursing
AIM: to explore whether nurses can undertake the pre operative assessment of children prior to day case surgery as safely as senior house officers. DESIGN: a randomised controlled trial involving 595 children, using an equivalence methodology (a method which looks for similarity rather than a significant difference). Pre-operative assessment prior to day case surgery was randomised to either a nurse (experimental group) or a junior doctor (control group). Blinded expert verification of nurse/junior doctor performance was ascertained by an experienced anaesthetist (the 'gold standard'). RESULTS: there was equivalence between nurses and senior house officers in their ability to detect clinically significant abnormalities within the sample population. Subgroup analysis also demonstrated equivalence in respect of history taking abilities. The smaller number of clinically significant physical findings within the sample meant that equivalence in respect of physical examination remains uncertain. Although the study was limited to a single setting, the results demonstrate nurses' equivalence with junior doctors in a discrete paediatric context.
2006
Rushforth H; Burge D; Mullee M; Jones S; McDonald H; Glasper EA
Paediatric Nursing
2006
Article information provided for research and reference use only. PedPalASCNET does not hold any rights over the resource listed here. All rights are retained by the journal listed under publisher and/or the creator(s).
Journal Article
Clinician predictions of intensive care unit mortality
Female; Humans; Male; Medical Staff; Hospital Mortality; Prognosis; Prospective Studies; Middle Aged; Respiration; Severity of Illness Index; Survival Analysis; Risk Factors; Predictive Value of Tests; Chi-Square Distribution; Proportional Hazards Models; Nursing Staff; Artificial; Intensive Care Units/statistics & numerical data; APACHE; Nursing Assessment/standards; Likelihood Functions; Clinical Competence/standards; Critical Illness/mortality/therapy; Hospital/standards; Multiple Organ Failure/classification/mortality
OBJECTIVE: Predicting outcomes for critically ill patients is an important aspect of discussions with families in the intensive care unit. Our objective was to evaluate clinical intensive care unit survival predictions and their consequences for mechanically ventilated patients. DESIGN: Prospective cohort study. SETTING: Fifteen tertiary care centers. PATIENTS: Consecutive mechanically ventilated patients > or = 18 yrs of age with expected intensive care unit stay > or = 72 hrs. INTERVENTIONS: We recorded baseline characteristics at intensive care unit admission. Daily we measured multiple organ dysfunction score (MODS), use of advanced life support, patient preferences for life support, and intensivist and bedside intensive care unit nurse estimated probability of intensive care unit survival. MEASUREMENTS AND MAIN RESULTS: The 851 patients were aged 61.2 (+/- 17.6, mean + SD) yrs with an Acute Physiology and Chronic Health Evaluation (APACHE) II score of 21.7 (+/- 8.6). Three hundred and four patients (35.7%) died in the intensive care unit, and 341 (40.1%) were assessed by a physician at least once to have a < 10% intensive care unit survival probability. Independent predictors of intensive care unit mortality were baseline APACHE II score (hazard ratio, 1.16; 95% confidence interval, 1.08-1.24, for a 5-point increase) and daily factors such as MODS (hazard ratio, 2.50; 95% confidence interval, 2.06-3.04, for a 5-point increase), use of inotropes or vasopressors (hazard ratio, 2.14; 95% confidence interval, 1.66-2.77), dialysis (hazard ratio, 0.51; 95% confidence interval, 0.35-0.75), patient preference to limit life support (hazard ratio, 10.22; 95% confidence interval, 7.38-14.16), and physician but not nurse prediction of < 10% survival. The impact of physician estimates of < 10% intensive care unit survival was greater for patients without vs. those with preferences to limit life support (p < .001) and for patients with less vs. more severe organ dysfunction (p < .001). Mechanical ventilation, inotropes or vasopressors, and dialysis were withdrawn more often when physicians predicted < 10% probability of intensive care unit survival (all ps < .001). CONCLUSIONS: Physician estimates of intensive care unit survival < 10% are associated with subsequent life support limitation and more powerfully predict intensive care unit mortality than illness severity, evolving or resolving organ dysfunction, and use of inotropes or vasopressors.
2004
Rocker G; Cook D; Sjokvist P; Weaver B; Finfer S; McDonald E; Marshall J; Kirby A; Levy M; Dodek P; Heyland D; Guyatt G; Level of Care Study Investigators; Canadian Critical Care Trials Group
Critical Care Medicine
2004
Article information provided for research and reference use only. PedPalASCNET does not hold any rights over the resource listed here. All rights are retained by the journal listed under publisher and/or the creator(s).
Journal Article
<a href="http://doi.org/10.1097/01.ccm.0000126402.51524.52" target="_blank" rel="noreferrer">10.1097/01.ccm.0000126402.51524.52</a>
A systematic review of physicians' survival predictions in terminally ill cancer patients.
Humans; Terminally Ill; Survival Analysis; Longitudinal Studies; Reproducibility of Results; Analysis of Variance; Regression Analysis; Empirical Approach; Death and Euthanasia; decision making; Charting the Territory; Neoplasms/mortality; Clinical Competence/standards; Physicians/standards
OBJECTIVE: To systematically review the accuracy of physicians' clinical predictions of survival in terminally ill cancer patients. DATA SOURCES: Cochrane Library, Medline (1996-2000), Embase, Current Contents, and Cancerlit databases as well as hand searching. STUDY SELECTION: Studies were included if a physician's temporal clinical prediction of survival (CPS) and the actual survival (AS) for terminally ill cancer patients were available for statistical analysis. Study quality was assessed by using a critical appraisal tool produced by the local health authority. DATA SYNTHESIS: Raw data were pooled and analysed with regression and other multivariate techniques. RESULTS: 17 published studies were identified; 12 met the inclusion criteria, and 8 were evaluable, providing 1563 individual prediction-survival dyads. CPS was generally overoptimistic (median CPS 42 days, median AS 29 days); it was correct to within one week in 25% of cases and overestimated survival by at least four weeks in 27%. The longer the CPS the greater the variability in AS. Although agreement between CPS and AS was poor (weighted kappa 0.36), the two were highly significantly associated after log transformation (Spearman rank correlation 0.60, P < 0.001). Consideration of performance status, symptoms, and use of steroids improved the accuracy of the CPS, although the additional value was small. Heterogeneity of the studies' results precluded a comprehensive meta-analysis. CONCLUSIONS: Although clinicians consistently overestimate survival, their predictions are highly correlated with actual survival; the predictions have discriminatory ability even if they are miscalibrated. Clinicians caring for patients with terminal cancer need to be aware of their tendency to overestimate survival, as it may affect patients' prospects for achieving a good death. Accurate prognostication models incorporating clinical prediction of survival are needed.
2003
Glare P; Virik K; Jones M; Hudson M; Eychmuller S; Simes J; Christakis NA
Bmj (clinical Research Ed.)
2003
Article information provided for research and reference use only. PedPalASCNET does not hold any rights over the resource listed here. All rights are retained by the journal listed under publisher and/or the creator(s).
Journal Article
<a href="http://doi.org/10.1136/bmj.327.7408.195" target="_blank" rel="noreferrer">10.1136/bmj.327.7408.195</a>
Extent and determinants of error in doctors' prognoses in terminally ill patients: prospective cohort study
Male; Survival Rate; Cohort Studies; Prognosis; Prospective Studies; Non-U.S. Gov't; Human; Support; Terminally Ill; Clinical Competence/standards; Medical Errors/statistics & numerical data; Terminal Care/standards
OBJECTIVE: To describe doctors' prognostic accuracy in terminally ill patients and to evaluate the determinants of that accuracy. DESIGN: Prospective cohort study. SETTING: Five outpatient hospice programmes in Chicago. PARTICIPANTS: 343 doctors provided survival estimates for 468 terminally ill patients at the time of hospice referral. MAIN OUTCOME MEASURES: Patients' estimated and actual survival. RESULTS: Median survival was 24 days. Only 20% (92/468) of predictions were accurate (within 33% of actual survival); 63% (295/468) were overoptimistic and 17% (81/468) were overpessimistic. Overall, doctors overestimated survival by a factor of 5.3. Few patient or doctor characteristics were associated with prognostic accuracy. Male patients were 58% less likely to have overpessimistic predictions. Non-oncology medical specialists were 326% more likely than general internists to make overpessimistic predictions. Doctors in the upper quartile of practice experience were the most accurate. As duration of doctor-patient relationship increased and time since last contact decreased, prognostic accuracy decreased. CONCLUSION: Doctors are inaccurate in their prognoses for terminally ill patients and the error is systematically optimistic. The inaccuracy is, in general, not restricted to certain kinds of doctors or patients. These phenomena may be adversely affecting the quality of care given to patients near the end of life.
2000
Christakis NA; Lamont EB
Bmj
2000
Article information provided for research and reference use only. PedPalASCNET does not hold any rights over the resource listed here. All rights are retained by the journal listed under publisher and/or the creator(s).
Journal Article
“the Nice Thing About Doctors Is That You Can Sometimes Get A Day Off School”: An Action Research Study To Bring Lived Experiences From Children, Parents And Hospice Staff Into Medical Students’ Preparation For Practice.
Adolescent; Child; Clinical Competence/standards; Education Medical/standards; Female; Focus Groups; Health Services Research; Hospice Care/standards; Humans; Male; Pediatrics/education; Pediatrics/standards; Physician-patient Relations
Education And Training; Hospice Care; Pediatrics; Palliative Care; Qualitative Research
Abstract
Patient and public involvement in healthcare is important to ensure services meet their needs and priorities. Increasingly, patient experiences are being used to educate healthcare professionals. The potential contribution to medical education of children and parents using hospice services has not yet been fully explored.
OBJECTIVES:
(1) To explore perceptions of what medical students must learn to become 'good doctors' among children, parents and staff in a hospice. (2) To collaborate with children/parents and staff to develop educational materials based on their lived experiences for medical students. (3) To assess feasibility of student-led action research in a children's hospice to develop research skills.
METHODS:
Prospective ethical approval received. Volunteer children (n=7), parents (n=5) and staff (n=6) were recruited from a children's hospice. Data were generated in audio-recorded semistructured focus groups, individual interviews and/or activity workshops. Participants discussed what newly qualified doctors' needed to care for children with life-limiting conditions. Audio data were transcribed and combined with visual data for thematic analysis. Findings were refined by participant feedback. This paper presents thematic findings and educational material created from the project.
RESULTS:
Thematic analysis identified six learning themes: (1) treat children as individuals; (2) act as a person before being a doctor; (3) interpersonal communication; (4) appreciate the clinical environment; (5) learn from children, parents and other staff; (6) how to be a doctor as part of a team. The student researcher successfully developed qualitative research skills, coproducing materials with participants for sharing learning derived from lived experiences.
CONCLUSIONS:
All participants were willing and able to make valuable contributions, and believed that this was a worthwhile use of time and effort. Further work is required to understand how best to integrate the experiences of children in hospices into medical education.
Spalding J; Yardley S
Bmj Supportive & Palliative Care
2016
Article information provided for research and reference use only. PedPalASCNET does not hold any rights over the resource listed here. All rights are retained by the journal listed under publisher and/or the creator(s).