We usually turn to nurses to get answers: How long will this fever last? When can I eat? Will it hurt? Yet, it’s also vitally important for nurses to have the opportunity to ask important questions that examine best practices and generate new knowledge. This ensures that our nurses at The Children’s Hospital of Philadelphia are providing care based on the best knowledge available — and who better to ask these questions than the nurses themselves?
At the annual Ruth M. Colket Nursing Research and Evidence Based Practice Grand Rounds held at CHOP May 3, during the national celebration of Nurses Week 2016, nurses presented scholarly accomplishments that resulted from simply asking, “What if …?” Their inquiries covered a wide range of practice areas, from pain management strategies to providing music after surgery, which demonstrates nurses’ influence on all aspects of patients’ care and highlights CHOP’s theme for this year’s Nurses Week “Nurses Make an Impact.”
Organized by the Center for Pediatric Nursing Research and Evidence Based Practice, Nursing Research & Evidence Based Practice Day celebrated its 10th anniversary this year. It is named in recognition of the tremendous commitment to the nursing profession that Ruth M. Colket, a nurse and CHOP Trustee Emerita, has shown through her generous financial gifts and personal dedication. In addition to major facilities support, the Ruth M. Colket Chair in Pediatric Nursing supports the research and teaching activities of Barbara Medoff-Cooper, PhD, BSN, a recognized expert on infant development.
In introducing the Grand Rounds presenters, Beth Ely, PhD, RN, program director of the Center for Pediatric Nursing Research and Evidence Based Practice, said the work accomplished by CHOP nurses and their study teams is “amazing to me.” This year, 48 nurses contributed to scholarly publications, 47 nurses gave podium presentations at national and international meetings, and 93 nurses have taken on roles as principal investigator, lead investigator, or co-investigators on research studies. Five of these exceptional nurses shared their work during Grand Rounds on Tuesday.
Patient Preferences for Pain Management Assessment Tools
The first presenter, Elena Becker, BSN, RN, a quality improvement and patient safety coordinator, described her study, “Reducing Pediatric Pain: One Ouch at a Time,” which aimed to better understand how pediatric patients experience pain during hospitalizations. The study team conducted 40 interviews with patients ages 10 to 17 with a variety of diagnoses and assessed their preferences for different pain assessment tools.
Twenty-three of the study participants favored the multidimensional Adolescent Pediatric Pain Tool (APPT), which uses a body outline diagram to assess pain location, a word graphic rating scale to assess pain intensity, and a list of pain descriptors such as “aching, stabbing, throbbing” to assess pain quality. Overall, the study team learned that patients want nurses to know that each individual’s perception of pain is different. Becker plans to share their findings about the APPT with nursing units at CHOP for their consideration.
Pursuing Patient Safety
Next, Concetta DiDomenico, MSN, CRNP, a nurse practitioner in neurooncology, presented her findings related to “Safety of Peripheral Administration of IV Vincristine in Patients with Retinoblastoma.” She was interested in exploring this because of the lack of published data on the safety and feasibility of administering this form of chemotherapy using a peripheral intravenous (IV) tube, instead of waiting for insertion of a central IV line.
The study team cross-referenced CHOP’s vascular access database with the hospital’s oncology tumor registry to determine the incidence of chemotherapy infiltration when using peripheral IVs. Infiltration occurs when the drug leaks out of the vein into the tissue and skin. Their results published in Pediatric Blood Cancer showed that vincristine infiltration was zero percent, and they concluded that giving chemotherapy via peripheral access to patients with retinoblastoma is safe in a clinic environment.
Caring for Medically Complex Children
Turning to home care, Antoinette Drill, MSN, CRNP, a surgical nurse practitioner, described a pilot intervention that involved weekly and biweekly phone conversations with 17 families who were providing care at home for their children with short bowel syndrome. Children with this rare condition cannot absorb enough water and nutrients from food, so they often receive parenteral nutrition (liquid fluids, electrolytes, vitamins, and minerals delivered into the blood stream through an IV) and enteral nutrition (liquid food delivered to the stomach or small intestine through a feeding tube).
Incorporating care of a chronically ill child into daily life can be stressful for families, so the study team wanted to find out if consistent communication with families could help to alleviate their concerns over managing medical issues and avoid hospital readmissions. The study team is still collecting data and analyzing, but so far they have determined that while the 20-minute conversations were labor-intensive for the nurse practitioner, overall the intervention appeared to help families “to feel more on top of” caring for their medically complex children. Feasibility, cost, and sustainability of this type of intervention will be examined.
Encouraging Non-nutritive Sucking in NICU
While observing premature infants as a nurse resident, Jennifer Jacob-Freese, RN, BSN, BS, became curious about strategies to offset some of the negative oral stimulation that occurs as a result of necessary treatments in the neonatal intensive care unit, such as breathing tubes and suctioning. She and her colleagues conducted a literature search of scientific articles published between 2008 and 2015 and determined that evidence suggests that encouraging non-nutritive sucking, such as by pairing a pulsatile pacifier with tube feedings, could be an important therapeutic intervention to promote infants’ oral skills. Her Grand Rounds presentation was titled “The Effect of Purposeful Positive Oral Stimulation on Oral Feeding Skills in Preterm Intubated Patients.”
Music as an Avenue for Pain Management
Ending the Grand Rounds on a musical note, Deborah Scalford, MSN, RN, a nurse manager in the post-anesthesia care unit (PACU), presented plans for her study “Music Listening in the PACU in Patients Undergoing Adenotonsillectomy Surgery.” She is eager to find out if music could have a positive effect on young patients’ pain and anxiety as they recover in the PACU.
A preoperative nurse will ask children ages 5 to 10 who are participating in the study to choose their favorite type of music. When the patients reach the recovery room, a PACU nurse will play their music choice for them using a portable digital audio device and speakers as a way to comfort them and to distract their attention away from their pain. The nurses will measure the patients’ pain assessment scores, medication use, feelings of anxiety, and length-of-stay. They also will conduct patient and parent satisfaction surveys. The study team’s goal is to determine whether or not music could be used as viable, enjoyable adjunct to pharmacologic pain management post-operatively.
In addition to the Grand Rounds, a poster session was held throughout the day highlighting other nurse researchers’ projects. Anne Ersig, PhD, RN, a nurse researcher in the Center for Pediatric Nursing Research and Evidence Based Practice who helped to coordinate the day’s events, was extremely proud of all the nurse researchers who participated.
“Pain, safety, and patient and family experiences are all critical elements of CHOP nurses' practice and inquiry,” Ersig said. “We learn from our patients and families, which gives us essential information to advance practice and research.”