The Morning Read: Volume IV

Plains of land are still painted with a coating of white, elegant snow. Even from afar, the moon stimulates a glistening effect as every snowflake seems vividly articulated to the naked eye. This is the view for the pediatric nursing staff working the night shift. Distantly above, glows of red and green flash are ever so revealing above the window panes. Symbolic to the season, Christmas lights now hang blissfully along the outer facets of the pediatric-focused hospital. A sign of joy, feasts, and giving. Yes, giving. These pediatric nurses write to Santa just wishing to give the gift of lowering pediatric anxiety. Unbeknownst to these nurses, Santa has been planning diffusion strategies for the facilitation of dissemination. Hey everyone, welcome back to the Morning Read with Zach Gaudette.

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Planning for dissemination is crucial for the adaptation of clinical research to become referenced into clinical settings as evidence based practice (EBP) [Singleton, 2017]. Posing great relevance to pediatric practice settings, effective interventions must be utilized by practicing pediatric nurses that meet the needs of care for patients undergoing surgical procedures (Atyekin, Doru, & Kucukoglu, 2016). Evidence stems from the result of having an anxiety trance state be the realization for over half of the pediatric population who find themselves admitted to pre-operative and surgical based environments every year (Chieng, Chan, Klainin-Yobas, & He, 2013; He, Zhu, Chan Klainin-Yobas & Wang, 2015). Implementation of a therapeutic play intervention has not been evaluated when the specific level of developmental achievement for a pediatric patient is known (Perry et al., 2015). As a result, this area of research should be implored further. Laying the groundwork for dissemination within research study potentiates the possibility for future adaptation of findings to additional studies (Neta et al., 2015).

EBP is referenced as the leading principle of evidence in its current state that provides a framework to guides and direct quality care measures in nursing practice (LoBiondo-Wood, Haber, Cameron, & Singh, 2018). The importance of utilizing EBP in practice is to ensure the optimal interventions are in place to promote higher levels of quality care that safeguard patient safety (Singleton, 2017).

Evidence

The student project should inform practice by stimulating findings that can be used in a future parent-study. Due to the clinical problem not being clearly articulated and sought out in previous research, a pilot study is most applicable for research design (He et al., 2015; Al-Yateem & Rossiter 2016; Li & Lopez, 2008). If there is an identified relationship existing amongst the variables within the study, then there can be the call for a larger study in future research (Connelly, 2008).

Three factors can facilitate or cause impede of the dissemination process. Firstly, facilitation of dissemination can be achieved through strong correlation findings between varying developmental achievement levels and the effectiveness of therapeutic play in the pilot study. Strong research findings will warrant the exploration of a larger-scale study to become constructed for analysis of the intervention further (Connelly, 2008). Continuing, effectual knowledge diffusion can also foster facilitation of dissemination processes (LoBiondo-Wood et al., 2018). Meaningful findings expressed to researchers imploring current interventions dealing with pediatric anxiety can help formulate the parent-study to occur, making the findings one step closer to being clinically relevant in practice settings (He et al., 2015; Connelly, 2008). Lastly, an impediment to dissemination of a study would occur if are not meaningful findings presented in the pilot study (LoBiondo-Wood et al., 2018). This would be evident if there lacked a relationship in understanding if developmental achievements posed any impact to more effectively lowering pediatric anxiety.

For generation of impactful diffusion strategies, two integral interventions are evident. For instance, the research study can become publicized in a relevant medical journal to reach the specified audience to potentially carry the findings to a parent-study (LoBiondo-Wood et al., 2018). As mentioned above, the target audience could be seen as additional researchers currently studying interventions to lower pediatric anxiety. Secondly, publication also promotes the viewers to evaluate the accuracy, feasibility and objectivity of the pilot study and the findings associated with the variables (LoBiondo-Wood et al., 2018). The platform of utilizing research journals for the promotion of the study can help smaller studies (such as a pilot study) to become clinically relevant for practice (LoBiondo-Wood et al., 2018).

This has been a classic installment of the Morning Read with Zach Gaudette. Thanks for continuing the journey with me.

Thank You - Words on Yellow Sticky Notes

References

Aytekin, A., Doru, O., & Kucukoglu, S. (2016). The effects of distraction on preoperative      anxiety level in children. Journal of PeriAnesthesia Nursing, 31(1), 56-62. doi:              http://dx.doi.org/10.1010/j.jopan.2014.11.016

Chieng, Y.J.S., Chan, W.C.S., Klainin-Yobas, P., & He, H.G. (2014). Perioperative anxiety and  postoperative pain in children and adolescent undergoing elective surgical procedures: a quantitative systematic review. Journal of Advanced Nursing, 70(2), 243-255. doi: 10.1111/ja.12205

Connelly, L. M. (2008). Pilot studies. Medsurg Nursing, 17(6), 411-412.

He, H.G., Zhu, L., Chi Chan, S.W., Klainin-Yobas, P., Wang, W. (2015). The effectiveness of     therapeutic play intervention in reducing perioperative anxiety, negative behaviors, and        post operative pain in children undergoing elective surgery: A systematic review. Pain Management Nursing, 16(3), 435-439. doi: http://dx.doi.org/10.1016/j.pmn.2014.08.011

Li, H.C.W., & Lopez, V. (2008). Effectiveness and appropriateness of therapeutic play     intervention in preparing children for surgery: A randomized controlled trial study. Journal for specialists in Pediatric Nursing, 13(2), 63-73. doi: https://doi.org/10.1111/j.1744-6155.2008.00138.x

LoBiondo-Wood, G., Haber, J., Cameron, C., & Singh, M. D. (2018). Nursing research in        Canada: Methods, critical appraisal, and utilization. Toronto, Canada: Elsevier.

Neta, G., Glasgow, R. E., Carpenter, C. R., Grimshaw, J. M., Rabin, B. A., Fernandez, M. E., & Brownson, R. C. (2015). A framework for enhancing the value of research for dissemination and implementation. American Journal of Public Health, 105(1), 49–57. doi: https://doi.org.eztest.ocls.ca/10.2105/AJPH.2014.302206

Singleton, J. K. (2017). Evidence-Based Practice Beliefs and Implementation in Doctor of Nursing Practice Students. Worldviews on Evidence-Based Nursing14(5), 412–418. doi: https://doi-org.eztest.ocls.ca/10.1111/wvn.12228

The Morning Read: Volume III (An Ethical Installment)

winterThe brisk air has remained within the tenure of the atmosphere. Maples are still bare, ever limber from the insidiously declining temperatures. Snow now paints the backdrop of the window pane. Winter, is in fact upon us. Through this paned glass, nurses look out at the vast horizon. How could they possibility conduct research within the realm of pediatric anxiety that meets ethical standards? Hey everyone, and welcome to the third installment of the Morning Read with Zach Gaudette.

Ethical principles for standing within current research denote the importance of safe guarding ethical standards for the protection of its participants (Canadian Institutes of Health Research, Natural Sciences and Engineering Research Council of Canada, & Social Sciences and Humanities Research Council of Canada, p. 5). The Tri-Council Policy Statement (TCPS) on Ethical Conduct for Research Involving Humans provides a guiding framework for the application of ethical policy in research practice (Canadian Institutes of Health Research et al., 2014, p. 11). With successful application, research under construct is fortified in a legal and ethical manner (Canadian Institutes of Health Research et al., 2014, p. 13; Shaddy & Denne, 2010). Alternatively, ethics approval of the study should also be sought after when conducting research to further demonstrate ethical principles in conjunction with the potential to displaying clinical relevance (Agha, Borrelli, Vella-Baldacchino, Thavayogan, & Orgill, 2017).

As eluded to in the Morning Read: Volume II, the purpose of this research proposal will be to measure the effectiveness of therapeutic play on pediatric patients with varying developmental stages between the ages of two to six admitted for preoperative surgical procedures in two Ontario pediatric hospitals. The Randomized Control Trial (RCT) will employ the use of a positivist paradigm for the research proposal. This aligns the methodology to the appropriate paradigm, as the research question(s) pose to answer a single reality that can be measured with quantitative means (LoBiondo-Wood, Haber, Cameron, & Singh, 2018).

ethicsThere are three core ethical considerations accompanied in the TCPS Ethical Conduct for Research Involving Humans document (Canadian Institutes of Health Research et al., 2014, p. 6). Accordingly, the considerations are stated as respect for persons, concern for welfare and justice (Canadian Institutes of Health Research et al., 2014, p. 6). All considerations will be present within the study and outlined below.

The samples inclusion criteria is based upon patients being between the ages of two to six years old, and needing to be undergoing elective surgery with parental consent obtained. Exclusion criteria is implemented for patients who have undergone numerous surgeries, if no consent could be obtained and if the patient has a diagnosed condition that is known to cause developmental delay. The research proposal plans to utilize the modified-Yale Preoperative Assessment Scale (m-YPAS), the Nipissing District Developmental  Screen (NDDS), the State Trait Anxiety Inventory for Children (STAI-C) and vital signs as data collection methods. Exclusion criterion was placed based upon previous studies, literature, and in addition to maintaining ethical principles. Firstly, the need to exclude patients based upon the previous number of surgical interventions is emphasized due to the realization that previous literature states the recognition of pediatric development and milestones becoming impeded if several hospitalized visits are perceived as anxiety-provoking experiences (Al-Yateem, & Rossiter, 2016).  Further, if no parental consent was obtained, then the need for exclusion is based upon standards set forth by the Canadian Institutes of Health Research et al. (2014), where consent in needed for participants to become a part of the study at hand (p. 46). This promotes the TCPS position on ethically considering respect for persons, as due to the pediatric nature of the research proposal, entrusted third-party parental consent of the patient will have to be obtained for inclusion within the study (Canadian Institutes of Health Research et al., 2014, p. 7).

Patient information will be safeguarded ensuring succinct confidentiality. Provided that, concerns for welfare is addressed in the research proposal. The TCPS expresses privacy, formal control of the patient’s information and informed consent as factors contributing to welfare within a study (Canadian Institutes of Health Research et al., 2014, p. 7). This will be achieved with patients being assigned a numerical character when obtaining, recording, and examining data throughout the entirety of the study. Continuing, only researchers conducting the research will have access to patient information with files being password protected. Informed consent will be obtained from the legal guardian(s) with the participant present, ensuring both parties understand the purpose and premise of the study.

Subsequently, ensuring justice within the research proposal also delineates importance to protecting pediatric participants. The relevance is highlighted within the Ethical Conduct for Research Involving Humans document, as the Canadian Institutes of Health Research et al. (2014) state pediatric patients as a vulnerable population due to the lack of autonomy they possess due to the inability to make informed decisions without guardian consent (p. 8). For the promotion of justice, participants should feel supported throughout the research study (Canadian Institutes of Health Research et al., 2014, p. 8). Perry et al. (2013) voice support for pediatric patients within hospitalized settings is best fostered with the child being able to see their parent whenever possible. Therefore, the study will ensure all participants will have easy accessibility to their parent or guardian when needed.ethics-decisions

Thank you for continuing the journey with me, this has been an ethical installment of the Morning Read with Zach Gaudette.

 

 

References

Agha, R.A., Borrelli, M.R., Vella-Baldacchino, M., Thavayogan, R., & Orgill, D.P. (2017). The STROCSS statement: Strengthening the reporting of cohort studied in surgery. International Journal of Surgery, 46(1), 198-202. doi: https://doi.org/10.1016/j.ijsu.2017.08.586

Al-Yateem, N., & Rossiter R.C. (2017). Unstructured play for anxiety in pediatric inpatient care. Journal for Specialists in Pediatric Nursing, 22(1), 1-7. doi: 10.111/jspn.12166

Canadian Institutes of Health Research, Natural Sciences and Engineering Research Council of Canada, and Social Sciences and Humanities Research Council of Canada. (December 2014). Tri-Council policy statement: Ethical conduct for research involving humans. Retrieved from http://www.pre.ethics.gc.ca/pdf/eng/tcps2-2014/TCPS_2_FINAL_Web.pdf

LoBiondo-Wood, G., Haber, J., Cameron, C., & Singh, M. D. (2018). Nursing research in Canada: Methods, critical appraisal, and utilization. Toronto, ON, Canada: Elsevier Canada.

Perry, S., Hockenberry, M., Lowdermilk, D.L., Wilson, D., Keenan-Lindsay, L., & Sams, C.A. (2013). Maternal child nursing care in Canada. Toronto: Elsevier.

Shaddy, R.E., & Denne, S.C. (2010). Guidelines for the ethical conduct of studies to evaluate drugs in pediatric populations. Pediatrics, 125(2), 850-860. doi: 10.1542/peds.2010-0082

The Morning Read: Volume II

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The air remains brisk, every inhalation induces slight tenderness when the now cooler air progress through the airways. Once exhaled, the moisture expelled promotes perceivable breathe condensation. The maple trees that once encompassed a plethora of warm framed colors are now bare. The terra firma providing the foundation for the starkly empty maples now flourish with expired and departed leaves. However, they now lay without the eloquently picturesque tones. These leaflets are dead, much like the hopes of pediatric nurses wishing to forever diminish the anxiety trance states their patients discern prior to surgical treatments. These nurses within this pediatric hospital are still looking for answers. Hey everyone, welcome to the second installment of the Morning Read with Zach Gaudette.

To begin, the following extract is referencing refinement on the background section found in the Morning Read: Volume I. More than half of admitted pediatric patients face heightened levels of anxiety whilst admitted to surgical and pre-operative hospitalized settings yearly (Chieng, Chan, Klainin-Yobas, & He, 2013; He, Zhu, Chan Klainin-Yobas & Wang, 2015). Anxiety experienced for pediatric populations within hospital ambiences create a plethora of health implications for patients (Atyekin, Doru, & Kucukoglu, 2016). Accordingly, this stipulates the need for expanded uses of sedative and analgesic pharmaceutical controlled therapy throughout patient care (Atyekin et al., 2016). Thereafter, perceived pain levels also become elevated within postoperative periods when heightened degrees of anxiety are identified prior to surgical intervention (Chieng et al., 2013). The continuation of heightened feelings of anxiety for patients needing numerous surgical interventions also cultivates the impeded of significant developmental milestones to occur with the pediatric population (Al-Yateem & Rossiter, 2016). Therapeutic interventions employed by nurses have a direct impact on the levels of anxiety pediatric patients within the preoperative period (Atyekin et al., 2016). Accordingly, the need for finding the most effective nursing intervention becomes clinically relevant (Al-Yateem & Rossiter, 2016).

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In succession, with clear recommendations from the Morning Read: Volume I, there lays the need for further refinement on the research question at hand. Previously, my blog post left the reader with “the purpose to determine the best therapeutic intervention to lower pediatric anxiety prior to surgical or medical procedures”. Denoting this realization of the broad spectrum surrounding the research question, developed refinement will pose the question and inquiry of, “does the developmental stage of pediatric patients between the years of three to eight years old alter the effectiveness of therapeutic play in the clinical environment to reduce preoperative anxiety?.” Although the revised question delineates no specific medical intervention, when reviewing literature pieces that have previously conducted studies on pediatric anxiety, the feeling of anxiety does not change from one procedure to another (He et al., 2015). Therefore, highlighting feasibility considerations based upon LoBiondo-Wood, Haber, Cameron, & Singh (2018), encompassing more medical interventions would increase availability of clinical participants. This, in turn, would also bolster the relevance of findings if a study contained multiple preoperative surgical interventions (LoBiondo-Wood et al., 2018).

Foregoing, it must be noted that the pediatric population pose different developmental stage groups (Perry, Hockenberry, Lowdermilk, & Wilson, 2013; Aytekin et al., 2016). The gap in research becomes identified through literary analysis when therapeutic play was successful in single studies conducted by Al-Yateem & Rossiter (2016), and Li & Lopez (2008), while the meta-analysis measuring play conducted by He et al.,  (2015) revealed mixed results. The meta-analysis completed by He et al. (2015) included the largest age gap amongst participants, ranging from two to twelve years of age. Through this, the problem is that a multitude of developmental stages fall between this age range, and can be explored further as the potential causation of differing findings (Perry et al., 2013).

In following, the purpose of this research proposal will be to measure the effectiveness of therapeutic play on pediatric patients with varying developmental stages between the ages of three to eight admitted for a preoperative surgical procedure in a North American hospital. This will be planned to be conducted with the use of a randomized control trial (RCT) or quasi-experimental study.

Currently drafted plan:

Methodology: Quantitative randomized control trial or quasi-experimental study.

Setting: 4 pediatric specialty hospitals in North America

Population: Pediatric patients aged three to eight years old admitted for surgical intervention.

Sample: 200 pediatric patients meeting inclusion criteria with parental consent obtained for child to partake in study. Inclusion criteria is listed as the following: patient between the ages of three to eight years, and needing to be undergoing elective surgery with parental consent obtained. Exclusion criteria is implemented for patients who have undergone previous surgery, and if the patient has a diagnosed condition that is known to cause developmental delay.

Data collection methods: the modified-Yale Preoperative Assessment Scale (m-YPAS), the Children’s Fear Scale (CFS), the State Trait Anxiety Inventory for children (STAI-C) tool and vital signs (resting respiration, blood pressure, and pulse).

Analysis: Descriptive statistics (mean, median, SD, mode), chi-square, t-tests, ANOVA testing pretest/post-test scores.

Presentation: Essay format including the refinement of blog postings.

Thank you, this has been an installment of the Morning Read with Zach Gaudette.

 

References

Al-Yateem, N., & Rossiter R.C. (2017). Unstructured play for anxiety in pediatric inpatient  care. Journal for Specialists in Pediatric Nursing, 22(1), 1-7. doi: 10.111/jspn.12166

Aytekin, A., Doru, O., & Kucukoglu, S. (2016). The effects of distraction on preoperative      anxiety level in children. Journal of PeriAnesthesia Nursing, 31(1), 56-62. doi:                http://dx.doi.org/10.1010/j.jopan.2014.11.016

Chieng, Y.J.S., Chan, W.C.S., Klainin-Yobas, P., & He, H.G. (2014). Perioperative anxiety and  postoperative pain in children and adolescent undergoing elective surgical procedures: a quantitative systematic review. Journal of Advanced Nursing, 70(2), 243-255. doi:         10.1111/ja.12205

He, H.G., Zhu, L., Chi Chan, S.W., Klainin-Yobas, P., Wang, W. (2015). The effectiveness of     therapeutic play intervention in reducing perioperative anxiety, negative behaviors, and  post operative pain in children undergoing elective surgery: A systematic review. Pain    Management Nursing, 16(3), 435-439. doi: http://dx.doi.org/10.1016/j.pmn.2014.08.011

Li, H.C.W., & Lopez, V. (2008). Effectiveness and appropriateness of therapeutic play     intervention in preparing children for surgery: A randomized controlled trial study.    Journal for specialists in Pediatric Nursing, 13(2), 63-73. doi:      https://doi.org/10.1111/j.1744-6155.2008.00138.x

LoBiondo-Wood, G., Haber, J., Cameron, C., & Singh, M. D. (2018). Nursing research in        Canada: Methods, critical appraisal, and utilization. Toronto, ON, Canada: Elsevier      Canada.

Perry, S., Hockenberry, M., Lowdermilk, D.L., Wilson, D., Keenan-Lindsay, L., & Sams, C.A.  (2013). Maternal child nursing care in Canada. Toronto: Elsevier.

 

The Morning Read: Volume I

The crisp, Fall air whistles through the branches of the maple tree sitting out in the parking lot of a pediatric hospital. The leaves pluck off one by one, with a now inconsistent array of color patterns that blooms vividly. Within the windows painting this picture, pediatric nurses are on the floor wondering what they can do to help lower anxiety in pediatric patients. Hey everyone, this is the morning read with Zach Gaudette.

Last year, within our research class, I focused heavily on the pediatric population and the effects anxiety levels had on the outcomes of medical procedures. This semester, I will continue to indulge in this research, by conducting a research proposal for the topic at hand. An anxiety trance state is the realization for over half of the pediatric population who find themselves admitted to pre-operative and surgical based environments every year (Chieng, Chan, Klainin-Yobas & He, 2013; He, Zhu, Chan, Klainin-Yobas & Wang, 2015). Anxiety within pediatric patients manifest with increased irritability and tension, in succession with activation of autonomic nervous system responses which potentiate a myriad of health implications (Aytekin, Doru & Kucukoglo, 2016). Significantly, these bodily responses to anxiety cultivate the elevated need to increase analgesia and sedative use through pharmaceutical therapy prior to pediatric surgical interventions, and consequently thereafter (Aytekin, Doru & Kucukoglo, 2016). Conversely, pediatric anxiety also constructs higher senses of pain during postoperative periods, which in turn, amalgamates negative health outcomes even further (Chieng, Chan, Klainin-Yobas & He, 2013). This association becomes imperative when children need to undergo multiple medical or surgical interventions spanning across several years, as the impediment of developmental milestones can become evident when heightened levels of anxiety and pain are experienced among pediatric patients (Al-Yateem & Rossiter, 2016).

To meet standards set forth by the Colleges of Nurses of Ontario [(CNO), 2002], nurses must expand and evolve their knowledge base to articulate the needs of the patient under care. This process is derived through research to facilitate patient outcomes whilst upholding the integrity of nursing practice (CNO, 2002). Clinical applicability becomes relevant, as measures to lower pediatric anxiety can be reviewed through the literature (Al-Yateem & Rossiter, 2016).  Not bound to strictly medical based approaches allows for the incorporation of holistic caring measures in the midst of nursing practice (Potter, Perry, Stockert, & Hall, 2014). Henceforth, the purpose of my research proposal is to determine the best therapeutic intervention to lower pediatric anxiety prior to surgical or medical procedures.

Thanks for taking the time to read my latest blog post, this has been the morning read with Zach Gaudette.

 

References:

Al-Yateem, N., & Rossiter R.C. (2017). Unstructured play for anxiety in pediatric inpatient  care. J Spec Pediatr Nurs, 22(1), 1-7. doi: 10.111/jspn.12166

Aytekin, A., Doru, O., & Kucukoglu, S. (2016). The effects of distraction on preoperative      anxiety level in children. Journal of PeriAnesthesia Nursing, 31(1), 56-62. doi:              http://dx.doi.org/10.1010/j.jopan.2014.11.016

Chieng, Y.J.S., Chan, W.C.S., Klainin-Yobas, P., & He, H.G. (2014). Perioperative anxiety and  postoperative pain in children and adolescent undergoing elective surgical procedures: a quantitative systematic review. Journal of Advanced Nursing, 70(2), 243-255. doi:         10.1111/ja.12205

College of Nurses of Ontario. (2002). Practice Standard: Professional Standards. Retrieved from: http://www.cno.org/globalassets/docs/prac/41006_profstds.pdf

He, H.G., Zhu, L., Chi Chan, S.W., Klainin-Yobas, P., Wang, W. (2015). The effectiveness of     therapeutic play intervention in reducing perioperative anxiety, negative behaviors, and  post operative pain in children undergoing elective surgery: A systematic review.        Pain Management Nursing, 16(3), 435-439. doi: http://dx.doi.org/10.1016/j.pmn.2014.08.011

Potter, P. A., Perry, A.G., Stockert, P.A., & Hall, A.M. (Eds.). (2014). Canadian fundamentals of nursing (5th ed.). Toronto, ON: Elsevier Canada.