Eine Aufgabe mit Schlüsselfunktion

Erfahrungsbericht: Im Rahmen ihres Studiums Master of Science in Nursing an der Zürcher Hochschule für Angewandte Wissenschaften in Winterthur absolvierte Cornelia Stricker ein Workshadowing im Pflegedienst des Universitätskinderspitals Zürich. Innerhalb von zwei Wochen erhielt sie einen direkten Einblick in die Pflegepraxis der Pflegeexpertinnen APN Kardiologie, APN Onkologie und APN Kontinenz und über ihre Verankerung in der klinischen Praxis. Hier beschreibt sie die vielfältigen Aufgaben pädiatrischer Pflegeexperten APN in der klinischen Praxis und zeigt Möglichkeiten des Umgangs auf

Use of a novel pressure distribution system for severely ill neonates: a clinical pilot study carried out by the PREPICare consortium

Background: Pressure Injuries are not exclusively an adult phenomenon; various risk factors contribute to a high prevalence rate of 43% in the neonatal and pediatric intensive care population. Effective preventive measures in this population are limited. Methods: We performed a pilot study to analyze the distribution and localization of support surface interface pressures in neonates in a pediatric intensive care unit (PICU). The hypothesis was that pressure redistribution by a novel air mattress would reduce pressure peaks in critical neonates. The measurements were conducted in a 27-bed level III PICU between November and December 2020. This included measuring pressure distribution and pressure peaks for five neonates positioned on either a state-of-the-art foam mattress or a new prototype air mattress. Results: We confirmed that the pressure peaks were significantly reduced using the prototype air mattress, compared with the state-of-the-art foam mattress. The reduction of mean pressure values was 9-29%, while the reduction of the highest 10% of pressure values was 23-41%. Conclusions: The journey to an effective, optimal, and approved product for severely ill neonates to reduce Pressure Injuries is challenging. However, a crucial step was completed by this pilot study with the first pressure measurements in a real-world setting and the successful realization of a decrease in pressure peaks obtained using a prototype air mattress

Assessment of compression forces in a digitally modified short leg cast for pressure injury risk monitoring in healthy children

Introduction: Casting is an essential treatment for neuro-orthopedic conditions in children with cognitive, sensory, and communicational disabilities. However, a main side-effect is the development of pressure injuries resulting in additional (wound) therapies and prolongation of the hospital stay. The primary aim of our study was to investigate the potential of objective pressure measurements in casts to assess the risk for pressure injury development. Methods: Five pediatric healthy participants were included in this study. We measured the global and the local compression force at body sites prone to pressure injury development for different body positions and the transfer in-between in a cast equipped with pressure sensors. These conditions resulted in partial or full body weight loading. Results and discussion: The global maximum compression force was affected significantly by body postures with partial and full loading of the cast and during transfer. The local compression force significantly correlated with the global compression force at the heel and instep area. In conclusion, the integration of sensing technologies into casts bears a high potential for early recognition of critical conditions inside the cast and inducing preventive measures in the at-risk population

Assessment of compression forces in a digitally modified short leg cast for pressure injury risk monitoring in healthy children

IntroductionCasting is an essential treatment for neuro-orthopedic conditions in children with cognitive, sensory, and communicational disabilities. However, a main side-effect is the development of pressure injuries resulting in additional (wound) therapies and prolongation of the hospital stay. The primary aim of our study was to investigate the potential of objective pressure measurements in casts to assess the risk for pressure injury development.MethodsFive pediatric healthy participants were included in this study. We measured the global and the local compression force at body sites prone to pressure injury development for different body positions and the transfer in-between in a cast equipped with pressure sensors. These conditions resulted in partial or full body weight loading.Results and discussionThe global maximum compression force was affected significantly by body postures with partial and full loading of the cast and during transfer. The local compression force significantly correlated with the global compression force at the heel and instep area. In conclusion, the integration of sensing technologies into casts bears a high potential for early recognition of critical conditions inside the cast and inducing preventive measures in the at-risk population

Comparison of clinical characteristics and healthcare resource use of pediatric chronic and non-chronic critically ill patients in intensive care units: a retrospective national registry study

IntroductionChronic critically ill patients (CCI) in pediatric intensive care unit (PICU) are at risk of negative health outcomes, and account for a considerable amount of ICU resources. This study aimed to (a) describe the prevalence of CCI children, (b) compare their clinical characteristics and ICU resources use with non-CCI children, and (c) identify associated risk factors of CCI.MethodsA retrospective national registry study including 2015–2017 data from the eight Swiss PICUs of five tertiary and three regional hospitals, admitting a broad case-mix of medical and surgical patients, including pre- and full-term infants. CCI patients were identified using an adapted definition: PICU length of stay (LOS) ≥8 days and dependence on ≥1 PICU technology.ResultsOut of the 12,375 PICU admissions, 982 (8%) were CCI children and compared to non-CCI children, they were younger (2.8 vs. 6.7 months), had more cardiac conditions (24% vs. 12%), and higher mortality rate (7% vs. 2%) (p < 0.001). Nursing workload was higher in the CCI compared to the non-CCI group (22 [17–27]; 21 [16–26] respectively p < 0.001). Factors associated with CCI were cardiac (aOR = 2.241) and neurological diagnosis (aOR = 2.062), surgery (aORs between 1.662 and 2.391), ventilation support (aOR = 2.278), high mortality risk (aOR = 1.074) and agitation (aOR = 1.867).Conclusionthe results confirm the clinical vulnerability and the complexity of care of CCI children as they were defined in our study. Early identification and adequate staffing is required to provide appropriate and good quality care

Self-efficacy expectancy in adolescents with anorexia nervosa in the outpatient setting : a cross-sectional study

Introduction: The population involved in this study are individuals with anorexia nervosa (AN). AN is a disease with sometimes life-threatening underweight. Self-esteem problems, anxiety and social problems accompany those affected. AN is often chronic. Hospitalized patients quickly gain weight, but often the underlying eating problem persists, which leads to rehospitalization. Studies on the self-efficacy expectation (SWE) of those affected are largely lacking. Aim: The aim of this study is to examine the SWE in those affected in the post-hospital setting with reference to the age of the affected persons, the number of hospitalizations and the course of the disease. Method: As part of this cross-sectional study, those affected were interviewed in the post-hospital, psychosomatic setting using a standardized questionnaire "General SWE". The data were evaluated descriptively and by means of inferential statistics. Result: 85 young people were interviewed. In the sample, the SWE score averaged = 28.53 with up to and including three hospitalizations and = 24.68 with four or more hospitalizations. If the inpatient stay was only recently, the SWE score shows a lower value (= 26.08) than for those with a longer stay (= 29.00). Conclusion: The results indicate that SWE can influence the course of the disease in those affected. People with higher SWE values show a more favorable course of the disease with fewer rehospitalizations. The strengthening of the SWE is therefore of great importance in the inpatient and outpatient setting through targeted interventions by specialists

[Pressure ulcer prevention and therapy: results of a descriptive study]

Pressure ulcers are a common nursing care issue in hospitals. Sick children, premature infants and toddlers, but also disabled and impaired children are at a high risk of developing pressure ulcers. The aim of this descriptive cross-sectional study was to describe the patients at risk as well as to identify the preventive and therapeutic interventions in a pediatric care setting. Of 213 hospitalised children, 155 (82 percent) from the age of 0 to 18 years could be included in the study. Altogether, preventive actions of any kind were performed with 92 percent of the patients. These were repositioning (84 percent), mobilisation of the patients (75 percent), followed by skin inspection (61 percent) and the application of lotions (56 percent). The high risk rate of pediatric patients considered at risk according to the Braden Scale is disconcerting and requires further exploration in terms of effective preventive and therapeutic interventions to improve the outcome for this patient group